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OBJECTIVE: The current study examined clustering of dietary intake and activity behaviours (i.e. physical activity (PA) and sedentary behaviour) in 5-year-old children, as well as the longitudinal association with BMI and overweight development. DESIGN: Principal component analysis (PCA) was used to identify behavioural patterns. Backward regression analyses were used to examine the association of behavioural patterns with parent and child background characteristics, as well as the association of the patterns with BMI Z-score and overweight development up to ages 7 and 8 years. SETTING: The Netherlands. SUBJECTS: Data originated from the KOALA Birth Cohort Study (n 2074 at age 5 years). RESULTS: Four patterns emerged: a 'sedentary-snacking' pattern (including television viewing and snack consumption), a 'healthy intake' pattern (including healthy items such as fruit, vegetables and fish), a 'sandwich' pattern (including bread and sandwich fillings) and a 'sporty-traditional meal' pattern (including sports, meat and potatoes). The patterns were related to child gender, general appetite and various parental characteristics. The sedentary-snacking pattern was positively associated with longitudinal BMI development. CONCLUSIONS: Cross-behavioural energy balance-related behavioural patterns exist at age 5 years. Different activity types (e.g. sports, television viewing) clustered differently with the behavioural patterns, indicating the need to incorporate these different types instead of one general PA measure in energy balance-related pattern analyses. The clustering and potential synergy between activity behaviours and dietary intake, as well as the associations with weight status development, stress the importance of an integrated approach to PA and healthy nutrition promotion in preventing childhood overweight.

BACKGROUND: Insights into the effects of energy balance-related parenting practices on children's diet and activity behavior at an early age is warranted to determine which practices should be recommended and to whom. The purpose of this study was to examine child and parent background correlates of energy balance-related parenting practices at age 5, as well as the associations of these practices with children's diet, activity behavior, and body mass index (BMI) development. METHODS: Questionnaire data originated from the KOALA Birth Cohort Study for ages 5 (N = 2026) and 7 (N = 1819). Linear regression analyses were used to examine the association of child and parent background characteristics with parenting practices (i.e., diet- and activity-related restriction, monitoring and stimulation), and to examine the associations between these parenting practices and children's diet (in terms of energy intake, dietary fiber intake, and added sugar intake) and activity behavior (i.e., physical activity and sedentary time) at age 5, as well as BMI development from age 5 to age 7. Moderation analyses were used to examine whether the associations between the parenting practices and child behavior depended on child characteristics. RESULTS: Several child and parent background characteristics were associated with the parenting practices. Dietary monitoring, stimulation of healthy intake and stimulation of physical activity were associated with desirable energy balance-related behaviors (i.e., dietary intake and/or activity behavior) and desirable BMI development, whereas restriction of sedentary time showed associations with undesirable behaviors and BMI development. Child eating style and weight status, but not child gender or activity style, moderated the associations between parenting practices and behavior. Dietary restriction and monitoring showed weaker, or even undesirable associations for children with a deviant eating style, whereas these practices showed a

Objectives:Studies regarding the association of child-care use with body mass index (BMI), overweight or obesity development show contradictory results. This study examined the relationship between child-care use and BMI z-scores and overweight, as well as associates of child-care use in children up to 2 years old.Methods:Longitudinal data originated from the Dutch KOALA Birth Cohort Study. Questionnaires assessed child-care use at ages 7 months and 1 and 2 years (N=2396). Height and weight assessed at 1 and 2 years were used to calculate BMI z-scores. Overweight was defined as a BMI z-score of >/=85th percentile. The influence of child-care use on weight development was tested using backward linear and logistic regression analyses. Outcomes were: (1) BMI z-score at 1 and 2 years; (2) change in BMI z-score between 1 and 2 years; (3) overweight vs non-overweight at 1 and 2 years; and (4) change from normal weight to overweight vs remaining normal weight between 1 and 2 years. The association between child-care use and parental background characteristics was tested using backward logistic regression analyses.Results:Child-care use (no/yes) at 1 and 2 years positively predicted BMI z-scores at age 2 years, as well as change in BMI z-score between 1 and 2 years. These associations were adjusted for various covariates (for example, parental working hours). Furthermore, child-care use significantly increased the odds of being overweight at age 1year. There were few differences in BMI or overweight between intensive (>16 h per week) and limited child-care use (

