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Knowledge about how weather conditions affect travel behavior in different user groups and contexts is relevant for planners and policymakers to facilitate sustainable transportation systems. We aimed to assess the influence of day-to-day weather on cycling for transportation among parents of young children with access to different bike types (e-bike vs non e-bike) in a natural study setting over nine months. We hypothesized less impact of weather variability on cycling when using an e-bike compared with a non e-bike. A randomized, controlled trial was conducted in Southern Norway. The intervention group (n = 18) was in random order equipped with an e-bike with trailer for child transportation (n = 6), a cargo (longtail) bike (n = 6) and a traditional bike with trailer (n = 6), each for three months. These 18 participants reported cycling on 832 out of 3276 person-days (25%). We used dynamic structural equation modeling for intensive longitudinal data to examine the relations between daily weather conditions, bike type (e-bike vs traditional bike), and cycling (dichotomized daily at yes or no). Air temperature (positively) and wind speed (negatively) were both credible predictors of cycling, whereas the other predictors (precipitation in the morning (yes or no) and presence of snow (yes or no) were not. We added interaction terms between bike type and weather conditions, but none of the interaction terms had a credible effect on cycling. Thus, the relations between weather conditions and cycling were not moderated by bike type among parents of young children.

Background Little evidence is available about how sports participation influences psychosocial health and quality of life in children and adolescents with a disability or chronic disease. Therefore, the aim of the current study is to assess the association of sports participation with psychosocial health and with quality of life, among children and adolescents with a disability. Methods In a cross-sectional study, 195 children and adolescents with physical disabilities or chronic diseases (11% cardiovascular, 5% pulmonary, 8% metabolic, 8% musculoskeletal/orthopaedic, 52% neuromuscular and 9% immunological diseases and 1% with cancer), aged 10–19 years, completed questionnaires to assess sports participation, health-related quality of life (DCGM-37), self-perceptions and global self-worth (SPPC or SPPA) and exercise self-efficacy. Results Regression analyses showed that those who reported to participate in sports at least twice a week had more beneficial scores on the various indicators compared to their peers who did not participate in sport or less than twice a week. Those participating in sports scored better on all scales of the DCGM-37 scale, on the scales for feelings of athletic competence and children but not adolescents participating in sports reported greater social acceptance. Finally, we found a strong association between sport participation and exercise self-efficacy. Conclusions This study provides the first indications that participating in sports is beneficial for psychosocial health among children and adolescents with a disability. However, more insight is needed in the direction of the relationships.

This study aims to assess the prevalence of different modes of commuting to school and work for 10–12 year-olds and their parents; to assess the associations with demographic variables (country, sex, parental education and ethnicity) and with weight status in eight European countries. As part of the ENERGY project a cross-sectional survey was conducted in 2010 in which modes of commuting and socio-demographic variables for children (N = 7903) and one of their parents (n = 6455) were measured by questionnaires. Children's weight and height were objectively measured; parents self-reported their weight and height. Logistic multilevel regression analyses assessed the associations between mode of commuting and overweight. Differences between countries and differences in mode of commuting according to demographic variables were tested using χ2-test and Marascuilo's Post-hoc analysis. There were marked differences between countries, especially regarding cycling to school, which was common in The Netherlands and Norway and rare in Greece and Spain. Demographic variables were associated with mode of commuting in children and parents. Mode of commuting was not associated with being overweight in children, after adjustment for demographic variables. Bicycling to work, but not other modes of commuting, was significantly inversely associated with being overweight among parents (OR = 0.74 (95%CI 0.57–0.97)). Interventions targeting active commuting may promote cycling, and should take into account the differences regarding demographic variables.

IntroductionCycling for transport could integrate physical activity (PA) into daily routines and potentially increase total PA levels. However, for parents with young children, most factors affecting transport mode choice tend to facilitate car use. Greater insight is necessary into reasons for (not) using sustainable transport modes in parents with young children. Therefore, the objective of this study was to explore the experiences, including motives, perceptions, attitudes, and norms, of parents of young children by using an e-bike, a longtail bike, and a traditional bike for everyday travel to the workplace, kindergarten, and the grocery store during the autumn, winter, and spring, in nine months.MethodsSemistructured focus group interviews were conducted with 18 parents of young children residing in southern Norway. Parents were recruited through Facebook announcements and direct contact with kindergartens, selected organisations, and companies in the Kristiansand municipality. Data were analysed by systematic text condensation by using NVivo V.11.ResultsParticipants' experiences were summarised by three main themes: 'cycling is cumbersome', 'cycling reflects the desirable me', and 'breaking the cycling code'. Time use, planning, logistics, wet and cold weather, long distances, and no cycling habit were frequently mentioned barriers, and the most notable facilitator was the children's attitude towards cycling. In general, children loved to cycle and preferred cycling to driving. Additionally, the freedom and independence of cycling were emphasised and valued.ConclusionIn challenging weather conditions, parents of young children may experience cycling as cumbersome but desirable, and bike access could increase the feasibility of daily cycling.

Introduction This study aims to assess (i) the prevalence of having regular family breakfast, lunch, dinner (i.e. 5–7 days/week together with their family) among 10–12 year olds in Europe, (ii) the association between family meals and child weight status, and (iii) potential differences in having family meals according to country of residence, gender, ethnicity and parental levels of education. Methods 7716 children (mean age: 11.5 ± 0.7 years, 52% girls) in eight European countries (Belgium, Greece, Hungary, The Netherlands, Norway, Slovenia, Spain, Switzerland) participated in a cross-sectional school-based survey in 2010. Data on family meals were self-reported by the parents and children's height and weight were objectively measured to determine overweight status. Binary regression analyses assessed the associations of having regular family meals (adjusted for potential confounders) with children's overweight/obesity and to assess potential differences in having family meals according to gender, ethnicity and parental education, in the total sample and for each country respectively. Results The prevalence of regular family meals was 35%, 37% and 76% for breakfast, lunch and dinner respectively. Having regular family breakfast, but not lunch or dinner, was inversely associated with overweight (OR = 0.78 (95% CI 0.67–0.91)). Children of higher educated parents were more likely to have regular family breakfast (1.63 (95% CI 1.42–1.86)) and less likely to have regular family lunch (0.72 (95% CI 0.63–0.82)) compared to children of lower educated parents. Conclusion This study showed that having regular family breakfast – but not other family meals- was inversely associated with children's weight status., Highlights • Having regular family breakfast, but not other family meals, was inversely associated with children's overweight. • Having regular family breakfast was associated with high parental education. • Having regular family lunch was inversely associated with high parental education.

