| 1. |
- Bammann, Karin, et al.
(författare)
-
Early Life Course Risk Factors for Childhood Obesity: The IDEFICS Case-Control Study
- 2014
-
Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:2
-
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.
|
|
| 2. |
- Formisano, Annarita, et al.
(författare)
-
Family structure and childhood obesity: results of the IDEFICS project
- 2014
-
Ingår i: Public Health Nutrition. - 1368-9800. ; 17:10, s. 2307-2315
-
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.
|
|
| 3. |
- Hunsberger, Monica, 1973
(författare)
-
Early feeding practices and family structure: associations with overweight in children.
- 2014
-
Ingår i: Proceedings of the Nutrition Society. The Nutrition Society Irish Section 22nd Annual Postgraduate Meeting. 14–15 February 2013, Belfast, Ireland. - 0029-6651 .- 1475-2719.
-
Konferensbidrag (refereegranskat)abstract
- The aim of this review is to examine two factors that may be associated with development of childhood overweight: early feeding, namely exclusive breastfeeding practices; family structure. Findings from the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study are presented in the context of the literature. IDEFICS is a multi-centre European study exploring the risks for overweight and obesity in children, which recruited 16 224 children aged 2–9 years from September 2007 to June 2008 at survey centres in Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain. Among the IDEFICS sample, after controlling for confounders, exclusive breastfeeding for 4–6 months was protective of overweight (including obesity) when compared with children never exclusively breastfed (OR 0·73, 95 % CI 0·63, 0·85). Family structure and number of siblings may also be associated with overweight. IDEFICS children without siblings were more likely (OR 1·52, 95 % CI 1·34, 1·72) to be overweight than their peers with siblings when controlling for factors related to childhood overweight such as country, parental education, parental weight, maternal age, child's age, birth weight and gender. Both early feeding practices and family structure play a role in the future development of obesity. The impact of breastfeeding on future development of overweight is dependent upon the dose. Exclusive breastfeeding for the recommended 6 months appears to be protective of overweight. Family structure is also an important component and emerging research suggests only children are at increased risk for overweight in comparison with those with siblings. In European countries, approximately 22 million children are overweight. Early dietary exposures, genetic, environmental and social factors have all been proposed as potential causal factors. Two such factors include exclusive breastfeeding and the impact of being an only child. We have investigated these two factors for associations with overweight; our studies, in the context of previous findings, are the focus of this review.
|
|
| 4. |
- Hunsberger, Monica, 1973, et al.
(författare)
-
Elementary school children’s recess schedule and dietary intake at lunch: a community-based participatory research partnership pilot study
- 2014
-
Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 14
-
Tidskriftsartikel (refereegranskat)abstract
- Background: School recess before lunch (e.g., reverse recess) has been suggested as a means to improve dietary intake and classroom behavior but limited research explores this school-based policy. This pilot study tests the impact of recess scheduling on dietary intake at school lunch. Methods: A mixed methods approach included assessment of dietary intake assessed by measured plate waste on five non-consecutive days at Madras Elementary School, Madras, Oregon, United States (n=104 intervention; 157 controls). Subjects included primary school children in grades kindergarten, first and second. Logistic regression was used to test associations between recess timing and dietary intake. Four focus groups involving teachers and staff explored reactions to the intervention. Qualitative data was transcribed verbatim and assessed for key themes. Results: Milk consumption was 1.3 oz greater in the intervention group (5.7 oz vs. 4.4 oz); and 20% more of the intervention participants drank the entire carton of milk (42% vs. 25%, p<0.0001). Intervention participants were 1.5 times more likely to meet the nutritional guidelines for calcium (≥267 mg, p=0.01) and fat (≤30% of total energy, p=0.02). Consumption of entrees, vegetables, and fruits did not differ between groups. Teachers perceived recess before lunch beneficial to classroom behavior and readiness to concentrate following lunch. Conclusions: The recess before lunch intervention yielded increased milk consumption; the nutritional and social benefits observed warrant policy change consideration. Future research should assess the impact of recess before lunch in larger districts.
|
|
| 5. |
- Hunsberger, Monica, et al.
