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Cheng, L., Pohlabeln, H., Ahrens, W., Lauria, F., Veidebaum, T., Chadjigeorgiou, C., . . . Hebestreit, A. (2020). Cross-sectional and longitudinal associations between physical activity, sedentary behaviour and bone stiffness index across weight status in European children and adolescents. International Journal of Behavioral Nutrition and Physical Activity, 17(1), Article ID 54.
Open this publication in new window or tab >>Cross-sectional and longitudinal associations between physical activity, sedentary behaviour and bone stiffness index across weight status in European children and adolescents
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2020 (English)In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 17, no 1, article id 54Article in journal (Refereed) Published
Abstract [en]

Background: The associations between physical activity (PA), sedentary behaviour (SB) and bone health may be differentially affected by weight status during growth. This study aims to assess the cross-sectional and longitudinal associations between PA, SB and bone stiffness index (SI) in European children and adolescents, taking the weight status into consideration. Methods: Calcaneus SI was first measured by quantitative ultrasound among children aged 2-9 years old in 2007/08. It was measured again after 2 years in the IDEFICS study and after 6 years in the I. Family study. A sample of 2008 participants with time spent at sports clubs, watching TV and playing computer/games self-reported by questionnaire, and a subsample of 1037 participants with SB, light PA (LPA) and moderate-to-vigorous PA (MVPA) objectively measured using Actigraph accelerometers were included in the analyses. Weight status was defined as thin/normal and overweight/obese according to the extended International Obesity Task Force criteria. Linear mixed-effects models were used to estimate the cross-sectional and longitudinal associations between PA, SB and SI percentiles, stratified by weight status. Results: The cross-sectional association between weekly duration of watching TV and SI percentiles was negative in thin/normal weight group (β =-0.35, p = 0.008). However, baseline weekly duration of watching TV (β =-0.63, p = 0.021) and change after 2 years (β =-0.63, p = 0.022) as well as the change in weekly duration of playing computer/games after 6 years (β =-0.75, p = 0.019) were inversely associated with corresponding changes in SI percentiles in overweight/obese group. Change in time spent at sports clubs was positively associated with change in SI percentiles after 2 years (β = 1.28, p = 0.001), with comparable effect sizes across weight status. In the subsample with accelerometer data, we found a positive cross-sectional association between MVPA and SI percentiles in thin/normal weight group. Baseline MVPA predicted changes in SI percentiles after 2 and 6 years in all groups. Conclusions: Our results suggested the beneficial effect of PA on SI. However, the increasing durations of screen-based SB might be risk factors for SI development, especially in overweight/obese children and adolescents. © 2020 The Author(s).

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Bone stiffness index, Observational study, Overweight, Physical activity, Sedentary behaviour
National Category
Pediatrics Public Health, Global Health, Social Medicine and Epidemiology Sport and Fitness Sciences
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-18445 (URN)10.1186/s12966-020-00956-1 (DOI)32345301 (PubMedID)2-s2.0-85084107131 (Scopus ID)
Available from: 2020-05-14 Created: 2020-05-14 Last updated: 2020-05-26Bibliographically approved
Iglesia, I., Intemann, T., De Miguel-Etayo, P., Pala, V., Hebestreit, A., Wolters, M., . . . Moreno, L. A. (2020). Dairy consumption at snack meal occasions and the overall quality of diet during childhood: Prospective and cross-sectional analyses from the idefics/i.family cohort. Nutrients, 12(3), Article ID 642.
Open this publication in new window or tab >>Dairy consumption at snack meal occasions and the overall quality of diet during childhood: Prospective and cross-sectional analyses from the idefics/i.family cohort
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2020 (English)In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 12, no 3, article id 642Article in journal (Refereed) Published
Abstract [en]

