Understanding and preventing childhood obesity and related disorders—IDEFICS: A European multilevel epidemiological approach

doi:10.1016/j.numecd.2006.01.011

Nutrition, Metabolism and Cardiovascular Diseases

Volume 16, Issue 4, May 2006, Pages 302-308

https://doi.org/10.1016/j.numecd.2006.01.011 Get rights and content

Abstract

The environment of children has drastically changed in Europe during the last decades as reflected in unhealthy dietary habits and sedentary lifestyle. Nutrition obviously plays a part in the development of overweight in childhood. However, dietary factors and physical activity are also involved in the development of metabolic syndrome, type II diabetes, cardiovascular diseases, osteoporosis, and postural deformities like scoliosis, effects related in part to excessive weight gain. To stop the resulting epidemic of diet- and lifestyle-induced morbidity, efficient evidence-based approaches are needed. These issues are the focus of IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants), a five-year project proposed under the sixth EU framework. The IDEFICS consortium comprises 25 research centres and SMEs across Europe. The planned prospective study will identify risk profile inventories for children susceptible to any of these disorders with emphasis on obesity and its co-morbid conditions. Genetic and non-genetic factors, psychosocial factors and social settings will be considered. The project will devise tailored prevention strategies that are effective, easy to implement and that account for the needs of different social groups. Population-based studies will investigate the impact of sensory perception and provide results concerning internal and external triggers of food choices and children's consumer behaviour. The ethical implications of a “right not to know” of genetic factors will be addressed. We will propose knowledge-based guidelines on dietary and lifestyle activities for health promotion and disease prevention in children for health professionals, stakeholders and consumers.

Introduction

For children in Europe the most critical changes to impact health in the last 20 years have been in social settings, and lifestyle has drastically changed during the last decades. These changes have impacted on child behaviour, with unhealthy dietary habits and low physical activity becoming the norm. The consequence has been an alarming increase in diet- and lifestyle-induced morbidity, primarily overweight and obesity, in children and a threat of a global epidemic [1]. To reverse this trend, efficient evidence-based approaches are needed immediately.

The IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) Consortium has devised an Integrated Project (IP) proposal for the 6th Framework Programme of the European Commission. This proposal first sets out to investigate the health effects of the altered environment of children, and secondly to develop and implement specific intervention approaches in order to reduce the prevalence of diet- and lifestyle-related diseases and disorders in the EU. It focuses on the key age groups of 2 to 10 years, which cover critical periods for the development of adiposity.

Section snippets

Background

Despite reports of a childhood obesity epidemic, the magnitude of the presumed increase in diet- and lifestyle-related diseases in children remains uncertain since comparable data are still missing. Published studies report prevalence data that vary between most European countries [1], [2]. However, it is not clear whether these disparities result from artefacts due to differences in measurement or classifications or whether they represent true findings. It is necessary to identify regional and

Work programme

Nutrition and physical activity obviously have a strong impact on overweight and obesity in childhood and are also thought to be involved in the development of related developmental disorders. Thus, we focus on overweight and obesity as major components of the metabolic syndrome and on associated disorders (diabetes, dyslipidaemia, hypertension). Musculo-skeletal disorders will be of interest on their own and in conjunction with overweight/obesity as they share part of the risk factor profile,

Study design and expected results

Evidence-based intervention programmes and the identification of risk factors and pathways that lead to diet- and lifestyle-related disorders in childhood constitute the groundwork of our approach. The project will be centred on population-based surveys of 17,000 2- to 10-year-old children in nine European countries. These surveys will examine risk factor profiles and the prevalence of overweight, obesity, metabolic syndrome, and postural deformity according to similar standards. Although not

Perspectives

The worldwide increase in overweight/obesity rates both in children and in adults reflects the upward shift in body weight of the whole population in response to environmental changes. Extensive changes at many societal levels are required to halt or even reverse this trend and to prevent subsequent morbidity. The IDEFICS working group will fully consider the biological and environmental determinants of overweight/obesity and related disorders in childhood. The project may give answers to