Background: Previous research has shown that children in child-care do not comply with dietary intake recommendations (i.e. either exceeding or not meeting recommendations), which may be attributable to specific features of the child-care environment. The present study explored the relationship between the social and physical child-care (day-care) environment and dietary intake of 2- and 3-year-olds in Dutch child-care centres. Methods: The dietary intake of 135 children, aged 2 and 3 years, who were in child-care was assessed by observing randomly selected children at three meals (morning snack, lunch and afternoon snack) to determine dietary intake (i.e. saturated fat, dietary fibre and energy intake). The environment was observed using the Environment and Policy Assessment and Observation checklist, a structured instrument assessing the physical and social environment. Results: Children consumed a mean of 486 kJ (116 kcal) during the morning snack, 2043 kJ (488 kcal) during lunch and 708 kJ (169 kcal) during the afternoon snack. There were some gender and age differences in dietary intake. Several environmental factors (e.g. serving style and staff's model dietary behaviour) were significantly associated with the children's dietary intake. Conclusions: Overall, energy intake was in the upper range of recommended intake for children in child-care. The associations of several environmental factors with dietary intake stress the importance of the child-care environment for children's dietary behaviour. Intervening in this setting could possibly contribute to the comprehensive prevention of childhood obesity.

Based on the KOALA Birth Cohort Study and child-care observations, the home and child-care environment were examined as potential determinants of overweight in young children (age 0-7). Breast-feeding protected against overweight, probably through affecting later snacking. Parental stimulation of children’s healthy behaviours was more effective than restriction of unhealthy behaviours. Furthermore, diet and physical activity already clustered (co-occurred) at a young age. Children attending child-care appeared to be more often overweight. Observations showed the importance of child-care staff and physical environmental factors regarding diet and physical activity. The findings can be used to inform future childhood overweight prevention interventions.

OBJECTIVE: To examine clustering of energy balance-related behaviors (EBRBs) in young children. This is crucial because lifestyle habits are formed at an early age and track in later life. This study is the first to examine EBRB clustering in children as young as 2 years. STUDY DESIGN: Cross-sectional data originated from the Child, Parent and Health: Lifestyle and Genetic Constitution (KOALA) Birth Cohort Study. Parents of 2578 2-year-old children completed a questionnaire. Correlation analyses, principal component analyses, and linear regression analyses were performed to examine clustering of EBRBs. RESULTS: We found modest but consistent correlations in EBRBs. Two clusters emerged: a "sedentary-snacking cluster" and a "fiber cluster." Television viewing clustered with computer use and unhealthy dietary behaviors. Children who frequently consumed vegetables also consumed fruit and brown bread more often and white bread less often. Lower maternal education and maternal obesity were associated with high scores on the sedentary-snacking cluster, whereas higher educational level was associated with high fiber cluster scores. CONCLUSIONS: Obesity-prone behavioral clusters are already visible in 2-year-old children and are related to maternal characteristics. The findings suggest that obesity prevention should apply an integrated approach to physical activity and dietary intake in early childhood.

AB - This study examined the relationship between diet-related parenting practices, parental characteristics, child characteristics, and 2-year-old child's dietary intake. Cross-sectional data (N=2578) originated from the KOALA Birth Cohort Study. Principal component analyses revealed two restrictive parenting practice clusters: a cluster characterized by prohibition of the intake of various snacks and soft drinks, and a separate cluster characterized by prohibition of cookies and cake. Regression analyses showed that these clusters were related to the children's behavioural style (i.e. oppositional, depressive and/or aggressive behaviour) and to educational level, age and alternative lifestyle of the mother. The clusters also had a favourable influence on dietary intake (i.e. restrictive parenting practices were related to less consumption of the restricted (unhealthy) items and higher consumption of items considered to be healthy), which was moderated by child characteristics. The parenting practices showed a stronger association with dietary intake in children with a favourable behavioural style (i.e. non-depressed, low anxious, low overactive), a favourable eating style or a lower BMI. The findings suggest opportunities for preventive interventions focussing on parents of young children, and indicate that different approaches to parenting practice interventions are needed for different types of children