Objectives Preterm birth is the leading pregnancy outcome associated with perinatal morbidity and mortality and remains difficult to prevent. There is evidence that some modifiable maternal health characteristics may influence the risk of preterm birth. Our aim was to investigate the relationships of self-reported maternal health behaviour and psychological characteristics in nulliparous women with spontaneous preterm birth in prenatal primary care. Methods The data of our prospective study was obtained from the nationwide DELIVER multicentre cohort study (September 2009–March 2011), which was designed to examine perinatal primary care in the Netherlands. In our study, consisting of 2768 nulliparous women, we estimated the relationships of various self-reported health behaviours (smoking, alcohol consumption, folic acid supplementation, daily fruit, daily fresh vegetables, daily hot meal and daily breakfast consumption) and psychological characteristics (anxious/depressed mood and health control beliefs) with spontaneous preterm birth as a dichotomous outcome. Due to the clustering of clients within midwife practices, Generalized Estimating Equations was used for these analyses. Results Low health control beliefs was the sole characteristic significantly associated with spontaneous preterm birth (odds ratio 2.26; 95 % confidence interval 1.51, 3.39) after being adjusted for socio-demographics, anthropometrics and the remaining health behaviour and psychological characteristics. The other characteristics were not significantly associated with spontaneous preterm birth. Conclusions for Practice Maternal low health control beliefs need to be explored further as a possible marker for women at risk for preterm birth, and as a potentially modifiable characteristic to be used in interventions which are designed to reduce the risk of spontaneous preterm birth.

Background:The school environment can play an important role in the prevention of childhood overweight and obesity. Photos of the school environment may contribute to more adequate measurement of the school environment, as photos can be rated by different assessors. We aimed to examine the interrater reliability for rating characteristics of primary school environments related to physical activity and eating.Methods:Photos taken at 172 primary schools in 7 European countries were rated according to a standardized protocol. Briefly, after categorizing all photos in subsections of physical activity or eating opportunities, 2 researchers independently rated aspects of safety, functionality, aesthetics, type of food/drinks advertised, type/variety of foods provided. Interrater reliability was assessed using the intraclass correlation coefficient (ICC) and Cohen’s kappa.Results:Six subsections of the photo-rating instrument showed excellent (ICC or Cohen’s kappa ≥0.81) or good (ICC or Cohen’s kappa 0.61 to 0.80) interrater reliability. Outdoor physical activity facilities (ICC = 0.54) showed moderate, and school canteens (Cohen’s kappa = 0.05) and vending machines showed poor (Cohen’s kappa = 0.16) interrater reliability.Conclusion:Interrater reliability of the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) photo-rating instrument was good-to-excellent for 6 out of 9 characteristics of primary school environment components related to physical activity and eating.

IntroductionWe aimed to investigate whether providing parents with children in kindergarten with access to different bicycle types could influence (i) travel behavior and cycling amount, and (ii) intrinsic motivation for cycling and psychological constructs related to car use.MethodsA randomized, controlled trial was conducted in Southern Norway from September 2017 to June 2018. In total 36 parents were recruited and randomly drawn into an intervention (n = 18) or control group (n = 18). The intervention group was in random order equipped with an e-bike with trailer (n = 6), a cargo (longtail) bike (n = 6) and a traditional bike with trailer (n = 6).ResultsAt follow-up, more participants from the intervention group (vs. the control group) were classified as cyclists to the workplace (n = 7 (38.9%) vs. n = 1 (5.9%), p = 0.04), but not to the kindergarten (n = 6 (33.3%) vs. n = 2 (11.8%), p = 0.23) or to the grocery store (n = 2 (11.1%) vs. n = 0 (0%), p = 0.49). A significant (p = ≤0.05) increase in cycling frequency (0.1 to 2.0 days/week) from baseline to follow-up was found in the intervention group for all destinations and seasons, except to the grocery store during winter (p = 0.16). A decrease in frequency of car driving (-0.2 to -1.7 days/week) was found to be apparent in terms of travelling to the workplace and the kindergarten for all seasons, yet not to the grocery store for any season (p = 0.15-0.49). The intervention group (vs. the control group) reported significantly higher "intrinsic regulation" for cycling (p = 0.01) at follow-up.ConclusionAccess to different bike types for parents with children attending kindergarten resulted in overall increased cycling, decreased car use and higher intrinsic motivation for cycling. E-bikes obtained the greatest cycling amount in total, with the smallest sample variability. Hence, providing parents with children in kindergarten with access to e-bikes might result in increased and sustained cycling, also during the winter season.

The intake of fruit and vegetables is associated with beneficial health outcomes, and studies aimed at increasing fruit and vegetable intake lack long-term follow-up. The primary objective of this study was to evaluate the long-term (14-year) effects of a multicomponent school-based educational intervention targeted to increase fruit and vegetable intake in children. The secondary objective was to evaluate the potential synergistic effect between free school fruit and the educational program. A cluster randomized school-based intervention was initiated in 2001 in Norway, known as the Fruit and Vegetable Make the Marks study. In total, 38 schools were randomized; for the intervention (n = 18) and as control schools (n = 20). A subsample of the intervention schools (n = 9) were additionally given free school fruit, resulting in two intervention groups - one with and one without free fruit. Participants completed questionnaires in September 2001 (baseline, mean age 11.8), May 2002 (at the end of the intervention), May 2003, May 2005, September 2009 and throughout 2016 (mean age 26.5). Of 1950 participants, 982 (50.4%) completed the 14-year follow-up and were considered as the current study sample. Analysis yielded no 14-year effects of the educational program on fruit and vegetable intake. A synergistic effect between the educational program and free fruit was not observed either. Future studies might benefit from increased focus on more extensive parental involvement, increased home availability, and a longer intervention period. However, more long-term studies are needed to evaluate the effects of school-based interventions into adulthood. Trial registration number: Ethical approval and research clearance was obtained from The National Committees for Research Ethics in Norway (file number S-01076) and The Norwegian Centre for Research Data (file number 12395).

Background The rationale for promoting increased consumption of fruit and vegetables (FV) at an early age is based on results from previous tracking-studies, indicating that dietary habits learned in childhood sustain into adulthood. Previous tracking studies have several limitations (e.g. low study sample, few repeated measurements and/or short a follow-up period). In addition, to our knowledge, no study has shown that a dietary intervention initiated in childhood affects tracking of dietary behaviour. The main objectives in this study were therefore to assess tracking of FV and unhealthy snacks in a large sample with multiple follow-up surveys over 15-years, and whether exposure to free school fruit for one school year modified tracking. Method The longitudinal cohort-study, Fruit and Vegetables Make the Marks, included 38 randomly drawn schools in Norway; nine intervention schools received free fruit (or vegetable) in the school year 2001/2002 and 29 schools severed as control. The baseline sample included 1950 subjects, and 16–92% participated at five follow-up surveys (2002–2016). FV consumption and unhealthy snacks were measured by FFQ. Mixed models were applied to estimate overall tracking coefficients, and to assess whether the intervention modified tracking ((from baseline, from follow-up one (while intervention was running) and from follow-up two (after end of intervention)). Results Overall tracking coefficients were 0.33 for fruit, 0.36 for vegetables and differed by sex for unhealthy snacks: 0.46 males and 0.39 for females (interaction p = 0.065). Most analyses showed no significant difference in tracking between the intervention group and control group. However, from follow-up one, tracking coefficients were different for unhealthy snacks, 0.46 vs. 0.38 (interaction p = 0.036), and from follow-up two for vegetables, 0.35 vs 0.48 (p = 0.036), in the intervention group and control group, respectively. Conclusion Our results indicate low to moderate tracking of FV and unhealthy snacks from childhood to adulthood. We found little evidence that the free fruit intervention modified tracking of fruit, vegetables or unhealthy snacks. More research is needed on if or how we can influence the tracking of fruit, vegetables and unhealthy snacks consumption to improve public health.

