To examine the parental food consumption and diet quality and its associations with children’s consumption in families at high risk for developing type 2 diabetes mellitus across Europe. Also, to compare food frequency consumption among parents and children from high-risk families to the European Dietary guidelines/recommendations.

Cross-sectional study using Feel4diabetes FFQ.

Families completed FFQ and anthropometric measures were obtained. Linear regression analyses were applied to investigate the relations between parental food consumption and diet quality and their children’s food consumption after consideration of potential confounders.

2095 European families (74·6 % mothers, 50·9 % girls). The participants included parent and one child, aged 6–8 years.

Parental food consumption was significantly associated with children’s intake from the same food groups among boys and girls. Most parents and children showed under-consumption of healthy foods according to the European Dietary Guidelines. Parental diet quality was positively associated with children’s intake of ‘fruit’ (boys: β = 0·233, P < 0·001; girls: β = 0·134, P < 0·05) and ‘vegetables’ (boys: β = 0·177, P < 0·01; girls: β = 0·234, P < 0·001) and inversely associated with their ‘snacks’ consumption (boys: β = –0·143, P < 0·05; girls: β = –0·186, P < 0·01).

The present study suggests an association between parental food consumption and diet quality and children’s food intake. More in-depth studies and lifestyle interventions that include both parents and children are therefore recommended for future research.

This study aimed to investigate the mediating role of food parenting practices (FPP), including home availability of different types of foods and drinks, parental modelling of fruit intake, permissiveness and the use of food as a reward in the relationship between parental education and dietary intake in European children.

Single mediation analyses were conducted to explore whether FPP explain associations between parents’ educational level and children’s dietary intake measured by a parent-reported FFQ.

Six European countries.

Parent–child dyads (n 6705, 50·7 % girls, 88·8 % mothers) from the Feel4Diabetes-study.

Children aged 8·15 ± 0·96 years were included. Parental education was associated with children’s higher intake of water, fruits and vegetables and lower intake of sugar-rich foods and savoury snacks. All FPP explained the associations between parental education and dietary intake to a greater or lesser extent. Specifically, home availability of soft drinks explained 59·3 % of the association between parental education and sugar-rich food intake. Home availability of fruits and vegetables was the strongest mediators in the association between parental education and fruit and vegetable consumption (77·3 % and 51·5 %, respectively). Regarding savoury snacks, home availability of salty snacks and soft drinks was the strongest mediators (27·6 % and 20·8 %, respectively).

FPP mediate the associations between parental education and children’s dietary intake. This study highlights the importance of addressing FPP in future interventions targeting low-educated populations.

To examine the effect of the intervention implemented in the ToyBox-study on changes observed in age- and sex-specific BMI percentile and investigate the role of perinatal factors, parental perceptions and characteristics on this change.

A multicomponent, kindergarten-based, family-involved intervention with a cluster-randomised design. A standardised protocol was used to measure children’s body weight and height. Information was also collected from parents/caregivers via the use of validated questionnaires. Linear mixed effect models with random intercept for country, socio-economic status and school were used.

Selected preschools within the provinces of Oost-Flanders and West-Flanders (Belgium), Varna (Bulgaria), Bavaria (Germany), Attica (Greece), Mazowieckie (Poland) and Zaragoza (Spain).

A sample of 6268 preschoolers aged 3·5–5·5 years (51·9 % boys).

There was no intervention effect on the change in children’s BMI percentile. However, parents’ underestimation of their children’s actual weight status, parental overweight and mothers’ pre-pregnancy overweight/obesity were found to be significantly and independently associated with increases in children’s BMI percentile in multivariate modelling.

As part of a wide public health initiative or as part of a counseling intervention programme, it is important to assist parents/caregivers to correctly perceive their own and their children’s weight status. Recognition of excessive weight by parents/caregivers can increase their readiness to change and as such facilitate higher adherence to favourable behavioural changes within the family.

Introduction: Childhood obesity is rising in all countries. Dietary habits are modifiable factors which develop early in life. During growth, several factors, such as peer- influence and food availability, determine the development of food preferences and eating behaviour. Parents play also a key role model by influencing their own food intake.

Objetives: The purpose of this study was to assess the influence of parental role modelling, as predictor of fruits and vegetables intake in European pre-schoolers.