(författare)
-
Infant feeding practices and prevalence of obesity in eight European countries - the IDEFICS study
- 2013
-
Ingår i: Public Health Nutrition. - : Cambridge University Press. - 1368-9800 .- 1475-2727. ; 16:2, s. 219-227
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the association between exclusive breast-feeding and childhood overweight. Design: Cross-sectional data are from the baseline survey of the longitudinal cohort study IDEFICS. Exclusive rather than partial breast-feeding is the focus of the study due to the theoretical relationship between exclusive breast-feeding and development of dietary self-regulation. Children's measured heights and weights were used to calculate weight status, while waist-to-height ratio (WtHR) and skinfold measures were examined as alternative indicators of adiposity and fat patterning. Setting: Examination centres in eight European countries (Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain). Subjects: The analysis included 14 726 children aged 2-9 years for whom early feeding practices were reported by parents in standardized questionnaires. Results: After controlling for education, income and other potential confounders, breast-feeding exclusively for 4-6 months was protective of overweight (including obesity) when compared with children never exclusively breast-fed (OR=0.73; 95% CI 0.63, 0.85) across all measures of overweight. Exclusively breast-feeding for 6 months offered slightly more protection than for 4 and 5 months combined (OR=0.71; 95% CI 0.58, 0.85). The associations could not be explained by socio-economic characteristics or maternal overweight. Conclusions: This multi-country investigation indicated that exclusive breast-feeding for 4-6 months may confer protection against overweight in addition to other known benefits. There was no demonstrated benefit of exclusive breast-feeding for more than 6 months or combination feeding for any duration across all measures of overweight examined.
|
|
| 6. |
|
|
| 7. |
- Hunsberger, Monica, 1973, et al.
(författare)
-
Overweight in singletons compared to children with siblings: the IDEFICS study.
- 2012
-
Ingår i: Nutrition and diabetes. - : Springer Science and Business Media LLC. - 2044-4052. ; 2
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to compare the prevalence of overweight in only children to those with siblings and to explore potential behavioral mediating factors. This study relies upon cross-sectional data collected at survey centers in eight European countries participating in Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS). The present analysis is based on measured anthropometry and parent or guardian-reported socio-demographic characteristics. Subjects include 12720 children aged 2–9 years for whom number of siblings was known. Singletons were more likely (odds ratio 1.52, 95% confidence interval (CI):1.34–1.72) to be overweight than their peers with siblings when controlling for factors related to childhood overweight, including survey country, parental education, parental weight, maternal age, child's age, birth weight and gender. The three southernmost countries have over threefold risk of overweight, dominated by Italy, compared with the north-central countries, which is not explained by the prevalence of singleton children. The excess risk of overweight among children without siblings was robustly observed even when considering behavioral mediating factors (playtime, screen time per day, dietary propensities for sugar or fat, parental attitudes towards food rewards and television in the child's bedroom). Among singletons aged 6–9 years, the excess risk of overweight was 1.70 (95% CI: 1.44–2.01) compared with 1.32 (95% CI: 1.10–1.60) in younger singletons.
|
|
| 8. |
- Hunsberger, Monica, 1973, et al.
(författare)
-
Physician Care Patterns and Adherence to Postpartum Glucose Testing after Gestational Diabetes Mellitus in Oregon
- 2012
-
Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 7:10
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: This study examines obstetrician/gynecologists and family medicine physicians' reported care patterns, attitudes and beliefs and predictors of adherence to postpartum testing in women with a history of gestational diabetes mellitus. Research Design and Methods: In November-December 2005, a mailed survey went to a random, cross-sectional sample of 683 Oregon licensed physicians in obstetrician/gynecologists and family medicine from a population of 2171. Results: Routine postpartum glucose tolerance testing by both family physicians (19.3%) and obstetrician/gynecologists physicians (35.3%) was reportedly low among the 285 respondents (42% response rate). Factors associated with high adherence to postpartum testing included physician stated priority (OR 4.39, 95% CI: 1.69-7.94) and physician beliefs about norms or typical testing practices (OR 3.66, 95% CI: 1.65-11.69). Specialty, sex of physician, years of practice, location, type of practice, other attitudes and beliefs were not associated with postpartum glucose tolerance testing. Conclusions: Postpartum glucose tolerance testing following a gestational diabetes mellitus pregnancy was not routinely practiced by responders to this survey. Our findings indicate that physician knowledge, attitudes and beliefs may in part explain suboptimal postpartum testing. Although guidelines for postpartum care are established, some physicians do not prioritize these guidelines in practice and do not believe postpartum testing is the norm among their peers.
|
|
| 9. |
|
|
| 10. |
- Hunsberger, Monica, 1973, et al.
