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  • 1. Abarca-Gómez, L.
    et al.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Ezzati, M
    Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults.2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 390, no 10113, p. 2627-2642Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults.

    METHODS: We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity).

    FINDINGS: Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m(2) per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m(2) per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m(2) per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m(2) per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m(2) per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4-1·2) in 1975 to 5·6% (4·8-6·5) in 2016 in girls, and from 0·9% (0·5-1·3) in 1975 to 7·8% (6·7-9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0-12·9) in 1975 to 8·4% (6·8-10·1) in 2016 in girls and from 14·8% (10·4-19·5) in 1975 to 12·4% (10·3-14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7-29·6) among girls and 30·7% (23·5-38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44-117) million girls and 117 (70-178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24-89) million girls and 74 (39-125) million boys worldwide were obese.

    INTERPRETATION: The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults.

  • 2. Ali, MA
    et al.
    Strandvik, B
    Palme-Kilander, C
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Lower polyamine levels in breast milk of obese mothers compared to mothers with normal body weight2013In: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 26 Suppl 1, p. 164-170Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:Obesity is associated with risks for mother and infant, and the mothers' dietary habits influence breast milk composition. Polyamines are secreted in breast milk and are essential for the regulation of intestinal and immune function in newborns and infants. The present study aimed to investigate the level of polyamines in human milk obtained from obese and normal weight mothers at different times of lactation.METHODS:Breast milk from 50 mothers was obtained at day 3, and at 1 and 2 months after delivery. The mothers had normal body weight [body mass index (BMI) < 25 kg m(-2) ] or were obese (BMI > 30 kg/m(2) ). A subgroup of obese mothers participated in a weight reduction programme during pregnancy. Polyamines were analysed using high-performance liquid chromatography.RESULTS:The total polyamine content was significantly lower at all times in breast milk from obese mothers compared to milk from controls. Spermine levels did not differ between groups at any time in contrast to the levels of putrescine and spermidine. Putrescine concentrations were highest on day 3 and spermidine and spermine were highest at 1 month of lactation. The obese mothers, who received dietary advice during pregnancy based on the Nordic Nutrition Recommendations, had higher concentrations of putrescine and spermidine in their milk than the obese mothers without any intervention.CONCLUSIONS:Polyamine concentrations were lower in breast milk from obese mothers compared to mothers with a normal weight. General dietary intervention in obese mothers increased the polyamine levels, suggesting that the low levels in obesity were at least partly associated with food habits. However, the consistency of spermine suggests a special metabolic function of this polyamine.

  • 3.
    Ali, Mohamed A.
    et al.
    Karolinska Inst, Novum, Dept Biosci & Nutr, Unit Publ Hlth Nutr, SE-14183 Huddinge, Sweden; Akershus Univ Coll, Fac Hlth Nutr & Management, Lillestrom, Norway.
    Yngve, Agneta
    Karolinska Inst, Dept Biosci & Nutr, S-10401 Stockholm, Sweden.
    Polyamines: dietary intake, database progress and food contribution to the total daily intake2009In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 55, p. 203-204Article in journal (Other academic)
  • 4.
    Ali, Mohamed Atiya
    et al.
    Karolinska Inst, Novum, Dept Biosci & Nutr, Unit Publ Hlth Nutr, SE-14183 Huddinge, Sweden; Akershus Univ Coll, Fac Hlth Nutr & Management, Lillestrom, Norway.
    Poortvliet, Eric
    Show the Organization-Enhanced name(s).
    Stromberg, Roger
    Karolinska Inst, Novum, Dept Biosci & Nutr, SE-14183 Huddinge, Sweden.
    Yngve, Agneta
    Karolinska Inst, Dept Biosci & Nutr, S-10401 Stockholm, Sweden.
    Polyamines: total daily intake in adolescents compared to the intake estimated from the Swedish Nutrition Recommendations Objectified (SNO)2011In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 55, p. 5455-Article in journal (Refereed)
    Abstract [en]

    Background: Dietary polyamines have been shown to give a significant contribution to the body pool of polyamines. Knowing the levels of polyamines (putrescine, spermidine, and spermine) in different foods and the contribution of daily food choice to polyamine intake is of interest, due to the association of these bioactive amines to health and disease. Objective: To estimate polyamine intake and food contribution to this intake in adolescents compared to a diet fulfilling the Swedish Nutrition Recommendations. Design: A cross-sectional study of dietary intake in adolescents and an 'ideal diet' (Swedish nutrition recommendations objectified [SNO]) list of foods was used to compute polyamine intake using a database of polyamine contents of foods. For polyamine intake estimation, 7-day weighed food records collected from 93 adolescents were entered into dietetic software (Dietist XP) including data on polyamine contents of foods. The content of polyamines in foods recommended according to SNO was entered in the same way. Results: The adolescents' mean daily polyamine intake was 316 +/- 170 mu mol/day, while the calculated contribution according to SNO was considerably higher with an average polyamine intake of 541 mu mol/day. In both adolescent's intake and SNO, fruits contributed to almost half of the total polyamine intake. The reason why the intake among the adolescents was lower than the one calculated from SNO was mainly due to the low vegetable consumption in the adolescents group. Conclusions: The average daily total polyamine intake was similar to that previously reported in Europe. With an 'ideal' diet according to Swedish nutrition recommendations, the intake of this bioactive non-nutrient would be higher than that reported by our adolescents and also higher than that previously reported from Europe.

  • 5.
    Ali, Mohamed Atiya
    et al.
    Karolinska Inst, Novum, Dept Biosci & Nutr, Unit Publ Hlth Nutr, SE-14183 Huddinge, Sweden; Akershus Univ Coll, Fac Hlth Nutr & Management, Lillestrom, Norway.
    Poortvliet, Eric
    Karolinska Inst, Novum, Dept Biosci & Nutr, Unit Publ Hlth Nutr, SE-14183 Huddinge, Sweden.
    Strömberg, Roger
    Karolinska Inst, Novum, Dept Biosci & Nutr, SE-14183 Huddinge, Sweden.
    Yngve, Agneta
    Karolinska Inst, Dept Biosci & Nutr, S-10401 Stockholm, Sweden.
    Polyamines in foods: development of a food database2011In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 55, p. 5572-Article in journal (Refereed)
    Abstract [en]

    Background: Knowing the levels of polyamines (putrescine, spermidine, and spermine) in different foods is of interest due to the association of these bioactive nutrients to health and diseases. There is a lack of relevant information on their contents in foods. Objective: To develop a food polyamine database from published data by which polyamine intake and food contribution to this intake can be estimated, and to determine the levels of polyamines in Swedish dairy products. Design: Extensive literature search and laboratory analysis of selected Swedish dairy products. Polyamine contents in foods were collected using an extensive literature search of databases. Polyamines in different types of Swedish dairy products (milk with different fat percentages, yogurt, cheeses, and sour milk) were determined using high performance liquid chromatography (HPLC) equipped with a UV detector. Results: Fruits and cheese were the highest sources of putrescine, while vegetables and meat products were found to be rich in spermidine and spermine, respectively. The content of polyamines in cheese varied considerably between studies. In analyzed Swedish dairy products, matured cheese had the highest total polyamine contents with values of 52.3, 1.2, and 2.6 mg/kg for putrescine, spermidine, and spermine, respectively. Low fat milk had higher putrescine and spermidine, 1.2 and 1.0 mg/kg, respectively, than the other types of milk. Conclusions: The database aids other researchers in their quest for information regarding polyamine intake from foods. Connecting the polyamine contents in food with the Swedish Food Database allows for estimation of polyamine contents per portion.

  • 6.
    Anderson, Cheryl B
    et al.
    epartment of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
    Hagströmer, Maria
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden.
    Validation of the PDPAR as an adolescent diary: effect of accelerometer cut points2005In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 37, no 7, p. 1224-1230Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate the validity of the Previous Day Physical Activity Recall (PDPAR) as a physical activity diary in adolescents using two accelerometer intensity classifications.

    METHODS: One hundred eighth graders (47 boys, 53 girls) used the PDPAR as a daily diary and wore MTI accelerometers for four consecutive days. Measured time spent in moderate (> or = 3 METs) and vigorous (> or = 6 METs) activity was based on two published MTI cut-point limits (that of Freedson et al./Trost et al. and that of Puyau et al.). Spearman rank order correlations and Bland-Altman plots were used to examine agreement between MTI and PDPAR diary estimates of activity.

    RESULTS: MTI estimates of mean minutes per day of total moderate to vigorous physical activity (MVPA) were 65.2 (+/-43.2) using the Freedson et al./Trost et al. cutoffs and 17.5 (+/-18.5) using those of Puyau et al., while students self-reported 105.1 (+/-80.1) min.d(-1). Significant relationships were observed between the diary and MTI for total MVPA using either the Freedson et al./Trost et al. (r = 0.42) or Puyau et al. (r = 0.41) cutoff as well as raw counts (r = 0.44). Plots showed reasonable agreement between the diary and Freedson et al./Trost et al. MTI estimates of MVPA for daily totals of < or = 60 min, but the Puyau et al. estimates were consistently lower. Diaries overestimated activity as time increased when compared to either MTI cut point, especially on vigorous activity.

    CONCLUSIONS: Time estimates of MVPA differed by assessment tool, but diary estimates showed adequate association with the MTI. Diaries reflected intensity-specific activity, corresponding most closely with the Freedson et al./Trost et al. classification of moderate, but substantially overestimated vigorous activity regardless of cut-point method. This is likely due to the measurement characteristics of the PDPAR, which classifies activities in 30-min blocks, as well as the nature of common activities in which high levels of intensity are not sustained.

  • 7.
    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.

  • 8.
    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.

  • 9.
    Atiya Ali, M.
    et al.
    Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden.
    Strandvik, B.
    Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden.
    Sabel, K-G.
    Borås Children Hospital, SÄS, Borås, Sweden.
    Palme Kilander, C.
    Division of Neonatology, Department of Paediatrics, Karolinska Institutet at Danderyd, Danderyd, Stockholm, Sweden.
    Strömberg, R.
    Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Polyamine levels in breast milk are associated with mothers' dietary intake and are higher in preterm than full-term human milk and formulas2014In: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 27, no 5, p. 459-467Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Polyamine intake from milk is considered essential for post-natal maturation of the immune system and small intestine. The present study aimed to determine polyamine content in human milk after preterm delivery and the association with mothers' dietary intake. In comparison, the polyamine levels were compared with those in term breast milk and some corresponding formulas.

