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  • 1.
    Androutsos, O
    et al.
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greec.
    Apostolidou, E
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greec.
    Iotova, V
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    Socha, P
    The Children’s Memorial Health Institute, Warsaw, Poland.
    Birnbaum, J
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Moreno, L
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain .
    De Bourdeaudhuij, I
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Koletzko, B
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Process evaluation design and tools used in a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 74-80Article in journal (Refereed)
    Abstract [en]

    Process evaluation (PE) is used for the in-depth evaluation of the implementation process of health promotion programmes. The aim of the current paper was to present the PE design and tools used in the ToyBox-intervention. The PE design was based on a three-step approach, including the identification of ToyBox-specific PE elements (step 1), the development of PE tools and harmonization of procedures (step 2), and the implementation of PE using standardized protocol and tools across the intervention countries (step 3). Specifically, to evaluate the implementation of the intervention, teachers' monthly logbooks were recorded (dose delivered, fidelity, dose received); post-intervention questionnaires were completed by parents/caregivers and teachers (dose received); participation and attrition rates were recorded (recruitment, reach); and audit questionnaires and retrospective information on weather conditions were collected (physical and social environment within which the intervention was implemented). Regarding the teachers' training sessions, the researchers who performed the trainings completed evaluation forms and documented teachers' attendance after each training (dose delivered, fidelity, dose received) and teachers completed evaluation forms after each training (dose received). The PE performed in the ToyBox-intervention may contribute in the evaluation of its effectiveness, guide the revision of the intervention material and provide insights for future health promotion programmes and public health policy.

  • 2.
    Androutsos, O
    et al.
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Katsarou, C
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Payr, A
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Birnbaum, J
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Geyer, C
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Wildgruber, A
    State Institute of Early Childhood Research, Munich, Germany.
    Kreichauf, S
    State Institute of Early Childhood Research, Munich, Germany.
    Lateva, M
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    De Decker, E
    Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
    De Craemer, M
    Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
    Socha, P
    The Children’s Memorial Health Institute, Warsaw, Poland.
    Moreno, L
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain.
    Iotova, V
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    Koletzko, B V
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Designing and implementing teachers' training sessions in a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 48-52Article in journal (Refereed)
    Abstract [en]

    Since school-based interventions are mainly delivered by the school staff, they need to be well-trained and familiarized with the programme's aims, procedures and tools. Therefore, the institute, research group, governmental or non-governmental body in charge of the coordination and implementation of the programme needs to devote time and resources to train the school staff before programme's implementation. This is particularly crucial in multi-centre studies where more than one research teams are involved. Both research teams and school staff need to be trained, using standard protocols and procedures, to ensure that the intervention will be delivered in a standardized manner throughout the intervention centres. The ToyBox-intervention, a multi-component, kindergarten-based, family-involved intervention, focusing on water consumption, snacking, physical activity and sedentary behaviours in preschool children, was implemented over the academic year 2012-2013 in six European countries. As part of this intervention, three teachers' training sessions were delivered to motivate and train teachers in implementing the intervention. The local researchers were trained centrally before delivering the training sessions for the teachers and followed a common protocol using standardized presentations and procedures. The aim of the current paper is to describe the protocol and methodological issues related to the teachers' training sessions conducted within the ToyBox-intervention.

  • 3.
    De Craemer, M
    et al.
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    De Decker, E
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    De Bourdeaudhuij, I
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Verloigne, M
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Duvinage, K
    Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University of Munich, München, Germany.
    Koletzko, B
    Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University of Munich, München, Germany.
    Ibrügger, S
    Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University of Munich, München, Germany.
    Kreichauf, S
    State Institute of Early Childhood Research, Munich, Germany.
    Grammatikaki, E
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Moreno, L
    Growth, Exercise, Nutrition and Development Research Group, University of Zaragoza, Zaragoza, Spain.
    Iotova, V
    Department of Social Medicine and Health Care Organization, Medical University Varna, Varna, Bulgaria.
    Socha, P
    Children’s Memorial Health Institute, Warsaw, Poland.
    Szott, K
    Children’s Memorial Health Institute, Warsaw, Poland.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Cardon, G
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Applying the Intervention Mapping protocol to develop a kindergarten-based, family-involved intervention to increase European preschool children's physical activity levels: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 14-26Article in journal (Refereed)
    Abstract [en]

