Freia De Bock

Positive impact of a pre-school-based nutritional intervention on children's fruit and vegetable intake: results of a cluster-randomized trial.

OBJECTIVE To assess the short-term impact of a nutritional intervention aimed at reducing childhood overweight in German pre-school children. DESIGN Using a cluster-randomized study design with waiting-list controls, we tested a 6-month intervention administered once weekly by a nutrition expert consisting of joint meal preparation and activities for children and parents such as tasting and preparing nutritious, fresh foods. At baseline, 6 and 12 months, a parent-completed questionnaire assessed fruit and vegetable intakes (primary outcomes) and water and sugared drinks consumption (secondary outcomes). Direct measurement assessed BMI, skinfold thickness and waist-to-height-ratio. An intention-to-treat analysis used random-effects panel regression models to assess the intervention effect, adjusted for each childs age, gender, immigrant background and maternal education. SETTING Eighteen pre-schools from three south German regions. SUBJECTS Healthy children aged 3-6 years. RESULTS Three hundred and seventy-seven (80 %) eligible pre-school children participated in the study. Of these, 348 provided sufficient data for analysis. The sample mean age was 4·26 (sd 0·78) years; the majority (53·2 %) were boys. Childrens fruit and vegetable intakes increased significantly (P < 0·001 and P < 0·05, respectively); no significant changes in the consumption of water, sugared drinks or anthropometric measurements were noted. CONCLUSIONS Nutritional interventions in pre-schools have the potential to change eating behaviours in young children, which in the long term might reduce risk for developing overweight.

A participatory physical activity intervention in preschools: a cluster randomized controlled trial

BACKGROUND Previous studies on physical activity interventions in preschools have reported limited effectiveness. Participatory community-based approaches hold promise for increasing intervention effectiveness and involving parents as key stakeholders in a sustainable way. PURPOSE To assess whether a participatory parent-focused approach using parents as agents of behavioral change enhances the efficacy of a preschool physical activity (PA) intervention. DESIGN Two-armed, cluster-RCT with preschool as unit of randomization and children as unit of analysis. SETTING/PARTICIPANTS 39 South German preschools applying for an existing state-sponsored PA program with 826 children (52% boys, aged 5.0±0.2 years), with 441 allocated to the intervention arm. INTERVENTION Control preschools received a state-sponsored program consisting of twice-weekly gym classes over 6 months. In intervention preschools, this program was augmented by motivating parents to develop and implement their own project ideas for promoting childrens PA. MAIN OUTCOME MEASURES Primary outcomes included mean accelerometry counts and time spent in moderate- to vigorous-intensity PA or sedentary behavior. Secondary outcomes were BMI, percentage body fat, quality of life, sleep quality, and general health. Outcomes were measured at baseline and at 6 and 12 months in both study arms (time period: 2008-2010). Using an intention-to-treat-analysis, linear multilevel regression models assessed change over time and across study arms, adjusted for age, gender, season, and preschool location. Analysis was conducted in 2011. RESULTS In 15 intervention preschools, parents implemented 25 PA projects. Compared with controls, intervention arm children were 11 minutes less sedentary per day (95% CI=5.39, 17.01, p=0.014); had significantly more mean accelerometry counts (1.4 counts/15 seconds [95% CI=0.22, 2.54], p=0.019); and showed benefits in perceived general health and quality of life. All other outcomes showed no difference between study arms. CONCLUSIONS A participatory preschool intervention focusing on parents as agents of behavioral change may be able to promote PA and reduce sedentary behavior in preschoolers. These benefits may go beyond the effects of existing nonparticipatory interventions. TRIAL REGISTRATION This study is registered at clinicaltrials.gov NCT00987532.

