18 research outputs found
Prospective associations between dietary patterns and high sensitivity C-reactive protein in European children : the IDEFICS study
No full textPurpose This prospective study explores high sensitivity C-reactive protein (hs-CRP) levels in relation to dietary patterns at two time points in European children. Methods Out of the baseline sample of the IDEFICS study (n = 16,228), 4020 children, aged 2-9 years at baseline, with available hs-CRP levels and valid data from a food frequency questionnaire (FFQ) at baseline (T0) and 2 years later (T1) were included. K-means clustering algorithm based on the similarities between relative food consumption frequencies of the FFQ was applied. hs-CRP was dichotomized according to sex-specific cutoff points. Multilevel logistic regression was performed to assess the relationship between dietary patterns and hs-CRP adjusting for covariates. Results Three consistent dietary patterns were found at T0 and T1: 'animal protein and refined carbohydrate', 'sweet and processed' and 'healthy'. Children allocated to the 'protein' and 'sweet and processed' clusters at both time points had significantly higher odds of being in the highest category of hs-CRP (OR 1.47; 95% CI 1.03-2.09 for 'animal protein and refined carbohydrate' and OR 1.44; 95% CI 1.08-1.92 for 'sweet and processed') compared to the 'healthy' cluster. The odds remained significantly higher for the 'sweet and processed' pattern (OR 1.39; 95% CI 1.05-1.84) when covariates were included. Conclusions A dietary pattern characterized by frequent consumption of sugar and processed products and infrequent consumption of vegetables and fruits over time was independently related with inflammation in European children. Efforts to improve the quality of the diet in childhood may prevent future diseases related with chronic inflammation.Peer reviewe
The IDEFICS intervention trial to prevent childhood obesity: design and study methods
No full textIntroduction: One of the major research dimensions of the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study involved the development, implementation and evaluation of a setting-based community-oriented intervention programme for primary prevention of childhood obesity. In this supplement of Obesity Reviews, a compilation of key results of the IDEFICS intervention is packaged in a series of complementary papers.
Objective: This paper describes the overall design and methods of the IDEFICS intervention in order to facilitate a comprehensive reading of the supplement. In addition, some best practice' examples are described.
Results: The IDEFICS intervention trial was conducted to assess whether the IDEFICS intervention prevented obesity in young children aged 2 to 9.9years. The study was a non-randomized, quasi-experimental trial with one intervention matched to one control region in each of eight participating countries. The intervention was designed following the intervention mapping framework, using a socio-ecological theoretical approach. The intervention was designed to address several key obesity-related behaviours in children, parents, schools and community actors; the primary outcome was the prevalence of overweight/obesity according to the IOTF criteria based on body mass index. The aim was to achieve a reduction of overweight/obesity prevalence in the intervention regions. The intervention was delivered in school and community settings over a 2-year period. Data were collected in the intervention and control cohort regions at baseline and 2 years later.
Conclusion: This paper offers an introductory framework for a comprehensive reading of this supplement on IDEFICS intervention key results
Assessment of diet, physical activity and biological, social and environmental factors in a multi-centre European project on diet- and lifestyle-related disorders in children (IDEFICS)
No full textObesity is a major public health problem in
developed countries. We present a European project, called Identification and Prevention of Dietary and Lifestyle induced
Health Effects in Children and Infants (IDEFICS),
that focuses on diet- and lifestyle-related diseases in
children. This paper outlines methodological aspects and
means of quality control in IDEFICS. IDEFICS will use a
multi-centre survey design of a population-based cohort of
about 17,000 2- to 10-year-old children in nine European
countries (Belgium, Cyprus, Estonia, Germany, Greece,
Hungary, Italy, Spain and Sweden). The project will
investigate the impact of dietary factors such as food
intake activity, psychosocial factors and genetic factors on the
development of obesity and other selected diet- and
lifestyle-related disorders. An intervention study will be
set up in pre-school and primary school settings in eight of the survey centres. Standardised survey instruments will be designed during the first phase of the project and applied in
the surveys by all centres. Standard operation procedures (SOPs) will be developed, as well as a plan for training the
personnel involved in the surveys. These activities will be
accompanied by a quality control strategy that will
encompass the evaluation of process and result quality
throughout the project. IDEFICS will develop comparable
Europe-wide health indicators and instruments for data
collection among young children. Establishment of a new
European cohort within IDEFICS will provide a unique
opportunity to document the development of the obesity
epidemic in the current generation of young Europeans and
investigate the impact of primary prevention in European
children population
Diets of European children, with focus on BMI, well-being, and families The IDEFICS/I.Family cohort
No full textThe overall aim of this thesis was to investigate children’s diet, BMI z-score, and parental feeding practices (PFPs), in relation to mutans streptococci (MS) count, psychosocial well-being and children’s BMI trajectory, as well as exploring the effect of the intervention in the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study on diets of families five years after the intervention.