    Although sufficient physical activity is beneficial for preschoolers' health, activity levels in most preschoolers are low. As preschoolers spend a considerable amount of time at home and at kindergarten, interventions should target both environments to increase their activity levels. The aim of the current paper was to describe the six different steps of the Intervention Mapping protocol towards the systematic development and implementation of the physical activity component of the ToyBox-intervention. This intervention is a kindergarten-based, family-involved intervention implemented across six European countries. Based on the results of literature reviews and focus groups with parents/caregivers and kindergarten teachers, matrices of change objectives were created. Then, theory-based methods and practical strategies were selected to develop intervention materials at three different levels: (i) individual level (preschoolers); (ii) interpersonal level (parents/caregivers) and (iii) organizational level (teachers). This resulted in a standardized intervention with room for local and cultural adaptations in each participating country. Although the Intervention Mapping protocol is a time-consuming process, using this systematic approach may lead to an increase in intervention effectiveness. The presented matrices of change objectives are useful for future programme planners to develop and implement an intervention based on the Intervention Mapping protocol to increase physical activity levels in preschoolers.

  • 4.
    De Miguel-Etayo, P
    et al.
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; Department of Physiatry and Nursing. Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; Department of Paediatrics. Faculty of Medicine, University of Zaragoza, Zaragoza, Spain.
    Mesana, M I
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; Department of Physiatry and Nursing. Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
    Cardon, G
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    De Bourdeaudhuij, I
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Góźdź, M
    he Children’s Memorial Health Institute, Warsaw, Poland.
    Socha, P
    he Children’s Memorial Health Institute, Warsaw, Poland.
    Lateva, M
    Department of Paediatrics, Medical University Varna , Varna, Bulgaria.
    Iotova, V
    Department of Paediatrics, Medical University Varna , Varna, Bulgaria.
    Koletzko, B V
    Division of Metabolic Diseases and Nutritional Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany.
    Duvinage, K
    Division of Metabolic Diseases and Nutritional Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany.
    Androutsos, O
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Moreno, L A
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; Department of Physiatry and Nursing. Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
    Reliability of anthropometric measurements in European preschool children: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 67-73Article in journal (Refereed)
    Abstract [en]

    The ToyBox-study aims to develop and test an innovative and evidence-based obesity prevention programme for preschoolers in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. In multicentre studies, anthropometric measurements using standardized procedures that minimize errors in the data collection are essential to maximize reliability of measurements. The aim of this paper is to describe the standardization process and reliability (intra- and inter-observer) of height, weight and waist circumference (WC) measurements in preschoolers. All technical procedures and devices were standardized and centralized training was given to the fieldworkers. At least seven children per country participated in the intra- and inter-observer reliability testing. Intra-observer technical error ranged from 0.00 to 0.03 kg for weight and from 0.07 to 0.20 cm for height, with the overall reliability being above 99%. A second training was organized for WC due to low reliability observed in the first training. Intra-observer technical error for WC ranged from 0.12 to 0.71 cm during the first training and from 0.05 to 1.11 cm during the second training, and reliability above 92% was achieved. Epidemiological surveys need standardized procedures and training of researchers to reduce measurement error. In the ToyBox-study, very good intra- and-inter-observer agreement was achieved for all anthropometric measurements performed.

  • 5.
    Duvinage, K
    et al.
    Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, Ludwig- Maximilians-University of Munich, München, Germany.
    Ibrügger, S
    Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, Ludwig- Maximilians-University of Munich, München, Germany.
    Kreichauf, S
    State Institute of Early Childhood Research, Munich, Germany.
    Wildgruber, A
    State Institute of Early Childhood Research, Munich, Germany.
    De Craemer, M
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    De Decker, E
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Androutsos, O
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Lateva, M
    Department of Pediatrics and Medical Genetics, Medical University Varna, Varna, Bulgaria.
    Iotova, V
    Department of Pediatrics and Medical Genetics, Medical University Varna, Varna, Bulgaria.
    Socha, P
    Children’s Memorial Health Institute, Warsaw, Poland.
    Zych, K
    Children’s Memorial Health Institute, Warsaw, Poland.
    Mouratidou, T
    GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.
    Mesana Graffe, M I
    GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Koletzko, B
    Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children’s Hospital, Ludwig- Maximilians-University of Munich, München, Germany.
    Developing the intervention material to increase physical activity levels of European preschool children: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 27-39Article in journal (Refereed)
    Abstract [en]