European Consortium of the IDEFICS Project

Project co-ordinator: Wolfgang Ahrens

1.
Bremen Institute for Prevention Research and Social Medicine, University of Bremen, Bremen, Germany (Wolfgang Ahrens, Iris Pigeot, Karin Bammann, Jenny Peplies, Hermann Pohlabeln)
2.
Department of Public Health/ Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium (Stefaan de Henauw, Guy de Backer, Lea Maes, Ilse de Bourdeaudhuij)
3.
Research and Education Foundation of Child Health, Strovolos, Cyprus

References (32)

J.J. Reilly
Descriptive epidemiology and health consequences of childhood obesity
Best Pract Res Clin Endocrinol Metab
(2005)
D.W. Haslam et al.
Obesity
Lancet
(2005)
T. Reinehr et al.
Cardiovascular risk factors in overweight German children and adolescents: relation to gender, age and degree of overweight
Nutr Metab Cardiovasc Dis
(2005)
I. Thorsdottir et al.
Association of birth weight and breast-feeding with coronary heart disease risk factors at the age of 6 years
Nutr Metab Cardiovasc Dis
(2003)
S.A. French et al.
Environmental interventions to promote vegetable and fruit consumption among youth in school settings
Prev Med
(2003)
K.L. Rennie et al.
Behavioural determinants of obesity
Best Pract Res Clin Endocrinol Metab
(2005)
G. de Simone
State of the heart in the metabolic syndrome
Nutr Metab Cardiovasc Dis
(2005)
A. Drewnowski et al.
Taste response and preferences for sweet high-fat foods: evidence for opioid involvement
Physiol Behav
(1992)
A. Drewnowski et al.
Taste preferences in human obesity: environmental and familial factors
Am J Clin Nutr
(1991)
B.J. Rolls et al.
Volume of food consumed affects satiety in men
Am J Clin Nutr
(1998)

D.L. Borzekowski et al.

The 30-second effect: An experiment revealing the impact of television commercials on food preferences of preschoolers

J Am Diab Assoc

(2001)

J.C. Halford et al.

The effect of television (TV) food advertisements/commercials on food consumption in children

Appetite

(2004)

Rigby N, James P. International Obesity Task Force position paper—obesity in Europe, www.iotf.org/media/euobesity.pdf;...

I.S. Farooqi

Genetic and hereditary aspects of childhood obesity

Best Pract Res Clin Endocrinol Metab

(2005)

Rodriguez G, Moreno LA. Is dietary intake able to explain differences in body fatness in children and adolescents? Nutr...

R. Weiss et al.

Obesity and the metabolic syndrome in children and adolescents

N Engl J Med

(2004)