BACKGROUND Insufficient physical activity (PA) is highly prevalent and associated with adverse health conditions and the risk of noncommunicable diseases. To increase levels of PA, effective interventions to promote PA are needed. Present-day technologies such as smartphones, smartphone apps, and activity trackers offer several possibilities in health promotion. OBJECTIVE This study aimed to explore the use and short-term effects of an app-based intervention (Active2Gether) to increase the levels of PA in young adults. METHODS Young adults aged 18-30 years were recruited (N=104) using diverse recruitment strategies. The participants were allocated to the Active2Gether-Full condition (tailored coaching messages, self-monitoring, and social comparison), Active2Gether-Light condition (self-monitoring and social comparison), and the Fitbit-only control condition (self-monitoring). All participants received a Fitbit One activity tracker, which could be synchronized with the intervention apps, to monitor PA behavior. A 12-week quasi-experimental trial was conducted to explore the intervention effects on weekly moderate-to-vigorous PA (MVPA) and relevant behavioral determinants (ie, self-efficacy, outcome expectations, social norm, intentions, satisfaction, perceived barriers, and long-term goals). The ActiGraph wGT3XBT and GT3X+ were used to assess baseline and postintervention follow-up PA. RESULTS Compared with the Fitbit condition, the Active2Gether-Light condition showed larger effect sizes for minutes of MVPA per day (regression coefficient B=3.1; 95% CI −6.7 to 12.9), and comparatively smaller effect sizes were seen for the Active2Gether-Full condition (B=1.2; 95% CI −8.7 to 11.1). Linear and logistic regression analyses for the intervention effects on the behavioral determinants at postintervention follow-up showed no significant intervention effects of the Active2Gether-Full and Active2Gether-Light conditions. The overall engagement with the Fitbit activity tracker was high (median 88% (74/84) of the days), but lower in the Fitbit condition. Participants in the Active2Gether conditions reported more technical problems than those in the Fitbit condition. CONCLUSIONS This study showed no statistically significant differences in MVPA or determinants of MVPA after exposure to the Active2Gether-Full condition compared with the Active2Gether-Light or Fitbit condition. This might partly be explained by the small sample size and the low rates of satisfaction in the participants in the two Active2Gether conditions that might be because of the high rates of technical problems.

Background: The obesity epidemic presents a major public health challenge, and a poor diet quality has been identified as one of the most important contributing factors. Whereas a sufficient fruit and vegetable consumption has been associated with several positive health outcomes, the long-term effect on overweight and obesity is unclear. Thus, the aims of this study were to investigate if one year with free school fruit had any effect on weight status 14 years later, and if it affected the birth weight of the participants’ children. Methods: In 2001, 10 -12-year old Norwegian children, received one year of free school fruit in the intervention study “Fruits and Vegetables Make the Marks” (FVMM) and in 2016, a total of 1081 participants of 2049 eligible responded to a follow-up survey. Multilevel logistic regression was used to investigate if one year of free school fruit was associated with weight status and with birthweight status of the offspring. The analyses were adjusted for gender, educational level, and the offspring analysis also for parents’ weight status, and the nested design (child/parent). Results: The odds ratios of being overweight (OR: 0.93, 95% CI: 0.70, 1.24) or having a child with high or low birth weight (OR: 0.52, 95% CI: 0.21, 1.30) in the intervention group compared to the control group were not statistically significant, 14 years after the intervention period. Conclusions: One year of free school fruit did not have an effect on weight status on the participants or birth weight of their offspring, 14 years after the intervention period. Although, results from the present study contribute to fill the knowledge gaps concerning long-term effects of public health efforts on weight status, more follow-up studies with larger samples are warranted.

Objective We assessed whether differences in children's sports participation and television time according to parental education were mediated by parental modeling. Moreover, we explored the differences between parental and child reports on parental sports participation and television time as potential mediators. Methods 5729 children and 5183 parents participating in the EuropeaN Energy balance Research to prevent excessive weight Gain among Youth (ENERGY-project) during 2010 in seven European countries provided information on sports participation and television time using validated self-report questionnaires. Multilevel country-specific mediation models analyzed the potential mediation effect of parental self-reports and child-reports on parental sports participation and television time. Results Significant mediation effect was found for parental self-reported television time in four countries (Greece, Hungary, The Netherlands and Slovenia), with the highest proportion for Slovenia (40%) and the lowest for Greece (21%). Child-reported parental television time showed mediation effect in Greece only. Parental self-reported sports participation showed significant mediation effect only in Greece. With child-reported parental sports participation, significant mediation was observed in Greece and Norway. Conclusions Parental behaviors appear to be important in explaining parental educational differences in children's sports participation and television time. However, child reports on parental behavior appear to be more relevant than parents' self-reports as correlates of children's own sports participation and television time.

BackgroundIt is well known that the prevalence of overweight and obesity is considerably higher among youth from lower socio-economic families, but there is little information about the role of some energy balance-related behaviors in the association between socio-economic status and childhood overweight and obesity. The objective of this paper was to assess the possible mediation role of energy balance-related behaviors in the association between parental education and children’s body composition.MethodsData were obtained from the cross sectional study of the “EuropeaN Energy balance Research to prevent excessive weight Gain among Youth” (ENERGY) project. 2121 boys and 2516 girls aged 10 to 12 from Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia and Spain were included in the analyses. Data were obtained via questionnaires assessing obesity related dietary, physical activity and sedentary behaviors and basic anthropometric objectively measured indicators (weight, height, waist circumference). The possible mediating effect of sugared drinks intake, breakfast consumption, active transportation to school, sports participation, TV viewing, computer use and sleep duration in the association between parental education and children’s body composition was explored via MacKinnon’s product-of-coefficients test in single and multiple mediation models. Two different body composition indicators were included in the models, namely Body Mass Index and waist circumference.ResultsThe association between parental education and children’s body composition was partially mediated by breakfast consumption, sports participation, TV viewing and computer use. Additionally, a suppression effect was found for sugared drinks intake. No mediation effect was found for active transportation and sleep duration. The significant mediators explained a higher proportion of the association between parental education and waist circumference compared to the association between parental education and BMI.ConclusionsTailored overweight and obesity prevention strategies in low SES preadolescent populations should incorporate specific messages focusing on the importance of encouraging daily breakfast consumption, increasing sports participation and decreasing TV viewing and computer use. However, longitudinal research to support these findings is needed.