    Early childhood is an important period for adopting positive health-related behaviours. More than 95% of European preschool children attend kindergartens, making these settings ideal for the implementation of health promotion interventions. The ToyBox-intervention addressed preschool children, their parents/caregivers and teachers. The aim of the intervention was to improve four energy balance-related behaviours (i.e. healthy snacking, water consumption, physical activity and sedentary behaviour) by implementing a kindergarten-based, family-involved intervention in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain). The intervention material was developed following the intervention mapping protocol, taking into account local and cultural differences among the intervention countries. The present paper focuses on the development of the physical activity component of the intervention. Parental involvement was addressed by providing parents/caregivers with two newsletters, two tip cards and a poster. Teachers received a handbook with guidance on environmental changes in the classroom, 26 physical education sessions and suggestions for fun, interactive classroom activities aiming at total class participation to increase preschoolers' physical activity levels. The ToyBox-intervention material was distributed according to a standard time frame. Teachers received their material prior to the start of the intervention and parents/caregivers received their material during the intervention when each energy balance-related behaviour was implemented.

  • 6.
    González-Gil, E M
    et al.
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
    Mouratidou, T
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.
    Cardon, G
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Androutsos, O
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    De Bourdeaudhuij, I
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Góźdź, M
    The Children’s Memorial Health Institute, Warsaw, Poland.
    Usheva, N
    Department of Social Medicine and Health Care Organization, Medical University Varna, Varna, Bulgaria.
    Birnbaum, J
    Division of Metabolic and Nutritional Medicine Dr. von Hauner Children’s Hospital Ludwig-Maximilians-University of Munich, München, Germany.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Moreno, L A
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
    Reliability of primary caregivers reports on lifestyle behaviours of European pre-school children: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 61-66Article in journal (Refereed)
    Abstract [en]

    Reliable assessments of health-related behaviours are necessary for accurate evaluation on the efficiency of public health interventions. The aim of the current study was to examine the reliability of a self-administered primary caregivers questionnaire (PCQ) used in the ToyBox-intervention. The questionnaire consisted of six sections addressing sociodemographic and perinatal factors, water and beverages consumption, physical activity, snacking and sedentary behaviours. Parents/caregivers from six countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain) were asked to complete the questionnaire twice within a 2-week interval. A total of 93 questionnaires were collected. Test-retest reliability was assessed using intra-class correlation coefficient (ICC). Reliability of the six questionnaire sections was assessed. A stronger agreement was observed in the questions addressing sociodemographic and perinatal factors as opposed to questions addressing behaviours. Findings showed that 92% of the ToyBox PCQ had a moderate-to-excellent test-retest reliability (defined as ICC values from 0.41 to 1) and less than 8% poor test-retest reliability (ICC < 0.40). Out of the total ICC values, 67% showed good-to-excellent reliability (ICC from 0.61 to 1). We conclude that the PCQ is a reliable tool to assess sociodemographic characteristics, perinatal factors and lifestyle behaviours of pre-school children and their families participating in the ToyBox-intervention.

  • 7.
    Hedberg, Jakob
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Duodenal switch versus Roux-en-Y gastric bypass for morbid obesity: systematic review and meta-analysis of weight results, diabetes resolution and early complications in single-centre comparisons2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no 7, p. 555-563Article in journal (Refereed)
    Abstract [en]

    Long-term weight loss after Roux-en-Y gastric bypass (RYGB) in super-obese patients has not been ideal. Biliopancreatic diversion with duodenal switch (DS) is argued to be better; however, additional side effects are feared. The aim of the present study was to determine differences in results after DS and RYGB in publications from single-centre comparisons. A systematic review of studies containing DS and RYGB performed at the same centre was performed. Outcome data were weight results, resolution of comorbid conditions, perioperative results and complications. Main outcome was difference in weight loss after DS and RYGB. Secondary outcomes were difference in resolution of comorbidities, perioperative results and complications. The final analysis included 16 studies with in total 874 DS and 1,149 RYGB operations. When comparing weight results at the longest follow-up of each study, DS yielded 6.2 (95% confidence interval 5.0-7.5) body mass index units additional weight loss compared with RYGB, P < 0.001. Operative time and length of stay were significantly longer after DS, as well as the risk for post-operative leaks, P < 0.05. DS is more effective than RYGB as a weight-reducing procedure. However, this comes at the price of more early complications and might also yield slightly higher perioperative mortality.

  • 8.
    Jacobsson, Josefin A.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Schioth, Helgi B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Fredriksson, Rorbert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    The impact of intronic single nucleotide polymorphisms and ethnic diversity for studies on the obesity gene FTO2012In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 13, no 12, p. 1096-1109Article, review/survey (Refereed)
    Abstract [en]

    In 2007, the first common genetic variants were identified, which undoubtedly affect our susceptibility to obesity. These variants are located in the fat mass and obesity-associated gene FTO. Since then, over 50 loci for common obesity have been identified. As the research on these loci is still at an early stage, there is a great need to review, for clarification purposes, the current research on FTO, as this is likely to influence future studies. Based on the current knowledge, FTO seems to be directly involved in the regulation of energy intake, but there is an urgent need for the identification of regulatory polymorphisms. Thus, herein, we discuss current knowledge and highlight putative functional regions in FTO based on published data and computer-based analysis.