(författare)
-
Student and Parental Perceptions of School-Based Body Mass Index Screening and Notification
- 2014
-
Ingår i: Journal of Community Medicine & Health Education. - 2161-0711. ; S2:009
-
Tidskriftsartikel (refereegranskat)abstract
- To address the childhood obesity epidemic, school-based body mass index (BMI) screening and surveillance is proposed or mandated in 30 states. We examined parent and student perceptions of school-based measuring and reporting in an ethnically diverse school district in Madras, Oregon, USA. Four broad themes emerged from focus groups held separately with parents and students. Students generally expressed a neutral opinion of BMI measurement. Parents felt that they held primary responsibility for their child’s weight. Parents and students perceived BMI notification as important; however, BMI reporting did not widely serve as an impetus for physician involvement or self-reported behavior change. Perceived barriers to behavior change included the lack of a supportive environment, poor access to healthcare, cultural issues, lack of concern over childhood overweight or a minimizing of health risks associated with overweight and poor understanding of the BMI graph and accompanied reporting of health information. Notification letters had limited effectiveness in this community.
|
|
| 11. |
- Hunsberger, Monica, et al.
(författare)
-
Validity of self-reported lunch recalls in Swedish school children aged 6-8 years
- 2013
-
Ingår i: Nutrition Journal. - : BioMed Central. - 1475-2891. ; 12
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Previous studies have suggested that young children are inaccurate reporters of dietary intake. The purpose of this study was to validate a single recall of the previous day's school lunch reported by 6-8 year old Swedish children and to assess teacher-recorded intake of the same meal in a standardized food journal. An additional research question was whether parents could report their child's intake of the previous day's lunch. Subjects constituted a convenience sample from the large, multi-country study Identification and prevention of Dietary-and lifestyle-induced health EFfects In Children and infantS (IDEFICS). Validations of both children's recalls and teachers' records were made by comparing results with the duplicate plate reference method. Findings: Twenty-five children (12 boys/13 girls) aged 6-8 years participated in the validation study at one school in western Sweden. Children were accurate self-reporters of their dietary intake at lunch, with no significant difference between reported and weighed intake (Mean difference (SD): 7(50) kcals, p=0.49). Teachers significantly over-reported intake (Mean difference (SD): 65(79) kcals, p=0.01). For both methods, child-reported and teacher-recorded, correlations with weighed intake were strong (Pearson's correlations r=0.92, p<0.001 and r=0.83, p<0.001 respectively). Bland-Altman plots showed strong agreement between child-reported and weighed intakes but confirmed systematic differences between teacher-records and weighed intakes. Foods were recalled by children with a food-match rate of 90%. In all cases parents themselves were unable to report on quantities consumed and only four of 25 children had parents with knowledge regarding food items consumed. Conclusions: Children 6-8 years of age accurately recalled their school lunch intake for one occasion while teachers recorded with less accuracy. Our findings suggest that children as young as six years of age may be better able to report on their dietary intake than previously suggested, at least for one main meal at school. Teacher-recorded intake provides a satisfactory estimate but with greater systematic deviation from the weighed intake. Parents were not able to report on their children's school lunches consumed on the previous day.
|
|
| 12. |
|
|
| 13. |
- McGinnis, Paul B, et al.
(författare)
-
Transitioning from CHIP to CHIRP: blending community health development with community-based participatory research.
- 2010
-
Ingår i: Family & community health. - 1550-5057. ; 33:3, s. 228-37
-
Tidskriftsartikel (refereegranskat)abstract
- In 2006, a community health development model was used to engage citizens in Jefferson County, Oregon, around local health concerns. Childhood obesity emerged as a priority health issue. In 2007, a research component was introduced by Oregon Health & Science University to help the community garner resources and inform the field. This case study describes the collaboration between the Mountain View Community Health Improvement Partnership and Oregon Health & Science University to increase the number of county children at a healthy weight. Research and projects occurred simultaneously since community members are motivated by action, and research is a slower process.
|
|
| 14. |
- Wiberger, Maja, et al.
(författare)
-
Children consuming milk cereal drink are at increased risk for overweight: The IDEFICS Sweden study, on behalf of the IDEFICS Consortium.
- 2014
-
Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 42:6, s. 518-524
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: 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.
|
|