Purpose Accelerometer-based wearables can provide the user with real-time feedback through the device's interface and the mobile platforms. Few studies have focused on the minute-by-minute validity of wearables, which is essential for high-quality real-time feedback. This study aims to assess the validity of the Fitbit One compared with the ActiGraph GT3x + for assessing physical activity (i.e., steps, time spent in moderate, vigorous, and moderate–vigorous physical activity) in young adults using traditional time intervals (i.e., days) and smaller time intervals (i.e., minutes and hours).Methods Healthy young adults (N = 34) wore the ActiGraph GT3x+ and a Fitbit One for 1 wk. Three aggregation levels were used: minute, hour, and day. Mixed models analyses, intraclass correlation coefficients, Bland–Altman analyses, and absolute error percentage for steps per day were conducted to analyze the validity for steps and minutes spent in moderate, vigorous, and moderate–vigorous physical activity.Results As compared with ActiGraph (mean = 9 steps per minute, 509 steps per hour and 7636 steps per day), the Fitbit One systematically overestimated physical activity for all aggregation levels: on average 0.82 steps per minute, 45 steps per hour, and 677 steps per day. Strong and significant associations were found between ActiGraph and Fitbit results for steps taken (B = 0.72–0.89). Weaker but statistically significant associations were found for minutes spent in moderate, vigorous, and moderate–vigorous physical activity for all time intervals (B = 0.39–0.57).Conclusions Although the Fitbit One overestimates the step activity compared with the ActiGraph, it can be considered a valid device to assess step activity, including for real-time minute-by-minute self-monitoring. However, agreement and correlation between ActiGraph and Fitbit One regarding time spent in moderate, vigorous, and moderate–vigorous physical activity were lower.

Background Insufficient physical activity (PA) is highly prevalent and associated with adverse health conditions and the risk of noncommunicable diseases. To increase levels of PA, effective interventions to promote PA are needed. Present-day technologies such as smartphones, smartphone apps, and activity trackers offer several possibilities in health promotion. Objective This study aimed to explore the use and short-term effects of an app-based intervention (Active2Gether) to increase the levels of PA in young adults. Methods Young adults aged 18-30 years were recruited (N=104) using diverse recruitment strategies. The participants were allocated to the Active2Gether-Full condition (tailored coaching messages, self-monitoring, and social comparison), Active2Gether-Light condition (self-monitoring and social comparison), and the Fitbit-only control condition (self-monitoring). All participants received a Fitbit One activity tracker, which could be synchronized with the intervention apps, to monitor PA behavior. A 12-week quasi-experimental trial was conducted to explore the intervention effects on weekly moderate-to-vigorous PA (MVPA) and relevant behavioral determinants (ie, self-efficacy, outcome expectations, social norm, intentions, satisfaction, perceived barriers, and long-term goals). The ActiGraph wGT3XBT and GT3X+ were used to assess baseline and postintervention follow-up PA. Results Compared with the Fitbit condition, the Active2Gether-Light condition showed larger effect sizes for minutes of MVPA per day (regression coefficient B=3.1; 95% CI −6.7 to 12.9), and comparatively smaller effect sizes were seen for the Active2Gether-Full condition (B=1.2; 95% CI −8.7 to 11.1). Linear and logistic regression analyses for the intervention effects on the behavioral determinants at postintervention follow-up showed no significant intervention effects of the Active2Gether-Full and Active2Gether-Light conditions. The overall engagement with the Fitbit activity tracker was high (median 88% (74/84) of the days), but lower in the Fitbit condition. Participants in the Active2Gether conditions reported more technical problems than those in the Fitbit condition. Conclusions This study showed no statistically significant differences in MVPA or determinants of MVPA after exposure to the Active2Gether-Full condition compared with the Active2Gether-Light or Fitbit condition. This might partly be explained by the small sample size and the low rates of satisfaction in the participants in the two Active2Gether conditions that might be because of the high rates of technical problems.

Psychosocial stress is associated with chronic disease. We evaluated whether in the general population the number of stressful life events is associated with risk of mortality and whether this association is mediated by behavioral factors and morbidities. We conducted this study in the Hoorn cohort; a population-based cohort study among older men and women. Our main variable of interest was the number of stressful life events experienced during the previous 5 years, which were assessed by questionnaire. We calculated Cox proportional hazard ratios (HRs) for all-cause and cause-specific mortality during follow-up for those who experienced stressful life events compared to those who did not. We included 2385 participants (46% male; 62 ± 7 years). During 20 years of follow-up 834 (35%) participants died, of whom 239 (28.6%) died of cardiovascular disease. Compared to the group with no stressful life events, the age, sex and socioeconomic status adjusted HRs (with 95% confidence intervals) for all-cause mortality, for the groups who had 1 event, 2 events, 3 events and ≥4 events were 0.89 (0.72–1.09), 1.01 (0.81–1.24), 1.29 (1.00–1.66) and 1.44 (1.08–1.92), respectively. Similar results were observed for cardiovascular mortality. Mediation analysis showed that smoking, prevalent type 2 diabetes and cardiovascular disease were statistically significant mediators of the association between the number of stressful life events and mortality. Having 3 or more stressful life events is associated with a significantly increased risk for mortality in an elderly population-based cohort. This association is mediated by smoking, type 2 diabetes and cardiovascular disease.

Little is known about the mediating effects of the determinants of fruit and vegetable (FV) intake in school-based interventions that promote FV intake, and few studies have examined the impact of the degree of implementation on the effects of an intervention. The present study examined whether the degree of implementation of an intervention had an effect on children's fruit or vegetable intake and determined possible mediators of this effect. The study is part of the European PRO GREENS intervention study which aimed to develop effective strategies to promote consumption of fruit and vegetables in schoolchildren across Europe. Data from 727 Finnish children aged 11 years were used. The baseline study was conducted in spring 2009 and the follow-up study 12 months later. The intervention was conducted during the school year 2009–2010. The effects were examined using multilevel mediation analyses. A high degree of implementation of the intervention had an effect on children's fruit intake. Knowledge of recommendations for FV intake and liking mediated the association between a high degree of implementation of the intervention and an increase in the frequency of fruit intake. Knowledge of recommendations for FV intake and bringing fruits to school as a snack mediated the association between a low degree of implementation of the intervention and an increase in the frequency of fruit intake. Overall, the model accounted for 34 % of the variance in the change in fruit intake frequency. Knowledge of recommendations acted as a mediator between the degree of implementation of the intervention and the change in vegetable intake frequency. In conclusion, the degree of implementation had an effect on fruit intake, and thus in future intervention studies the actual degree of implementation of interventions should be assessed when considering the effects of interventions.

ObjectiveTo examine which factors act as mediators between parental educational level and children's fruit and vegetable (F&V) intake in ten European countries.DesignCross-sectional data were collected in ten European countries participating in the PRO GREENS project (2009). Schoolchildren completed a validated FFQ about their daily F&V intake and filled in a questionnaire about availability of F&V at home, parental facilitation of F&V intake, knowledge of recommendations about F&V intake, self-efficacy to eat F&V and liking for F&V. Parental educational level was determined from a questionnaire given to parents. The associations were examined with multilevel mediation analyses.SettingSchools in Bulgaria, Finland, Germany, Greece, Iceland, the Netherlands, Norway, Portugal, Slovenia and Sweden.SubjectsEleven-year-old children (n 8159, response rate 72%) and their parents.ResultsIn five of the ten countries, children with higher educated parents were more likely to report eating fruits daily. This association was mainly mediated by knowledge but self-efficacy, liking, availability and facilitation also acted as mediators in some countries. Parents’ education was positively associated with their children's daily vegetable intake in seven countries, with knowledge and availability being the strongest mediators and self-efficacy and liking acting as mediators to some degree.ConclusionsParental educational level correlated positively with children's daily F&V intake in most countries and the pattern of mediation varied among the participating countries. Future intervention studies that endeavour to decrease the educational-level differences in F&V intake should take into account country-specific features in the relevant determinants of F&V intake.