  • 9. Johansson, K.
    et al.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research center.
    Neovius, K.
    Rössner, S.
    Neovius, M.
    Long-term changes in blood pressure following orlistat and sibutramine treatment: a meta-analysis2010In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 11, no 11, p. 777-791Article in journal (Refereed)
    Abstract [en]

    Previous meta-analyses investigating blood pressure effects of anti-obesity drugs have included studies using non-licensed doses, but not data from head-to-head studies. Furthermore, although diabetes is an important comorbidity in obesity, variation in blood pressure effects across diabetes status has not been investigated. The objective of this study was to estimate the effects on systolic (SBP) and diastolic blood pressure (DBP) of orlistat and sibutramine. Medline, EMBASE, the Cochrane controlled trials register and reference lists of identified articles from 1990 to February 2009 were searched. All placebo-controlled randomized controlled trials of 12-month duration or randomized head-to-head studies of any duration on adults using standard doses were included. Studies/study arms were excluded if they only evaluated weight maintenance after weight loss. Randomized controlled trials were identified, subjected to inclusion and exclusion criteria, and reviewed. Random effects models were used for assessment of weighted mean differences. Eighteen placebo-controlled (12 orlistat, 5540 patients; 6 sibutramine, 1495 patients) and four head-to-head trials (348 patients) met the inclusion criteria. Three orlistat and three sibutramine studies examined overweight subjects with type 2 diabetes (T2DM), as did two head-to-head trials. Mean baseline SBP ranged from 119 to 153 mmHg, and mean DBP from 69 to 98 mmHg. Overall, the placebo-controlled SBP change was -1.9 (95% CI; -2.7, -1.1) mmHg for orlistat, and 0.5 (-1.1, 2.1) mmHg for sibutramine. The corresponding values for DBP were -1.5 (-2.2, -0.8) and 1.7 (0.7, 2.6). Compared with patients without diabetes, diabetic patients treated with orlistat experienced smaller and non-significant reductions of SBP (-0.9; -2.6, 0.7 vs. -2.2; -3.0, -1.3) and DBP (-1.0; -2.4, 0.3 vs. -1.6; -2.4, -0.8). For sibutramine, higher on-treatment elevations in SBP (1.6; -1.3, 4.5 vs. 0.1; -1.8, 2.0) and DBP (2.4; 0.6, 4.1 vs. 1.4; 0.3, 2.5) were seen in patients with vs. without diabetes. In head-to-head trials, the overall differences between sibutramine and orlistat were small and non-significant for both SBP (1.0; -2.3, 4.3) and DBP (-0.2; -2.9, 2.5). In conclusion, in the studies using approved sibutramine doses, the drug caused significant elevations in DBP, while the overall SBP effect was near null. Moreover, absence of a blood pressure-lowering effect of orlistat ad a higher DBP elevation by sibutramine were observed for persons with diabetes. Head-to-head studies indicated that an indirect comparison of placebo-adjusted blood pressure effects may overestimate the adverse effects associated with sibutramine, but these studies were small, of shorter duration and of lower quality.

  • 10. Klingenberg, L
    et al.
    Sjödin, A
    Holmbäck, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Astrup, A
    Chaput, J-P
    Short sleep duration and its association with energy metabolism2012In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 13, no 7, p. 565-577Article in journal (Refereed)
    Abstract [en]

    A growing body of observational evidence suggests that short sleep duration is a risk factor for the development of obesity. Although increased energy intake is the most prevailing causal explanation for this association, we should also consider possible effects on energy metabolism to understand fully the potential impact of short sleep duration on the regulation of energy balance. We performed a search of the literature from 1970 to 2011, including original papers, investigating the relation between short sleep and energy metabolism in animals and humans. Although the limited number of experimental studies in humans precludes any definitive conclusions about causality, short sleep duration does not seem to substantially affect total daily energy expenditure, nor is there sufficient evidence in support of any meaningful effect of restricted sleep on the specific components of energy metabolism (i.e. resting metabolic rate, intentional as well as unintentional physical activity, diet-induced thermogenesis, and substrate utilization). As studies on rats suggest that other factors that can potentially influence energy metabolism could be affected (i.e. hormonal systems and thermoregulation), we included these factors in our literature search and found some indications in support of an up-regulation of thyroid hormones and glucocorticoids as well as increased heat dissipation following total or severe sleep deficit. Although we found some evidence also in humans that suggests a possible effect on energy metabolism, the limitations of the studies make it difficult to draw conclusions on the effect of short sleep on energy metabolism under relevant free living conditions. To explore this area further, more studies using suitable methodology under relevant conditions to mimic real-life situations are needed.

