| 1. |
- Bixby, H., et al.
(author)
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Rising rural body-mass index is the main driver of the global obesity epidemic in adults
- 2019
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In: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 569:7755, s. 260-4
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Journal article (peer-reviewed)abstract
- Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.
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| 2. |
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| 3. |
- Iguacel, I., et al.
(author)
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Prospective associations between socioeconomically disadvantaged groups and metabolic syndrome risk in European children. Results from the IDEFICS study
- 2018
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 272, s. 333-340
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Journal article (peer-reviewed)abstract
- Objective: Socioeconomic disadvantages during childhood are hypothesised to have negative implications for health. We aimed to investigate the association between socioeconomic disadvantages and children's total metabolic syndrome (MetS) score at baseline and follow-up and the extent to which socioeconomic disadvantages over time and the accumulation of these socioeconomic disadvantages can affect children's MetS risk. Methods: The two-year longitudinal IDEFICS study included 2401 European children (aged 2.0-9.9) with complete information of the 16,229 participating at baseline. Sociodemographic variables, psychosocial factors and lifestyle were proxy-reported via questionnaires. Socioeconomically disadvantaged groups included children from families with low income, low education, migrant origin, unemployed parents, parents who lacked a social network, and from non-traditional families. MetS risk score was calculated as the sum of z-scores of waist circumference, blood pressure, lipids and insulin resistance. Linear mixed-effects models were used to study the association between social disadvantages and MetS risk. Models were adjusted for sex, age, well-being and lifestyle (fruit and vegetables consumption, physical activity, screen time). Results: At both time points, children from low-income families (0.20 [0.03-0.37]); (beta estimate and 99% confidence interval), children from non-traditional families (0.14 [0.02-026]), children whose parents were unemployed (0.31 [0.05-0.57]) and children who accumulated >3 disadvantages (0.21 [0.04-0.37]) showed a higher MetS score compared to non-socioeconomically disadvantaged groups. Conclusion: Children from socioeconomically disadvantaged families are at high metabolic risk independently of diet, physical activity, sedentary behaviours and well-being. Interventions focusing on these socioeconomically disadvantaged groups should be developed to tackle health disparities. (C) 2018 Elsevier B.V. All rights reserved.
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| 5. |
- Gonzalez-Gil, E. M., et al.
(author)
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Whole-blood fatty acids and inflammation in European children: the IDEFICS Study
- 2016
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In: European Journal of Clinical Nutrition. - : Springer Science and Business Media LLC. - 0954-3007 .- 1476-5640. ; 70:7, s. 819-823
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Journal article (peer-reviewed)abstract
- BACKGROUND/OBJECTIVES: Fatty acids are hypothesized to influence cardiovascular disease risk because of their effect on inflammation. The aim of this study is to assess the relationship between whole-blood fatty acids (WBFAs) and high-sensitivity C-reactive protein (hs-CRP) in European children. SUBJECTS/METHODS: A total of 1401 subjects (697 boys and 704 girls) aged between 2 and 9 years from the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects in Children and infantS) study were measured in this cross-sectional analysis. The sample was divided into three categories of hs-CRP. Associations between WBFA and hs-CRP were assessed by logistic regression models adjusting for body mass index (BMI), country, age, breastfeeding, mother's education and hours of physical activity. RESULTS: Linoleic acid (LA) (P = 0.013, 95% confidence interval (CI):0.822-0.977) and sum of n-6 WBFA (P = 0.029, 95% CI: 0.866-0.992) concentrations were associated with lower concentrations of hs-CRP in boys. In girls, a high ratio of eicosapentaenoic acid (EPA)/arachidonic acid (AA) was associated (P = 0.018, 95% CI: 0.892-0.989) with lower hs-CRP concentrations. In contrast, sum of blood n-6 highly unsaturated fatty acids (P = 0.012, 95% CI: 1.031-1.284), AA (P = 0.007, 95% CI: 1.053-1.395) and AA/LA ratio (P = 0.005, 95% CI: 1.102-1.703) were associated (P < 0.05) with higher concentrations of hs-CRP in girls. CONCLUSIONS: The n-6 WBFAs (sum of n-6 FA and LA) were associated with lower hs-CRP in boys and with higher hs-CRP in girls (AA, sum of n-6 highly unsaturated and AA/LA ratio). More studies are needed to identify the optimal levels of WBFAs to avoid low-grade inflammation in children considering the differences by sex and BMI.