Methods: The present study included a sample of 6633 preschool children (51.9% boys) from six European centres (Belgium, Bulgaria, Germany, Greece, Poland and Spain), 3.5 to 5.5 years of age, participating in the ToyBox-study. Data on parental role modelling related with their own fruits and vegetables intake (portions/day) and children's fruits and vegetables intake (portions/day) were collected via standardized proxy-administered questionnaires. Linear regression model was used to assess this association. The adjusted model included socioeconomic status and weight status.

Results: In the unadjusted model, boys whose parents consumed fruits, showed a mean intake of 0.09 (95% CI: 0.08–0.11; p ≤ 0.001) portions of fruits more than the boys whose parents did not consume fruits. Also, girls whose parents consumed fruits, had intake of 0.10 (95% CI: 0.08–0.12; p ≤ 0.001) portions of fruits more than the girls whose parents did not consume fruits.

Moreover, boys whose parents consumed vegetables, showed a mean intake of 0.09 (95% CI: 0.07–0.11; p ≤ 0.001) portions of vegetables more than the boys whose parents did not consume vegetables. Also, girls whose parents consumed fruits, had intake of 0.11 (95% CI: 0.09–0.13; p ≤ 0.001) portions of vegetables more than the girls whose parents did not consume vegetables.

Finally, parental role related with fruits consumption explained 19.3% of fruits intake in European pre-schoolers and the 17.8% of vegetables intake in boys and 21.9% of vegetable intake in girls taking into consideration the potential effect of socioeconomic status of the family and the weight status of the children.

Conclusions: Parental role model of fruit intake has moderate effect on the pre-schooler's dietary intake. However, home environment characteristics such as family rules or availability and accessibility of foods should be considered as potential factors related to food intake in pre-schoolers.

Introduction: Dietary habits are established from a very young age. Parental role modeling is an important factor influencing the eating behavior of their children. Drinking behavior may have an impact in the development of childhood obesity. This study aimed to explore the correlations of core drinking beverages between parents and their children.

Materials and Methods: The present study included children of 3.5–5.5 years and their parents from the (Multifactorial evidence-based approach using behavioral models in understanding and promoting fun, healthy food, play and policy for the prevention of obesity in early childhood) ToyBox study. The study was a kindergarten-based family-involved intervention, in preschool children from six European countries: Belgium, Bulgaria, Germany, Greece, Poland, and Spain. For this study, we analyzed data from the baseline cross-sectional survey.

Data on consumption frequency of water, homemade or fresh fruit juice, prepacked fruit juice, light beverages and sugared sweetened beverages consumption from parents and their children was obtained via a validated food frequency questionnaire. Parents were given examples of serving sizes and asked about how to self-report their usual consumption per day or week. Beverage consumption of children was reported by their parents and information about frequency and portion sizes was collected. Body weight and height of children was measured and classified according to the International Obesity Task Force (IOTF). Bivariate correlations were performed to analyze beverage consumption (servings per day) in children and their parents.

Results: The studied sample included 5266 pairs of children (49.2% girls) and parents (91.7% women) that were included in the analysis.

Girls presented higher correlations in water (r2 = 0,317) and sugar sweetened beverages (r2 = 0,302), whereas boys, presented slightly higher correlations of light soft drinks (r2 = 0,273), pure fruit juices (r2 = 0,308) and prepacked fruit juices (r2 = 0,324), all of them at < 0.01 level of significance. Considering boys and girls together, a slightly higher significant correlation coefficients were found between children-parents’ dyads with overweight/obesity compared to normal weight children-parentś for sugar sweetened beverages (r2 = 0,303) and light soft drinks (r2 = 0,396).

Discussion: Beverage consumption of children and their parents were found to be moderately correlated. Overweight children seem to have better correlations with their parents in relation of sugar sweetened beverages and light soft drinks. Parents should encourage a healthy beverage consumption for their own health and most important, because there are key role models to their children.

The present study aimed to explore the mediating role of family-related determinants on the effects of the ToyBox-intervention on pre-school children’s consumption of healthy and unhealthy snacks.

The ToyBox-intervention was a kindergarten-based, family-involved intervention with a cluster-randomized design, aiming to promote healthy lifestyle behaviours to prevent obesity at pre-school age.

Kindergartens (n 309) in six European countries.

A total of 6290 pre-schoolers and their families participated in the ToyBox-intervention in 2012–2013 and data from 5212 pre-schoolers/families were included in the current analyses.