  • 11.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Methodological procedures followed in a kindergarten-based, family-involved intervention implemented in six European countries to prevent obesity in early childhood: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15 Suppl 3, p. 1-4Article in journal (Refereed)
  • 12.
    Manios, Y
    et al.
    Department of Nutrition and Dietetics , Harokopio University , Athens , Greece.
    Androutsos, O
    Department of Nutrition and Dietetics , Harokopio University , Athens , Greece.
    Katsarou, C
    Department of Nutrition and Dietetics , Harokopio University , Athens , Greece.
    Iotova, V
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    Socha, P
    The Children’s Memorial Health Institute, Warsaw, Poland.
    Geyer, C
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Moreno, L
    GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain.
    Koletzko, B
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    De Bourdeaudhuij, I
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Designing and implementing a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 5-13Article in journal (Refereed)
    Abstract [en]

    The development of the ToyBox-intervention was based on the outcomes of the preliminary phase of the ToyBox-study, aiming to identify young children's key behaviours and their determinants related to early childhood obesity. The ToyBox-intervention is a multi-component, kindergarten-based, family-involved intervention with a cluster-randomized design, focusing on the promotion of water consumption, healthy snacking, physical activity and the reduction/ breaking up of sedentary time in preschool children and their families. The intervention was implemented during the academic year 2012-2013 in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. Standardized protocols, methods, tools and material were used in all countries for the implementation of the intervention, as well as for the process, impact, outcome evaluation and the assessment of its cost-effectiveness. A total sample of 7,056 preschool children and their parents/caregivers, stratified by socioeconomic level, provided data during baseline measurements and participated in the intervention. The results of the ToyBox-study are expected to provide a better insight on behaviours associated with early childhood obesity and their determinants and identify effective strategies for its prevention. The aim of the current paper is to describe the design of the ToyBox-intervention and present the characteristics of the study sample as assessed at baseline, prior to the implementation of the intervention.

  • 13.
    Manios, Yannis
    et al.
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Grammatikaki, Eva
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Androutsos, O
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Chinapaw, MJ
    Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
    Gibson, EL
    Department of Psychology, Whitelands College, University of Roehampton, London, United Kingdom.
    Buijs, G
    Netherlands Institute for Health Promotion NIGZ, Woerden, Netherlands.
    Iotova, V
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    Socha, P
    The Children's Memorial Health Institute, Warsaw, Poland.
    Annemans, L
    Department of Public Health, Ghent University, Ghent, Belgium.
    Wildgruber, A
    State Institute for Early Childhood Research, Munich, Germany.
    Mouratidou, T
    GENUD (Growth Exercise NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.
    Yngve, Agneta
    Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Science, Lillestrøm, Norway.
    Duvinage, K
    Dr von Hauner Children's Hospital, University of Munich Medical Centre, München, Germany.
    de Bourdheaudhuij, Ilse
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    A systematic approach for the development of a kindergarten-based intervention for the prevention of obesity: the Toy Box-study2012In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 13, no suppl1, p. 3-12Article in journal (Refereed)
    Abstract [en]

    The increasing childhood obesity epidemic calls for appropriate measures and effective policies to be applied early in life. Large-scale socioecological frameworks providing a holistic multifactorial and cost-effective approach necessary to support obesity prevention initiatives in this age are however currently missing. To address this missing link, ToyBox-study aims to build and evaluate a cost-effective kindergarten-based, family-involved intervention scheme to prevent obesity in early childhood, which could potentially be expanded on a pan-European scale. A multidisciplinary team of researchers from 10 countries have joined forces and will work to realize this according to a systematic stepwise approach that combines the use of the PRECEDE-PROCEED model and intervention mapping protocol. ToyBox-study will conduct systematic and narrative reviews, secondary data analyses, focus group research and societal assessment to design, implement and evaluate outcome, impact, process and cost effectiveness of the intervention. This is the first time that such a holistic approach has been used on a pan-European scale to promote healthy weight and healthy energy balance-related behaviours for the prevention of early childhood obesity. The results of ToyBox-study will be disseminated among key stakeholders including researchers, policy makers, practitioners and the general population.