There is scarce information on the influence of dairy consumption between main meals on the overall diet quality through childhood, constituting the main aim of this research. From the Identification and prevention of Dietary-and lifestyle induced health EFfects In Children and infantS (IDEFICS) study, and based on the data availability in each period due to drop outs, 8807 children aged 2 to 9.9 years from eight European countries at baseline (T0: 2007–2008); 5085 children after two years (T1); and 1991 after four years (T3), were included in these analyses. Dietary intake and the Diet Quality Index (DQI) were assessed by two 24 hours dietary recalls (24-HDR) and food frequency questionnaire. Consumption of milk and yogurt (p = 0.04) and cheese (p < 0.001) at snack meal occasions was associated with higher DQI scores in T0; milk and yogurt (p < 0.001), and cheese (p < 0.001) in T1; and cheese (p = 0.05) in T3. Consumers of milk (p = 0.02), yogurt (p < 0.001), or cheese (p < 0.001) throughout T0 and T1 at all snack moments had significantly higher scores of DQI compared to non-consumers. This was also observed with the consumption of cheese between T1 and T3 (p = 0.03). Consumption of dairy products at snack moments through childhood is associated with a better overall diet quality, being a good strategy to improve it in this period. 

Place, publisher, year, edition, pages
MDPI, 2020
Keywords
Children, Dairy, Diet quality, Snack
National Category
Nutrition and Dietetics Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-18335 (URN)10.3390/nu12030642 (DOI)32121167 (PubMedID)2-s2.0-85080858522 (Scopus ID)
Note

consortia on behalf of the IDEFICS/I.Family

Available from: 2020-03-20 Created: 2020-03-20 Last updated: 2020-04-22
Graffe, M. I., Pala, V., De Henauw, S., Eiben, G., Hadjigeorgiou, C., Iacoviello, L., . . . Moreno, L. A. (2020). Dietary sources of free sugars in the diet of European children: the IDEFICS Study. European Journal of Nutrition, 59(3), 979-989
Open this publication in new window or tab >>Dietary sources of free sugars in the diet of European children: the IDEFICS Study
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2020 (English)In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 59, no 3, p. 979-989Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To report dietary free sugars consumption and their different types and food sources in European children.

METHODS: The present study is based on the IDEFICS study, a European multicenter cohort study in children (2-9 years old) from eight countries, comprising 8308 children (51.4% males). Dietary intake of the previous 24 h was assessed using a computer-assisted 24-h dietary recalls (24-HDR) and the different types of sugars were assessed using the German food composition database.

RESULTS: Mean total energy intake was 1720 (SD 477) kcal/d for boys and 1631 (SD 451) kcal/d for girls. Total sugars intake was 98 (SD 52) g/day for boys and 93 (SD 49) g/day for girls. Free sugars intake was 81 (SD 49) g/day for boys and 77 (SD 47) g/day for girls. Girls had significantly lower intakes of energy, total and free sugars compared with than boys but did not differ in terms of percent of energy from total (23%) or free sugars (18%). There were large variations between countries in average % energy from free sugars (ranging from 13% in Italy to 27% in Germany). Less than 20% of children were within the recommended intake of 10% of energy from free sugars. The food groups that contributed substantially to free sugars intakes were "Fruit juices", "Soft drinks", "Dairy" and "Sweets and candies".

CONCLUSIONS: The contribution of free sugars to total energy intake in European children is higher than recommendations. The main food contributors to free sugars intake are sweetened beverages ("Fruit juices" and "Soft drinks"). It is especially important to reduce children's intake of free sugars, focusing in target population on certain foods and food groups.

Place, publisher, year, edition, pages
Springer, 2020
Keywords
Children, Food sources, Free sugars, Sugar recommendations, Sugar sweetened beverages
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nutrition and Dietetics
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-18389 (URN)10.1007/s00394-019-01957-y (DOI)000521741500012 ()30949765 (PubMedID)2-s2.0-85064335589 (Scopus ID)
Available from: 2020-04-16 Created: 2020-04-16 Last updated: 2020-04-30Bibliographically approved
Santaliestra-Pasías, A. M., González-Gil, E. M., Pala, V., Intemann, T., Hebestreit, A., Russo, P., . . . Moreno, L. A. (2020). Predictive associations between lifestyle behaviours and dairy consumption: The IDEFICS study. NMCD. Nutrition Metabolism and Cardiovascular Diseases, 30(3), 514-522
Open this publication in new window or tab >>Predictive associations between lifestyle behaviours and dairy consumption: The IDEFICS study
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2020 (English)In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 30, no 3, p. 514-522Article in journal (Refereed) Published
Abstract [en]

