Staffan Mårild

The IDEFICS cohort: design, characteristics and participation in the baseline survey.

Background:The European IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study was set up to determine the aetiology of overweight, obesity and related disorders in children, and to develop and evaluate a tailored primary prevention programme.Objective:This paper focuses on the aetiological element of the multicentre study, the measures and examinations, sociodemographic characteristics of the study sample and proportions of participation.Design:Prospective cohort study with an embedded intervention study that started with a baseline survey in eight countries in 2007–2008.Subjects and measurements:Baseline participants of the prospective cohort study were 16 224 children aged 2–9 years. Parents reported sociodemographic, behavioural, medical, nutritional and other lifestyle data for their children and families. Examinations of children included anthropometry, blood pressure, fitness, accelerometry, DNA from saliva and physiological markers in blood and urine. The built environment, sensory taste perception and other mechanisms of childrens food choices and consumer behaviour were studied in subgroups.Results:Between 1507 and 2567, children with a mean age of 6.0 years and an even sex distribution were recruited from each country. Of them, 82% lived in two-parent families. The distribution of standardised income levels differed by study sample, with low-income groups being strongly represented in Cyprus, Italy and Germany. At least one 24-h dietary recall was obtained for two-thirds of the children. Blood pressure and anthropometry were assessed in more than 90%. A 3-day accelerometry was performed in 46%, motor fitness was assessed in 41%, cardiorespiratory fitness in 35% and ∼11% participated in taste perception tests. The proportion of children donating venous blood, urine and saliva was 57, 86 and 88%, respectively.Conclusion:The IDEFICS cohort provides valuable data to investigate the interplay of social, environmental, genetic, physiological and behavioural factors in the development of major diet- and lifestyle-related disorders affecting children at present.

Incidence rate of first-time symptomatic urinary tract infection in children under 6 years of age

A retrospective population‐based study was performed to describe the incidence rate of first time symptomatic urinary tract infection in children under 6 y of age. A total number of 299 children was identified during the 20‐month study period in a population of 20 000 girls and 21 000 boys. The cumulative incidence rate during the first 6y of life was 6.6% for girls and 1.8% for boys. The annual incidence rate in girls of urinary tract infection/1000 at risk was between 9 and 14 for each of the six 1‐y age intervals. In girls, the proportion of febrile urinary tract infection was high during the infant year, while girls older than 2 y most often had non‐febrile infection. For infant boys, the incidence rate and the proportion of febrile urinary tract infection were comparable to that of girls, while after the first year of life urinary infection of any kind was rare, with an incidence rate of 1–2/1000 at risk.

Recent anthropometric trends among Swedish school children: evidence for decreasing prevalence of overweight in girls.

Aim: To assess the recent prevalence of overweight and obesity in 10 year old children in Göteborg, Sweden.

Prevalence trends of obesity and overweight among 10-year-old children in western Sweden and relationship with parental body mass index.

Aim: To determine the regional prevalence, secular and family‐related trends of obesity and overweight among 10‐y‐old children. Methods: A cross‐sectional study of 10‐y‐old children, born in 1990, was performed during September 2000 to June 2001 at school health centres in three communities in the western part of Sweden. Evaluation was performed in 6311 children, or 81% of the target population. Data from a cohort of children, born in 1974, who form the national growth charts, were available for comparison. Results: The mean body mass index was 17.9 kg/m2 in 10‐y‐old children born in 1990 and 17.0 kg/m2 for 10‐y‐olds born in 1974 (p < 0.0001). Of the 10‐y‐old children in 2000–2001, born in 1990, 18% were overweight and 2.9 % obese, which corresponds to a twofold increase in presence of overweight and a fourfold increase in presence of obesity among 10‐y‐old children from 1984 to 2000. There was a significant correlation between parental and child body mass index. The prevalence of obesity and being overweight appeared to be higher in children whose parents did not participate in the study.