    METHODS: Transitional breast milk was collected from 40 mothers delivering after 24-36 weeks of gestation, and from 12 mothers delivering after full term. Food intake was assessed in mothers delivering preterm babies using a 3-day diary. Polyamines were analysed by high-performance liquid chromatography.

    RESULTS: The dietary intake of polyamines was significantly associated with breast milk content but weaker for spermine than for spermidine and putrescine. Total polyamine level was higher in preterm than term milk and lower in the corresponding formulas. Putrescine, spermidine and spermine contents [mean (SEM)] in preterm milk were 165.6 (25), 615.5 (80) and 167.7 (16) nmol dL(-1) , respectively, with the levels of putrescine and spermidine being 50% and 25% higher than in term milk. The content of spermine did not differ.

    CONCLUSIONS: Dietary intake of polyamines has an impact on the content in breast milk. The difference between human milk after preterm and term delivery might be considered when using donor human milk for preterm infants. The corresponding formulas had lower contents. Further studies are important for determining the relationship between tissue growth and maturation and optimal intake.

  • 10.
    Blaznik, Urška
    et al.
    National Institute of Public Health, Ljubljana, Slovenija.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Eržen, Ivan
    National Institute of Public Health, Ljubljana, Slovenija; Department of the Public Health, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
    Hlastan Ribič, Cirila
    National Institute of Public Health, Ljubljana, Slovenija; Department of the Public Health, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
    Consumption of fruits and vegetables and probabilistic assessment of the cumulative acute exposure to organophosphorus and carbamate pesticides of schoolchildren in Slovenia2016In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 19, no 4, p. 557-563Article in journal (Refereed)
    Abstract [en]

    Objective: Adequate consumption of fruits and vegetables is a part of recommendations for a healthy diet. The aim of the present study was to assess acute cumulative dietary exposure to organophosphorus and carbamate pesticides via fruit and vegetable consumption by the population of schoolchildren aged 11-12 years and the level of risk for their health.

    Design: Cumulative probabilistic risk assessment methodology with the index compound approach was applied.

    Setting: Slovenia, primary schools.

    Subjects: Schoolchildren (n 1145) from thirty-one primary schools in Slovenia. Children were part of the PRO GREENS study 2009/10 which assessed 11-year-olds' consumption of fruit and vegetables in ten European countries.

    Results: The cumulative acute exposure amounted to 8·3 (95 % CI 7·7, 10·6) % of the acute reference dose (ARfD) for acephate as index compound (100 µg/kg body weight per d) at the 99·9th percentile for daily intake and to 4·5 (95 % CI 3·5, 4·7) % of the ARfD at the 99·9th percentile for intakes during school time and at lunch. Apples, bananas, oranges and lettuce contributed most to the total acute pesticides intake.

    Conclusions: The estimations showed that acute dietary exposure to organophosphorus and carbamate pesticides is not a health concern for schoolchildren with the assessed dietary patterns of fruit and vegetable consumption.

  • 11.
    Brug, Johannes
    et al.
    Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
    Yngve, Agneta
    Unit for Preventive Nutrition, Karolinska Institutet, Stockholm , Sweden.
    Klepp, Knut-Inge
    Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway .
    The pro children study: conceptualization, baseline results and intervention development of a European effort to promote fruit and vegetable consumption in schoolchildren2005In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 49, no 4, p. 209-211Article in journal (Refereed)
  • 12. Börjel, Anna K.
    et al.
    Yngve, Agneta
    Karolinska Inst, Huddinge, Sweden.
    Sjöström, Michael
    Nilsson, Torbjörn K.
    Novel mutations in the 5'-UTR of the FOLR1 gene2006In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 44, no 2, p. 161-167Article in journal (Refereed)
    Abstract [en]

    We have previously reported two novel mutations in the 5'-untranslated region (UTR) of the gene for folate receptor-alpha (FOLR1). In our search for additional mutations, 92 patient samples with elevated levels of homocysteine were screened by single-strand conformation polymorphism (SSCP) between nt -425 and -782, and -712 and -1110. Between nt -425 and -782 we did not find any mutations. Between nt -712 and -1110 there were three novel mutations. One subject had two mutations very close to each other, c.-856C>T and c.-921T>C. Two subjects had a c.-1043G>A mutation. To get an idea of the prevalence of FOLR1 mutations in an unselected population, we also screened 692 healthy school children for mutations. In this cohort, between nt -188 and +272 we discovered one novel mutation, a single nucleotide substitution, c.-18C>T, in addition to five children with the 25-bp deletion mutation previously described by us. Thus, so far we have discovered six novel mutations in the 5'-UTR region of the gene for folate receptor-alpha. We genotyped all 17 subjects with a FOLR1 mutation for the methylenetetrahydrofolate reductase (MTHFR) 677C>T polymorphism, and developed new single-nucleotide polymorphism (SNP) genotyping protocols for MTHFR 1298A>C and 1793G>A utilising Pyrosequencing technology. None of the 17 subjects had the 677TT genotype, which ruled out this as a cause of elevated homocysteine levels, which was observed in some of the subjects. Further studies of mutations in the 5'-UTR of FOLR1, and in particular of their interplay with folate intake status, are warranted.

  • 13.
    Börnhorst, Claudia
    et al.
    Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology, BIPS GmbH, Bremen, Germany .
    Wijnhoven, Trudy M. A.
    Division of Noncommunicable Diseases and Promoting Health Through the Life-Course, WHO Regional Office for Europe, UN City, Copenhagen, Denmark .
    Kunesova, Marie
    Obesity Management Centre, Institute of Endocrinology, Prague 1, Czech Republic .
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Rito, Ana I.
    National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal .
    Lissner, Lauren
    Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden .
    Duleva, Vesselka
    Department of Food and Nutrition, National Center of Public Health and Analyses, Sofia, Bulgar.
    Petrauskiene, Ausra
    Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania .
    Breda, Joao
    Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology, BIPS GmbH, Bremen, Germany .
    WHO European Childhood Obesity Surveillance Initiative: associations between sleep duration, screen time and food consumption frequencies2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 1, article id 442Article in journal (Refereed)
    Abstract [en]

    Background: Both sleep duration and screen time have been suggested to affect children's diet, although in different directions and presumably through different pathways. The present cross-sectional study aimed to simultaneously investigate the associations between sleep duration, screen time and food consumption frequencies in children.

    Methods: The analysis was based on 10 453 children aged 6-9 years from five European countries that participated in the World Health Organization European Childhood Obesity Surveillance Initiative. Logistic multilevel models were used to assess associations of parent-reported screen time as well as sleep duration (exposure variables) with consumption frequencies of 16 food items (outcome variables). All models were adjusted for age, sex, outdoor play time, maximum educational level of parents and sleep duration or screen time, depending on the exposure under investigation.

    Results: One additional hour of screen time was associated with increased consumption frequencies of 'soft drinks containing sugar' (1.28 [1.19; 1.39]; odds ratio and 99% confidence interval), 'diet/light soft drinks' (1.21 [1.14; 1.29]), 'flavoured milk' (1.18 [1.08; 1.28]), 'candy bars or chocolate' (1.31 [1.22; 1.40]), 'biscuits, cakes, doughnuts or pies' (1.22 [1.14; 1.30]), 'potato chips (crisps), corn chips, popcorn or peanuts' (1.32 [1.20; 1.45]), 'pizza, French fries (chips), hamburgers' (1.30 [1.18; 1.43]) and with a reduced consumption frequency of 'vegetables (excluding potatoes)' (0.89 [0.83; 0.95]) and 'fresh fruits' (0.91 [0.86; 0.97]). Conversely, one additional hour of sleep duration was found to be associated with increased consumption frequencies of 'fresh fruits' (1.11 [1.04; 1.18]) and 'vegetables (excluding potatoes)' (1.14 [1.07; 1.23]).

    Conclusion: The results suggest a potential relation between high screen time exposure and increased consumption frequencies of foods high in fat, free sugar or salt whereas long sleep duration may favourably be related to children's food choices. Both screen time and sleep duration are modifiable behaviours that may be tackled in childhood obesity prevention efforts.

  • 14.
    Böttiger, Anna K.
    et al.
    Orebro Univ Hosp, Dept Clin Chem, SE-70185 Orebro, Sweden.
    Hurtig-Wennlof, Anita
    Sjöström, Michael
    Yngve, Agneta
    Karolinska Inst, Dept Biosci & Nutr, SE-14157 Huddinge, Sweden.
    Nilsson, Torbjorn K.
    Association of total plasma homocysteine with methylenetetrahydrofolate reductase genotypes 677C > T, 1298A > C, and 1793G > A and the corresponding haplotypes in Swedish children and adolescents2007In: International Journal of Molecular Medicine, ISSN 1107-3756, E-ISSN 1791-244X, Vol. 19, no 4, p. 659-665Article in journal (Refereed)
    Abstract [en]

    We studied 692 Swedish children and adolescents (aged 9-10 or 15-16 years, respectively), in order to evaluate the effect of the methylenetetrahydrofolate reductase (MTHFR) 677C > T, 1298A > C, and 1793G > A polymorphisms on total plasma homocysteine concentrations (tHcy). Genotyping was performed with Pyrosequencing (TM) technology. The MTHFR 677C > T polymorphism was associated with increased tHcy concentrations in both the children and the adolescents (P < 0.001 for both age groups) in both genders. The effect of MTHFR 1298A > C was studied separately in subjects with the 677CC and 677CT genotypes, and the 1298C allele was found to be associated with higher tHcy levels both when children were stratified according to 677C > T genotypes, and when using haplotype analyses and diplotype reconstructions. The 1793A allele was in complete linkage disequilibrium with the 1298C allele. It was still possible to show that the 1793A allele was associated with lower tHcy levels, statistically significant in the adolescents. In conclusion, a haplotype-based approach was slightly superior in explaining the genetic interaction on tHcy plasma levels in children and adolescents than a simple genotype based approach (R-2 adj 0.44 vs. 0.40). The major genetic impact on tHcy concentrations is attributable to the MTHFR 677C > T polymorphism. The common 1298A > C polymorphism had a minor elevating effect on tHcy, whereas the 1793G > A polymorphism had a lowering effect on tHcy.

