Hanna Henriksson

Mobile-based intervention intended to stop obesity in preschool-aged children: the MINISTOP randomized controlled trial

Background: Traditional obesity prevention programs are time- and cost-intensive. Mobile phone technology has been successful in changing behaviors and managing weight; however, to our knowledge, its potential in young children has yet to be examined.Objective: We assessed the effectiveness of a mobile health (mHealth) obesity prevention program on body fat, dietary habits, and physical activity in healthy Swedish children aged 4.5 y.Design: From 2014 to 2015, 315 children were randomly assigned to an intervention or control group. Parents in the intervention group received a 6-mo mHealth program. The primary outcome was fat mass index (FMI), whereas the secondary outcomes were intakes of fruits, vegetables, candy, and sweetened beverages and time spent sedentary and in moderate-to-vigorous physical activity. Composite scores for the primary and secondary outcomes were computed.Results: No statistically significant intervention effect was observed for FMI between the intervention and control group (mean ± SD: -0.23 ± 0.56 compared with -0.20 ± 0.49 kg/m2). However, the intervention group increased their mean composite score from baseline to follow-up, whereas the control group did not (+0.36 ± 1.47 compared with -0.06 ± 1.33 units; P = 0.021). This improvement was more pronounced among the children with an FMI above the median (4.11 kg/m2) (P = 0.019). The odds of increasing the composite score for the 6 dietary and physical activity behaviors were 99% higher for the intervention group than the control group (P = 0.008).Conclusions: This mHealth obesity prevention study in preschool-aged children found no difference between the intervention and control group for FMI. However, the intervention group showed a considerably higher postintervention composite score (a secondary outcome) than the control group, especially in children with a higher FMI. Further studies targeting specific obesity classes within preschool-aged children are warranted. This trial was registered at clinicaltrials.gov as NCT02021786.

Body-composition development during early childhood and energy expenditure in response to physical activity in 1.5-y-old children

BACKGROUNDnThe prevalence of childhood overweight and obesity has increased recently, but the mechanisms involved are incompletely known. Previous research has shown a correlation between the percentage of total body fat (TBF) and physical activity level (PAL). However, the PAL values used may involve a risk of spurious correlations because they are often based on predicted rather than measured estimates of resting energy metabolism.nnnOBJECTIVESnWe studied the development of body composition during early childhood and the relation between the percentage of TBF and PAL on the basis of the measured resting energy metabolism.nnnDESIGNnBody composition was previously measured in 108 children when they were 1 and 12 wk old. When 44 of these children (21 girls and 23 boys) were 1.5 y old, their total energy expenditure and TBF were assessed by using the doubly labeled water method. Resting energy metabolism, which was assessed by using indirect calorimetry, was used to calculate PAL.nnnRESULTSnSignificant correlations were shown for TBF (r = 0.32, P = 0.035) and fat-free mass (r = 0.34, P = 0.025) between values (kg) assessed at 12 wk and 1.5 y of age. For TBF (kg) a significant interaction (P = 0.035) indicated a possible sex difference. PAL at 1.5 y was negatively correlated with the percentage of TBF (r = -0.40, P = 0.0076) and the increase in the percentage of TBF between 12 wk and 1.5 y (r = -0.38, P = 0.0105).nnnCONCLUSIONSnThe results indicate that body fatness and physical activity interact during early childhood and thereby influence obesity risk. Our results are based on a small sample, but nevertheless, they motivate additional studies in boys compared with girls regarding the development of body composition during early life.

Evaluation of Actiheart and a 7 d activity diary for estimating free-living total and activity energy expenditure using criterion methods in 1·5- and 3-year-old children.