Background and aim: Physical activity (PA) and sedentary behaviours (SB) are related to obesity and cardiometabolic risk; however, the literature is controversial regarding the effect of dairy consumption on the development of cardiovascular disease (CVD) risk factors. The aim of this study was to assess longitudinally the relationship between specific lifestyle behaviours (PA and SB) and dairy consumption in a sample of European children and adolescents. Methods and results: Children from the IDEFICS study were included in the analyses. Two measurements, with 2 years' interval, were conducted. A total of 1688 (50.8% boys) children provided information regarding diet, measured by a 24-h dietary recall, PA measured by accelerometers and parent-reported sedentary screen time (SST) at both time points. Different combinations of these behaviours, at each survey and over time, were derived applying specific recommendations. Multilevel ordinal logistic regression and analysis of covariance were used to assess their association with dairy consumption, adjusted for potential confounders. Differences by gender were found regarding dairy product consumption and also adherence to SB and PA recommendations at T0 and T1. Children meeting both lifestyle recommendations, at the two measurement points, had higher probability to consume more milk and yogurt and less cheese than the rest of combinations. Conclusions: These results suggest that European children with a healthy lifestyle, especially regarding PA and SB over time, consumed more milk and yogurt. This study suggests that the protective effect of specific dairy products found in literature could be partially due to the association of their consumption with specific healthy lifestyles.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Children, Dairy consumption, European, IDEFICS study, Lifestyle behaviours, Physical activity, Sedentary
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nutrition and Dietetics
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-18289 (URN)10.1016/j.numecd.2019.10.006 (DOI)000516749500019 ()31791633 (PubMedID)2-s2.0-85079704892 (Scopus ID)
Note

The IDEFICS Consortium

Available from: 2020-03-06 Created: 2020-03-06 Last updated: 2020-04-22Bibliographically approved
Cheng, L., Pohlabeln, H., Ahrens, W., Russo, P., Veidebaum, T., Chadjigeorgiou, C., . . . Hebestreit, A. (2020). Sex differences in the longitudinal associations between body composition and bone stiffness index in European children and adolescents. Bone, 131, Article ID 115162.
Open this publication in new window or tab >>Sex differences in the longitudinal associations between body composition and bone stiffness index in European children and adolescents
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2020 (English)In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 131, article id 115162Article in journal (Refereed) Published
Abstract [en]

Fat mass (FM) and fat free mass (FFM) may influence bone health differentially. However, existing evidences on associations between FM, FFM and bone health are inconsistent and vary according to sex and maturity. The present study aims to evaluate longitudinal associations between FM, FFM and bone stiffness index (SI) among European children and adolescents with 6 years follow-up. A sample of 2468 children from the IDEFICS/I.Family was included, with repeated measurements of SI using calcaneal quantitative ultrasound, body composition using skinfold thickness, sedentary behaviors and physical activity using self-administrated questionnaires. Regression coefficients (β) and 99%-confidence intervals (99% CI) were calculated by sex-specified generalized linear mixed effects models to analyze the longitudinal associations between FM and FFM z-scores (zFM and zFFM) and SI percentiles, and to explore the possible interactions between zFM, zFFM and maturity. Baseline zFFM was observed to predict the change in SI percentiles in both boys (β = 4.57, 99% CI: 1.36, 7.78) and girls (β = 3.42, 99% CI: 0.05, 6.79) after 2 years. Moreover, baseline zFFM (β = 8.72, 99% CI: 3.18, 14.27 in boys and β = 5.89, 99% CI: 0.34, 11.44 in girls) and the change in zFFM (β = 6.58, 99% CI: 0.83, 12.34 in boys and β = 4.81, 99% CI: -0.41, 10.02 in girls) were positively associated with the change in SI percentiles after 6 years. In contrast, a negative association was observed between the change in zFM and SI percentiles in boys after 6 years (β = -3.70, 99% CI: -6.99, -0.42). Besides, an interaction was observed between the change in zFM and menarche on the change in SI percentiles in girls at 6 years follow-up (p = .009), suggesting a negative association before menarche while a positive association after menarche. Our findings support the existing evidences for a positive relationship between FFM and SI during growth. Furthermore, long-term FM gain was inversely associated with SI in boys, whereas opposing associations were observed across menarche in girls. 