Objectives: This study aims to describe the time devoted to sedentary and physical activities at school in five European countries and to examine differences according to country, sex, ethnicity, parental education and weight status. Design: cross-European cross-sectional survey. Methods: Primary schoolchildren (n=1025) aged 10-12 years in Belgium, Greece, Hungary, the Netherlands, and Switzerland wore accelerometers for at least six consecutive days. Only weekdays were used for this study to calculate the percentages of school-time spent in sedentary activities and moderate to vigorous intensity activity. Trained research assistants measured height and weight. Sex and date of birth were self-reported by the child and parental education and ethnicity were parent-reported. Results: European schoolchildren spent on average 65% of their time at school in sedentary activities and 5% on moderate to vigorous intensity activities, with small differences between countries. Girls spent a significant larger amount of school-time in sedentary activities (67%) than boys (63%; p

Objective The aim of the study was to evaluate mediating effects of energy balance-related behaviors on measures of adiposity in the Dutch Obesity Intervention in Teenagers-study (DOiT). Design and Methods DOiT was an 8-month behavioral intervention program consisting of educational and environmental components and evaluated in 18 prevocational secondary schools in the Netherlands (n = 1,108, baseline age 12.7 years, 50% girls). Outcome measures were changes in body mass index (BMI), waist circumference, and sum of skinfold thickness. Self-reported consumption of sugar-containing beverages and high caloric snacks, active transport to/from school, and screen-viewing behaviors were the hypothesized mediators. Data were collected at 0, 8, 12, and 20 months. For the data analysis, parallel process latent growth modeling was used. Results Total sugar-containing beverages consumption mediated the intervention effects on BMI (ab = −0.01, 95%CI = −0.20, −0.001). The intervention group lowered their sugar-containing beverages consumption more than controls (B = −0.14, 95%CI = −0.22, −0.11) and this, in turn, led to smaller increases in BMI. No significant mediated effect by the targeted behaviors was found for waist circumference or sum of skinfolds. Conclusions Future school-based overweight prevention interventions may target decreasing sugar-containing beverages consumption.

Background The present study aims to increase bicycling and level of physical activity (PA), and thereby promote health in parents of toddlers, by giving access to different bicycle types. There is a need for greater understanding of e-bikes and their role in the transportation network, and further effects on PA levels and health. Moreover, longtail bikes could meet certain practical needs not fulfilled by e-bikes or traditional bikes, hence increased knowledge regarding their feasibility should be obtained. No previous studies have investigated whether providing an e-bike or a longtail bike over an extended period in a sample of parents of toddlers influence objectively assessed amount of bicycling and total PA level, transportation habits, cardiorespiratory fitness, body composition and blood pressure. Methods A randomized cross-over trial will be performed, entailing that participants in the intervention group (n = 18) complete the following intervention arms in random order: (i) three months access to an e-bicycle with trailer for child transportation (n = 6), (ii) three months access to a longtail bicycle (n = 6), and (iii) three months access to a regular bicycle with trailer (n = 6), in total nine months. Also, a control group (n = 18) maintaining usual transportation and PA habits will be included. A convenience sample consisting of 36 parents of toddlers residing in Kristiansand municipality, Southern Norway, will be recruited. Total amount of bicycling (distance and time), total level of PA, and transportation habits will be measured at baseline and in connection to each intervention arm. Cardiorespiratory fitness, body composition and blood pressure will be measured at baseline and post-intervention. Main outcome will be bicycling distance and time spent cycling. Discussion New knowledge relevant for the timely issues of public health and environmental sustainability will be provided among parents of toddlers, representing a target group of greatest importance. There is a call for research on the influence of e-bikes and longtail bikes on travel behavior and PA levels, and whether voluntary cycling could improve health. If the present study reveals promising results, it should be replicated in larger and more representative samples. Eventually, inclusion in national public health policies should be considered. Trial registration ID NCT03131518 , made public 26.04.2017.

CAMERON, A. J., M. M. VAN STRALEN, A. E. KUNST, S. J. TE VELDE, F. J. VAN LENTHE, J. SALMON, and J. BRUG. Macroenvironmental Factors Including GDP per Capita and Physical Activity in Europe. Med. Sci. Sports Exerc., Vol. 45, No. 2, pp. 278–285, 2013. Purpose: Socioeconomic inequalities in physical activity at the individual level are well reported. Whether inequalities in economic development and other macroenvironmental variables between countries are also related to physical activity at the country level is comparatively unstudied. Methods: We examined the relationship between country-level data on macroenvironmental factors (gross domestic product (GDP) per capita, public sector expenditure on health, percentage living in urban areas, and cars per 1000 population) with country-level physical activity prevalence obtained from previous pan-European studies. Studies that assessed leisuretime physical activity (n = 3 studies including 27 countries in adults, n = 2 studies including 28 countries in children) and total physical activity (n = 3 studies in adults including 16 countries) were analyzed separately as were studies among adults and children. Results :S trong and consistent positive correlations were observed between country prevalence of leisure-time physical activity and country GDP per capita in adults (average r = 0.70; all studies, P G 0.05). In multivariate analysis, country prevalence of leisure-time physical activity among adults remained associated with country GDP per capita (two of three studies) but not urbanization or educational attainment. Among school-age populations, no association was found between country GDP per capita and country prevalence of leisure-time physical activity. In those studies that assessed total physical activity (which also includes occupational and transport physical activity), no association with country GDP per capita was observed. Conclusion: Clear differences in national leisure-time physical activity levels throughout Europe may be a consequence of economic development. Lack of economic development of some countries in Europe may make increasing leisure-time physical activity more difficult. Further examination of the link between country GDP per capita and national physical activity levels (across

ObjectiveThe present study examined associations of several home and neighbourhood environmental variables with fruit consumption and explored whether these associations were mediated by variables derived from the Theory of Planned Behaviour (TPB) and by habit strength.DesignData of the Dutch GLOBE study on household and neighbourhood environment, fruit intake and related factors were used, obtained by self-administered questionnaires (cross-sectional), face-to-face interviews and audits.SettingThe city of Eindhoven in the NetherlandsSubjectsAdults (n 333; mean age 58 years, 54 % female).ResultsMultiple mediation analyses were conducted using regression analyses to assess the association between environmental variables and fruit consumption, as well as mediation of these associations by TPB variables and by habit strength. Intention, perceived behaviour control, subjective norm and habit strength were associated with fruit intake. None of the neighbourhood environmental variables was directly or indirectly associated with fruit intake. The home environmental variable ‘modelling behaviour by family members’ was indirectly, but not directly, associated with fruit intake. Habit strength and perceived behaviour control explained most of the mediated effect (71·9 %).ConclusionsModelling behaviour by family members was indirectly associated with fruit intake through habit strength and perceived behaviour control. None of the neighbourhood variables was directly or indirectly, through any of the proposed mediators, associated with adult fruit intake. These findings suggest that future interventions promoting fruit intake should address a combination of the home environment (especially modelling behaviour by family members), TPB variables and habit strength for fruit intake.