  • 15.
    Böttiger, Anna K.
    et al.
    Örebro universitet, Hälsoakademin.
    Hurtig-Wennlöf, Anita
    Örebro universitet, Hälsoakademin.
    Sjöström, Michael
    Yngve, Agneta
    Nilsson, Torbjörn K.
    Örebro universitet, Hälsoakademin.
    Association of total plasma homocysteine with methylenetetrahydrofolate reductase genotypes 677C>T, 1298A>C, and 1793G>A and the corresponding haplotypes in Swedish children and adolescents2007In: International Journal of Molecular Medicine, ISSN 1107-3756, E-ISSN 1791-244X, Vol. 19, no 4, p. 659-665Article in journal (Refereed)
    Abstract [en]

    We studied 692 Swedish children and adolescents (aged 9-10 or 15-16 years, respectively), in order to evaluate the effect of the methylenetetrahydrofolate reductase (MTHFR) 677C>T, 1298A>C, and 1793G>A polymorphisms on total plasma homocysteine concentrations (tHcy). Genotyping was performed with Pyrosequencing technology. The MTHFR 677C>T polymorphism was associated with increased tHcy concentrations in both the children and the adolescents (P<0.001 for both age groups) in both genders. The effect of MTHFR 1298A>C was studied separately in subjects with the 677CC and 677CT genotypes, and the 1298C allele was found to be associated with higher tHcy levels both when children were stratified according to 677C>T genotypes, and when using haplotype analyses and diplotype reconstructions. The 1793A allele was in complete linkage disequilibrium with the 1298C allele. It was still possible to show that the 1793A allele was associated with lower tHcy levels, statistically significant in the adolescents. In conclusion, a haplotype-based approach was slightly superior in explaining the genetic interaction on tHcy plasma levels in children and adolescents than a simple genotype based approach (R2 adj 0.44 vs. 0.40). The major genetic impact on tHcy concentrations is attributable to the MTHFR 677C>T polymorphism. The common 1298A>C polymorphism had a minor elevating effect on tHcy, whereas the 1793G>A polymorphism had a lowering effect on tHcy.

  • 16.
    Cattaneo, Adriano
    et al.
    U. for Hlth. Serv. Res./Intl. Coop., Istituto per l'Infanzia, Trieste, Italy .
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden .
    Koletzko, Berthold
    Metabolic Diseases and Nutrition, Dr. von Hauner Children's Hospital, University of Munich, Germany .
    Guzman, Luis Ruiz
    Baby Friendly Hospital Initiative, Barcelona, Spain .
    Protection, promotion and support of breast-feeding in Europe: current situation2005In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 8, no 1, p. 39-46Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the current situation regarding protection, promotion and support of breast-feeding in Europe, as a first step towards the development of a blueprint for action.

    DESIGN AND SETTING: A questionnaire was completed by 29 key informants and 128 other informants in the EU, including member states, accession and candidate countries.

    RESULTS: EU countries do not fully comply with the policies and recommendations of the Global Strategy on Infant and Young Child Feeding that they endorsed during the 55th World Health Assembly in 2002. Some countries do not even comply with the targets of the Innocenti Declaration (1990). Pre-service training on breast-feeding practice is inadequate and in-service training achieves only low to medium coverage. The Baby Friendly Hospital Initiative is well developed only in three countries; in 19 countries, less than 15% of births occur in baby-friendly hospitals. The International Code of Marketing of Breastmilk Substitutes, endorsed in 1981 by all countries, is not fully applied and submitted to independent monitoring. The legislation for working mothers meets on average the International Labour Organization standards, but covers only women with full formal employment. Voluntary mother-to-mother support groups and trained peer counsellors are present in 27 and 13 countries, respectively. Breast-feeding rates span over a wide range; comparisons are difficult due to use of non-standard methods. The rate of exclusive breast-feeding at 6 months is low everywhere, even in countries with high initiation rates.

    CONCLUSIONS: EU countries need to revise their policies and practices to meet the principles inscribed in the Global Strategy on Infant and Young Child Feeding in order to better protect, promote and support breast-feeding.

  • 17.
    Craig, Cora L
    et al.
    Canadian Fitness and Lifestyle Research Institute, Ottawa, Canada.
    Marshall, Alison L
    chool of Human Movement Studies, University of Queensland, Brisbane, Australia.
    Sjöström, Michael
    PrevNut at Novum, Karolinska Institutet, Stockholm, Sweden.
    Bauman, Adrian E
    Centre for Physical Activity and Health, School of Public Health and Community Medicine, University of NSW, Sydney, Australia.
    Booth, Michael L
    Centre for Advancement of Adolescent Health, New Childrens Hospital, Westmead, Sydney, Australia.
    Ainsworth, Barbara E
    Department of Epidemiology and Biostatistics, Department of Exercise Science, Norman J. Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
    Pratt, Michael
    Division of Physical Activity and Nutrition, Centers for Disease Control, Atlanta, GA; 8 Department of Psychology, San Diego State University, San Diego, CA, USA.
    Ekelund, Ulf
    PrevNut at Novum, Karolinska Institutet, Stockholm, Sweden.
    Yngve, Agneta
    PrevNut at Novum, Karolinska Institutet, Stockholm, Sweden.
    Sallis, James F
    Department of Psychology, San Diego State University, San Diego, CA, USA.
    Oja, Pekka
    UKK Institute, Tampere, Finland.
    International physical activity questionnaire: 12-country reliability and validity2003In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 35, no 8, p. 1381-1395Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity.

    METHODS: Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity.

    RESULTS: Overall, the IPAQ questionnaires produced repeatable data (Spearman's rho clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median rho of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode.

    CONCLUSIONS: The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment.

  • 18.
    De Bourdeaudhuij, I
    et al.
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    te Velde, S
    EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands.
    Brug, J
    EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands.
    Due, P
    Department of Social Medicine, University of Copenhagen, Copenhagen, Denmark.
    Wind, M
    Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
    Sandvik, C
    Faculty of Psychology, Department of Education and Health Promotion, Research Centre for Health Promotion, University of Bergen, Bergen, Norway.
    Maes, L
    Department of Public Health, Ghent University, Ghent, Belgium.
    Wolf, A
    Institute for Nutritional Sciences, University of Vienna, Vienna, Austria.
    Perez Rodrigo, C
    Community Nutrition Unit of Bilbao, Bilbao, Spain.
    Yngve, Agneta
    Unit for Preventive Nutrition, Karolinska Institute, Stockholm, Sweden.
    Thorsdottir, I
    Unit for Nutrition Research, Landspitali University Hospital, Reykjavik, Iceland.
    Rasmussen, M
    Department of Social Medicine, University of Copenhagen, Copenhagen, Denmark.
    Elmadfa, I
    Institute for Nutritional Sciences, University of Vienna, Vienna, Austria.
    Franchini, B
    Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.
    Klepp, K-I
    Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway.
    Personal, social and environmental predictors of daily fruit and vegetable intake in 11-year-old children in nine European countries2008In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 62, no 7, p. 834-841Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate potential personal, social and physical environmental predictors of daily fruit intake and daily vegetable intake in 11-year-old boys and girls in nine European countries.

    SUBJECTS: The total sample size was 13 305 (90.4% participation rate).

    RESULTS: Overall, 43.2% of the children reported to eat fruit every day, 46.1% reported to eat vegetables every day. Daily fruit intake and daily vegetable intake was mainly associated with knowledge of the national recommendations, positive self-efficacy, positive liking and preference, parental modeling and demand and bringing fruit to school (odds ratio between 1.40 and 2.42, P<0.02). These factors were associated fairly consistently with daily fruit intake across all nine European countries, implying that a rather uniform intervention strategy to promote fruit can be used across Europe. For vegetables, the pattern was, however, less consistent. Differences between countries in cooking and preparing vegetables might be responsible for this larger diversity.

    CONCLUSIONS: This study showed that especially a combination of personal and social factors is related to daily fruit and vegetable intake in schoolchildren. This shows that a comprehensive multilevel intervention strategy based upon a series of individual and social correlates will be most promising in the promotion of daily fruit and vegetable intake in children.

  • 19.
    De Bourdeaudhuij, Ilse
    et al.
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Yngve, Agneta
    Unit for Preventive Nutrition, Karolinska Institutet, Stockholm, Sweden.
    te Velde, Saskia J
    Erasmus University Medical Center Rotterdam, Departme nt of Public Health, Rotterdam, The Netherlands.
    Klepp, Knut-Inge
    Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway.
    Rasmussen, Mette
    Department of Social Medicine, Univ ersity of Copenhagen, Copenhagen, Denmark.
    Thorsdottir, Inga
    Unit for Nutrition Research, Landspitali Un iversity Hospital, Reykjavik, Iceland.
    Wolf, Alexandra
    Institute of Nutrition, University of Vienna, Austria.
    Brug, Johannes
    Erasmus University Medical Center Rotterdam, Departme nt of Public Health, Rotterdam, The Netherlands.
    Personal, social and environmental correlates of vegetable intake in normal weight and overweight 9 to 13-year old boys2006In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 3, p. 37-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The first aim of the present study was to investigate differences in correlates of vegetable intake between the normal weight and the overweight boys in the Pro Children Cross Sectional Study. The second aim was to explore whether the association between vegetable intake and potential correlates is different in overweight boys compared with normal weight boys.

    METHODS: Random samples of mainly 11-year old children were recruited in 9 European countries. The total sample size consisted of 3960 boys (16.5% overweight). A validated self-report questionnaire was used to measure vegetable intake, and personal, social and environmental factors related to vegetable intake in the classroom. Weight and height were reported by the parents of the children in parents' questionnaires.

    RESULTS: Regression analyses explained 23% to 28% of the variance in vegetable intake by potential correlates. Liking, self-efficacy and bringing vegetables to school were related to intake in both normal weight and overweight boys (beta's>0.10). Active parental encouragement and availability at home was only related to intake in overweight boys (beta's>0.10), whereas knowledge about recommendations was only related to vegetable consumption in normal weight boys (beta>0.10)

    CONCLUSION: Intervention strategies to increase vegetable intake should focus on increase in liking and preferences, increase in self-efficacy, and increase in bringing vegetables to school in both normal weight and overweight boys. Further research should investigate whether advising parents of overweight boys to encourage their child to eat vegetables every day, to insist as far as possible that their child eats vegetables regularly and to make vegetables easily available at home is effective in changing vegetable intake.

