| 1. |
- Bammann, Karin, et al.
(författare)
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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)
- 2006
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Ingår i: Journal of Public Health. - 0943-1853 .- 1613-2238. ; 14, s. 279-289
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Tidskriftsartikel (refereegranskat)abstract
- Obesity 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 multicentre 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 and food preferences, lifestyle factors such as physical 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 populations.
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| 2. |
- Bammann, Karin, et al.
(författare)
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Early Life Course Risk Factors for Childhood Obesity: The IDEFICS Case-Control Study
- 2014
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: 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.
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| 3. |
- Bel-Serrat, Silvia, et al.
(författare)
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Relative validity of the Children's Eating Habits Questionnaire- food frequency section among young European children : the IDEFICS Study
- 2014
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Ingår i: Public Health Nutrition. - : Cambridge University Press. - 1368-9800 .- 1475-2727. ; 17:2, s. 266-276
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare, specifically by age group, proxy-reported food group estimates obtained from the food frequency section of the Children's Eating Habits questionnaire (CEHQ-FFQ) against the estimates of two non-consecutive 24h dietary recalls (24-HDR). Design: Estimates of food group intakes assessed via the forty-three-food-group CEHQ-FFQ were compared with those obtained by a computerized 24-HDR. Agreement on frequencies of intakes (equal to the number of portions per recall period) between the two instruments was examined using crude and de-attenuated Pearson's correlation coefficients, cross-classification analyses, weighted kappa statistics (kappa(w)) and Bland-Altman analysis. Setting: Kindergartens/schools from eight European countries participating in the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) Study cross-sectional survey (2007-2008). Subjects: Children aged 2-9 years (n 2508, 50.4% boys). Results: The CEHQ-FFQ provided higher intake estimates for most of the food groups than the 24-HDR. De-attenuated Pearson correlation coefficients ranged from 0.01 (sweetened fruit) to 0.48 (sweetened milk) in children aged 2-<6 years (mean = 0.25) and from 0.01 (milled cereal) to 0.44 (water) in children aged 6-9 years (mean = 0.23). An average of 32 % and 31 % of food group intakes were assigned to the same quartile in younger and older children, respectively, and classification into extreme opposite quartiles was <= 12 % for all food groups in both age groups. Mean kappa(w) was 0.20 for 2-<6-year-olds and 0.17 for 6-9-year-olds. Conclusions: The strength of association estimates assessed by the CEHQ-FFQ and the 24-HDR varied by food group and by age group. Observed level of agreement and CEHQ-FFQ ability to rank children according to intakes of food groups were considered to be low.
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| 4. |
- Börnhorst, Claudia, et al.
(författare)
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Diet-obesity associations in children : approaches to counteract attenuation caused by misreporting
- 2013
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Ingår i: Public Health Nutrition. - : Cambridge University Press. - 1368-9800 .- 1475-2727. ; 16:2, s. 256-266
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Measurement errors in dietary data lead to attenuated estimates of associations between dietary exposures and health outcomes. The present study aimed to compare and evaluate different approaches of handling implausible reports by exemplary analysis of the association between dietary intakes (total energy, soft drinks, fruits/vegetables) and overweight/obesity in children. Design: Cross-sectional multicentre study. Setting: Kindergartens/schools from eight European countries participating in the IDEFICS Study. Subjects: Children (n 5357) aged 2-9 years who provided one 24 h dietary recall and complete covariate information. Results: The 24 h recalls were classified into three reporting groups according to adapted Goldberg cut-offs: under-report, plausible report or over-report. In the basic logistic multilevel model (adjusted for age and sex, including study centre as random effect), the dietary exposures showed no significant association with overweight/obesity (energy intake: OR=0.996 (95% CI 0.983, 1.010); soft drinks: OR=0.999 (95% CI 0.986, 1.013)) and revealed even a positive association for fruits/vegetables (OR=1.009 (95% CI 1.001, 1.018)). When adding the reporting group (dummy variables) and a propensity score for misreporting as adjustment terms, associations became significant for energy intake as well as soft drinks (energy: OR=1.074 (95% CI 1.053, 1.096); soft drinks: OR=1.015 (95% CI 1.000, 1.031)) and the association between fruits/vegetables and overweight/obesity pointed to the reverse direction compared with the basic model (OR=0.993 (95% CI 0.984, 1.002)). Conclusions: Associations between dietary exposures and health outcomes are strongly affected or even masked by measurement errors. In the present analysis consideration of the reporting group and inclusion of a propensity score for misreporting turned out to be useful tools to counteract attenuation of effect estimates.
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| 5. |
- Börnhorst, Claudia, et al.