BACKGROUND The Active2Gether intervention is an app-based intervention designed to help and encourage young adults to become and remain physically active by means of personalized, real-time activity tracking and context-specific feedback. OBJECTIVE The objective of our study was to describe the development and content of the Active2Gether intervention for physical activity promotion. METHODS A systematic and stepwise approach was used to develop the Active2Gether intervention. This included formulating objectives and a theoretical framework, selecting behavior change techniques, specifying the tailoring, pilot testing, and describing an evaluation protocol. RESULTS The development of the Active2Gether intervention comprised seven steps: analyzing the (health) problem, developing a program framework, writing (tailored) messages, developing tailoring assessments, developing the Active2Gether intervention, pilot testing, and testing and evaluating the intervention. The primary objective of the intervention was to increase the total time spent in moderate-vigorous physical activity for those who do not meet the Dutch guideline, maintain physical activity levels of those who meet the guideline, or further increase physical activity levels if they so indicated. The theoretical framework is informed by the social cognitive theory, and insights from other theories and evidence were added for specific topics. Development of the intervention content and communication channel resulted in the development of an app that provides highly tailored coaching messages that are framed in an autonomy-supportive style. These coaching messages include behavior change techniques aiming to address relevant behavioral determinants (eg, self-efficacy and outcome expectations) and are partly context specific. A model-based reasoning engine has been developed to tailor the intervention with respect to the type of support provided by the app, send relevant and context-specific messages to the user, and tailor the graphs displayed in the app. For the input of the tailoring, different instruments and sensors are used, such as an activity monitor (Fitbit One), Web-based and mobile questionnaires, and the location services on the user’s mobile phone. CONCLUSIONS The systematic and stepwise approach resulted in an intervention that is based on theory and input from end users. The use of a model-based reasoning system to provide context-specific coaching messages goes beyond many existing eHealth and mHealth interventions.

Background: Fiber intake is associated with lower cardiovascular disease risk. Whether arterial stiffness is influenced by lifetime fiber intake is not known. Any such association could explain, at least in part, the cardioprotective effects attributed to fiber intake. Objective: The objective was to investigate whether a lower intake of fiber (and fiber-rich foods) throughout the course of young life (ie, from adolescence to adulthood) is associated with arterial stiffness in adulthood. Design: This was a longitudinal cohort study among 373 participants in whom dietary intake was assessed between the ages of 13 to 36 y (2-8 repeated measures, median of 5), and arterial stiffness estimates of 3 large arteries (ultrasonography) were ascertained at age 36 y. Results: After adjustment for sex, height, total energy intake, and other lifestyle variables, subjects with stiffer carotid arteries consumed less fiber (in g/d) during the 24-y study than did those with less stiff carotid arteries, as defined on the basis of the highest compared with the lowest sex-specific tertiles of the distensibility and compliance coefficients (reversed) and Young's elastic modulus: -1.9 (95% CI: -3.1, -0.7), -2.3 (-3.5, -1.1), and -1.3 (-2.5, -0.0), respectively. Furthermore, subjects with stiffer carotid arteries were characterized by a lower lifetime consumption of fruit, vegetables, and whole grains - deleterious associations that could be explained, to a great extent, by related low fiber intake. Conclusions: Lower lifetime intake of fiber during the course of young age is associated with carotid artery stiffness in adulthood. Promoting consumption of fiber-rich foods among the young may offer a means to prevent accelerated arterial stiffening in adulthood and related cardiovascular sequelae. © 2012 American Society for Nutrition.

Objective. To explore the association between home environmental variables and television (TV) time, and the mediating pathways underlying this association. Methods. The current study used data from the longitudinal ENDORSE study. Self-reported data was available for 1 265 adolescents (mean age of 12-15 years at baseline) on home environment (availability of a TV in the bedroom, perceived parental modelling, family rules), potential mediators (intention, attitude, perceived behavioural control, subjective norm towards TV viewing) and TV viewing time. Mediation analyses were conducted using General Estimating Equations and mediation effects were calculated as the product-of-coefficients. Results. Significant overall positive associations were found for the presence of a TV in the bedroom and parental modelling with self-reported TV viewing. Controlling family rules showed an inverse association with reported TV time. Similarly, parental modelling and a TV in the bedroom were significantly positively associated with the Theory of Planned Behaviour variables and habit strength, while family rules showed an inverse association with these potential mediators. In turn, most potential mediators were positively associated with TV viewing. Intention, attitude and habit strength were the strongest mediators in all three associations explaining more than 55% of the overall association. Habit strength alone explained 38.2%-58.0% of the overall associations. Conclusions. Home and family environmental predictors of TV time among adolescents may be strongly mediated by habit strength and other personal factors. Future intervention studies should explore if changes in home and family environments indeed lead to reductions in TV time through these mediators.

This study provides an example on how to assess the cost-effectiveness of a nation wide implementation of two school-based interventions promoting fruit and vegetable intake among primary schoolchildren in the Netherlands compared to 'no intervention' and to each other. Data collection using self-report questionnaires in both studies was conducted between 2003 and 2005. Effects of the intervention in terms of fruit and vegetable intake were assessed and epidemiological modeling (conducted in 2008) was used to estimate the number of disability-adjusted life years gained over the lifetime of all 10 years old in the Netherlands. We assumed 30% of the effect on consumption was permanent. Incremental cost effectiveness ratios (ICER) and net monetary benefits (NMB) were estimated and one-way and probabilistic sensitivity analyses were conducted. The ICER for the Pro Children intervention in comparison with no intervention was estimated at €5728/DALY and the ICER for the Schoolgruiten intervention in comparison with no intervention at €10,674/DALY. Using the Dutch per capita income as a decision threshold (€19,600) the probability that the Pro Children intervention was cost-effective in comparison with no intervention was 80% and that the Schoolgruiten intervention was cost-effective in comparison with no intervention was 68%. The Pro Children had a 70% chance of being dominant over the Schoolgruiten intervention in terms of cost-effectiveness. The current cost-effectiveness model shows that both the Pro Children intervention and the Schoolgruiten intervention were cost-effective in comparison with no intervention. Extensive sensitivity analyses showed that the conclusions were sensitive to the discount rate and the proportion of effects that remains lifelong.

The aim of this review was to systematically review the results and quality of studies investigating the moderators of school-based interventions aimed at energy balance-related behaviors. We systematically searched the electronic databases of Pubmed, EMBASE, Cochrane, PsycInfo, ERIC and Sportdiscus. In total 61 articles were included. Gender, ethnicity, age, baseline values of outcomes, initial weight status and socioeconomic status were the most frequently studied potential moderators. The moderator with the most convincing evidence was gender. School-based interventions appear to work better for girls than for boys. Due to the inconsistent results, many studies reporting non-significant moderating effects, and the moderate methodological quality of most studies, no further consistent results were found. Consequently, there is lack of insight into what interventions work for whom. Future studies should apply stronger methodology to test moderating effects of important potential target group segmentations.