  • 20.
    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.

  • 21.
    De Craemer, Marieke
    et al.
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    De Decker, Ellen
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Verloigne, Maïté
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium; Research Foundation Flanders, Brussels, Belgium.
    De Bourdeaudhuij, Ilse
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Manios, Yannis
    Department of Nutrition and Dietetics, Harokopio University, Athens , Greece.
    Cardon, Greet
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    The effect of a cluster randomised control trial on objectively measured sedentary time and parental reports of time spent in sedentary activities in Belgian preschoolers: the ToyBox-study2016In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 13, article id 1Article in journal (Refereed)
    Abstract [en]

    Background: In preschoolers, high levels of sedentary behaviour are associated with several adverse health outcomes. The purpose of this study is to report the effects of the ToyBox-intervention (a European 24-week cluster randomised controlled trial) on sedentary behaviour in preschoolers.

    Methods: In Belgium, 859 preschoolers from 27 kindergartens (15 intervention and 12 control) wore an accelerometer to objectively measure their sedentary time and 1715 parents/caregivers completed a questionnaire to assess sedentary activities in which preschoolers participate at home. Main outcomes were objectively measured sedentary time, time spent watching TV, using the computer and time spent in quiet play. Multilevel repeated measures analyses were conducted to take clustering into account. Intention to treat analysis was used to handle missing data.

    Results: A sample of 859 (29.5% of all contacted children) preschoolers (4.4 ± 0.6 years, 54.4% boys) provided valid accelerometer data at either baseline or follow-up and parents of 1715 (58.9% of all contacted children) preschoolers (4.4 ± 0.5 years, 52.5% boys) completed a questionnaire at either baseline or follow-up. No intervention effects were found on objectively and subjectively measured total sedentary time in the total sample. However, some effects on objectively and subjectively measured sedentary time were found in specific subgroups. Preschoolers from the intervention group from high SES kindergartens and preschoolers with high levels of sedentary time at baseline decreased their sedentary time, while preschoolers from the control group increased their sedentary time. Girls in the intervention group decreased their TV viewing time during weekend days (-5.83 min/day), while girls' &TV viewing in the control group increased (+4.15 min/day). In low SES kindergartens, a smaller increase for computer time during weekend days was found in preschoolers in intervention kindergartens (+6.06 min/day) than in control kindergartens (+12.49 min/day).

    Conclusion: While some small positive effects were found in some sub-groups, the ToyBox-intervention had no effect on objectively and subjectively measured sedentary time in the total sample. A longer period to implement the intervention and a more active involvement of parents/caregivers might enhance intervention effects. The ToyBox-study is registered with the clinical trials registry clinicaltrials.gov, ID: NCT02116296.

  • 22.
    De Craemer, Marieke
    et al.
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium .
    De Decker, Ellen
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Verloigne, Maïté
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    De Bourdeaudhuij, Ilse
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    Manios, Yannis
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece .
    Cardon, Greet
    Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
    The effect of a kindergarten-based, family-involved intervention on objectively measured physical activity in Belgian preschool boys and girls of high and low SES: the ToyBox-study.2014In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 11, no 1, p. 38-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The ToyBox-study developed an evidence- and theory-based intervention to improve preschoolers' energy balance-related behaviours - including physical activity (PA) - by targeting the kindergarten environment and involving their parents/caregivers. The present study aimed to examine the effect of the ToyBox-intervention on increasing Belgian preschoolers' objectively measured PA levels.

    METHODS: A sample of 472 preschoolers (4.43 ± 0.55 years; 55.1% boys) from 27 kindergartens (15 intervention, 12 control kindergartens) in Flanders, Belgium were included in the data analyses. Preschoolers wore an ActiGraph accelerometer for six consecutive days and were included in the data analyses if they had a minimum of two weekdays and one weekend day, both at baseline and follow-up (one year later). Preschoolers' PA outcomes were estimated for an average day, weekday, weekend day, during school hours, and during after school hours. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample, and for sub-groups (according to sex, kindergarten levels of socio-economic status (SES) and risk groups (low levels of PA at baseline)) of preschoolers.

    RESULTS: Small intervention effects were found in the total sample. Most intervention effects were found in boys and in preschoolers from high SES kindergartens. Boys from the intervention group had an increase in vigorous PA (ß=1.47, p=0.03) and moderate-to-vigorous PA (ß=1.27, p=0.03) from baseline to follow-up, whereas PA levels in boys from the control group stagnated or decreased. In preschoolers from high SES kindergartens, the largest effects were found for PA outcomes during school hours and during after school hours.

    CONCLUSION: The results from the Belgian sample demonstrate that effects of the PA-component of the ToyBox-intervention on objectively measured PA were found in preschool boys and in preschoolers from high SES kindergartens, which means that the ToyBox-intervention was mainly effective in those sub-groups. Future interventions should search for alternative strategies to increase preschoolers' PA levels in preschool girls and preschoolers from low SES kindergartens, as these are the most important at-risk groups regarding PA.

  • 23.
    De Craemer, Marieke
    et al.
    Ghent University, Ghent, Belgium.
    Lateva, Mina
    Medical University Varna, Varna, Bulgaria.
    Iotova, Violeta
    Medical University Varna, Varna, Bulgaria.
    De Decker, Ellen
    Ghent University, Ghent, Belgium.
    Verloigne, Maite
    Ghent University, Ghent, Belgium; Research Foundation Flanders, Brussels, Belgium.
    De Bourdeaudhuij, Ilse
    Ghent University, Ghent, Belgium.
    Androutsos, Odysseas
    Harokopio University, Athens, Greece.
    Socha, Piotr
    Children’s Memorial Health Institute, Warsaw, Poland.
    Kulaga, Zbigniew
    Children’s Memorial Health Institute, Warsaw, Poland.
    Moreno, Luis
    University of Zaragoza, Zaragoza, Spain.
    Koletzko, Berthold
    University of Munich Medical Centre, Munich, Germany.
    Manios, Yannis
    Harokopio University, Athens, Greece.
    Cardon, Greet
    Ghent University, Ghent, Belgium.
    Differences in Energy Balance-Related Behaviours in European Preschool Children: The ToyBox-Study2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 3, article id e0118303Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the current study was to compare levels of energy balance-related behaviours (physical activity, sedentary behaviour, and dietary behaviours (more specifically water consumption, sugar-sweetened beverage consumption and unhealthy snacking)) in four-to six-year-old preschoolers from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, and Spain) within the ToyBox cross-sectional study.

    Methods: A sample of 4,045 preschoolers (4.77 +/- 0.43 years; 52.2% boys) had valid physical activity data (steps per day), parents of 8,117 preschoolers (4.78 +/- 0.46 years; 53.0% boys) completed a parental questionnaire with questions on sedentary behaviours (television viewing, computer use, and quiet play), and parents of 7,244 preschoolers (4.77 +/- 0.44 years; 52.0% boys) completed a food frequency questionnaire with questions on water consumption, sugar-sweetened beverage consumption and unhealthy snacking.

    Results: The highest levels of physical activity were found in Spain (12,669 steps/day on weekdays), while the lowest levels were found in Bulgaria and Greece (9,777 and 9,656 steps/day on weekdays, respectively). German preschoolers spent the least amount of time in television viewing (43.3 min/day on weekdays), while Greek preschoolers spent the most time in television viewing (88.5 min/day on weekdays). A considerable amount of time was spent in quiet play in all countries, with the highest levels in Poland (104.9 min/day on weekdays), and the lowest levels in Spain (60.4 min/day on weekdays). Belgian, German, and Polish preschoolers had the lowest intakes of water and the highest intakes of sugar-sweetened beverages. The intake of snacks was the highest in Belgian preschoolers (73.1 g/day) and the lowest in Greek preschoolers (53.3 g/day).

    Conclusions: Across six European countries, differences in preschoolers' energy balance-related behaviours were found. Future interventions should target European preschoolers' energy balance-related behaviours simultaneously, but should apply country-specific adaptations.

  • 24. De Craemer, Marieke
    et al.
    Verloigne, Maïté
    De Bourdeaudhuij, Ilse
    Androutsos, Odysseas
    Iotova, Violeta
    Moreno, Luis
    Koletzko, Berthold
    Socha, Piotr
    Manios, Yannis
    Cardon, Greet
    Effect and process evaluation of a kindergarten-based, family-involved cluster randomised controlled trial in six European countries on four- to six-year-old children's steps per day: the ToyBox-study.2017In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 14, no 1, article id 116Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The ToyBox-intervention is a theory- and evidence-based intervention delivered in kindergartens to improve four- to six-year-old children's energy balance-related behaviours and prevent obesity. The current study aimed to (1) examine the effect of the ToyBox-intervention on increasing European four- to six-year-old children' steps per day, and (2) examine if a higher process evaluation score from teachers and parents was related to a more favourable effect on steps per day.

    METHODS: A sample of 2438 four- to six-year-old children (51.9% boys, mean age 4.75 ± 0.43 years) from 6 European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain) wore a motion sensor (pedometer or accelerometer) for a minimum of two weekdays and one weekend day both at baseline and follow-up to objectively measure their steps per day. Kindergarten teachers implemented the physical activity component of the ToyBox-intervention for 6 weeks in total, with a focus on (1) environmental changes in the classroom, (2) the child performing the actual behaviour and (3) classroom activities. Children's parents received newsletters, tip cards and posters. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample and the six intervention countries separately. In addition, process evaluation questionnaires were used to calculate a total process evaluation score (with implementation and satisfaction as a part of the overall score) for teachers and parents which was then linked with the physical activity outcomes.

    RESULTS: No significant intervention effects on four- to six-year-old children' steps per weekday, steps per weekend day and steps per average day were found, both in the total sample and in the country-specific samples (all p > 0.05). In general, the intervention effects on steps per day were least favourable in four- to six-year-old children with a low teachers process evaluation score and most favourable in four- to six-year-old children with a high teachers process evaluation score. No differences in intervention effects were found for a low, medium or high parents' process evaluation score.