  • 14.
    Mouratidou, T
    et al.
    GENUD (Growth Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.
    Miguel, M L
    GENUD (Growth Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.
    Androutsos, O
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    De Bourdeaudhuij, I
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Cardon, G
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Kulaga, Z
    The Children’s Memorial Health Institute, Warszawa, Poland.
    Socha, P
    The Children’s Memorial Health Institute, Warszawa, Poland.
    Galcheva, S
    Medical University Varna, Varna, Bulgaria.
    Iotova, V
    Medical University Varna, Varna, Bulgaria.
    Payr, A
    Dr von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Koletzko, B
    Dr von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Moreno, L A
    GENUD (Growth Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; Faculty of Health Science, University of Zaragoza, Zaragoza, Spain.
    Tools, harmonization and standardization procedures of the impact and outcome evaluation indices obtained during a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 53-60Article in journal (Refereed)
    Abstract [en]

    The ToyBox-intervention is a kindergarten-based, family-involved intervention targeting multiple lifestyle behaviours in preschool children, their teachers and their families. This intervention was conducted in six European countries, namely Belgium, Bulgaria, Germany, Greece, Poland and Spain. The aim of this paper is to provide a descriptive overview of the harmonization and standardization procedures of the baseline and follow-up evaluation of the study (and substudies). Steps related to the study's operational, standardization and harmonization procedures as well as the impact and outcome evaluation assessment tools used are presented. Experiences from the project highlight the importance of safeguarding the measurement process to minimize data heterogeneity derived from potential measurement error and country-by-country differences. In addition, it was made clear that continuing quality control and support is an important component of such studies. For this reason, well-supported communication channels, such as regular email updates and teleconferences, and regular internal and external meetings to ensure smooth and accurate implementation were in place during the study. The ToyBox-intervention and its harmonized and standardized procedures can serve as a successful case study for future studies evaluating the efficacy of similar interventions.

  • 15.
    Nethe, A
    et al.
    Netherlands Institute for Health Promotion NIGZ, Woerden, Netherlands.
    Dorgelo, A
    Netherlands Institute for Health Promotion NIGZ, Woerden, Netherlands.
    Kugelberg, S
    Department for Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
    van Aasche, J
    Department of Political Science, Ghent University, Ghent, Belgium.
    Buijs, Goof
    Netherlands Institute for Health Promotion NIGZ, Woerden, Netherlands.
    Yngve, Agneta
    Department for Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
    de Henauw, Stefan
    Department for Public Health, Ghent University, Ghent, Belgium.
    Boskou, G
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Existing policies, regulation, legislation and ongoing health promotion activities related to physical activity and nutrition in pre-primary education settings: an overview2012In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 13, no suppl 1, p. 118-128Article in journal (Refereed)
    Abstract [en]

    Obesity prevention efforts for school-aged children and adolescents are increasing in number. However, little has been done to address the problem in the preschool age. To address this age group, an evidence-based preschool programme on physical activity (PA) and nutrition is developed within the ToyBox project. Environmental influencing factors such as policies and competitive health promotion activities could inhibit or induce a successful health promotion programme. This paper describes an overview of existing policies, legislation and/or regulations and health promotion activities in the preschool setting. Method: data were gathered on policies and activities aiming to improve healthy eating and PA of young children (age group 4-6 years) in Belgium-Flanders, Bulgaria, Germany, Greece, Poland and Spain. A limited number of influencing policies, regulations and/or legislation exists; agenda setting of health promotion and policy evaluations in all relevant policy areas was lacking. Also, health promotion activities in preschool the setting did not exist in all six European countries and high-quality preschool-based health interventions existed in three of the six ToyBox countries.

  • 16.
    Payr, A
    et al.
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Birnbaum, J
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Wildgruber, A
    State Institute of Early Childhood Research, Munich, Germany.
    Kreichauf, S
    State Institute of Early Childhood Research, Munich, Germany.
    Androutsos, O
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Lateva, M
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    De Decker, E
    Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
    De Craemer, M
    Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
    Iotova, V
    Department of Pediatrics, Medical University Varna, Varna, Bulgaria.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Koletzko, B
    Dr. von Hauner Children’s Hospital, University of Munich Medical Centre, Munich, Germany.
    Concepts and strategies on how to train and motivate teachers to implement a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 40-47Article in journal (Refereed)
    Abstract [en]