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Body composition, Bone stiffness index, Longitudinal study, Pediatrics, Sex differences, adolescent, article, calcaneus, child, European, fat free mass, female, follow up, human, human experiment, human tissue, major clinical study, male, maturity, physical activity, quantitative analysis, questionnaire, rigidity, sedentary lifestyle, sex difference, skinfold thickness, ultrasound
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pediatrics
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-18122 (URN)10.1016/j.bone.2019.115162 (DOI)31760215 (PubMedID)2-s2.0-85077222724 (Scopus ID)
Note

"on behalf of the IDEFICS and I.Family Consortia"

Available from: 2020-01-10 Created: 2020-01-10 Last updated: 2020-04-22Bibliographically approved
Gwozdz, W., Reisch, L. A., Eiben, G., Hunsberger, M. L., Konstabel, K., Kovacs, E., . . . Wolters, M. (2020). The effect of smileys as motivational incentives on children's fruit and vegetable choice, consumption and waste: A field experiment in schools in five European countries. Food Policy, Article ID 101852.
Open this publication in new window or tab >>The effect of smileys as motivational incentives on children's fruit and vegetable choice, consumption and waste: A field experiment in schools in five European countries
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2020 (English)In: Food Policy, ISSN 0306-9192, E-ISSN 1873-5657, article id 101852Article in journal (Refereed) Epub ahead of print
Abstract [en]

To assess whether smiley stamps work as a motivational incentive to promote fruit and vegetable eating among children, we conducted a field experiment in ten primary schools in five European countries using one control and one treatment school per country. The six-week experiment was split into three two-week phases before, during and after the smiley was implemented. During the smiley phase, the children received a smiley stamp for choosing a portion of fruits or vegetables. We find an increase attributed to the smiley stamp on children's fruit and vegetable choice and consumption, but also waste. Comparing the effects across countries, we observe significant variations in the smiley effect. This study thus demonstrates, in general, that a low-cost, easy-to-implement incentive such as a smiley stamp has the potential to motivate school children to increase their fruit and vegetable consumption; the study simultaneously underscores the high relevance of context for the effects of incentives. 

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Children, Cross-country, Field experiment, Food choice, Motivational incentives
National Category
Nutrition and Dietetics Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-18338 (URN)10.1016/j.foodpol.2020.101852 (DOI)2-s2.0-85081273791 (Scopus ID)
Note

on behalf of the I.Family consortium

Available from: 2020-03-20 Created: 2020-03-20 Last updated: 2020-04-22
Steene-Johannessen, J., Eiben, G. & Ekelund, U. (2020). Variations in accelerometry measured physical activity and sedentary time across Europe - harmonized analyses of 47,497 children and adolescents. International Journal of Behavioral Nutrition and Physical Activity, 17(1), Article ID 38.
Open this publication in new window or tab >>Variations in accelerometry measured physical activity and sedentary time across Europe - harmonized analyses of 47,497 children and adolescents
2020 (English)In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 17, no 1, article id 38Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Levels of physical activity and variation in physical activity and sedentary time by place and person in European children and adolescents are largely unknown. The objective of the study was to assess the variations in objectively measured physical activity and sedentary time in children and adolescents across Europe.

METHODS: Six databases were systematically searched to identify pan-European and national data sets on physical activity and sedentary time assessed by the same accelerometer in children (2 to 9.9 years) and adolescents (≥10 to 18 years). We harmonized individual-level data by reprocessing hip-worn raw accelerometer data files from 30 different studies conducted between 1997 and 2014, representing 47,497 individuals (2-18 years) from 18 different European countries.

RESULTS: Overall, a maximum of 29% (95% CI: 25, 33) of children and 29% (95% CI: 25, 32) of adolescents were categorized as sufficiently physically active. We observed substantial country- and region-specific differences in physical activity and sedentary time, with lower physical activity levels and prevalence estimates in Southern European countries. Boys were more active and less sedentary in all age-categories. The onset of age-related lowering or leveling-off of physical activity and increase in sedentary time seems to become apparent at around 6 to 7 years of age.