(författare)
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Potential selection effects when estimating associations between the infancy peak or adiposity rebound and later body mass index in children
- 2017
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Ingår i: International Journal of Obesity. - London : Nature Publishing Group. - 0307-0565 .- 1476-5497. ; 41:4, s. 518-526
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION:This study aims to evaluate a potential selection effect caused by exclusion of children with non-identifiable infancy peak (IP) and adiposity rebound (AR) when estimating associations between age and body mass index (BMI) at IP and AR and later weight statusSUBJECTS AND METHODS: In 4744 children with at least 4 repeated measurements of height and weight in the age interval from 0 to 8 years (37 998 measurements) participating in the IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants)/I.Family cohort study, fractional polynomial multilevel models were used to derive individual BMI trajectories. Based on these trajectories, age and BMI at IP and AR, BMI values and growth velocities at selected ages as well as the area under the BMI curve were estimated. The BMI growth measures were standardized and related to later BMI z-scores (mean age at outcome assessment: 9.2 years).RESULTS: Age and BMI at IP and AR were not identifiable in 5.4% and 7.8% of the children, respectively. These groups of children showed a significantly higher BMI growth during infancy and childhood. In the remaining sample, BMI at IP correlated almost perfectly (r⩾0.99) with BMI at ages 0.5, 1 and 1.5 years, whereas BMI at AR correlated perfectly with BMI at ages 4-6 years (r⩾0.98). In the total study group, BMI values in infancy and childhood were positively associated with later BMI z-scores where associations increased with age. Associations between BMI velocities and later BMI z-scores were largest at ages 5 and 6 years. Results differed for children with non-identifiable IP and AR, demonstrating a selection effect.CONCLUSIONS: IP and AR may not be estimable in children with higher-than-average BMI growth. Excluding these children from analyses may result in a selection bias that distorts effect estimates. BMI values at ages 1 and 5 years might be more appropriate to use as predictors for later weight status instead. © 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved.
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| 6. |
- Börnhorst, Claudia, et al.
(författare)
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Potential selection effects when estimating associations between the infancy peak or adiposity rebound and later body mass index in children
- 2018
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Ingår i: Revue d'épidémiologie et de santé publique. - Issy les Moulineaux Cedex : Elsevier. - 0398-7620 .- 1773-0627. ; 66:Suppl. 5, s. S422-S423
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Lots of research has been conducted to identify early life factors or growth characteristics in infancy and childhood related to an unfavorable weight development. For instance, a late age at infancy peak (IP), an early age at adiposity rebound (AR) as well as body mass index (BMI) at IP and AR were shown to be positively associated with later adiposity status. The present study aims to investigate the usefulness of the IP and AR in comparison to other measures of BMI growth as indicators of later weight status. For the first time, the selection effect possibly occurring when excluding children with non-identifiable IP or AR will be explored.Methods: Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants (IDEFICS)/I. Family is an ongoing cohort study conducted in eight European countries with 16,229 children participating in the baseline survey in 2006/2007 [1]. In a subset of 4744 children with at least four repeated measurements of height and weight in the age interval from 0 to 8 years (37,998 measurements in total; survey data supplemented with records of routine child visits), fractional polynomial mixed-effects models were used to derive individual BMI trajectories. Based on these trajectories, age and BMI at IP and AR, BMI values and growth velocities at selected ages as well as the area under the BMI curve were estimated. The BMI growth measures were standardized and related to later BMI z-scores (mean age at outcome assessment: 9.2 years).Results: Age and BMI at IP and AR were not identifiable in 5.4% and 7.8% of the children, respectively. These groups of children showed a significantly higher BMI growth during infancy and childhood. In the remaining sample, BMI at IP correlated almost perfectly (r ≥ 0.99) with BMI at ages 0.5, 1 and 1.5 years, whereas BMI at AR correlated perfectly with BMI at ages 4–6 years (r ≥ 0.98). In the total study group, BMI values in infancy and childhood were positively associated with later BMI z-scores where associations increased with age. Associations between BMI velocities and later BMI z-scores were largest at ages 5 and 6 years. Results markedly differed for children with non-identifiable IP and AR, demonstrating a selection effect.Conclusions: IP and AR may not be estimable in children with higher-than-average BMI growth. Excluding these children from analyses may result in a selection bias that distorts effect estimates. BMI values at ages 1 and 5 years might be more appropriate to use as predictors for later weight status instead.© 2018 Published by Elsevier Masson SAS
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| 7. |
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| 8. |
- Dello Russo, Marika, et al.