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| 6. |
- Iguacel, I., et al.
(author)
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Associations between social vulnerabilities and psychosocial problems in European children. Results from the IDEFICS study
- 2017
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In: European Child & Adolescent Psychiatry. - : Springer Science and Business Media LLC. - 1018-8827 .- 1435-165X. ; 26:9, s. 1105-1117
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Journal article (peer-reviewed)abstract
- The effect of socioeconomic inequalities on children's mental health remains unclear. This study aims to explore the cross-sectional and longitudinal associations between social vulnerabilities and psychosocial problems, and the association between accumulation of vulnerabilities and psychosocial problems. 5987 children aged 2-9 years from eight European countries were assessed at baseline and 2-year follow-up. Two different instruments were employed to assess children's psychosocial problems: the KINDL (Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents) was used to evaluate children's well-being and the Strengths and Difficulties Questionnaire (SDQ) was used to evaluate children's internalising problems. Vulnerable groups were defined as follows: children whose parents had minimal social networks, children from non-traditional families, children of migrant origin or children with unemployed parents. Logistic mixed-effects models were used to assess the associations between social vulnerabilities and psychosocial problems. After adjusting for classical socioeconomic and lifestyle indicators, children whose parents had minimal social networks were at greater risk of presenting internalising problems at baseline and follow-up (OR 1.53, 99% CI 1.11-2.11). The highest risk for psychosocial problems was found in children whose status changed from traditional families at T0 to non-traditional families at T1 (OR 1.60, 99% CI 1.07-2.39) and whose parents had minimal social networks at both time points (OR 1.97, 99% CI 1.26-3.08). Children with one or more vulnerabilities accumulated were at a higher risk of developing psychosocial problems at baseline and follow-up. Therefore, policy makers should implement measures to strengthen the social support for parents with a minimal social network.
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| 7. |
- Iguacel, I., et al.
(author)
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Prospective associations between social vulnerabilities and children's weight status. Results from the IDEFICS study
- 2018
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In: International Journal of Obesity. - : Springer Science and Business Media LLC. - 0307-0565 .- 1476-5497. ; 42:10, s. 1691-1703
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Journal article (peer-reviewed)abstract
- Background/objectives In high-income countries, childhood obesity follows a clear socioeconomic gradient with greater prevalence in children with lower socioeconomic status (SES). The extent to which the trend of other social vulnerabilities over time and the accumulation of these vulnerabilities can affect children's weight is still unknown. Subjects/methods In the IDEFICS study, 8624 children aged 2.0-9.9 years from eight European countries were examined at baseline and after 2 years. Sociodemographic variables, maternal body mass index (BMI), and lifestyle were reported by parents. Children were measured and classified as thin, normal weight, and overweight/obese using the extended IOTF criteria. Four vulnerable groups were defined: children whose parents were migrants, children whose parents lack a social network, children from non-traditional families (children not living with both biological parents), and children with unemployed parents. Logistic mixed-effects models were used to study the association between vulnerabilities and children's weight at baseline and follow-up, temporal trends in vulnerabilities and children's weight and accumulation of vulnerabilities and children's weight. Models were adjusted for lifestyle, maternal BMI, parental education, and income. Results Children whose parents lost their social support at follow-up were more likely to be thin than non-vulnerable children (OR = 1.69, 99% CI = 1.03-2.78). Children whose parents had a migrant background (OR = 1.30, 99% CI 1.04-1.62), children from non-traditional families at both time points (OR = 1.40, 99% CI 1.03-1.90) and whose parents were unemployed at baseline and follow-up (OR = 2.03, 99% CI 1.03-3.99) were more likely to be overweight/obese compared to non-vulnerable children. Cross-sectionally, we did not find an association between parental lack of network, non-traditional family structure, or employment and children's weight status. Conclusions Policy actions are required to tackle inadequate weight loss and gain among vulnerable children (especially those exposed over the long term) since they are at a higher risk of thinness and overweight.
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| 8. |
- Langeheine, M., et al.