Combining Accelerometry and HR for Assessing Preschoolers' Physical Activity

PURPOSE With rising obesity and rapidly decreasing levels of physical activity (PA) in young children, accurate PA measurement is needed for early screening and intervention evaluation. Although the combination of accelerometry (ACC) with HR recordings is accurate in assessing PA intensity in older children, its utility in correctly classifying PA in preschoolers is unknown. METHODS Thirty-three children (64% were boys) were recruited from four German preschools. Data included direct observation and Actiheart (CamNtech, Cambridge, UK) monitoring during 2.5 T 0.7 h (derivation data) and 1.5 T 0.3 h (validation data). Observers assessed PA using the Childrens Activity Rating Scale (CARS). Moderate-to-vigorous PA (MVPA) was defined by a CARS score of 4 or 5, and sedentary behavior (SB) was defined by a CARS score of 1 or 2. Actiheart recordings were linked to CARS level, with means and 95% confidence intervals calculated for ACC and HR at each observed CARS level and for MVPA/SB. Using receiver operating characteristic analysis, gender-specific ACC and HR cutoffs for correctly classifying MVPA and SB were first determined in a derivation data set and then tested in a separate validation data set of observations. RESULTS By combining HR and ACC cutoffs, 91% and 87% of the 15-s intervals observed as MVPA were correctly classified in girls and boys, respectively. Although generally lower, correct classification rates for SB were highest when only ACC cutoffs were applied (69% for girls and 67% for boys) rather than when combined cutoffs were used. CONCLUSIONS Devices that combine HR and ACC data yield an accurate classification of MVPA in preschoolers but perform less well for classifying SB. These differences underscore the need to match evaluation methods with the objectives of future PA interventions.

Lifetime indirect cost of childhood overweight and obesity: A decision analytic model

To estimate the indirect lifetime cost of childhood overweight and obesity for Germany.

Sex differences in the variables associated with objectively measured moderate-to-vigorous physical activity in preschoolers.

OBJECTIVE To investigate variables associated with objectively measured moderate-to-vigorous physical activity (MVPA) in German preschool children. METHODS Cross-sectional data was collected from 649 three to six year old children (51% boys) in 52 preschools in south Germany between autumn and spring 2008-2009. Sociodemographic, health and socio-cultural variables that could affect childrens objectively measured MVPA minutes, averaged over two to four week and weekend days, were tested in bivariate and multivariate linear regression models. RESULTS MVPA was significantly associated with the extrinsic variables age (-4.52 min/year of age), health status (5.62 min/category), high TV time (9.22 min/category) and high parental PA (6.59 min/category) among girls. For boys, only the intrinsic variable desire to be active (5.19 min/category) was significantly, positively associated with MVPA. The final models for girls and boys explained approximately 10% and 7% of the variance, respectively, in childrens MVPA. CONCLUSION We found differences by sex in variables associated with objectively measured MVPA in preschoolers. A focus on extrinsic motivators such as parental PA for girls and intrinsic motivators for boys may be an important consideration when designing interventions and PA programs for this age group.

Deformational plagiocephaly in normal infants: a systematic review of causes and hypotheses

Background Deformational plagiocephaly (DP) is one of the most prevalent abnormal findings in infants and a frequent reason for parents to seek paediatric advice. Objective To systematically review the literature and identify evidence and hypotheses on the aetiology and determinants of DP in otherwise healthy infants. Design Systematic keyword search in all major biomedical databases to identify peer-reviewed publications reporting (a) empirical research or (b) hypotheses on the aetiology of DP in healthy, term infants. 3150 studies published between 1985 and 2016 and containing relevant keywords were screened. In a two-pronged approach, results were summarised separately for the body of empirical work (22 studies) and the body of hypotheses (110 articles). Review findings Only a few empirical studies have examined risk factors in non-selected patient populations on a higher grade methodological level. The most commonly reported risk factors were: male gender, supine sleep position, limited neck rotation or preference in head position, first-born child, lower level of activity and lack of tummy time. Agreement between empirical studies was poor for most exposures, including supine sleep position, tummy time and use of car seats. The articles reporting hypotheses on the aetiology of DP cover a wide field of environmental and biological factors, but include little suggestions as to the potential influence of the everyday care environment of the baby. Conclusions and relevance The evidence on the aetiology of DP is fragmentary and heterogeneous. In addition, factors possibly relevant to the development of DP have not been appreciated in the scientific discussion.