(författare)
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Dietary Diversity and Its Association with Diet Quality and Health Status of European Children, Adolescents, and Adults : Results from the I.Family Study
- 2023
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Ingår i: Foods. - : MDPI. - 2304-8158. ; 12:24
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Tidskriftsartikel (refereegranskat)abstract
- Dietary diversity (DD) plays a crucial role in fostering high-quality diets, but its association with health outcomes, particularly body adiposity and non-communicable diseases (NCDs), is inconsistent. This may be due to a lack of a standardized method for estimating DD. Our study investigates the association between two DD indices, namely the dietary diversity score (DDS) and food variety score (FVS), and anthropometric measures, biochemical parameters, and diet quality in a large population sample from the I.Family study across research centers in eight European countries. In our cross-sectional analysis of 3035 participants, DDSs varied among countries, with a higher prevalence in the third DDS tertile among those with higher education. DDS showed a positive association with diet quality across all age groups. Higher DDS tertile individuals showed increased fiber, fruit, and vegetable intake, greater meal frequency, and lower ultra-processed food consumption. No relevant biochemical differences were observed across DDS tertiles, and a higher DDS was associated with lower overweight/obesity prevalence only in adults. No significant associations were found with FVS. Our findings emphasize the need to consider food groups for a more accurate estimation of diet quality. This aligns with studies suggesting DDS alone is not an independent risk factor for obesity in children and adolescents. Public health programs should prioritize food diversity to promote improved nutrition and overall well-being in communities.
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| 9. |
- Floegel, Anna, et al.
(författare)
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Cohort-Based Reference Values for Serum Ferritin and Transferrin and Longitudinal Determinants of Iron Status in European Children Aged 3–15 Years
- 2024
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Ingår i: Journal of Nutrition. - : Elsevier. - 0022-3166 .- 1541-6100. ; 154:2, s. 658-669
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Tidskriftsartikel (refereegranskat)abstract
- Background: Reference values of ferritin and transferrin for European children do not exist. Objective: We aimed to provide sex-, age-, and body mass index (BMI)-specific serum ferritin and transferrin reference percentiles of 3–15-y-old children based on cohort data and to investigate determinants of iron status. Methods: A total of 3390 ferritin and 3416 transferrin measurements from children residing in 8 European countries participating in the IDEFICS/I.Family cohort (https://www.isrctn.com/ISRCTN62310987) at baseline (W0) and 6 y later (W3) were used to estimate percentiles using the generalized additive model for location, scale and shape. Associations of serum ferritin and transferrin concentrations with total iron intake, total iron intake additionally adjusted for vitamin C intake, and iron from heme sources were investigated separately with adjustment for sex, age, country of residence, parental education, usual energy intake and BMI z-score in regression models using cross-sectional and longitudinal data. Results: The age-specific ferritin and transferrin 5th and 95th reference percentiles ranged from 10.9 to 81.1 μg/L and 2.23 to 3.56 g/L, respectively. A deficient iron status was observed in 3% of children at W0 and 7% of children and adolescents at W3, respectively. At both waves, a higher iron intake from heme sources was positively associated with serum ferritin {W0: β = 3.21 [95% confidence interval (CI): 0.71, 5.71]; W3: β = 4.48 [95% CI: 2.09, 6.87]}, that is, children consuming one mg more heme iron had a 3.21 and 4.48 μg/L higher ferritin concentration. Adherence to a mainly vegetarian diet was associated with a lower chance for sufficient serum ferritin cross-sectionally at W3 [odds ratio (OR) 0.40 (95% CI: 0.21, 0.81)] and longitudinally [OR 0.35 (95% CI: 0.15, 0.93)]. Conclusions: Age-, sex-, and BMI-specific reference percentiles of serum ferritin and transferrin concentrations based on cohort data are provided for European children aged 3–15 y and may be used in clinical practice.
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| 10. |
- Formisano, Annarita, et al.
(författare)
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Family structure and childhood obesity: results of the IDEFICS project
- 2014
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Ingår i: Public Health Nutrition. - 1368-9800. ; 17:10, s. 2307-2315
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyze the association between family structure and adiposity in children. Design: Cross-sectional and longitudinal analysis of the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study cohort. Setting: Primary schools and kindergartens. Subjects: Children (n 12 350; aged 7 to 9 (SD 1.8) years) for the cross-sectional analysis and children (n 5236; at baseline: normal weight, aged 5 to 9 (SD 1.8) years) for the longitudinal study underwent anthropometry. Family structure was analyzed as (i) number and type of cohabiting adults and (ii) number of siblings. Results: In the cross-sectional analysis, after controlling for covariates, children living with grandparents had significantly higher BMI Z-score than those living with both parents (0.63; 95% CI 0.33, 0.92 v. 0.19; 95% CI 0.17, 0.22; P,0.01); in addition, the higher the number of siblings, the lower the BMI Z-score (only child 50.31; 95% CI 0.24, 0.38; 1 sibling 50.19; 95% CI 0.16, 0.23; 2 siblings 50.15; 95% CI 0.09, 0.20; >2 siblings 50.07, 95% CI 0.04, 0.19;P,0.001). Over the 2-year follow-up, differences in weight gain were observed across family-structure categories. Further, the risk of incidence of overweight/ obesity was significantly lower the higher the number of siblings living in the household (v. only child: 1 sibling 50.74, 95% CI 0.57, 0.96; 2 siblings 50.63, 95% CI 0.45, 0.88; >2 siblings 50.40, 95% CI 0.21, 0.77), independently of confounders. Conclusions: The study suggests that an independent association between family structure and childhood obesity exists.
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