    CONCLUSION: The physical activity component of the ToyBox-intervention had no overall effect on four- to six-year-old children' steps per day. However, the process evaluation scores showed that kindergarten teachers that implemented the physical activity component of the ToyBox-intervention as planned and were satisfied with the physical activity component led to favourable effects on children's steps per day. Strategies to motivate, actively involve and engage the kindergarten teachers and parents/caregivers are needed to induce larger effects.

  • 25.
    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.

  • 26.
    Der Ananian, Cheryl
    et al.
    School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA.
    Soroush, Ali
    Department of Sports Medicine, Imam Reza Hospital, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.
    Ainsworth, Barbara
    School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA.
    Belyea, Michael
    College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.
    Walker, Jenelle
    College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.
    Poortvliet, Eric
    Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Swan, Pamela
    School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    Trajectories and predictors of steps in a worksite intervention: ASUKI-step2015In: Health Behavior & Policy Review, ISSN 2326-4403, Vol. 2, no 1, p. 46-61Article in journal (Refereed)
    Abstract [en]

    Objectives: We evaluated the trajectory of steps over time, success in walking 10,000 steps/day for 100 days, and socio-demographic predictors of success in a pedometer-based intervention (ASUKI-Step).

    Methods: A single-group, pre-post quasi-experimental design was used. Participants were university employees in Arizona (N = 712) and Sweden (N = 1390). Linear growth models and logistic regression were used to assess the trajectories of change in steps and the predictors of meeting the step standard, respectively.

    Results: Linear and curvilinear changes in steps occurred over time with individual variation in the trajectories of change (p < .01). Half of the participants (52.9%) accumulated 10,000 steps for 100 days. No changes were observed for accelerometer-derived minutes of activity.

    Conclusions: Individually tailoring pedometer-based interventions may enhance success.

  • 27.
    Der Ananian, Cheryl
    et al.
    Arizona State University, Phoenix, AZ, USA.
    Soroush, Ali
    Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
    Ainsworth, Barbara E.
    Arizona State University, Phoenix, AZ, USA.
    Belyea, Michael
    Arizona State University, Phoenix, AZ, USA.
    Swan, Pamela
    Exericse Science and Health Promotion, Phoenix, AZ, USA.
    Walker, Jenelle
    Arizona State University, Phoenix, AZ, USA.
    Poortvliet, Eric
    Karolinska Institute, Huddinge, Sweden.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan.
    TRAJECTORIES AND SOCIO-DEMOGRAPHIC PREDICTORS OF STEPS IN A WORKSITE INTERVENTION: ASUKI-STEP2015In: Annals of Behavioral Medicine, ISSN 0883-6612, E-ISSN 1532-4796, Vol. 49, p. S170-S170Article in journal (Other academic)
    Abstract [en]

    Promoting physical activity (PA) through worksite wellness programs may help decrease physical inactivity in adults. Purpose: This study examined the effects of a pedometer-based intervention (ASUKI-Step) on (1) trajectories of step counts over time; (2) the proportion of individuals who accumulated at least 10,000 steps per day for a minimum of 100 days; and (3) trajectories of accelerometer-determined PA over time in a sub-set of individuals. We also examined the sociodemographic characteristics associated with each outcome. Methods: ASUKI-Step was a 6-month, pedometer-based intervention offered to employees at Arizona State University (n=712) and the Karolinska Institutet (n=1390). The intervention was grounded in the theory of social support and participants enrolled in teams of 3-4 individuals to promote social support. Trajectories of change in PA were evaluated using a single-group, pre-post quasi-experimental design. Linear growth models were used to assess trajectories of change in and predictors of pedometer-based and accelerometer-determined PA. Logistic regression analyses were used to examine the proportion of individuals who met 10,000 steps per day for at least 100 days. Results: There was a significant linear (t = -20.76, p =.001) and curvilinear change in steps over time (t = 7.65, p = 0.001). Steps declined over the six months and there was significant individual variation in the trajectory of change. Men had a greater decline in steps over time while increased age was associated with a slower decline in steps over time (p < 0.05). Overall, 52.9% (n = 1105) of the participants accumulated 10,000 steps on at least 100 days of the study. Older age, being married, working in a non-managerial position, having a normal body weight, and higher initial PA level were positively associated with meeting the step goal (p <0.05). Finally, in the subset of individuals for whom we had accelerometer-derived PA levels (n=226), there were no changes over time in minutes of physical inactivity, light activity, moderate lifestyle or moderate activity. Conclusions: Findings suggest that a low-intensity, pedometer-based intervention can work with some segments of the typical office population but a more intensive intervention may be needed for individuals who are sedentary or overweight.

  • 28. Dernini, S
    et al.
    Berry, E M
    Serra-Majem, L
    La Vecchia, C
    Capone, R
    Medina, F X
    Aranceta-Bartrina, J
    Belahsen, R
    Burlingame, B
    Calabrese, G
    Corella, D
    Donini, L M
    Lairon, D
    Meybeck, A
    Pekcan, A G
    Piscopo, S
    Yngve, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Trichopoulou, A
    Med Diet 4.0: the Mediterranean diet with four sustainable benefits.2017In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 20, no 7, p. 1322-1330Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To characterize the multiple dimensions and benefits of the Mediterranean diet as a sustainable diet, in order to revitalize this intangible food heritage at the country level; and to develop a multidimensional framework - the Med Diet 4.0 - in which four sustainability benefits of the Mediterranean diet are presented in parallel: major health and nutrition benefits, low environmental impacts and richness in biodiversity, high sociocultural food values, and positive local economic returns.

    DESIGN: A narrative review was applied at the country level to highlight the multiple sustainable benefits of the Mediterranean diet into a single multidimensional framework: the Med Diet 4.0. Setting/subjects We included studies published in English in peer-reviewed journals that contained data on the characterization of sustainable diets and of the Mediterranean diet. The methodological framework approach was finalized through a series of meetings, workshops and conferences where the framework was presented, discussed and ultimately refined.

    RESULTS: The Med Diet 4.0 provides a conceptual multidimensional framework to characterize the Mediterranean diet as a sustainable diet model, by applying principles of sustainability to the Mediterranean diet.

    CONCLUSIONS: By providing a broader understanding of the many sustainable benefits of the Mediterranean diet, the Med Diet 4.0 can contribute to the revitalization of the Mediterranean diet by improving its current perception not only as a healthy diet but also a sustainable lifestyle model, with country-specific and culturally appropriate variations. It also takes into account the identity and diversity of food cultures and systems, expressed within the notion of the Mediterranean diet, across the Mediterranean region and in other parts of the world. Further multidisciplinary studies are needed for the assessment of the sustainability of the Mediterranean diet to include these new dimensions.

  • 29.
    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.

  • 30.
    Ekelund, Ulf
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Poortvliet, Eric
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Huddinge, Sweden.
    Nilsson, Andreas
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Huddinge, Sweden.
    Holmberg, Anders
    Department of Statistics, Örebro University, 701 82 Örebro, Sweden.
    Sjöström, Michael
    Department of Physical Education and Health, Örebro University, Örebro, Sweden; Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Huddinge, Sweden.
    Physical activity in relation to aerobic fitness and body fat in 14- to 15-year-old boys and girls2001In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 85, no 3-4, p. 195-201Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to examine the strength of the relationship between different variables of physical activity and aerobic fitness and body fat in adolescent boys and girls. Activity energy expenditure (AEE), time spent in a sedentary state, and time spent engaged in moderate and vigorous physical activity (MVPA, > or = 50% peak oxygen uptake, VO2peak) were assessed by the minute-by-minute heart rate monitoring method in 82 randomly selected 14- to 15-year olds (42 boys, 40 girls). Body fat was determined by measuring skinfold thicknesses. VO2peak was measured by indirect calorimetry. Somatic maturity level was determined by percentages of adult (i.e. 18 years) height attained at examination. AEE was related to aerobic fitness for both genders (boys, r = 0.30, P = 0.056; girls, r = 0.45, P = 0.003). For boys, there was a significant relationship between maturity level and VO2peak (r = 0.48, P < 0.001). For both genders, body fat was significantly and negatively related to VO2peak (r = -0.48 and r = -0.43, P < 0.01). Body fat and maturity explained 47% of the variation in VO2peak in boys, whereas AEE and body fat explained 22% of the variation in VO2peak in girls. No significant associations between physical activity variables and the data on body fat were observed. The total amount of physical activity (AEE) was related to VO2peak, at least in adolescent girls. Although VO2peak seems to be influenced by the maturity level in adolescent boys, the data support the promotion of a daily active lifestyle among young people.

  • 31.
    Ekelund, Ulf
    et al.
    Örebro universitet, Hälsovetenskapliga institutionen.
    Poortvliet, Eric
    Yngve, Agneta
    Hurtig-Wennlöf, Anita
    Örebro universitet, Institutionen för klinisk medicin.
    Nilsson, Andreas
    Örebro universitet, Hälsovetenskapliga institutionen.
    Sjöström, Michael
    Heart rate as an indicator of the intensity of physical activity in human adolescents2001In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 85, no 3-4, p. 244-249Article in journal (Refereed)
    Abstract [en]

    The aims of this study were, in a group of adolescents, firstly to identify the absolute heart rates (HR) and the percentages of maximal heart rates (HRmax) corresponding to 40%, 60% and 80% of peak oxygen uptake (PVO2), secondly to identify absolute and relative (%PVO2) oxygen uptakes (VO2) corresponding to HR of 120, 140 and 160 beats.min-1, and thirdly to examine a possible effect of fatness and fitness on the relationship between HR and VO2. The subjects were 127 (60 boys, 67 girls) adolescents with a mean age of 14.8 (SD 0.3) years. The HR and VO2 were measured by means of an incremental exercise test to exhaustion. Linear regressions were performed for the HR-VO2 and VO2-HR relationships using absolute and relative (%HRmax, %PVO2) data for each individual. From these regressions, target HR and VO2 were computed. Average target HR corresponding to 40%, 60% and 80% of PVO2 were: 119 (SD 9), 145 (SD 9), 171 (SD 8), and 120 (SD 10), 146 (SD 8), 172 (SD 8) beats.min-1 for boys and girls, respectively. Average VO2 corresponding to HR of 120, 140 and 160 beats.min-1 were: 22 (SD 5), 30 (SD 5), 38 (SD 6) and 18 (SD 4), 24 (SD 4), 31 (SD 4) mlO2.kg-1.min-1 for boys and girls, respectively. An analysis of covariance showed a significant fitness effect (P < 0.001) for predicted VO2 at all HR studied. The results suggest that the use of absolute HR to define exercise intensity levels when assessing young people's physical activity using HR monitoring detracts from the validity of the interpretation of the data.