    The key person for the implementation of kindergarten-based behavioural interventions is the kindergarten teacher. When conducting intervention studies in kindergartens, training sessions are needed to train and motivate kindergarten teachers for programme implementation. This paper presents the systematic development of the teachers' trainings executed in the ToyBox-intervention - a kindergarten-based and family-involved obesity prevention programme for children aged 4-6. Based on concepts for the education of kindergarten teachers, on general strategies for successful programme implementation and on the ToyBox programme-specific requirements, the aims of the teachers' trainings were defined and an overall concept was deduced. Regarding the concept for the ToyBox teachers' training sessions, it is concluded that the training modules should focus on presenting information on the practical implementation of the intervention. Furthermore, these modules should also include self-efficacy enhancing components and should give kindergarten teachers opportunities to share experiences. Regarding the didactic methods applied in the ToyBox teachers' training sessions, constructivist learning approaches that facilitate active participation, reflective thinking and personal involvement were implemented. Emphasis was put not only on the content but especially on the didactic methods of teachers' trainings in order to enhance devotion to, and quality and sustainability of the ToyBox-intervention.

  • 17.
    Pil, L
    et al.
    Department of Public Health, Ghent University, Ghent, Belgium.
    Putman, K
    Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
    Cardon, G
    Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
    De Bourdeaudhuij, I
    Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
    Manios, Y
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Androutsos, O
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Lateva, M
    Clinic of Paediatric Endocrinology, Medical University of Varna, Varna, Bulgaria.
    Iotova, V
    Clinic of Paediatric Endocrinology, Medical University of Varna, Varna, Bulgaria.
    Zych, K
    Public Health Division, The Children’s Memorial Health Institute, Warsaw, Poland.
    Góźdź, M
    Public Health Division, The Children’s Memorial Health Institute, Warsaw, Poland.
    González-Gil, E M
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.
    De Miguel-Etayo, P
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.
    Geyer, C
    Division of Metabolic and Nutritional Medicine Dr. von Hauner Children’s Hospital Ludwig-Maximilians-University of Munich, München, Germany.
    Birnbaum, J
    Division of Metabolic and Nutritional Medicine Dr. von Hauner Children’s Hospital Ludwig-Maximilians-University of Munich, München, Germany.
    Annemans, L
    Department of Public Health, Ghent University, Ghent, Belgium; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
    Establishing a method to estimate the cost-effectiveness of a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no Suppl 3, p. 81-89Article in journal (Refereed)
    Abstract [en]

    Overweight and obesity in children are recognized as a major health problem. The ToyBox-intervention was developed with the aim of preventing obesity in pre-schoolers. Because it is increasingly important to inform policy makers not only on the effects of prevention interventions, but also on their costs and cost-effectiveness, our purpose was to establish a method to estimate the cost-effectiveness of the ToyBox-intervention. In order to estimate the long-term impact of the ToyBox-intervention on health and societal costs, extrapolations of the intervention effect will be conducted to predict children's weight status (based on the body mass index) at adult age. Effects of the adult weight status on the prevalence of obesity-related complications will be modelled through a Markov model, with a total time horizon of 70 years and a cycle length of 1 year. The model will be conducted in six European countries participating in the ToyBox-intervention, based on country-specific economic and epidemiological data. This study describes the methodological rationale and implementation of an analytic model to examine the cost-effectiveness of the ToyBox-intervention for six European countries, in order to inform decision-makers on the value for money of this intervention in the prevention of obesity in pre-schoolers.