Accurate and easy-to-use methods to assess free-living energy expenditure in response to physical activity in young children are scarce. In the present study, we evaluated the capacity of (1) 4xa0d recordings obtained using the Actiheart (mean heart rate (mHR) and mean activity counts (mAC)) to provide assessments of total energy expenditure (TEE) and activity energy expenditure (AEE) and (2) a 7xa0d activity diary to provide assessments of physical activity levels (PAL) using three sets of metabolic equivalent (MET) values (PALTorun, PALAdolph and PALAinsworth) in forty-four and thirty-one healthy Swedish children aged 1·5 and 3 years, respectively. Reference TEE, PALref and AEE were measured using criterion methods, i.e. the doubly labelled water method and indirect calorimetry. At 1·5 years of age, mHR explained 8xa0% (P=xa00·006) of the variation in TEE above that explained by fat mass and fat-free mass. At 3 years of age, mHR and mAC explained 8 (P=xa00·004) and 6 (P=xa00·03)xa0% of the variation in TEE and AEE, respectively, above that explained by fat mass and fat-free mass. At 1·5 and 3 years of age, average PALAinsworth values were 1·44 and 1·59, respectively, and not significantly different from PALref values (1·39 and 1·61, respectively). By contrast, average PALTorun (1·5 and 3 years) and PALAdolph (3 years) values were lower (P<xa00·05) than the corresponding PALref values. In conclusion, at both ages, Actiheart recordings explained a small but significant fraction of free-living energy expenditure above that explained by body composition variables, and our activity diary produced mean PAL values in agreement with reference values when using MET values published by Ainsworth.

Diet quality and attention capacity in European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

Adolescence represents an important period for the development of executive functions, which are a set of important cognitive processes including attentional control. However, very little is known regarding the associations of nutrition with components of executive functions in adolescence. Thus, the aim of this study was to investigate associations of dietary patterns and macronutrient composition with attention capacity in European adolescents. This cross-sectional study included 384 (165 boys and 219 girls) adolescents, aged 12·5-17·5 years, from five European countries in the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Attention capacity was examined using the d2 Test of Attention. Dietary intake was assessed through two non-consecutive 24 h recalls using a computer-based self-administered tool. Three dietary patterns (diet quality index, ideal diet score and Mediterranean diet score) and macronutrient/fibre intakes were calculated. Linear regression analysis was conducted adjusting for age, sex, BMI, maternal education, family affluence scale, study centre and energy intake (only for Mediterranean diet score). In these adjusted regression analyses, higher diet quality index for adolescents and ideal diet score were associated with a higher attention capacity (standardised β=0·16, P=0·002 and β=0·15, P=0·005, respectively). Conversely, Mediterranean diet score or macronutrient/fibre intake were not associated with attention capacity (P>0·05). Our results suggest that healthier dietary patterns, as indicated by higher diet quality index and ideal diet score, were associated with attention capacity in adolescence. Intervention studies investigating a causal relationship between diet quality and attention are warranted.

Prevalence of ideal cardiovascular health in European adolescents: The HELENA study

BACKGROUNDnThe ideal cardiovascular health (iCVH) construct consists of 4 health behaviours and 3 health factors and is strongly related to later cardiovascular disease. However, the prevalence of iCVH in European adolescents is currently unknown.nnnMETHODSnThe Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study is a cross-sectional, multicentre study conducted in 9 European countries during 2006-2007 and included 3528 adolescents (1683 boys and 1845 girls) between 12.5 and 17.5years of age. Status (ideal vs. non-ideal) for the health behaviours (smoking status, body mass index, physical activity and diet) and health factors (total cholesterol, blood pressure and fasting glucose) were determined.nnnRESULTSnOverall, the prevalence of ideal health behaviours was low; non-smoking (60.9% ideal), body mass index (76.8%), physical activity (62.1%), and diet (1.7%). The prevalence of ideal health factors was; total cholesterol (65.8%), blood pressure (62.0%) and plasma glucose (88.8%).nnnCONCLUSIONSnThe low prevalence of iCVH behaviours, especially diet and physical activity, identified in European adolescents is likely to influence later cardiovascular health which strongly motivates efforts to increase ideal health behaviours in this population.

Is BMI a relevant marker of fat mass in 4 year old children? Results from the MINISTOP trial

Background/objectivesDue to the increase in childhood obesity, identifying children with excess body fat as early as possible is essential. Body mass index (BMI) is commonly used as a marker of body fat in children, adolescents, and adults, yet whether BMI is a valid marker of body fat in pre-school aged children remains to be confirmed. Therefore, we analyzed the associations of BMI with fat and fat-free mass in healthy 4-year-old Swedish children.Subjects/methodsThe study comprised of 303 children (135 girls) participating in the MINISTOP obesity prevention trial. Fat and fat-free mass were measured using air displacement plethysmography and we computed fat mass index (FMI) and fat free mass index (FFMI) as fat and fat free mass (kg)/height2 (m).ResultsBMI was positively yet weakly associated with percent fat mass (boys: r2u2009=u20090.120, Pu2009<u20090.001 and girls: r2u2009=u20090.224, Pu2009<u20090.001). There was a strong association between BMI and the FMI (boys: r2u2009=u20090.468, Pu2009<u20090.001 and girls r2u2009=u20090.598, Pu2009<u20090.001) as well as between BMI and the FFMI (boys: r2u2009=u20090.621, Pu2009<u20090.001 and girls: r2u2009=u20090.499, Pu2009<u20090.001). Children classified as normal weight had a wide range of percent fat mass (12.3 to 35.3%) and FMI (1.75 to 5.78u2009kg/m2).ConclusionsBMI was strongly associated to both FMI and FFMI. Therefore, caution is needed when interpreting body fat status based on BMI values in pre-school children.