This longitudinal study aimed to identify individual and environmental predictors of adolescents' sports participation and to examine whether availability of sports facilities moderated the intention-behaviour relation. Data were obtained from the ENvironmental Determinants of Obesity in Rotterdam SchoolchildrEn study (2005/2006 to 2007/2008). A total of 247 adolescents (48% boys, mean age at follow-up 15 years) completed the surveys at baseline and follow-up. At baseline, adolescents completed a survey that assessed engagement in sports participation, attitude, subjective norm, perceived behavioural control and intention towards sports participation. Availability of sports facilities (availability) was assessed using a geographic information system. At follow-up, sports participation was again examined. Multiple logistic regression analyses were conducted to test associations between availability of sports facilities, theory of planned behaviour variables and the interaction of intention by availability of sports facilities, with sports participation at follow-up. Simple slopes analysis was conducted to decompose the interaction effect. A significant availability x intention interaction effect [odds ratio: 1.10; 95% confidence interval: 1.00-1.20] was found. Simple slopes analysis showed that intention was more strongly associated with sports participation when sports facilities were more readily available. The results of this study indicate that the intention-sports participation association appears to be stronger when more facilities are available.

The aim of this study was to investigate gender, ethnic and school type differences in overweight and energy balance-related behaviours: snack, soft drink and breakfast consumption, walking, bicycling, and playing sports during leisure time, active commuting to school, television viewing and computer use among 12-15-year-old adolescents.Cross-sectional data on weight status and energy balance-related behaviours were obtained from 1 206 adolescents (2005-06). Energy balance-related behaviours were self-reported and body mass index was calculated from measured height and weight. Gender, ethnic and school type differences in weight status and behaviours were examined with multi-level logistic regression analyses.Overweight and unfavourable energy balance-related behaviours were more likely among youth from non-Western ethnic backgrounds and those attending vocational schools. Analyses stratified by ethnicity showed that girls from non-Western ethnic backgrounds were more likely to be overweight (OR = 1.5) and to report not bicycling (OR = 2.4) and watching more than two hours of television (OR = 2.3) compared with boys from non-Western ethnic backgrounds. Vocational students from Western ethnic backgrounds were more likely to report high levels of soft drink consumption (OR = 3.2), watching television (OR = 2.9) and computer use (OR = 2.1) compared with higher-level education students from Western ethnic backgrounds.The study findings indicate important ethnic and educational differences in overweight and energy balance-related behaviours. Future research should focus on what kind of interventions work and for which target groups they work, taking demographic variables, such as gender, ethnicity, school type into account.

ObjectivesTo evaluate the long-term effects of the Schoolgruiten Project, a Dutch primary school-based intervention providing free fruit and vegetables (F&V). In addition, we assessed whether children’s appreciation of the project mediated these intervention effects.Design and methodsParticipating schoolchildren (mean age 9·9 years at baseline) and their parents completed parallel questionnaires at baseline, at 1-year and at 2-year follow-up, including questions on usual F&V intake of the child, potential behavioural determinants, their appreciation of the project and general demographics. Primary outcomes were usual F&V intakes as assessed by parent and child self-reported food frequency measures. Secondary outcome measures were taste preference, knowledge of daily recommendations, availability and accessibility for fruit intake. Multilevel linear regression analyses were used to assess differences at second follow-up adjusted for baseline values between control and intervention groups.SubjectsReports were available for 346 intervention children (148 parents) and 425 control children (287 parents).ResultsBoth child and parent reports indicated that the intervention group had a significantly higher fruit intake at 2-year follow-up (difference, servings/d: 0·15; 95 % CI 0·004, 0·286 for child reports; 0·19; 95 % CI 0·030, 0·340 for parent reports). No significant effects on vegetable intake were observed. Significant positive intervention effects were also found for knowledge of fruit recommendations among boys. Some evidence was found for partial mediation analyses of the effects on fruit intake.ConclusionThe present study indicates that the Schoolgruiten scheme was effective in increasing children’s fruit intake and that appreciation of the project partially mediated this effect.

The present paper explores the relative importance of liking and taste preferences as correlates of fruit and vegetable (FV) intakes among schoolchildren in Europe. The paper first provides an overview of potential determinants of food choice among children and subsequently summarizes the results of two recent observational studies on determinants of FV intakes among school-aged children. It is proposed that taste preferences and liking are important for children's food choices as part of a broader spectrum of nutrition behaviour determinants. Taste preferences and liking are important for motivation to eat certain foods, but social-cultural and physical environmental factors that determine availability and accessibility of foods, as well as nutrition knowledge and abilities should also be considered.Study 1 shows that children with a positive liking for FV have a greater likelihood to eat fruits (odds ratio (OR) = 1·97) or vegetables (OR = 1·60) every day, while ability and opportunity related factors such as knowledge, self-efficacy, parental influences and accessibility of FV were also associated with likelihood of daily intakes (ORs between 1·16 and 2·75). These results were consistent across different countries in Europe. Study 2 shows that taste prerences were the stongest mediator of gender differences in FV intakes among children; the fact that girls eat more could for a large extend be explained by there stronger taste preferences.

ObjectiveTo identify determinants of adolescents’ consumption of carbonated soft drinks (regular and diet), both of total consumption and of consumption at school.Design/Setting/SubjectsRegular and diet soft drink consumption was measured by food frequency questions that were dichotomised. Several potential environmental and personal determinants of consumption were measured. A total of 2870 (participation rate: 85%) 9th and 10th graders, within 33 Norwegian schools, participated in the study. Multilevel logistic regression analyses were preformed for total soft drink consumption (twice a week or more vs. less) and for consumption at school (once a week or more vs. less).ResultsA total of 63% and 27% of the participants reported to drink respectively regular and diet soft drinks twice a week or more, and 24% and 8%, respectively, reported to drink soft drinks once a week or more at school. Preferences, accessibility, modelling and attitudes were the strongest determinants of both regular and diet soft drink consumption. In addition, gender, educational plans and dieting were related to both total soft drink consumption and consumption at school. Pupils with longer distance from school to shop and those in schools with rules concerning soft drink consumption tended to have lower odds of drinking both regular and diet soft drinks at school.ConclusionThis study shows that gender, educational plans, dieting, accessibility, modelling, attitudes and preferences all seem to be strong determinants of adolescents’ soft drink consumption. Parents and the home environment appear as great potential intervention targets.

Background Leisure time physical activity (LTPA) is inversely related to mortality risk among patients with a history of myocardial infarction (MI). The aims were to explore if heart failure (HF) status and psychosocial variables moderate the association. Methods Participants (n = 1169) were from a multi-center prospective cohort study. Information on LTPA (none, irregular,1–150, 151–300 and >300 weekly minutes), depression, social support and other prognostic indicators were collected 10–13 years after index MI. Cox regressions were conducted, adjusting for potential confounders. In case of significant moderation by HF-status or psychosocial variables, stratified analyses were performed. Results During follow-up (M = 8.4 years), 25.6 % of the sample had died. LTPA was inversely associated with mortality (p for trend 300 min, patients with a high level of social support had a lower mortality risk than those with a low level (0.38 (0.19, 0.79) versus 0.51 (0.30, 0.87)). Conclusions LTPA was inversely related to mortality risk of post-MI patients. HF did not moderate the relationship; depression and social support partially did. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0363-7) contains supplementary material, which is available to authorized users.