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Parents' perception of health promotion: What do parents think of a healthy lifestyle in parenting and the impact of the school environment? A qualitative research in the Netherlands
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This study aimed at gaining insight into parents' perceptions towards health behaviour in parenting and the impact of the school environment. Healthcare professionals experience barriers to discuss health behaviour in families where levels of overweight and obesity are elevated. There is a need to understand parents' perception and perceived significance of health behaviour.
Sixty-three semi-structured interviews were conducted with parents of children from three primary schools located in two different neighbourhoods in Zwolle, the Netherlands. Parents were asked to formulate their top three priority goals in parenting, additionally supplemented with 15 predetermined goals, including a health behaviour related goal. Parents ranked the goals in order of importance and gave an explanation. Finally, parents shared their opinions regarding the school environment in promoting health behaviour, according to the EnrG framework.
In 8 out of 63 interviews, health was reported in the top three self-formulated goals. Other goals considered important were happiness and being respectful to others. When health was ranked as less important in parenting, routine of health behaviour, own beliefs and religion were given as explanations. The physical school environment and teachers were mentioned as important factors in promoting health behaviour.
Parents indicate health behaviour as a key-element in parenting, even when health behaviour is not considered as the most important priority. Practice Implications: Since school is perceived as a logical and powerful environment, healthcare professionals should collaborate with school staff to empower their own, teachers' and parents' roles to address health promotion.
Secular trend in growth and nutritional status in a sample of girls aged 7–9 years from Serbia
2018, HOMO
Citation Excerpt :
The reference systems currently used to describe the weight status of children are based on age-and sex-specific BMI. According to Ahrens and co-workers (2006: 100) at least nine different reference systems have been commonly used to classify overweight/obesity in children and adolescents. It has been shown that the references most commonly used by researchers and health practitioners can result in discrepancies in terms of prevalence rates, and therefore, caution should be applied when comparing results of different studies (Barbosa et al., 2009; Martinović et al., 2015).
Secular trend changes over time and therefore is a marker of the public health of the populations. The aim of the study is to compare the anthropometric data of 7–9 year-old girls obtained in recent investigations in Serbia with data from 1980/81, by using Z-score and percentile classification systems, according to the Center for Disease Control and Prevention – CDC anthropometric criteria. In 1980 and 1981 we used data for 800 schoolgirls aged 6.50–9.49 years. The data for the period 2011–2016 were obtained from recently conducted field investigations in certain parts of the Vojvodina region and from the East and Central Serbia. In total, 1313 girls were included in both investigations. Mean Z-score values for height-for-age, weight-for-age and BMI-for-age in the present sample were compared with the corresponding values for the period 1980/81, and also compared with the reference. The results show that nutritional status Z-scores indicate similar mean values in both investigations. The secular trend of height has slowed down, but the percentage of girls with normal weight is considerably lower in the second investigation. The results indicate that nutritional problems are more common among present generation of girls. Both the problems of underweight and overweight in girls aged 7–9 have to be addressed.
Sekularni trend se menja tokom vremena i zbog toga može biti marker javnog zdravlja jedne populacije. Cilj istraživanja je bio da se uporede antropometrijski podaci kod devojčica uzrasta 7–9 godina iz nedavnih istraživanja u Srbiji, sa podacima iz 1980/81, na osnovu Z-score i percentilne klasifikacije, prema antropometrijskom kriterijumu Centra za kontrolu i prevenciju bolesti (Center for Disease Control and Prevention – CDC). Za period tokom 1980 i 1981 godine korišćeni su podaci za 800 devojčica školskog uzrasta od 6.60 do 9.49 decimalne starosti. Podaci za period 2011–2016, dobijeni su iz nedavno sprovedenih terenskih istraživanja u određenim regionima Vojvodine, kao i istočne i centralne Srbije. Ukupno 1313 devojčica je bilo uključeno u oba istraživanja. Srednje z-score vrednosti za visinu za uzrast, masu za uzrast i BMI za uzrast, kod današnjih devojčica, poređene su sa odgovarajućim vrednostima za period 1980/81 kao i sa referentnim vrednostima. Rezultati su ukazali da Z-score indikatori nutricionog statusa pokazuju slične srednje vrednosti u oba istraživanja. Sekularni trend visine tela se usporava, međutim procenat devojčica sa normalnom masom tela je znatno niži u novijem istraživanju. Rezultati ukazuju da današnje devojčice znatno češće imaju neki nutricioni problem. Trenutno se mora raditi na smanjenju i rešavanju oba problema, kako pothranjenosti, tako i prekomerne uhranjenosti.
Physical Fitness and Metabolic Syndrome in Children with Repaired Congenital Heart Disease Compared with Healthy Children
2017, Journal of Pediatrics
Citation Excerpt :