  • 32.
    Ekelund, Ulf
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Sjöström, Michael
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden;.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden;.
    Nilsson, Andreas
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Total daily energy expenditure and pattern of physical activity measured by minute-by-minute heart rate monitoring in 14-15 year old Swedish adolescents2000In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 54, no 3, p. 195-202Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess total daily energy expenditure (TDEE) and patterns of physical activity among Swedish male and female adolescents and to relate the amount and intensity of physical activity to existing recommendations (energy expenditure equal to or above 12.4 kJ/kg/day or accumulation of 30 min/day in moderate physical activity equal to 4.5 times sedentary energy expenditure or more).

    DESIGN: TDEE, physical activity level (PAL=TDEE/BMR), energy expenditure (EE) and time spent in different intensities of physical activity were assessed by using minute-by-minute heart rate monitoring in combination with laboratory measured sedentary energy expenditure (SEE) and peak oxygen uptake.

    SETTING: Department of Physical Education and Health, Orebro University, and Department of Clinical Physiology, Orebro Medical Centre Hospital, Sweden.

    SUBJECTS: Eighty-two 14-15 y old adolescents (42 boys, 40 girls) from the city of Orebro, randomly selected through a two-stage sampling procedure.

    RESULTS: TDEE was 12.8 MJ/day and 10.0 MJ/day for boys and girls respectively (P<0.001) and PAL was 1.74 and 1.67 (NS). Forty-four percent and 47%, respectively, of TDEE referred to EE in physical activity, of which 70% for both genders referred to light physical activity (corresponding to <4.5 times SEE). Eleven boys and 14 girls had an EE lower than 12.4 kJ/kg/day and/or did not accumulate 30 min/day in physical activity >/=4.5 SEE. Those (n=20) with the highest PAL values (>2.01 and 1.81, respectively) spent 149 min/day at a >/=4.5 SEE intensity level compared to 40 min/day for those (n=30) with the lowest PAL values (<1.55 and 1.45, respectively).

    CONCLUSIONS: Swedish adolescent boys and girls are similarly physically active. The major amount of time devoted to physical activity refers to light physical activity. At least thirty percent of adolescents seem not to achieve appropriate levels of physical activity considered to be beneficial for health.

  • 33.
    Ekelund, Ulf
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Sjöström, Michael
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Poortvliet, Eric
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Andreas
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Fröberg, Karsten
    Institute of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
    Wedderkopp, Niels
    Institute of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
    Westerterp, Klaas
    Department of Human Biology, Maastricht University, Maastricht, The Netherlands.
    Physical activity assessed by activity monitor and doubly labeled water in children2001In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 33, no 2, p. 275-281Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To validate the Computer Science and Application's (CSA) activity monitor for assessment of the total amount of physical activity during two school-weeks in 9-yr-old children and to develop equations to predict total energy expenditure (TEE) and activity energy expenditure (AEE) from activity counts and anthropometric variables.

    METHODS: A total of 26 children (15 boys and 11 girls, mean age 9.1 +/- 0.3 yr) were monitored for 14 consecutive days. TEE was simultaneously measured by the doubly labeled water method. Averaged activity counts (counts.min(-1)) were compared with data on: 1) TEE, 2) AEE = TEE minus basal metabolic rate (BMR; estimated from predictive equations), and 3) daily physical activity level (PAL = TEE/BMR).

    RESULTS: Physical activity determined by activity counts was significantly related to the data on energy expenditures: TEE (r = 0.39; P < 0.05), AEE (r = 0.54; P < 0.01), and PAL (r = 0.58; P < 0.01). Multiple stepwise regression analysis showed that TEE was significantly influenced by gender, body composition (body weight or fat free mass), and activity counts (R(2) = 0.54--0.60). AEE was significantly influenced by activity counts and gender (R(2) = 0.45). There were no significant differences between activity counts and PAL in discriminating among activity levels with "low" (PAL < 1.56), "moderate" (1.57 < or = PAL > or = 1.81), and "high" (PAL > 1.81) intensity.

    CONCLUSION: Activity counts from the CSA activity monitor seems to be a useful measure of the total amount of physical activity in 9-yr-old children. Activity counts contributed significantly to the explained variation in TEE and was the best predictor of AEE.

  • 34.
    Ekelund, Ulf
    et al.
    MRC Epidemiology Unit, Cambridge, United Kingdom; Department of Physical Education and Health, Örebro University, Örebro, Sweden; MRC Epidemiology Unit, Strangeways Research Laboratory, Worts Causeway, Cambridge, United Kingdom .
    Yngve, Agneta
    PREVNUT at Novum, Karolinska Institutet, Stockholm, Sweden .
    Brage, Sören
    Department of Physical Education and Health, Örebro University, Örebro, Sweden; Institute of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark .
    Westerterp, Klaas
    Department of Human Biology, Maastricht University, Maastricht, Netherlands .
    Sjöström, Michael
    PREVNUT at Novum, Karolinska Institutet, Stockholm, Sweden .
    Body movement and physical activity energy expenditure in children and adolescents: how to adjust for differences in body size and age2004In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 79, no 5, p. 851-856Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Physical activity data in children and adolescents who differ in body size and age are influenced by whether physical activity is expressed in terms of body movement or energy expenditure.

    OBJECTIVE: We examined whether physical activity expressed as body movement (ie, accelerometer counts) differs from physical activity energy expenditure (PAEE) as a function of body size and age.

    DESIGN: This was a cross-sectional study in children [n = 26; (+/-SD) age: 9.6 +/- 0.3 y] and adolescents (n = 25; age: 17.6 +/- 1.5 y) in which body movement and total energy expenditure (TEE) were simultaneously measured with the use of accelerometry and the doubly labeled water method, respectively. PAEE was expressed as 1) unadjusted PAEE [TEE minus resting energy expenditure (REE); in MJ/d], 2) PAEE adjusted for body weight (BW) (PAEE. kg(-1). d(-1)), 3) PAEE adjusted for fat-free mass (FFM) (PAEE. kg FFM(-1). d(-1)), and 4) the physical activity level (PAL = TEE/REE).

    RESULTS: Body movement was significantly higher (P = 0.03) in children than in adolescents. Similarly, when PAEE was normalized for differences in BW or FFM, it was significantly higher in children than in adolescents (P = 0.03). In contrast, unadjusted PAEE and PAL were significantly higher in adolescents (P < 0.01).

    CONCLUSIONS: PAEE should be normalized for BW or FFM for comparison of physical activity between children and adolescents who differ in body size and age. Adjusting PAEE for FFM removes the confounding effect of sex, and therefore FFM may be the most appropriate body-composition variable for normalization of PAEE. Unadjusted PAEE and PAL depend on body size.

  • 35.
    Ekelund, Ulf
    et al.
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm; Department of Physical Education and Health, Örebro University, Sweden.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm.
    Sjöström, Michael
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm; Department of Physical Education and Health, Örebro University, Sweden.
    Total daily energy expenditure and patterns of physical activity in adolescents assessed by two different methods1999In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 9, no 5, p. 257-264Article in journal (Refereed)
    Abstract [en]

    Minute-by-minute heart rate monitoring and an activity diary were used simultaneously during three days in 30 randomly selected adolescents (16 boys, 14 girls; mean age 15.0+/-1.0). Total daily energy expenditure (TDEE) and its components (energy expenditure during sleep, during rest and in physical activity) and times spent at different intensity levels (sedentary, light, moderate physical activity and vigorous physical activity) were compared. TDEE from heart rate monitoring averaged 10.9+/-2.7 MJ x d(-1) compared to 11.3+/-2.3 MJ x d(-1) from the activity diary (NS). The limits of agreement (mean+/-2 SD) were -3.54 MJ x d(-1) and 2.74 MJ x d(-1). There was no significant difference for any of the TDEE components between the methods (MANOVA). A significant method effect (P<0.001) was observed for time spent in sedentary and light physical activity (MANOVA). No significant difference was observed for time spent in moderate and vigorous physical activity. According to this, heart rate monitoring and activity diary are comparable for group assessment of TDEE and its components, and for estimating time spent in moderate and vigorous physical activity. The activity diary underestimated time spent in moderate and vigorous physical activity for inactive subjects and consequently overestimated highly active subjects.

  • 36.
    Ekelund, Ulf
    et al.
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden; Department of Physical Education and Health, Örebro of University, Örebro, Sweden .
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden .
    Sjöström, Michael
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden; Department of Physical Education and Health, Örebro of University, Örebro, Sweden.
    Westerterp, Klaas
    Department of Human Biology, Maastricht University, Maastricht, Netherlands .
    Field evaluation of the Computer Science and Application's Inc. Activity monitor during running and skating training in adolescent athletes2000In: International Journal of Sports Medicine, ISSN 0172-4622, E-ISSN 1439-3964, Vol. 21, no 8, p. 586-592Article in journal (Refereed)
    Abstract [en]

    This study investigated the validity of the CSA activity monitor for assessment of the total amount of physical activity in adolescent athletes. Activity data were compared to data on daily energy expenditure and its derivatives measured by the doubly labeled water method. Seven athletes (speed skaters) with a mean age of 18.2+/-1.1 y were monitored twice (off-season and pre-season) by the activity monitor for eight consecutive days. The primary training during the off-season period was running whereas the pre-season period mainly involved skate training (i.e. inline skating, slideboard training, and skating imitations). Activity counts were significantly correlated to all energy estimates during the off-season period (r=0.93-0.96; P<0.01) whereas not during the pre-season period (r=0.32-0.57). A two-way multivariate analysis of variance showed a significant period effect for activity counts (668+/-163 vs. 548+/-91; P=0.026) whereas not for total daily energy expenditure (15.7+/-2.1 MJ x d(-1) vs. 16.0+/-1.0 MJ x d(-1); P=0.71). The relationship between activity counts and total daily energy expenditure seems to be affected by different training conditions. Therefore these circumstances have to be carefully considered in the interpretation of activity monitor data.