CONCLUSIONS: Two third of European children and adolescents are not sufficiently active. Our findings suggest substantial gender-, country- and region-specific differences in physical activity. These results should encourage policymakers, governments, and local and national stakeholders to take action to facilitate an increase in the physical activity levels of young people across Europe.

Place, publisher, year, edition, pages
BioMed Central, 2020
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-18371 (URN)10.1186/s12966-020-00930-x (DOI)000521284000001 ()32183834 (PubMedID)2-s2.0-85081992575 (Scopus ID)
Available from: 2020-04-09 Created: 2020-04-09 Last updated: 2020-05-27Bibliographically approved
Sina, E., Buck, C., Jilani, H., Tornaritis, M., Veidebaum, T., Russo, P., . . . Hebestreit, A. (2019). Association of infant feeding patterns with taste preferences in European children and adolescents: A retrospective latent profile analysis. Nutrients, 11(5), 1-16, Article ID 1040.
Open this publication in new window or tab >>Association of infant feeding patterns with taste preferences in European children and adolescents: A retrospective latent profile analysis
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2019 (English)In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 11, no 5, p. 1-16, article id 1040Article in journal (Refereed) Published
Abstract [en]

The aim was to investigate associations between the duration of infant feeding practices (FP) and taste preferences (TP) in European children and adolescents. A total of 5526 children (6-16 years old) of the I.Family study completed a Food and Beverage Preference Questionnaire to measure their preferences for sweet, fatty and bitter tastes. Mothers retrospectively reported the FPs duration in months: exclusive breastfeeding (EBF), exclusive formula milk feeding (EFMF), combined breastfeeding (BF&FMF) and the age at the introduction of complementary foods (CF). Using logistic regression analyses and latent class analysis (latent profiles of FP and CF were identified), we explored associations between profiles and TP, adjusting for various covariates, including the Healthy Diet Adherence Score (HDAS). A total of 48% of children had short durations of EBF (≤4 months) and BF&FMF (≤6 months) and were introduced to CF early (<6 months). No significant relationship was observed between the single FPs and TP, even when considering common profiles of FP. HDAS was inversely associated with sweet and fatty TP, but positively with bitter TP. Contrary to our hypotheses, we did not observe associations between FP and children’s TP later in life. Further studies with higher FP variation and longitudinal design are needed to investigate the causal associations between infant FP and taste preferences later in life. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
Breastfeeding, Children, Formula milk, Healthy diet adherence, I.Family, IDEFICS study, Taste preference, adolescent, article, artificial milk, bitter taste, breast feeding, child, European, feeding behavior, female, healthy diet, human, human experiment, latent class analysis, major clinical study, mother, questionnaire, retrospective study
National Category
Public Health, Global Health, Social Medicine and Epidemiology Pediatrics Nutrition and Dietetics
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17232 (URN)10.3390/nu11051040 (DOI)000471021600100 ()31075915 (PubMedID)2-s2.0-85065951480 (Scopus ID)
Available from: 2019-06-20 Created: 2019-06-20 Last updated: 2019-08-06Bibliographically approved
van Meer, F., van der Laan, L. N., Eiben, G., Lissner, L., Wolters, M., Rach, S., . . . Smeets, P. A. .. (2019). Development and body mass inversely affect children's brain activation in dorsolateral prefrontal cortex during food choice. NeuroImage, 201, 1-10, Article ID 116016.
Open this publication in new window or tab >>Development and body mass inversely affect children's brain activation in dorsolateral prefrontal cortex during food choice
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2019 (English)In: NeuroImage, ISSN 1053-8119, E-ISSN 1095-9572, Vol. 201, p. 1-10, article id 116016Article in journal (Refereed) Published
Abstract [en]