About 16,000 children from eight European countries participated in the IDEFICS study in 2007/2008 (referred to as index children). During 2008 a community intervention was carried out targeting diet, physical activity and stress. In 2009, 68% of the children returned for a follow-up examination. In 2013, I.Family started and 6,055 of the children returned for a third follow-up, and at this time point 7,794 parents and 2,512 siblings also participated. Height and weight were measured, saliva was collected, and information on eating habits, feeding practices, well-being, and socioeconomic factors were reported at all time points.
High salivary MS count was found among 18% of the children in a sub-sample from the Swedish IDEFICS cohort. Higher BMI z-score, more frequent intake of meals and higher propensity for consuming sugar were all independently associated with higher MS count. In contrast, an inverse association was found between hours of sleep and MS count.
Bi-directional associations were identified between a healthy diet, measured by adherence to healthy dietary guidelines, and better self-esteem. Additionally, a healthy diet was associated with fewer emotional and peer problems two years later, with a monotonic trend entailing a consistent increase for all indicators of well-being associated with higher adherence. These associations were moderated by children’s sex.
PFPs at IDEFICS baseline explained 22% of the variation in children’s BMI z-score at I.Family. More specifically, PFPs involving restriction and considering putting the child on a diet were associated with higher odds of developing overweight independent of baseline BMI z-score and parental BMI. This association was stable across social vulnerability groups.
At I.Family, better diet quality (as measured by lower propensity for consuming fat and sugar, and higher propensity for consuming water, and fruit and vegetables) was reported by families in the intervention communities. However, investigation of the five-year change in fat, sugar, and water propensity ratio among index children failed to identify any differences between the intervention and control groups longitudinally.
This thesis documents the importance of healthy eating habits in reducing the risk of dental caries and maintaining good psychosocial well-being in children. Furthermore, restrictive PFPs are not helpful in promoting a healthy weight development. It is therefore important to identify other, more effective, PFPs and to include parents more directly in future intervention studies aiming at improving children’s eating habits
Urban Moveability and physical activity in children:longitudinal results from the IDEFICS and I.Family cohort
No full textBackground:Physical activity (PA) is one of the major protective behaviours to prevent non-communicable diseases. Positive effects of the built environment on PA are well investigated, although evidence of this association is mostly based on cross-sectional studies. The present study aims to investigate the longitudinal effects of built environment characteristics in terms of a moveability index on PA of children in their transition phase to adolescence using data of the IDEFICS/I.Family cohort.Methods:We used data on 3,394 accelerometer measurements of 2,488 children and adolescents aged 3 to 15 years old from survey centres of three countries, Germany, Italy, and Sweden, who participated in up to three surveys over six years. In network-dependent home neighbourhoods, a moveability index was calculated based on residential density, land use mix, street connectivity, availability of public transport and public open spaces such as green spaces and public playgrounds in order to quantify opportunities for PA of children and adolescents. Linear trajectories of light PA (LPA) and moderate-to-vigorous PA (MVPA) were estimated using linear mixed models accounting for repeated measurements nested within individuals. Least squares means were estimated to quantify differences in trajectories over age.Results:LPA and MVPA declined annually with age by approximately 20 min/day and 2 min/day respectively. In girls, the moveability index showed a consistent significantly positive effect on MVPA (β ̂= 2.14, 95%CI: (0.11; 4.16)) for all ages, while in boys the index significantly lessened the decline in LPA with age for each year. (β ̂= 2.68, 95%CI: (0.46; 4.90)).Availability of public open spaces was more relevant for MVPA in girls and LPA in boys during childhood, whereas in adolescence, residential density and intersection density became more important.Conclusion:Built environment characteristics are important determinants of PA and were found to have a supportive effect that ameliorates the decline in PA during the transition phase from childhood to adolescence. In childhood environmental support for leisure time PA through public open spaces was found to be the most protective factor whereas in adolescence the positive influence of street connectivity and residential density was most supportive of physical activity.<br/
Mediterranean diet and obesity polygenic risk interaction on adiposity in European children : The IDEFICS/I.Family Study