Intra- and inter-observer reliability in anthropometric measurements in children

Introduction:Studies such as IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) seek to compare data across several different countries. Therefore, it is important to confirm that body composition indices, which are subject to intra- and inter-individual variation, are measured using a standardised protocol that maximises their reliability and reduces error in analyses.Objective:To describe the standardisation and reliability of anthropometric measurements. Both intra- and inter-observer variability of skinfold thickness (triceps, subscapular, biceps, suprailiac) and circumference (neck, arm, waist, hip) measurements were investigated in five different countries.Methods:Central training for fieldwork personnel was carried out, followed by local training in each centre involving the whole survey staff. All technical devices and procedures were standardised. As part of the standardisation process, at least 20 children participated in the intra- and inter-observer reliability test in each centre. A total of 125 children 2–5 years of age and 164 children 6–9 years of age took part in this study, with a mean age of 5.4 (±1.2) years.Results:The intra-observer technical error of measurement (TEM) was between 0.12 and 0.47 mm for skinfold thickness and between 0.09 and 1.24 cm for circumference measurements. Intra-observer reliability was 97.7% for skinfold thickness (triceps, subscapular, biceps, suprailiac) and 94.7% for circumferences (neck, arm, waist, hip). Inter-observer TEMs for skinfold thicknesses were between 0.13 and 0.97 mm and for circumferences between 0.18 and 1.01 cm. Inter-observer agreement as assessed by the coefficient of reliability for repeated measurements of skinfold thickness and circumferences was above 88% in all countries.Conclusion:In epidemiological surveys it is essential to standardise the methodology and train the participating staff in order to decrease measurement error. In the framework of the IDEFICS study, acceptable intra- and inter-observer agreement was achieved for all the measurements.

Assessment of diet, physical activity and biological, social and environmental factors in a multi-centre European project on diet- and lifestyle-related disorders in children (IDEFICS)

Obesity is a major public health problem in developed countries. We present a European project, called Identification and Prevention of Dietary and Lifestyle-induced Health Effects in Children and Infants (IDEFICS), that focuses on diet- and lifestyle-related diseases in children. This paper outlines methodological aspects and means of quality control in IDEFICS. IDEFICS will use a multicentre survey design of a population-based cohort of about 17,000 2- to 10-year-old children in nine European countries (Belgium, Cyprus, Estonia, Germany, Greece, Hungary, Italy, Spain and Sweden). The project will investigate the impact of dietary factors such as food intake and food preferences, lifestyle factors such as physical activity, psychosocial factors and genetic factors on the development of obesity and other selected diet- and lifestyle-related disorders. An intervention study will be set up in pre-school and primary school settings in eight of the survey centres. Standardised survey instruments will be designed during the first phase of the project and applied in the surveys by all centres. Standard operation procedures (SOPs) will be developed, as well as a plan for training the personnel involved in the surveys. These activities will be accompanied by a quality control strategy that will encompass the evaluation of process and result quality throughout the project. IDEFICS will develop comparable Europe-wide health indicators and instruments for data collection among young children. Establishment of a new European cohort within IDEFICS will provide a unique opportunity to document the development of the obesity epidemic in the current generation of young Europeans and investigate the impact of primary prevention in European children populations.

The IDEFICS community-oriented intervention programme: a new model for childhood obesity prevention in Europe?

Background and objectives:The European Union—as well as other parts of the world—faces a major challenge of increasing incidence of overweight/obesity. In particular, the increase in childhood obesity gives rise to a strong imperative for immediate action. Yet, little is known about the effectiveness of community interventions, and further research in this field is needed. There is, however, a growing consensus that such research should start from the paradigm that the current living environments tend to counteract healthy lifestyles. Questioning these environments thoroughly can help to develop new pathways for sustainable health-promoting communities. Against this background, the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study developed and implemented innovative community-oriented intervention programmes for obesity prevention and healthy lifestyle primarily in children aged 2–10 years in eight European countries: Sweden, Estonia, Germany, Belgium, Hungary, Italy, Spain and Cyprus.Materials and methods:The IDEFICS community-oriented intervention study mobilised an integrated set of interventional efforts at different levels of society, with the aim of facilitating the adoption of a healthy obesity-preventing lifestyle. The overall programme has been composed of 10 modules: three at community level, six at school level and one for parents. The main focus was on diet, physical activity and stress-coping capacity. The sphere of action encompassed both children and their (grand) parents, schools, local public authorities and influential stakeholders in the community. All materials for the interventions were centrally developed and culturally adapted.Results:So far, the following has been achieved: focus group research, literature review and expert consultations were done in an early phase as a basis for the development of the intervention modules. The intervention mapping protocol was followed as guide for structuring the intervention research. The overall intervention programmes duration was 2 years, but a longer-term follow-up programme is under development.Conclusions:This large-scale European effort is expected to contribute significantly to the understanding of this major public health challenge.