Do our children lose vagus activity? Potential time trends of children's autonomic nervous system activity

Abbreviations: ECG, Electrocardiogram; HRV, Heart ra Nervous System; NN, Normal RR intervals; SDNN, Standa RMSSD, Square root of themean of the sumof the squares NN intervals; HF, High Frequency Index (Frequency doma Index (Frequency domain measure); HR, Heart rate. ⁎ Corresponding author at: Mannheim Institute of Publ Medicine, Medical Faculty Mannheim, Heidelberg Univer 68167 Mannheim, Germany. Tel.: +49 621 383 9914; fax E-mail address: freia.debock@medma.uni-heidelberg.d

Sweets consumption of preschool children—extent, context, and consumption patterns

ObjectivesSweets consumption is one of the risk factors of caries, especially among children. The aim of our study was to explore the extent and context of preschoolers’ sweets consumption and to identify high-risk groups.Materials and methodsThe baseline cross-sectional data used originated from a nutritional intervention study encompassing 879 parental surveys, which were obtained in 52 kindergartens in Baden-Württemberg—the third largest federal state in Germany—between September and March 2009. Our outcome variable “sweets consumption” was operationalized using food-frequency items and analyzed by testing the influence of sociodemographic, educational, cultural, and family context covariates.ResultsMost preschoolers consumed sweets every day—on average 9.7 ± 6.2 times per week. Most popular were cookies, gummy bears, and chocolate. Sweets consumption did not correlate significantly with sociodemographic factors like age and sex but rather was associated with cultural and contextual factors such as immigrant background, parental education, specific nutritional knowledge levels, and access arrangements in the home.ConclusionsThe consumption patterns identified are a result of high availability and parental influence (factors such as parents’ knowledge levels, interest in, and habits regarding their child’s nutrition).Clinical relevanceDental practitioners should place more emphasis on gathering information from young patients regarding excessive and frequent consumption of sweets and consequently on trying to educate the children and their parents on oral health risks associated with such consumption. Particular attention is to be paid to children of Turkish and Arabic decent, as they have been shown to consume above-average amounts of sweets.

Bedeutung der sportlichen Aktivität für Kinder und Jugendliche aus soziologischer und pädagogischer Perspektive

Die Entwicklungsprozesse, die Kinder und Jugendliche in physischer, psychischer und sozialer Hinsicht durchleben, sind auserst komplex. Hier kann Sportaktivitat dabei helfen, Ressourcen zu entwickeln, die bei der Bewaltigung der Entwicklungsaufgaben hilfreich sein konnen. Beispielsweise kann die Mitgliedschaft in einem Sportverein dabei helfen, soziale Normen und Werte zu verinnerlichen. Das bedeutet, Kinder und Jugendliche lernen durch den Sport soziales Handwerkzeug kennen, welches sie fur verschiedene Lebenssituationen gebrauchen konnen. Aber nicht nur sportliche Aktivitat sondern auch die reinen Alltagsbewegungen konnen positive Auswirkungen haben. Aus diesem Grund ist Bewegungsforderung bereits im Kindesalter eine wichtige Masnahme. Damit Bewegungsforderung erfolgreich sein kann, ist die Berucksichtigung bestimmter Prinzipien elementar. Demnach sollte sie in das soziale System der Kinder eingebaut werden, sie sollte nachhaltig und selbsterhaltend gestaltet sein und sie sollte als Gewohnheit in den Alltag eingebaut werden. Sowohl bei der Bewegungsforderung als auch bei der Forderung sportlicher Aktivitat ist es zudem wichtig, dass die Masnahmen dem Entwicklungsstand des Kindes entsprechen. Sowohl eine Uberforderung als auch eine Unterforderung sollten vermieden werden.

Deformational plagiocephalyThe case for an evolutionary mismatch

Abstract Lay Summary: In industrialized societies some babies develop flattening of the back part of their head. It is thought that this comes from sleeping supine, which has been shown to be the safest option for babies. However, this explanation cannot be correct from an evolutionary standpoint: why should safe sleep come at the cost of a misshaped head? Babies in industrialized societies are generally healthy. The medical problems they may be afflicted with are usually well understood. Deformational plagiocephaly presents a notable exception. In many industrialized countries, one in six babies shows posterior flattening of the skull—a feature noteworthy from an evolutionary perspective as the well rounded cranium is part of the ‘Kindchenschema’ evolved to secure care for the infant. It is commonly held that the deformation of the posterior cranium occurs as a consequence of the supine sleep position, now advocated as the safest sleep position for babies by medical experts. This explanation, however, does not fare well in the light of evolutionary theory: why should safe sleep come at the cost of a social handicap? Here, we present an alternative hypothesis that is grounded on evolutionary mismatch theory and exemplifies how evolutionary reasoning can help clarify medical conditions relevant to today’s public health.