A 12-month follow-up of a mobile-based (mHealth) obesity prevention intervention in pre-school children: the MINISTOP randomized controlled trial

BackgroundTo date, few mobile health (mHealth) interventions aimed at changing lifestyle behaviors have measured long term effectiveness. At the 6-month follow-up the MINISTOP trial found a statistically significant intervention effect for a composite score comprised of fat mass index (FMI) as well as dietary and physical activity variables; however, no intervention effect was observed for FMI. Therefore, the aim of this study was to investigate if the MINISTOP intervention 12-months after baseline measurements: (i) improved FMI and (ii) had a maintained effect on a composite score comprised of FMI and dietary and physical activity variables.MethodsA two-arm parallel randomized controlled trial was conducted in 315 healthy 4.5xa0year old children between January 2014 and October 2015. Parents’ of the participating children either received the MINISTOP intervention or a basic pamphlet on dietary and physical activity behaviors (control group). After 6xa0months, participants did not have access to the intervention content and were measured again 6xa0months later (i.e. the 12-month follow-up). The Wilcoxon rank-sum test was then used to examine differences between the groups.ResultsAt the 12-month follow-up, no statistically significant difference was observed between the intervention and control groups for FMI (pu2009=u20090.57) and no maintained effect for the change in composite score was observed (meanu2009±u2009standard deviation for the intervention and control group: +u20090.53u2009±u20091.49xa0units andu2009+u20090.35u2009±u20091.27xa0units respectively, pu2009=u20090.25 between groups).ConclusionsThe intervention effect observed at the 6-month follow-up on the composite score was not maintained at the 12-month follow-up, with no effect on FMI being observed at either follow-up. Future studies using mHealth are needed to investigate how changes in obesity related markers in young children can be maintained over longer time periods.Trial registrationClinicalTrials.gov (NCT02021786; 20 Dec 2013).

Parental body mass index and its association with body composition, physical fitness and lifestyle factors in their 4-year-old children: results from the MINISTOP trial

Background/Objectives:To examine the association between parental body mass index (BMI) and their offspring’s body composition, physical fitness and lifestyle factors (that is, sedentary time, physical activity and diet).Subjects/Methods:A total of 307 preschoolers (4.5±0.1 years) and their parents (fathers: 38.1±5.1 years and mothers: 35.6±4.2 years) participated in this study. Parental BMI was calculated using self-reported weight and height. Preschoolers body composition was assessed using: BMI, fat mass percentage, fat mass index, fat-free mass index (measured via air-displacement plethysmography) and waist circumference. Physical fitness was assessed by the PREFIT fitness battery. Lifestyle factors were assessed using the ActiGraph wGT3x-BT (sedentary time and physical activity), and the mobile-phone based tool for energy balance in children (diet).Results:Parental BMI were positively associated with their offspring’s BMI (paternal BMI: standardised beta, β=0.233, P<0.001; maternal BMI: β=0.186, P=0.001), fat mass index (paternal BMI: β=0.130, P=0.026; maternal BMI: β=0.163, P=0.005), fat-free mass index (paternal BMI: β=0.214, P<0.001; maternal BMI: β=0.119, P=0.036) and waist circumference (paternal BMI: β=0.178, P=0.001; maternal BMI: β=0.179, P=0.001). A negative association was found between maternal BMI and their offspring’s standing long jump test (β=−0.132, P=0.022). Paternal BMI was associated with their offspring’s sedentary time (β=0.100, P=0.026), whereas parental BMI was not associated with neither physical activity nor diet (all P⩾0.104).Conclusions:Parental BMI was positively associated with their offspring’s BMI, fat as well as fat-free mass index and waist circumference. Moreover, a higher paternal and maternal BMI were related to higher levels of sedentary time and a lower performance in the standing long jump test of their offspring, respectively.