Serum Phospholipid Fatty Acids, Adipose Tissue, and Metabolic Markers in Obese Adolescents

Objective: Fatty acid (FA) composition has a role in adipogenesis. The objective was to study serum phospholipid (PL) FAs in adolescents and their relation to abdominal adipose tissue (AT) compartments and metabolic markers.

Urinary tract infections in children below two years of age: a quality assurance project in Sweden

The objective of this study was to evaluate the basis for diagnosis and assessment of children <2 y of age with urinary tract infections (UTI) and to describe their subsequent management as currently practised in Sweden. The study was a prospective, multicentre project as part of a programme for quality assurance. A total of 2309 children (1111M, 1198F) was studied during a 2‐y period. Of the population at risk, 1.6% of both boys and girls were diagnosed with a UTI. This represents a minimum figure. Suprapubic bladder aspiration was mainly used during the first year of life, with the highest frequency in the youngest infants. Adhesive bags were used in half of the children, and the frequency increased with age. Imaging of the urinary tract was performed in 97% of the children. Vesicoureteric reflux was the most common finding, occurring in 36% of the girls and 24% of the boys. The presence of dilatation of the upper urinary tract correlated significantly to the presence and grade of reflux. Initial intravenous therapy was given to 31% of the children and long‐term antibacterial prophylaxis to 20%. Major differences were found between centres in diagnostic rate, urine sampling technique and the use of parenteral therapy. In conclusion, this study showed a high diagnostic rate of urinary infections in children below 2 y of age. The urine sampling technique was optimal (suprapubic aspiration) in half of the infants, but less reliable in the children above 1 y of age. The frequency of imaging investigations of the urinary tract was high. The strategies for diagnosis and treatment varied considerably among centres.

Prevalence and determinants of childhood overweight and obesity in European countries: pooled analysis of the existing surveys within the IDEFICS Consortium.

Objective:To pool and analyse, according to standardized criteria and using harmonized variables, the existing databases of surveys on childhood overweight and obesity carried out from 1995 to 2005 in different European countries by research groups participating in the IDEFICS project.Methods:Detailed information from seven surveys in five European countries was collected. A common database was built after harmonization of the single studies regarding sample size and age distribution. Variables were critically reviewed and harmonized according to a common protocol. On the pooled database, descriptive comparative analyses on the prevalence of overweight/obesity and association analyses of these conditions with perinatal, parental and environmental factors were performed.Results:Starting from total number of 74 871 children, data of 18 626 children were included in the common database (Belgium, n=1766; Cyprus, n=5540; Estonia, n=583; Italy, n=4480 and Sweden, n=6257). After the exclusion of children outside the defined age ranges (4–5 and 9–11 years), the analysis was conducted on 1738 younger and 12 923 older children. Relevant differences in the prevalence of overweight/obesity were observed between countries in both age groups, the highest values being observed in Italy. Age- and gender-related associations between the risk of obesity/overweight and perinatal, parental and environmental factors were observed. An increased risk of high blood pressure in overweight/obese children was consistently observed.Conclusions:The results of this collaborative work of European research centres, although providing potentially useful findings, confirmed that the validity of comparisons between communities depends critically on the comparability of the survey methods. To monitor the current epidemic of childhood obesity and develop appropriate prevention strategies, a coordinated European approach is needed to collect homogeneous sets of epidemiological data.