Childhood obesity is a rising problem caused in part by unhealthy food choices. Food choices are based on a neural value signal encoded in the ventromedial prefrontal cortex, and self-control involves modulation of this signal by the dorsolateral prefrontal cortex (dlPFC). We determined the effects of development, body mass (BMI Cole score) and body mass history on the neural correlates of healthy food choice in children. 141 children (aged 10-17y) from Germany, Hungary and Sweden were scanned with fMRI while performing a food choice task. Afterwards health and taste ratings of the foods were collected. In the food choice task children were asked to consider the healthiness or tastiness of the food or to choose naturally. Overall, children made healthier choices when asked to consider healthiness. However, children who had a higher weight gain per year chose less healthy foods when considering healthiness but not when choosing naturally. Pubertal development stage correlated positively while current body mass correlated negatively with dlPFC activation when accepting foods. Pubertal development negatively and current body mass positively influenced the effect of considering healthiness on activation of brain areas involved in salience and motivation. In conclusion, children in earlier stages of pubertal development and children with a higher body weight exhibited less activation in the dlPFC, which has been implicated in self-control during food choice. Furthermore, pubertal development and body mass influenced neural responses to a health cue in areas involved in salience and motivation. Thus, these findings suggest that children in earlier stages of pubertal development, children with a higher body mass gain and children with overweight may possibly be less susceptible to healthy eating interventions that rely on self-control or that highlight health aspects of food. 

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Development, Overweight, Decision making, fMRI, Food choice
National Category
Psychology (excluding Applied Psychology)
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17504 (URN)10.1016/j.neuroimage.2019.116016 (DOI)000487755700008 ()31310861 (PubMedID)2-s2.0-85069629740 (Scopus ID)
Note

on behalf of the I.Family Consortium

Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-11-11Bibliographically approved
Oli, N., Vaidya, A., Eiben, G. & Krettek, A. (2019). Effectiveness of health promotion regarding diet and physical activity among Nepalese mothers and their young children: The Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) trial. Global Health Action, 12, 1-12, Article ID 1670033.
Open this publication in new window or tab >>Effectiveness of health promotion regarding diet and physical activity among Nepalese mothers and their young children: The Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) trial
2019 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, p. 1-12, article id 1670033Article in journal (Refereed) Published
Abstract [en]

Background: Nepal, like many low- and middle-income countries, exhibits rising burden of cardiovascular diseases. Misconceptions, poor behavior, and a high prevalence of risk factors contribute to this development. Health promotion efforts along with primary prevention strategies, including risk factor reduction in both adults and children, are therefore critical. Objectives: This study assessed the effectiveness of a health promotion intervention on mothers' knowledge, attitude and practice (KAP) and their children's behavior regarding diet and physical activity. Methods: The Heart-health Associated Research, Dissemination and Intervention in the Community (HARDIC), a community-based trial, used peer education to target mothers with 1-9-year-old children in the peri-urban Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal, during August-November 2016. In the intervention area, 47 peer mothers were trained to conduct four education classes for about 10 fellow mothers (N = 391). After 3 months, all eligible mothers in the intervention and control areas were interviewed and the results were compared with the KAP of all eligible mothers at baseline. Results: Post-intervention, mothers' KAP median scores had improved regarding heart-healthy diet and physical activity. More mothers had 'good' KAP (>75% of maximum possible scores), and mothers with 'good' knowledge increased from 50% to 81%. Corresponding control values increased only from 58% to 63%. Mothers' attitude and practice improved. Additionally, mothers in the intervention area reported improvement in their children's diet and physical activity behavior. Moreover, Difference in Differences analysis showed that the HARDIC intervention significantly increased mothers' KAP scores and children's behavior scores in the intervention area compared to the control area. Conclusions: Our intervention improves KAP scores regarding diet and physical activity and shows potential for expansion via community health workers, volunteers, and/or local women. Moreover, HARDIC can contribute to Nepal's Package of Essential Noncommunicable Diseases Initiative, which currently lacks a specific package for health promotion.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Diet, health promotion, mothers, physical activity, young children
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-17750 (URN)10.1080/16549716.2019.1670033 (DOI)000489957600001 ()31573416 (PubMedID)2-s2.0-85072763901 (Scopus ID)
Available from: 2019-10-02 Created: 2019-10-02 Last updated: 2020-01-29
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4397-3721

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