Demographic and clinical information on medical history and current medication use were gathered from the participants' hospital files and a patient/guardian interview performed by a pediatric cardiologist. The control group included healthy Belgian children who participated in the IDEFICS (IDentification and prevention of dietary and lifestyle induced health EFfects In Children and infantS) study, which was conducted in 8 European countries (Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain, and Sweden) and aimed to identify key factors associated with the risk of developing obesity/metabolic alterations in children, as well as to design and implement specific intervention approaches to reduce the prevalence of these disorders in the European Union.28 Full information on this project has been published elsewhere.29
To determine whether children who underwent surgery for congenital heart disease (CHD) are as fit as their peers.
We studied 66 children (6-14 years) who underwent surgery for ventricular septal defect (n = 19), coarctation of aorta (n = 10), tetralogy of Fallot (n = 15), and transposition of great arteries (n = 22); and 520 healthy children (6-12 years). All children performed physical fitness tests: cardiorespiratory fitness, muscular strength, balance, flexibility, and speed. Metabolic score was assessed through z-score standardization using 4 components: waist circumference, blood pressure, blood lipids, and insulin resistance. Assessment also included self-reported and accelerometer-measured physical activity. Linear regression analyses with group (CHD vs control) as a predictor were adjusted for age, body mass index, physical activity, and parental education.
Measured physical activity level, body mass index, cardiorespiratory fitness, flexibility, and total metabolic score did not differ between children with CHD and controls, whereas reported physical activity was greater in the CHD group than control group. Boys with CHD were less strong in upper muscular strength, speed, and balance, whereas girls with CHD were better in lower muscular strength and worse in balance. High-density lipoprotein was greater in boys and girls with CHD, whereas boys with CHD showed unhealthier glucose homeostasis.
Appropriate physical fitness was achieved in children after surgery for CHD, especially in girls. Consequently, children with CHD were not at increased total metabolic risk. Lifestyle counseling should be part of every patient interaction.
Increased hair cortisol and antecedent somatic complaints in children with a first epileptic seizure
2017, Epilepsy and Behavior
Citation Excerpt :
In 2012, van Campen et al. reported that sensitivity of childhood epilepsy to stress is associated with the experienced negative life events [7]. Furthermore, one of the few studies that measured hair cortisol concentrations in children showed a positive correlation with negative life events [67]. In our study, such a connection was not revealed.
Stress is the most frequent seizure-precipitating factor reported by patients with epilepsy, while stressful life events may increase seizure susceptibility in humans. In this study, we investigated the relations between both biological and behavioral measures of stress in children with a first epileptic seizure (hereafter called seizure). We hypothesized that hair cortisol, a biomarker of chronic stress reflecting approximately 3 months of preceding exposure, might be increased in children with a first seizure. We also employed standardized questionnaires to examine presence of stress-related behavioral markers.
This was a cross-sectional clinical study investigating stress-related parameters in children with a first seizure (First Epileptic Seizure Group (FESG), n = 22) in comparison to healthy children without seizures (Control Group, n = 29). Within 24 h after a first seizure, hair samples were collected from children for the determination of cortisol. In parallel, perceived stress and anxiety and depressive symptoms were examined with appropriate self- and parent-completed questionnaires, and history of stressful life events during the past year was recorded. Emotional and behavioral problems were also assessed by parent-reported validated and widely-used questionnaires.
Higher hair cortisol measurements were observed in the FESG than control children (7.5 versus 5.0 pg/mg respectively, p = 0.001). The former were more likely to complain of somatic problems than the latter (59.8 vs. 55.4 according to DSM-oriented Scale, p = 0.021); however, there were no differences in perceived stress and anxiety or depressive symptoms between the two groups. Using ROC analysis of hair cortisol measurements for predicting disease status, the maximum sensitivity and specificity were observed for a cut-off point of 5.25 pg/mg.
Increased hair cortisol indicates chronic hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis prior to the first seizure. This might have contributed to the epileptogenesis process and may help explain the higher incidence of antecedent somatic complaints in the first seizure group.
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View all citing articles on Scopus

¹: Members of the Consortium are listed at the end of the paper.

View full text

Understanding and preventing childhood obesity and related disorders—IDEFICS: A European multilevel epidemiological approach

Abstract

Introduction

Section snippets

Background

Work programme

Study design and expected results

Perspectives

European Consortium of the IDEFICS Project

Best Pract Res Clin Endocrinol Metab

Lancet

Nutr Metab Cardiovasc Dis

Nutr Metab Cardiovasc Dis

Prev Med

Best Pract Res Clin Endocrinol Metab

Nutr Metab Cardiovasc Dis

Physiol Behav

Am J Clin Nutr

Am J Clin Nutr

J Am Diab Assoc

Appetite

Genetic and hereditary aspects of childhood obesity

Best Pract Res Clin Endocrinol Metab

Obesity and the metabolic syndrome in children and adolescents

N Engl J Med