  • 37.
    Ekelund, Ulf
    et al.
    Unit for Preventive Nutrition at Novum, Department of Medical Nutrition/Biosciences, Karolinska Institutet, Stockholm, Sweden; Department of Physical Education and Health, Örebro University, Sweden.
    Yngve, Agneta
    Unit for Preventive Nutrition at Novum, Department of Medical Nutrition/Biosciences, Karolinska Institutet, Stockholm, Sweden.
    Westerterp, Klaas
    Department of Human Biology, Maastricht University, Maastricht, The Netherlands.
    Sjöström, Michael
    Unit for Preventive Nutrition at Novum, Department of Medical Nutrition/Biosciences, Karolinska Institutet, Stockholm, Sweden.
    Energy expenditure assessed by heart rate and doubly labeled water in young athletes2002In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 34, no 8, p. 1360-1366Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare total energy expenditure (TEE) estimated by the FLEX heart rate (HR) method with that measured by the doubly labeled water (DLW) technique in young speed skaters. We hypothesized that the accuracy of FLEX HR-estimated TEE would be affected by a) the definition of the FLEX HR and b) the type of training regimen.

    METHODS: Eight young athletes (mean age 18.2 +/- 1.3 yr) underwent measurements during two 10-d training periods: an off-season period with voluntary training (predominantly running) and a preseason period mainly focused on skating technique training. TEE was measured simultaneously by the DLW and FLEX HR methods. FLEX HR1 was defined as the mean of the HRs during all resting calibration activities and the lowest HR during exercising calibration activities. FLEX HR2 was defined as the mean of the highest HR during resting activities and the lowest HR during exercising.

    RESULTS: ANOVA showed that FLEX HR1 was significantly lower than FLEX HR2 (mean of both periods; 77 +/- 5 vs 84 +/- 6 beats.min(-1); P = 0.004). TEE values obtained by DLW were 16.8 +/- 3.8 and 16.9 +/- 2.9 MJ.d(-1) in the two periods, respectively. TEE values calculated from FLEX HR1 were 17.8 +/- 3.6 and 17.4 +/- 2.6 MJ.d(-1), and those from FLEX HR2 17.1 +/- 3.1 and 17.0 +/- 2.7 MJ.d-1, respectively. No significant period (P = 0.83) or method (P = 0.44) effect on TEE was observed.

    CONCLUSION: FLEX HR-estimated TEE was not affected by the definition of the FLEX HR or by the type of training regimen as compared with TEE measured by the DLW method in young athletes.

  • 38.
    Ekelund, Ulf
    et al.
    Unit for Preventive Nutrition, Department of Medical Nutrition/Biosciences, Karolinska Institutet, Stockholm, Sweden; Department of Physical Education and Health, Örebro University, Örebro, Sweden; .
    Åman, Jan
    Örebro universitet, Hälsoakademin.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition/Biosciences, Karolinska Institutet, Stockholm, Sweden .
    Renman, Cecilia
    Department of Pediatrics, Örebro Medical Center, Örebro, Sweden .
    Westerterp, Klaas
    Department of Human Biology, Maastricht University, Maastricht, Netherlands.
    Sjöström, Michael
    Unit for Preventive Nutrition, Department of Medical Nutrition/Biosciences, Karolinska Institutet, Stockholm, Sweden .
    Physical activity but not energy expenditure is reduced in obese adolescents: a case-control study2002In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 76, no 5, p. 935-941Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The influence of physical activity on body weight in children and adolescents is controversial.

    OBJECTIVE: The objective was to test the hypothesis that the intensity and duration of physical activity differ between obese and normal-weight adolescents, with no difference in estimated energy expenditure.

    DESIGN: We compared physical activity in 18 (8 males, 10 females) obese [body mass index (in kg/m(2)) > 30] adolescents (14-19 y) with that in a matched, normal-weight (BMI < 27) control group. Total energy expenditure (TEE) was measured with the doubly labeled water method, and physical activity was measured simultaneously by accelerometry. The physical activity level was determined as the ratio of TEE to the resting metabolic rate (RMR) and activity energy expenditure as 0.9 TEE minus RMR. Accelerometry data included total physical activity (counts x min(-1) x d(-1)), accumulated and continuous duration of activity, and continuous 10-min periods of physical activity of moderate intensity.

    RESULTS: There was no significant difference in adjusted (analysis of covariance) TEE, RMR, or AEE between groups. The physical activity level was significantly lower (P < 0.05) in the obese group. No sex x group interaction was observed. Differences in total physical activity (P < 0.001), accumulated time (P < 0.05), continuous time (P < 0.01), and continuous 10-min periods of physical activity of moderate intensity (P < 0.01) were observed between groups.

    CONCLUSIONS: Obese adolescents are less physically active than are normal-weight adolescents, but physical activity-related energy expenditure is not significantly different between groups. The data suggest that physical activity is not necessarily equivalent to the energy costs of activity.

  • 39. Erlich, Rita
    et al.
    Yngve, Agneta
    Karolinska Institute, Stockholm.
    Wahlqvist, Mark L
    Cooking as a healthy behaviour2012In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 15, no 7, p. 1139-1140Article in journal (Refereed)
  • 40.
    Fischer, Claudia
    et al.
    The EMGO+ Institute for Health and Care Research and the Department of Epidemiology and Biostatistics, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
    Brug, Johannes
    Department of Health Sciences, VU University, De Boelelaan 1081, 1081 HV, Amsterdam, The Netherlands.
    Tak, Nannah I.
    oelelaan 1081, 1081 HV, Amsterdam, The Netherlands.
    Yngve, Agneta
    Department of Biosciences and Nutrition, Karolinska Institutet, Novum, SE-141 83, Huddinge, Sweden.
    Velde, Saskia J. Te
    The EMGO+ Institute for Health and Care Research and the Department of Epidemiology and Biostatistics, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
    Differences in fruit and vegetable intake and their determinants among 11-year-old schoolchildren between 2003 and 20092011In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 8, p. 141-Article in journal (Refereed)
    Abstract [en]

    Background: Fruit and vegetable (FV) intake in children in the Netherlands is much lower than recommended. Recurrent appraisal of intake levels is important for detecting changes in intake over time and to inform future interventions and policies. The aim of the present study was to investigate differences in fruit and vegetable intake, and whether these could be explained by differences in potential determinants of FV intake in 11-year-old Dutch schoolchildren, by comparing two school samples assessed in 2003 and 2009. Methods: For 1105 children of the Pro Children study in 2003 and 577 children of the Pro Greens study in 2009 complete data on intake and behavioural determinants were available. The self-administered questionnaire included questions on children's ethnicity, usual fruit and vegetable intake, mother's educational level, and important potential determinants of fruit and vegetable intake. Multiple regression analysis was applied to test for differences in intake and determinants between study samples. Mediation analyses were used to investigate whether the potential mediators explained the differences in intake between the two samples. Results: In 2009, more children complied with the World Health Organization recommendation of 400 g fruit and vegetables per day (17.0%) than in 2003 (11.8%, p = 0.004). Fruit consumption was significantly higher in the sample of 2009 than in the sample of 2003 (difference = 23.8 (95% CI: 8.1; 39.5) grams/day). This difference was mainly explained by a difference in the parental demand regarding their child's intake (23.6%), followed by the child's knowledge of the fruit recommendation (14.2%) and parental facilitation of consumption (18.5%). Vegetable intake was lower in the 2009 sample than in the 2003 sample (12.3 (95% CI -21.0; -3.6). This difference could not be explained by the assessed mediators. Conclusions: The findings indicate that fruit intake among 11-year-olds improved somewhat between 2003 and 2009. Vegetable intake, however, appears to have declined somewhat between 2003 and 2009. Since a better knowledge of the recommendation, parental demand and facilitation explained most of the observed fruit consumption difference, future interventions may specifically address these potential mediators. Further, the provision of vegetables in the school setting should be considered in order to increase children's vegetable intake.

  • 41.
    Fogelholm, Mikael
    et al.
    University of Helsinki, Palmenia Centre for Research and Continuing Education, Lahti, Finland.
    Kolset, Svein Olav
    Institute for Nutrition Research, University of Oslo, Norway.
    Rasmussen, Lone Banke
    Institut for Fodevareundersogelser og Ernaering, Afdelning for Ernaering, Copenhagen, Denmark.
    Sjöström, Michael
    Unit for preventive nutrition, Dept Physical Education and Health, University of Örebro, Sweden.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Physical activity - a part of dietary recommendations?: closing discussion and recommendations2001In: Physical activity: a part of healthy eating? : report from a Nordic Seminar, Lahti, Finland, February 2000 / [ed] Mikael Fogelholm, København, 2001, p. 131-135Conference paper (Refereed)
  • 42.
    Fogelholm, Mikael
    et al.
    University of Helsinki, Palmenia Centre for Research and Continuing Education, Lahti, Finland.
    Kolset, Svein Olav
    Institute for Nutrition Research, University of Oslo, Norway.
    Rasmussen, Lone Banke
    Institut for Fodevareundersogelser og Ernaering, Afdelning for Ernaering, Copenhagen, Denmark.
    Sjöström, Michael
    Unit for preventive nutrition, Dept Physical Education and Health, University of Örebro, Sweden.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Physical activity - a part of dietary recommendations?: closing discussion and recommendations2001In: Physical activity: a part of healthy eating? : report from a Nordic Seminar, Lahti, Finland, February 2000 / [ed] Mikael Fogelholm, København, 2001, p. 131-135Conference paper (Refereed)
  • 43.
    Friis, Robert
    et al.
    Department of Health Science, California State University, Long Beach, California, USA.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Biosciences of the Department of Medical Nutrition, Karolinska Institute, Stockholm, Sweden.
    Persson, Viveka
    Unit for Preventive Nutrition, Department of Biosciences of the Department of Medical Nutrition, Karolinska Institute, Stockholm, Sweden.
    Review of social epidemiologic research on migrants' health: findings, methodological cautions, and theoretical perspectives1998In: Scandinavian journal of social medicine, ISSN 0300-8037, Vol. 26, no 3, p. 173-80Article in journal (Refereed)
    Abstract [en]

    The phenomenon of world-wide immigration and migration has major implications for the health of the migrants in addition to its impact upon social and other service providers. Studies of migrants that utilize social epidemiologic methods fall within the traditional boundaries of descriptive and analytic approaches; this article reviews some of the studies that exemplify these approaches. It then suggests specific methodological issues and cautions pertaining to research on migrants and provides a theoretical model for organizing the diverse research studies that have been conducted. By stimulating discussion regarding social epidemiologic research on migrants' health, this model is intended to serve as a compass point for future research and needed interventions.