(author)
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Attrition in the European Child Cohort IDEFICS/I. Family: Exploring Associations Between Attrition and Body Mass Index
- 2018
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In: Frontiers in Pediatrics. - : Frontiers Media SA. - 2296-2360. ; 6
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Journal article (peer-reviewed)abstract
- Attrition may lead to bias in epidemiological cohorts, since participants who are healthier and have a higher social position are less likely to drop out. We investigated possible selection effects regarding key exposures and outcomes in the IDEFICS/I. Family study, a large European cohort on the etiology of overweight, obesity and related disorders during childhood and adulthood. We applied multilevel logistic regression to investigate associations of attrition with sociodemographic variables, weight status, and study compliance and assessed attrition across time regarding children's weight status and variations of attrition across participating countries. We investigated selection effects with regard to social position, adherence to key messages concerning a healthy lifestyle, and children's weight status. Attrition was associated with a higher weight status of children, lower children's study compliance, older age, lower parental education, and parent's migration background, consistent across time and participating countries. Although overweight (odds ratio 1.17, 99% confidence interval 1.05-1.29) or obese children (odds ratio 1.18, 99% confidence interval 1.03-1.36) were more prone to drop-out, attrition only seemed to slightly distort the distribution of children's BMI at the upper tail. Restricting the sample to subgroups with different attrition characteristics only marginally affected exposure-outcome associations. Our results suggest that IDEFICS/I. Family provides valid estimates of relations between socio-economic position, health-related behaviors, and weight status.
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| 9. |
- Santaliestra-Pasias, A. M., et al.
(author)
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Food and beverage intakes according to physical activity levels in European children: the IDEFICS (Identification and prevention of Dietary and lifestyle induced health EFfects In Children and infantS) study
- 2018
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In: Public Health Nutrition. - : Cambridge University Press (CUP). - 1368-9800 .- 1475-2727. ; 21:9, s. 1717-1725
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Journal article (peer-reviewed)abstract
- Objective: Physical activity (PA) levels and dietary habits are considered some of the most important factors associated with obesity. The present study aimed to examine the association between PA level and food and beverage consumption in European children (2-10 years old). Design/Setting/Subjects: A sample of 7229 children (49.0% girls) from eight European countries participating in the IDEFICS (Identification and prevention of Dietary and lifestyle induced health EFfects In Children and infantS) study was included. Moderate-to-vigorous PA (MVPA) was assessed objectively with accelerometers. FFQ was used to register dietary habits. ANCOVA and binary logistic regression were applied. Results: Boys who spent less time in MVPA reported lower consumption of vegetables, fruits, cereals, yoghurt, milk, bread, pasta, candies and sugar-sweetened beverages (SSB) than boys who spent more time in MVPA (P < 0.05). Moreover, boys who spent less time in MVPA were more likely to consume fast foods and water than those in the highest MVPA tertile (P < 0.05). Girls who spent less time in MVPA reported lower consumption frequencies of vegetables, pasta, bread, yoghurt, candies, jam/honey and SSB than girls in the highest MVPA tertile (P < 0.05). Also, girls in the lowest MVPA tertile were more likely to consume fast foods and water than those with high levels of MVPA (P < 0.05). Conclusions: Food intake among European children varied with different levels of daily MVPA. Low time spent in MVPA was associated with lowest consumption of both high-and low-energy-dense foods and high fast-food consumption.
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| 10. |
- Arvidsson, Louise, et al.
(author)
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Fat, sugar and water intakes among families from the IDEFICS intervention and control groups: first observations from I.Family
- 2015
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In: Obesity Reviews. - : Wiley. - 1467-7881 .- 1467-789X. ; 16:Suppl. 2, s. 127-137
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Journal article (peer-reviewed)abstract
- BackgroundThe objective of this paper is to investigate differences in diets of families in intervention versus control communities 5years after the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants intervention ended. MethodsAltogether, 4,691 families from the I.Family study with at least one participating parent and one child are included in this analysis. Diet quality indicators, defined as propensities to consume fat, sugar, water and fruit and vegetables, are calculated from a 59-item food frequency questionnaire. Multilevel linear models with random intercepts for study centre are used to determine whether mean diet indicators, calculated at the family level, differed as a function of previous exposure to the intervention. ResultsFamilies in the intervention communities reported a significantly lower sugar propensity (19.8% vs. 20.7% of total food items, p<0.01) and a higher water propensity (47.3% vs. 46.0% of total beverages, p<0.05) compared with families in the control communities, while fat and fruit and vegetables propensities were similar. No significant diet differences between intervention and control children were present at the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants baseline. DiscussionThis result indicates better diet quality in intervention families, which was not present in children when their diets were assessed before the intervention, and gives some cause for optimism regarding the sustainability of some aspects of the diet intervention.
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