No full textBackground and Objectives: To examine whether changes in the Mediterranean Diet (MD) or any of its MD food groups modulate the genetic susceptibility to obesity in European youth, both in cross-sectional and longitudinal analyses. Methods: For cross-sectional analysis, 1982 participants at baseline, 1649 in follow-up 1 (FU1) and 1907 in follow-up 2 (FU2), aged 2–16 years of the IDEFICS/I.Family studies were considered. For the longitudinal design, 1254 participants were included. Adherence to MD was assessed using the Mediterranean Diet Score (MDS), and genetic susceptibility to high BMI was assessed with a polygenic risk score (BMI-PRS). Multiple linear regression models were fitted to estimate gene × MD effects on markers of obesity. Results: In cross-sectional analyses, at baseline, higher MDS was associated with higher BMI in children with high genetic susceptibility (β = 0.12; 95% CI = [0.01, 0.24]). However, 6 years later, at FU2, higher MDS was associated with lower BMI (β = −0.19; 95% CI = [−0.38, −0.01]) in children with high genetic susceptibility, showing an attenuating MDS effect. Also in FU2, vegetables and legumes (V&L) showed inverse associations with BMI (β = −0.01; CI = [−0.02, −0.00]) and WC (β = −0.02; CI = [−0.03, −0.00]) regardless of the obesity genetic risk, although the effect sizes were small. In the longitudinal analyses, no MDS-obesity associations or gene × diet interaction effects were observed. Conclusions: In cross-sectional analysis (baseline and FU2), the MD modulated the association between obesity susceptibility and adiposity indicators in European youth, having an exacerbating effect in children measured during infancy years and an attenuating effect in early adolescent years.CC BY-NC-ND 4.0© 2025 The Author(s). Pediatric Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.Correspondence Address: L.A. Moreno; Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health Sciences, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, Pedro Cerbuna Street, 50009, Spain; email: [email protected] work was done as part of the IDEFICS (http://www.idefics.eu) and I.Family studies (http://www.ifamilystudy.eu/). We gratefully acknowledge the financial support of the European Union within the Sixth RTD Framework Programme Contract No. 016181 (FOOD) and the Seventh RTD Framework Programme Contract No. 266044. Participating partners also allocated their own resources towards the genotyping of children.</p
Children consuming milk cereal drink are at increased risk for overweight: The IDEFICS Sweden study, on behalf of the IDEFICS Consortium
No full textAims: The aims of this study were to characterize milk cereal drink (MCD) consumption among Swedish children and to investigate the association between MCD and overweight in a longitudinally followed cohort of children over 2 years of age. Methods: In the Swedish cohort from IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) we examined early feeding practices and weight status when children were aged 2–9 years (2007/2008) and at 2-year follow-up. Weight and height were measured at both time points in 1077 children. Characteristics of MCD consumers were explored with logistic regression. b ody mass index ( b MI) z -scores at both time points and weight status at follow-up were regressed on explanatory factors using mixed linear and logistic regression, respectively. Results: Nearly 69% of children had consumed MCD. The MCD consumers were more likely than never-consumers to have two native Swedish parents, parents with less than 2 years of post-secondary education, and a shorter period of breastfeeding. MCD consumers had a higher b MI z -score at follow-up compared with baseline (difference in b MI z -score=0.12, 95% confidence interval (CI)=0.07, 0.17), while the average b MI z -score in non-consumers remained stable over time (0.00, 95% CI= −0.07, 0.07). MCD consumers were nearly five times more likely than non-consumers to become overweight during the follow-up (odds ratio (OR)=4.78, 95% CI=1.68, 13.59), independent of breastfeeding. Conclusions: MCD was consumed by the majority of children in this study. MCD consumption is associated with an increased risk for overweight and less exposure to breastfeeding. Our findings motivate future research aimed at investigating how MCD should be recommended
Barriers and Facilitators of Health Promotion and Obesity Prevention in Early Childhood: A Focus on Parents Results from the IDEFICS Study
No full textBackground: Childhood obesity has increased dramatically during the past thirty years. Parents are key persons in their children’s lives and their efforts to create healthy lifestyles are very important. However, social and economic determinants of health also affect parents’ opportunities to promote a healthy lifestyle.
Aims: To explore barriers and facilitators in promoting healthy lifestyles and preventing childhood obesity, focusing on parental roles.
Methods and main findings: Three studies originated from the Identification and Prevention of Dietary- and Lifestyle-induced health Effects in Children and InfantS (IDEFICS) study of determinants for two to nine-year-old children’s health in eight European countries. The fourth study was a qualitative interview study conducted in southwest Sweden.
Paper I: In focus group discussions (20 focus groups with children and 36 with parents), parents described lack of time, financial constraints, availability and food marketing techniques as barriers for promoting healthy eating. School policies about food varied; only Sweden and Estonia provided free school lunches. Children described great variation in the availability of unhealthy foods and beverages in their homes.