Item does not contain fulltext, The aim of the study is to assess the impact of perceived and objective changes in greenery on physical activity and mental health of adolescents and adults living in severely deprived neighborhoods in the Netherlands. Longitudinal data regarding changes in greenery, walking, cycling, and depressive symptoms (CES-D), were gathered for 401 adolescents and 454 adults, using questionnaires and interviews with local district managers. Multivariate linear regression models examined the association between greenery and outcome variables, correcting for demographic and socioeconomic covariates and season. Overall, the results showed small and non-significant associations, with two exceptions. Objective improvements in greenery were associated with smaller decline in adolescents' leisure time cycling, and improvements in perceived greenery were related to a decrease in adults' depressive symptoms. In addition, there were several subgroup effects. In conclusion, changes in greenery did not yield consistent positive results among residents of severely deprived neighborhoods. However, there are some indications regarding positive effects of greenery in certain subgroups.

This study examined the relationship between the physical environment characteristics of primary schools and active school transport among 3,438 5- to 12-year-old primary school children in the Netherlands. The environmental characteristics were categorized into four theory-based clusters (function, safety, aesthetics, and destination). The correlations between the clusters and active school transport were examined, and multilevel regression analyses were used to examine the association between the clusters and active school transport. No correlations were found between environmental clusters and active school transport for younger children (age 5-9), but for older children (age 9-12), strong positive correlations were found between aesthetics and active transport as were found for safety and active transport. School neighborhood aesthetics were related to active transport for older primary school children. Presence of parks, good maintenance of green spaces, and absence of litter in the school environment contributed most to the positive association between aesthetics and active school transport.

Objectives: Intersectoral collaboration (ISC) is defined as collaboration between health and non-health local government officials and is a prerequisite for the development of integrated policies that address wicked public health problems. In practice, ISC has proven to be problematic, which might be related to differing views on ISC across various policy sectors. Therefore, our objective was to explore local officials views on ISC. Methods: We interviewed 19 officials responsible for 10 different policy sectors within two small-sized municipal governments within one Dutch region. We asked interviewees about ISC facilitators and barriers and categorized them in the theory-based concepts of capability, opportunity and motivation. Results: Capability was found to be determined by the ability to share policy goals, and was more likely to increase when officials had greater motivation to continue learning. Interviewees in both municipalities expected that flatter organizational structures and coaching of officials by managers could improve ISC opportunities. When the perceived feasibility of ISC and professional autonomy was low, motivation to learn new ISC skills was low. Conclusion: In the view of government officials, ISC is an appropriate tool to address wicked public health problems, but implementing ISC requires flatter organizational structures, merging of departmental cultures and leadership by heads of departments and town clerks in order to decrease officials fears of losing professional autonomy. Public Health Service officials can play a more active role in merging cultures by increasing understanding about the multi-dimensionality of public health and reframing health goals in the terminology of the non-ealth sector.

PURPOSE: Studies estimating the contribution of physical activity (PA) development of body mass index (BMI) in critical periods of childhood warranted. Therefore, we have prospectively investigated this boys and girls of the KOALA Birth Cohort study, the Netherlands, in the around adiposity rebound (i.e., 4-9 years old). METHODS: PA was assessed children (231 boys, 239 girls) using accelerometers at the ages of 5 and and height and weight were measured at 5, 7, and 9 years. BMI z-scores calculated to standardize for age and gender. Leaner and heavier classified according to the 25th and 75th percentile of our study examine longitudinal relationships between PA and BMI z-scores, estimating equation analyses were performed, stratified for gender and weight status (leaner, normal weight, and heavier children). RESULTS: In children, an increment of 6.5 minutes of moderate to vigorous physical (MVPA) was related to a subsequent decrease of 0.03 BMI z-scores both in (95% CI = - 0.07 to - 0.001) and girls (95% CI = - 0.05 to - 0.002). physical activity was also associated with a decrease of BMI in heavier not girls. In normal weight children, MVPA was associated with decrease boys but not girls. CONCLUSION: Increments of MVPA were associated with in BMI z-score in heavier children, both boys and girls. Promoting MVPA remain a major prevention vehicle for improving body composition in 4-9 children.