  • 44.
    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.

  • 45.
    Grjibovski, A M
    et al.
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden; Institute of Hygiene/Medical Ecology, Northern State Medical University, Arkhnagelsk, Russian Federation .
    Bygren, L O
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden; Dept. of Comm. Med./Rehabilitation, Umeå University, Umeå, Sweden.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden .
    Sjöström, Michael
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden .
    Large social disparities in spontaneous preterm birth rates in transitional Russia2005In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 119, no 2, p. 77-86Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study estimated the effect of maternal sociodemographic, obstetric and lifestyle factors on the risk of spontaneous preterm birth in a Russian town.

    METHODS: All women with singleton pregnancies registered at prenatal care centres in Severodvinsk in 1999 comprised the cohort for this study (n=1559). Analysis was based on spontaneous live singleton births at the maternity home (n=1103). Multivariable logistic regression was applied to quantify the effect of the studied factors on the risk of preterm birth. Differences in gestation duration were studied using multiple linear regression.

    RESULTS: In total, 5.6% of all spontaneous births were preterm. Increased risks of preterm delivery were found in women with lower levels of education and in students. Placental complications, stress and a history of fetal death in previous pregnancies were also associated with elevated risks for preterm delivery. Smoking, hypertension and multigravidity were associated with reduced length of pregnancy in metric form.

    CONCLUSION: In addition to medical risk factors, social factors are important determinants of preterm birth in transitional Russia. Large disparities in preterm birth rates may reflect the level of inequalities in transitional Russia. Social variations in pregnancy outcomes should be monitored.

  • 46.
    Grjibovski, Andrej M
    et al.
    Norwegian Institute of Public Health, Oslo, Norway .
    Ehrenblad, Bettina
    Unit for Public Health Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden .
    Yngve, Agneta
    Unit for Public Health Nutrition, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden .
    Infant feeding in Sweden: socio-demographic determinants and associations with adiposity in childhood and adolescence2008In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 3, p. 23-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Recent reviews and meta-analyses conclude that breastfeeding constitutes a small but consistent protective effect against obesity or higher values of body mass index (BMI) in children, though in some studies this effect was weakened after adjustment for potential confounders. The aim of this study was to explore the socio-demographic determinants of the duration of breastfeeding in Sweden and the associations between breastfeeding duration and adiposity in childhood and adolescence.

    METHODS: This was a cross-sectional study of Swedish children. Height, weight and waist circumference were measured and the sum of five skin fold measurements were obtained in 1137 9- and 15-year old children. Breastfeeding data were retrospectively obtained from the medical records for 812 (71.4%) children. Multiple ordinal logistic regression was applied to study individual effects of the maternal characteristics on the duration of breastfeeding. The relationship between children's anthropometric characteristics and duration of breastfeeding was studied by multiple linear regression. Associations between the odds of being overweight or obese and the duration of breastfeeding were studied by multiple logistic regression. Both linear and logistic models were adjusted for children's age, gender, birth weight, maternal education and parental BMI in 1998 as well as maternal age and smoking status at childbirth.

    RESULTS: Maternal education was positively associated with the duration of breastfeeding in both 1983 and 1989. Non-smoking mothers were more likely to breastfeed longer than smokers in 1989 (OR = 1.9, 95%CI: 1.3, 3.0). Fifteen-year old children breastfed for shorter than 2 months had 1.2 kg/m(2) (95%CI: 0.1, 2.4) higher BMI, 3.2 cm (95%CI: 0.2, 6.2) higher waist circumference and 10.6 mm (95%CI: 1.7, 19.6) higher sum of five skin fold measurements compared to those breastfed for 6 months or longer when adjusted for children's characteristics and maternal characteristics in 1998. Adjustment for maternal age and smoking status at childbirth weakened these associations to non-significant levels (0.9 kg/m(2), 95%CI: -0.4, 2.1; 1.4 cm, 95%CI: -1.5, 4.4 and 5.1 mm, 95%CI: -4.0, 14.2, respectively). In the 9-year olds, the associations were less pronounced, but in the same direction. No trends between duration of breastfeeding and children's anthropometric characteristics were observed in any of the age groups.

    CONCLUSION: Maternal education and smoking were significant predictors of breastfeeding duration in Sweden in the 1980s. Associations with measures of adiposity were observed only in 15-year old children between the children with shortest and longest breastfeeding duration, which were weakened after adjustment for maternal characteristics at childbirth.

  • 47.
    Grjibovski, Andrej M
    et al.
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden; Institute of Hygiene and Medical Ecology, Northern State Medical University, Arkhangelsk, Russian Federation .
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden .
    Bygren, Lars Olov
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden; Department of Community Medicine and Rehabilitation, Social Medicine, Umeå University, Umeå, Sweden .
    Sjöström, Michael
    Unit for Preventive Nutrition, Department of Biosciences at Novum, Karolinska Institutet, Huddinge, Sweden .
    Socio-demographic determinants of initiation and duration of breastfeeding in northwest Russia2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 5, p. 588-594Article in journal (Refereed)
    Abstract [en]

    AIM: This study examines socio-demographic determinants of initiation and duration of breastfeeding in a community-based cohort in northwest Russia.

    METHODS: All infants born to women who were registered at the antenatal clinics in Severodvinsk in 1999 comprised the cohort (n=1399) and were followed up at 1 y. Data on maternal and infant characteristics as well as the duration of breastfeeding were obtained from medical records. Proportional hazard analysis was applied to quantify the effect of the selected factors on the risk of breastfeeding discontinuation adjusted for potential confounders.

    RESULTS: Only 1.3% of infants were never breastfed. Breastfeeding rates were 75.0% and 47.2% at 3 and 6 mo, respectively. Maternal age and early initiation of prenatal care were positively associated with breastfeeding initiation rates. Increased risks of breastfeeding discontinuation were found in teenage mothers (OR=1.45, 95% CI: 1.06-1.99), in mothers with basic education (OR=1.68, 95% CI: 1.06-2.66) and in unmarried mothers (OR=1.19, 95% CI: 1.03-1.38). Women with no previous deliveries were more likely to breastfeed longer (OR=0.74, 95% CI: 0.62-0.90).

    CONCLUSIONS: Compared with previous studies in Russia, almost universal initiation and considerably higher rates of breastfeeding at specific time points were found. Social variations in initiation and duration of breastfeeding should raise concern of inequalities in breastfeeding practices in transitional Russia.

  • 48. Hodge, Allison
    et al.
    Haapala, Irja
    Yngve, Agneta
    Karolinska Inst, Novum, Dept Biosci & Nutr, SE-14183 Huddinge, Sweden.
    McNeill, Geraldine
    Tseng, Marilyn
    A refresher in research publication ethics2012In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 15, no 3, p. 377-378Article in journal (Other academic)
  • 49.
    Hurtig Wennlöf, Anita
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Yngve, Agneta
    Sjöström, Michael
    Sampling procedure, participation rates and representativeness in the Swedish part of the European Youth Heart Study (EYHS)2003In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 6, no 3, p. 291-299Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The European Youth Heart Study (EYHS) is a cross-sectional, school-based population study on risk factors for future cardiovascular disease in children, with an overall participation rate in Sweden of about 50%. To study the representativeness of the participants in the Swedish part of EYHS, a comprehensive non-participant follow-up study was carried out.

    DESIGN:

    A structured multilevel analysis model was developed, addressing each level in the sampling procedure. The income, educational and occupational categories of the geographical regions of the study (level I), school catchment areas (level II) and parents (level III) were compared with official data. Participating and non-participating pupils (level IV) were compared through a questionnaire.

    SETTING:

    Thirty-seven state schools in two regions of Central Sweden (Orebro and southern Stockholm) were visited during the school year 1998/1999.

    SUBJECTS:

    Boys and girls aged 9 and 15 years were randomly sampled through a multiphase sampling procedure.

    RESULTS:

    Data for socio-economic status for levels I and II corresponded well to national and regional official data. At level III, non-manually working parents were slightly over-represented among parents of participating children. At level IV, non-participating subjects corresponded in most respects to participants with a few exceptions--mainly more interest in physical exercise among participants.

    CONCLUSIONS:

    Based on the knowledge from the non-participant study, we do not foresee problems regarding interpretation of the outcomes in the EYHS, despite the low participation rate.

  • 50.
    Hurtig-Wennlöf, Anita
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Yngve, Agneta
    Nilsson, Torbjörn K.
    Örebro universitet, Institutionen för klinisk medicin.
    Sjöström, Michael
    Serum lipids, glucose and insulin levels in healthy schoolchildren aged 9 and 15 years from Central Sweden: reference values in relation to biological, social and lifestyle factors2005In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 65, no 1, p. 65-76Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    There is a shortage of reference values for cardiovascular risk factors such as serum lipids, glucose and insulin related to biological, social and lifestyle factors for Swedish children and adolescents. Such values are needed for planning and evaluation of public health activities, and for clinical use.

    DESIGN AND METHODS:

    Data for this cross-sectional, school-based study were collected during a school year (September to May). A random sample of 1137 girls and boys aged 9 and 15 years from two locations in central Sweden participated in the study, and blood samples were taken from 969 of them.

    METHODS:

    Fasting serum blood samples were analysed for triglycerides, total cholesterol, high-density lipoprotein cholesterol, glucose and insulin. Physical examination included measurement of height, weight and pubertal status. Questionnaires provided family background data. Total physical activity was measured by accelerometer registration.

    RESULTS:

    Serum levels differed significantly between age and gender groups and were correlated to pubertal status. Neither genetic nor socio-economic background nor smoking status influenced the serum levels. Insulin levels were elevated in subjects with a body mass index in the highest decentile, compared with the levels in the rest of the subjects. The insulin levels were inversely associated with total physical activity, and physical activity varied with season.

    CONCLUSIONS:

    Pubertal status (biological age) should to be considered in the interpretation of serum values in schoolchildren rather than chronological age. The interpretation of insulin values should include both body mass index and physical activity level, and perhaps also season. Previously described regional differences in serum lipid levels in Swedish adults seem to be present also in children.

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