  • 18.
    Veronese, N.
    et al.
    Univ Padua, Geriatr Sect, Dept Med DIMED, Padua, Italy..
    Cereda, E.
    Fdn IRCCS Policlin San Matteo, Nutr & Dietet Serv, Pavia, Italy..
    Solmi, M.
    Univ Padua, Dept Neurosci, Padua, Italy..
    Fowler, S. A.
    Washington Univ, Becker Med Lib, St Louis, MO USA..
    Manzato, E.
    Univ Padua, Geriatr Sect, Dept Med DIMED, Padua, Italy.;Inst Neurosci, Natl Res Council, Padua, Italy..
    Maggi, S.
    Inst Neurosci, Natl Res Council, Padua, Italy..
    Manu, P.
    Zucker Hillside Hosp, North Shore Long Island Jewish Hlth Syst, Psychiat Res, Glen Oaks, NY USA.;Hofstra North Shore LIJ Sch Med, Hempstead, NY USA.;Feinstein Inst Med Res, Manhasset, NY USA.;Albert Einstein Coll Med, Bronx, NY 10467 USA..
    Abe, E.
    Gunma Univ, Grad Sch Hlth Sci, Maebashi, Gumma 371, Japan..
    Hayashi, K.
    Gunma Univ, Grad Sch Hlth Sci, Maebashi, Gumma 371, Japan..
    Allard, J. P.
    Univ Hlth Network, Toronto Gen Hosp, Toronto, ON, Canada.;Univ Toronto, Dept Med, Toronto, ON, Canada..
    Arendt, B. M.
    Univ Hlth Network, Toronto Gen Hosp, Toronto, ON, Canada..
    Beck, A.
    Herlev Univ Hosp, Res Unit Nutr EFFECT, DK-2730 Herlev, Denmark..
    Chan, M.
    Tan Tock Seng Hosp, Dept Geriatr Med, Singapore, Singapore..
    Audrey, Y. J. P.
    Tan Tock Seng Hosp, Dept Geriatr Med, Singapore, Singapore..
    Lin, W. -Y
    Hsu, H. -S
    Lin, C. -C
    Diekmann, R.
    Univ Erlangen Nurnberg, Inst Biomed Aging, Nurnberg, Germany..
    Kimyagarov, S.
    Gilad Geriatr Ctr, Ramat Gan, Israel..
    Miller, M.
    Flinders Univ S Australia, Nutr & Dietet, Adelaide, SA 5001, Australia..
    Cameron, I. D.
    Univ Sydney, Walsh Ctr Rehabil Res, Sydney, NSW 2006, Australia..
    Pitkala, K. H.
    Univ Helsinki, Cent Hosp, Dept Gen Practice, Unit Primary Hlth Care, Helsinki, Finland..
    Lee, J.
    Chinese Univ Hong Kong, SH Ho Ctr Gerontol & Geriatr, Hong Kong, Hong Kong, Peoples R China.;Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China..
    Woo, J.
    Chinese Univ Hong Kong, SH Ho Ctr Gerontol & Geriatr, Hong Kong, Hong Kong, Peoples R China.;Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China..
    Nakamura, K.
    Niigata Univ, Grad Sch Med & Dent Sci, Div Prevent Med, Niigata, Niigata, Japan..
    Smiley, D.
    Emory Univ, Sch Med, Dept Med, Div Endocrinol & Metab, Atlanta, GA 30322 USA..
    Umpierrez, G.
    Emory Univ, Sch Med, Dept Med, Div Endocrinol & Metab, Atlanta, GA 30322 USA..
    Rondanelli, M.
    Univ Pavia, Dept Publ Hlth Expt & Forens Med, Sect Human Nutr, Endocrinol & Nutr Unit, Pavia, Italy..
    Sund-Levander, M.
    Linkoping Univ, Fac Hlth Sci, Linkoping, Sweden..
    Valentini, L.
    Univ Appl Sci, Sect Dietet, Dept Agr & Food Sci, Neubrandenburg, Germany..
    Schindler, K.
    Med Univ Vienna, Div Endocrinol & Metab, Dept Internal Med 3, Vienna, Austria..
    Törmä, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Volpato, S.
    Univ Ferrara, Dept Med Sci, I-44100 Ferrara, Italy..
    Zuliani, G.
    Univ Ferrara, Dept Med Sci, I-44100 Ferrara, Italy..
    Wong, M.
    Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China..
    Lok, K.
    Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China..
    Kane, J. M.
    Zucker Hillside Hosp, North Shore Long Island Jewish Hlth Syst, Psychiat Res, Glen Oaks, NY USA.;Hofstra North Shore LIJ Sch Med, Hempstead, NY USA.;Feinstein Inst Med Res, Manhasset, NY USA.;Albert Einstein Coll Med, Bronx, NY 10467 USA..
    Sergi, G.
    Univ Padua, Geriatr Sect, Dept Med DIMED, Padua, Italy..
    Correll, C. U.
    Zucker Hillside Hosp, North Shore Long Island Jewish Hlth Syst, Psychiat Res, Glen Oaks, NY USA.;Hofstra North Shore LIJ Sch Med, Hempstead, NY USA.;Feinstein Inst Med Res, Manhasset, NY USA.;Albert Einstein Coll Med, Bronx, NY 10467 USA..
    Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects2015In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 16, no 11, p. 1001-1015Article, review/survey (Refereed)
    Abstract [en]

    Body mass index (BMI) and mortality in old adults from the general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5-24.9, 25-29.9, 30kg/m(2)), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow-up were meta-analysed. Compared with normal weight, all-cause mortality HRs were 1.41 (95% CI=1.26-1.58) for underweight, 0.85 (95% CI=0.73-0.99) for overweight and 0.74 (95% CI=0.57-0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR=1.65 [95% CI=1.13-2.40]). RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than in normal-weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting.

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