Objectives: Although 'integrated' public health policies are assumed to be the ideal way to optimize public health, it remains hard to determine how far removed we are from this ideal, since clear operational criteria and defining characteristics are lacking. Methods: A literature review identified gaps in previous operationalizations of integrated public health policies. We searched for an approach that could fill these gaps. Results: We propose the following defining characteristics of an integrated policy: (1) the combination of policies includes an appropriate mix of interventions that optimizes the functioning of the behavioral system, thus ensuring that motivation, capability and opportunity interact in such a way that they promote the preferred (health-promoting) behavior of the target population, and (2) the policies are implemented by the relevant policy sectors from different policy domains. Conclusion: Our criteria should offer added value since they describe pathways in the process towards formulating integrated policy. The aim of introducing our operationalization is to assist policy makers and researchers in identifying truly integrated cases. The Behavior Change Wheel proved to be a useful framework to develop operational criteria to assess the current state of integrated public health policies in practice. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

The childhood obesity epidemic can be best tackled by means of an integrated approach, which is enabled by integrated public health policies, or Health in All Policies. Integrated policies are developed through intersectoral collaboration between local government policy makers from health and nonhealth sectors. Such intersectoral collaboration has been proved to be difficult. In this study, we investigated which resources influence intersectoral collaboration. The behavior change wheel framework was used to categorize motivation-, capability-, and opportunity-related resources for intersectoral collaboration. In-depth interviews were held with eight officials representing 10 non-health policy sectors within a local government. Results showed that health and non-health policy sectors did not share policy goals, which decreased motivation for intersectoral collaboration. Awareness of the linkage between health and nonhealth policy sectors was limited, and management was not involved in creating such awareness, which reduced the capability for intersectoral collaboration. Insufficient organizational resources and structures reduced opportunities for intersectoral collaboration. To stimulate intersectoral collaboration to prevent childhood obesity, we recommend that public health professionals should reframe health goals in the terminology of nonhealth policy sectors, that municipal department managers should increase awareness of public health in non-health policy sectors, and that flatter organizational structures should be established.

Preschools offer two main opportunities, recess and physical education (PE), for preschool children to participate in physical activity (PA) and are considered a suitable institution for PA promotion given the large number of children enrolled. Although PE can have a meaningful effect on preschoolers' PA levels, preschool PE characteristics associated with increased PA have, to the best of our knowledge, not been identified. Therefore, the purpose of the present study was to examine preschooler's PA levels and the associations with lesson context, teacher behavior, and environment during preschool physical education. A random sample of 573 preschoolers (288 boys: M-age = 5.4 years, SD = 0.4) from 35 preschools was examined during one PE class. Findings indicated that preschoolers accumulated 12 min (33%) of moderate-to-vigorous PA (MVPA), 5 min (13%) of light PA, and 20 min (54%) of sedentary behavior during PE. Forty-seven percent of the variance in pupils' MVPA may be attributed to differences between PE classes. Less knowledge content, less promotion, less management, less preschoolers per 100 m(2), using obstruction material, and not using throwing equipment were significantly associated with higher MVPA levels. These predictors explained 56% of the variance in MVPA at the PE class-level. To conclude, PE in its current format contributes only a small amount to the PA requirements of preschoolers. Preschoolers' MVPA levels were related to modifiable PE characteristics indicating that preschool PE can be restructured to increase MVPA.