ObjectiveTo evaluate the effect of a primary school-based intervention providing free fruit and vegetables (F&V), separately for children of Dutch and of non-Western ethnicity.SettingPrimary schools in two regions (west and east) in The Netherlands.Design and methodsParticipating schoolchildren and their parents completed questionnaires at baseline and 1 year later, including questions on usual F&V intake, potential determinants and general demographics. Primary outcomes were the usual fruit intake and the usual vegetable intake as assessed by parent- and child self-reported food frequency measures. Secondary outcome measures were child- or parent-reported taste preference, knowledge of daily recommendations, availability, and accessibility for fruit intake. Multilevel regression analyses were used to assess differences at follow-up adjusted for baseline values between the control and intervention group using both child and parent reports.SubjectsFive hundred and sixty-five children of Dutch ethnicity and 388 children of non-Western ethnicity (mean age 9.9 years at baseline) and their parents.ResultsChildren of non-Western ethnicity in the intervention group reported a significantly higher vegetable intake (difference = 20.7 g day–1, 95% confidence interval (CI) = 7.6–33.7). A significant positive intervention effect was also found for fruit intake for children of Dutch ethnicity (difference = 0.23 pieces day–1, 95% CI = 0.07–0.39). No significant effects in intake were observed based on parent reports. Significant positive intervention effects were also found for perceived accessibility among children of non-Western ethnicity, as well as for parent-reported taste preference of their child among children of non-Western ethnicity and boys of Dutch ethnicity.ConclusionProviding children with free F&V had some positive effects on child-reported intakes and important correlates of intakes.

Objective: A polymorphism near the promoter region of the IGF-I gene has been associated with serum IGF-I levels, body height and birth weight. In this study, we investigated whether this polymorphism is associated with body composition in young healthy subjects in two cohorts of different generations. Design: Observational study with repeated measurements. Methods: The study group consisted of two comparable young Dutch cohorts with a generational difference of around 20 years. The older cohort consisted of 359 subjects born between 1961 and 1965. Measurements were performed from 13 until 36 years of age. The younger cohort consisted of 258 subjects born between 1981 and 1989. Measurements were performed from 8 until 14 years of age. Height, body mass index (BMI), fat mass, fat-free mass, waist and hip circumference were compared between wild-type carriers and variant type carriers of the IGF-I polymorphism. Results: In the younger cohort, body weight, BMI, fat mass and waist circumference were significantly higher in female variant carriers of the IGF-I polymorphism. A similar trend was observed in male variant carriers. In contrast, these differences were not observed in the older cohort. Irrespective of genotype, the younger cohort showed a significantly higher total fat mass, body weight and BMI compared with the older cohort. Conclusions: Because the differences between both genotypes were small, it seems likely that the genetic variability due to this IGF-I polymorphism impacts only slightly on body composition. Importantly, our study suggested that associations between this IGF-I promoter polymorphism and body composition possibly reflect a gene–environmental interaction of this polymorphism and that an environment that promotes obesity leads to a slightly more pronounced fat accumulation in variant carriers of this IGF-I polymorphism.

Objective To investigate whether IGF-I promoter polymorphism was associated with birth weight and risk factors for cardiovascular disease (CVD) and type 2 diabetes (T2DM), and whether the birth weight – risk factor relationship was the same for each genotype. Design and participants 264 subjects (mean age 36 years) had data available on birth weight, IGF-I promoter polymorphism genotype, CVD and T2DM risk factors. Student's t-test and regression analyses were applied to analyse differences in birth weight and differences in the birth weight – risk factors relationship between the genotypes. Results Male variant carriers (VCs) of the IGF-I promoter polymorphism had a 0.2 kg lower birth weight than men with the wild type allele (p = 0.009). Of the risk factors for CVD and T2DM, solely LDL concentration was associated with the genotype for the polymorphism. Most birth weight – risk factor relationships were stronger in the VC subjects; among others the birth weight – systolic blood pressure relationship: 1 kg lower birth weight was related to an 8.0 mmHg higher systolic blood pressure Conclusion The polymorphism in the promoter region of the IGF-I gene is related to birth weight in men only, and to LDL concentration only. Furthermore, the genotype for this polymorphism modified the relationships between birth weight and the risk factors, especially for systolic and diastolic blood pressure.

Glucocorticoids play an important role in determining body composition. A polymorphism of the glucocorticoid receptor gene (in codons 22 and 23) has previously been found to be associated with relative glucocorticoid resistance, low cholesterol levels, and increased insulin sensitivity. In this study, we investigated whether this ER22/23EK polymorphism is associated with differences in body composition and muscle strength. We studied a cohort of 350 subjects who were followed from age 13 until 36 yr. We compared noncarriers and carriers of the ER22/23EK variant in anthropometric parameters, body composition, and muscle strength, as measured by arm pull tests and high jump from standing. We identified 27 (8.0%) heterozygous ER22/23EK carriers. In males at 36 yr of age, we found that ER22/23EK carriers were taller, had more lean body mass, greater thigh circumference, and more muscle strength in arms and legs. We observed no differences in body mass index or fat mass. In females, waist and hip circumferences tended to be smaller in ER22/23EK carriers at the age of 36 yr, but no differences in body mass index were found. Thus, the ER22/23EK polymorphism is associated with a sex-specific, beneficial body composition at young-adult age, as well as greater muscle strength in males.

Background Suboptimal maternal health conditions (such as obesity, underweight, depression and stress) and health behaviours (such as smoking, alcohol consumption and unhealthy nutrition) during pregnancy have been associated with negative pregnancy outcomes. Our first aim was to give an overview of the self-reported health status and health behaviours of pregnant women under midwife-led primary care in the Netherlands. Our second aim was to identify potential differences in these health status indicators and behaviours according to educational level (as a proxy for socio-economic status) and ethnicity (as a proxy for immigration status). Methods Our cross-sectional study (data obtained from the DELIVER multicentre prospective cohort study conducted from September 2009 to March 2011) was based on questionnaires about maternal health and prenatal care, which were completed by 6711 pregnant women. The relationships of education and ethnicity with 13 health status indicators and 10 health behaviours during pregnancy were examined using multilevel multiple logistic regression analyses, adjusted for age, parity, number of weeks pregnant and either education or ethnicity. Results Lower educated women were especially more likely to smoke (Odds Ratio (OR) 11.3; 95 % confidence interval (CI) 7.6– 16.8); have passive smoking exposure (OR 6.9; 95 % CI 4.4–11.0); have low health control beliefs (OR 10.4; 95 % CI 8.5–12.8); not attend antenatal classes (OR 4.5; 95 % CI 3.5–5.8) and not take folic acid supplementation (OR 3.4; 95 % CI 2.7–4.4). They were also somewhat more likely to skip breakfast daily, be obese, underweight and depressed or anxious. Non-western women were especially more likely not to take folic acid supplementation (OR 4.5; 95 % CI 3.5–5.7); have low health control beliefs (OR 4.1; 95 % CI 3.1–5.2) and not to attend antenatal classes (OR 3.3; 95 % CI 2.0–5.4). They were also somewhat more likely to have nausea, back pains and passive smoking exposure. Conclusions Substantial socio-demographic inequalities persist with respect to many health-related issues in medically low risk pregnancies in the Netherlands. Improved strategies are needed to address the specific needs of socio-demographic groups at higher risk and the structures underlying social inequalities in pregnant women.