Odysseas Androutsos

Levels of physical activity and sedentary time among 10- to 12-year-old boys and girls across 5 European countries using accelerometers: an observational study within the ENERGY-project

BackgroundThe study aim was to objectively assess levels of sedentary time, light, moderate and vigorous physical activity (PA) among 10-12 year olds across five European countries and to examine differences in sedentary time and PA according to gender and country.Methods686 children (mean age = 11.6 ± 0.8 years, 53% girls, mean BMI = 19.0 ± 3.4 kg/m2) from Belgium, Greece, Hungary, the Netherlands and Switzerland wore Actigraph accelerometers and had at least 2 weekdays with minimum 10 h-wearing time and 1 weekend day with minimum 8 h-wearing time. Data were analyzed using multivariate analyses of covariance.ResultsGirls spent significantly more time sedentary (500 minutes/day) than boys (474 minutes/day) and significantly less time in light (267 minutes/day) and moderate-to-vigorous PA (32 minutes/day) than boys (284 minutes/day; 43 minutes/day respectively; p < 0.001). 4.6% of the girls and 16.8% of the boys met moderate-to-vigorous PA recommendations of at least 60 minutes/day. Greek boys were more sedentary (510 minutes/day; all at p < 0.05) than other boys. Dutch girls were less sedentary (457 minutes/day; all at p < 0.05) than other girls. Swiss girls displayed more moderate-to-vigorous PA (43 minutes/day; at p < 0.05) than other girls.ConclusionsLarge proportions of children across different European countries did not meet PA recommendations and spent a lot of time sedentary. Mean time spent in moderate-to-vigorous PA was significantly lower than the recommended 60 minutes. Obesity prevention programmes focusing on both decreasing sedentary time and increasing light, moderate and vigorous PA are needed for European children, particularly girls.

Study protocol of physical activity and sedentary behaviour measurement among schoolchildren by accelerometry - Cross-sectional survey as part of the ENERGY-project

BackgroundPhysical activity and sedentary behaviour among children should be measured accurately in order to investigate their relationship with health. Accelerometry provides objective and accurate measurement of body movement, which can be converted to meaningful behavioural outcomes. The aim of this study was to evaluate the best evidence for the decisions on data collection and data processing with accelerometers among children resulting in a standardized protocol for use in the participating countries.Methods/DesignThis cross-sectional accelerometer study was conducted as part of the European ENERGY-project that aimed to produce an obesity prevention intervention among schoolchildren. Five countries, namely Belgium, Greece, Hungary, Switzerland and the Netherlands participated in the accelerometer study. We used three different Actigraph models-Actitrainers (triaxial), GT3Xs and GT1Ms. Children wore the device for six consecutive days including two weekend days. We selected an epoch length of 15 seconds. Accelerometers were placed at childrens waist at the right side of the body in an elastic belt.In total, 1082 children participated in the study (mean age = 11.7 ± 0.75 y, 51% girls). Non-wearing time was calculated as periods of more than 20 minutes of consecutive zero counts. The minimum daily wearing time was set to 10 hours for weekdays and 8 hours for weekend days. The inclusion criterion for further analysis was having at least three valid weekdays and one valid weekend day. We selected a cut-point (count per minute (cpm)) of <100 cpm for sedentary behaviour, <3000 cpm for light, <5200 cpm for moderate, and >5200 cpm for vigorous physical activity. We also created time filters for school-time during data cleaning in order to explore school-time physical activity and sedentary behaviour patterns in particular.DiscussionThis paper describes the decisions for data collection and processing. Use of standardized protocols would ease future use of accelerometry and the comparability of results between studies.

Self-reported TV and computer time do not represent accelerometer-derived total sedentary time in 10 to 12-year-olds

Screen-time activities are often used as proxies for sedentary time. We studied associations of self-reported television (TV), computer and total screen-time with accelerometer-derived total sedentary time in European children (10-12 years). Analyses showed significant positive associations between TV, computer and total screen-time with total sedentary time for the total sample, however, the explained variance was low and stratified analyses only revealed a significant positive association between total screen-time and total sedentary time in boys and between computer time and total sedentary time in Dutch children. This suggests that self-reported TV and computer time do not adequately reflect total sedentary time in schoolchildren.

A systematic approach for the development of a kindergarten‐based intervention for the prevention of obesity in preschool age children: the ToyBox‐study

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

Differences in Energy Balance-Related Behaviours in European Preschool Children : The ToyBox-Study

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.

Association between serum 25-hydroxyvitamin D levels and body composition in postmenopausal women: the Postmenopausal Health Study

Objective:The present study examined the association between body composition measurements, using dual-energy x-ray absorptiometry and anthropometry, with serum 25-hydroxyvitamin D levels in nonosteoporotic, postmenopausal women. Methods:Serum 25-hydroxyvitamin D, intact parathyroid hormone, insulin-like growth factor I levels, dual-energy x-ray absorptiometry measurements of fat and fat-free mass, anthropometric and handgrip strength measurements, dietary intake estimations, ultraviolet B radiation exposure, and physical activity levels were collected from 112 nonosteoporotic, postmenopausal women (age, 60.3 ± 5.0 y; body mass index, 29.5 ± 4.8 kg/m2). Results:At a bivariate level, serum 25-hydroxyvitamin D levels were inversely associated with regional and total body fat mass (P < 0.05), whereas positive associations were observed with regional and total body fat-free mass (P < 0.05). After controlling for age, serum intact parathyroid hormone, insulin-like growth factor I levels, ultraviolet B radiation exposure, and physical activity levels, most of the associations observed at a bivariate level between serum 25-hydroxyvitamin D levels and body composition indices (as obtained by dual-energy x-ray absorptiometry) remained significant. No significant associations were observed between anthropometric indices of body mass and serum 25-hydroxyvitamin D levels. Conclusions:An independent inverse association between serum 25-hydroxyvitamin D levels and dual-energy x-ray absorptiometry measurements of total body and regional fat mass was observed in nonosteoporotic, overweight, postmenopausal women. Further clinical trials are required to come to safe conclusions on whether it is the fat mass that affects serum 25-hydroxyvitamin D levels or vice versa and whether there is a need to also take into account body composition when providing recommendations for vitamin D intake in postmenopausal women.

Associations of physical activity and sedentary time with weight and weight status among 10- to 12-year-old boys and girls in Europe: a cluster analysis within the ENERGY project

Moderate‐to‐vigorous physical activity plays an important role in the prevention of childhood overweight and obesity. Sedentary time has an impact on overweight and obesity in adults, independently from moderate‐to‐vigorous physical activity. High levels of self‐reported sedentary time and moderate‐to‐vigorous physical activity can co‐exist in children.

Reliability of anthropometric measurements in European preschool children : the ToyBox-study

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.

Tools, harmonization and standardization procedures of the impact and outcome evaluation indices obtained during a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study

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

Reliability of primary caregivers reports on lifestyle behaviours of European pre‐school children: the ToyBox‐study

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.