Paper II: Objectively measured Body Mass Index (BMI) of children (n=16 220) were compared to parents’ perception of and concern for their children’s health and weight status. In all weight categories and all countries, a substantial proportion of parents failed to accurately judge their child’s weight status. In general, parents considered their children to be healthy, irrespective of their weight status. Parents of children with overweight or obesity systematically underestimated their children’s weight status across eight European countries. Accurate parental weight perception in Europe differed according to geographic region.
Paper III: Swedish IDEFICS participants (n=1825) were compared with an age- and sex-matched referent population (n=1825), using registers from Statistics Sweden and the Swedish Medical Birth Register. Longitudinal child growth data (n=3650) were collected from child health centers and school health services. Families with low income, less education, foreign background or single parenthood were underrepresented in the IDEFICS study. BMI at inclusion had no selection effect but, at eight years of age, the obesity prevalence was significantly greater among referents.
Paper IV: A qualitative content analysis was used to interpret the findings from interviews with nurses (n=15) working at child health centers in the southwest of Sweden. The BMI Chart to identify overweight and obesity in children facilitated greater recognition but nurses used it inconsistently, a barrier to prevention. Other barriers were obesity considered a sensitive issue and that some parents wanted overweight children.
Conclusion: Parents may not perceive their child’s growth trajectory from overweight to obesity, and the preschool years may pass without effort to change lifestyle. Therefore, objective measurement and information of children’s BMI weight status by healthcare professionals is of great importance. To reach all parents and avoid selection bias, health surveys or health promoting activities must be tailored. Health promoting activities at the family level as well as the societal level should start early in children’s lives to prevent childhood obesity.
Keywords: parents, children, obesity, weight perception, registers, prevention, health promotio
Early life course risk factors for childhood obesity : the IDEFICS case-control study
No full textBackground: The early life course is assumed to be a critical phase for childhood obesity; however the significance of single factors and their interplay is not well studied in childhood populations.
Objectives: The investigation of pre-, peri- and postpartum risk factors on the risk of obesity at age 2 to 9.
Methods: A case-control study with 1,024 1: 1-matched case-control pairs was nested in the baseline survey (09/2007-05/2008) of the IDEFICS study, a population-based intervention study on childhood obesity carried out in 8 European countries in pre- and primary school settings. Conditional logistic regression was used for identification of risk factors.
Results: For many of the investigated risk factors, we found a raw effect in our study. In multivariate models, we could establish an effect for gestational weight gain (adjusted OR = 1.02; 95% CI 1.00-1.04), smoking during pregnancy (adjusted OR = 1.48; 95% CI 1.08-2.01), Caesarian section (adjusted OR = 1.38; 95% CI 1.10-1.74), and breastfeeding 4 to 11 months (adjusted OR = 0.77; 95% CI 0.62-0.96). Birth weight was related to lean mass rather than to fat mass, the effect of smoking was found only in boys, but not in girls. After additional adjustment for parental BMI and parental educational status, only gestational weight gain remained statistically significant. Both, maternal as well as paternal BMI were the strongest risk factors in our study, and they confounded several of the investigated associations.
Conclusions: Key risk factors of childhood obesity in our study are parental BMI and gestational weight gain; consequently prevention approaches should target not only children but also adults. The monitoring of gestational weight seems to be of particular importance for early prevention of childhood obesity
Dairy consumption at snack meal occasions and the overall quality of diet during childhood : Prospective and cross-sectional analyses from the idefics/i.family cohort
No full textThere is scarce information on the influence of dairy consumption between main meals on the overall diet quality through childhood, constituting the main aim of this research. From the Identification and prevention of Dietary-and lifestyle induced health EFfects In Children and infantS (IDEFICS) study, and based on the data availability in each period due to drop outs, 8807 children aged 2 to 9.9 years from eight European countries at baseline (T0: 2007–2008); 5085 children after two years (T1); and 1991 after four years (T3), were included in these analyses. Dietary intake and the Diet Quality Index (DQI) were assessed by two 24 hours dietary recalls (24-HDR) and food frequency questionnaire. Consumption of milk and yogurt (p = 0.04) and cheese (p < 0.001) at snack meal occasions was associated with higher DQI scores in T0; milk and yogurt (p < 0.001), and cheese (p < 0.001) in T1; and cheese (p = 0.05) in T3. Consumers of milk (p = 0.02), yogurt (p < 0.001), or cheese (p < 0.001) throughout T0 and T1 at all snack moments had significantly higher scores of DQI compared to non-consumers. This was also observed with the consumption of cheese between T1 and T3 (p = 0.03). Consumption of dairy products at snack moments through childhood is associated with a better overall diet quality, being a good strategy to improve it in this period. consortia on behalf of the IDEFICS/I.Family</p