Even though the total effect of the ToyBox-intervention on healthy and unhealthy snacking was not significant, the ToyBox-intervention significantly improved parental rule setting on children’s unhealthy snack consumption (i.e. restriction of snacking while watching television and permission only at certain occasions) and parental consumption of unhealthy snacks, while it increased parental knowledge on snacking recommendations. Regarding healthy snacking, the ToyBox-intervention improved children’s attitude towards fruit and vegetables (F&V). All previously mentioned family-related determinants mediated the intervention effects on pre-schoolers’ consumption of healthy and unhealthy snacks. Almost all family-related determinants examined in the study were independently associated with pre-schoolers’ consumption of healthy and unhealthy snacks.

The intervention was effective in improving relevant family-related determinants. Interventions aiming to promote F&V consumption and limit the consumption of unhealthy snacks in pre-schoolers should target on these mediators, but also identify new family-, school- or peer-related determinants, to enhance their effectiveness.

To describe the design of the Feel4Diabetes-intervention and the baseline characteristics of the study sample.

School- and community-based intervention with cluster-randomized design, aiming to promote healthy lifestyle and tackle obesity and obesity-related metabolic risk factors for the prevention of type 2 diabetes among families from vulnerable population groups. The intervention was implemented in 2016–2018 and included: (i) the ‘all-families’ component, provided to all children and their families via a school- and community-based intervention; and (ii) an additional component, the ‘high-risk families’ component, provided to high-risk families for diabetes as identified with a discrete manner by the FINDRISC questionnaire, which comprised seven counselling sessions (2016–2017) and a text-messaging intervention (2017–2018) delivered by trained health professionals in out-of-school settings. Although the intervention was adjusted to local needs and contextual circumstances, standardized protocols and procedures were used across all countries for the process, impact, outcome and cost-effectiveness evaluation of the intervention.

Primary schools and municipalities in six European countries.

Families (primary-school children, their parents and grandparents) were recruited from the overall population in low/middle-income countries (Bulgaria, Hungary), from low socio-economic areas in high-income countries (Belgium, Finland) and from countries under austerity measures (Greece, Spain).

The Feel4Diabetes-intervention reached 30 309 families from 236 primary schools. In total, 20 442 families were screened and 12 193 ‘all families’ and 2230 ‘high-risk families’ were measured at baseline.

The Feel4Diabetes-intervention is expected to provide evidence-based results and key learnings that could guide the design and scaling-up of affordable and potentially cost-effective population-based interventions for the prevention of type 2 diabetes.

To study diet quality among pre-schoolers using the Diet Quality Index (DQI) and to investigate differences according to gender, socio-economic status (SES) and overweight/obesity status.

Kindergarten-based cross-sectional survey within the ToyBox-study. A standardized protocol was used and parents/caregivers self-reported sociodemographic data and a semi-quantitative FFQ. A total DQI and its four subcomponents (diversity, quality, equilibrium and meal index) were calculated based on this FFQ. High total DQI scores indicate better diet quality than low scores. Results of the total DQI and the subcomponents were reported as percentages of maximum scores (100 %).

Kindergartens in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain).

European pre-schoolers (aged 3·5–5·5 years) and their parents/caregivers (n 7063).

The mean total DQI score was 68·3 %. Mean scores of the subcomponents were 61·7 % for diversity, 56·5 % for quality, 65·4 % for equilibrium and 89·7 % for the meal index. Pre-schoolers of lower-SES backgrounds had lower scores on the total DQI and all its subcomponents. No clear differences were found by gender and overweight status. Results differed slightly according to country.

Pre-schoolers scored low on the total DQI and especially on dietary quality, as energy-dense, low-nutritious food items were more often consumed than highly nutritious food items. Furthermore, already in pre-schoolers lower-SES mothers were less likely to provide a good diet quality and this was consistent for all four subcomponents of the total DQI. Food intake in pre-schoolers should be enhanced, especially in pre-schoolers of lower-SES backgrounds.

To study the quantity and quality of water intake from beverages among pre-schoolers and investigate associations with gender and socio-economic status (SES).

Kindergarten-based cross-sectional survey within the large-scale European ToyBox-study. A standardized protocol was used and parents/caregivers filled in sociodemographic data and a semi-quantitative FFQ.

Kindergartens in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain).

European pre-schoolers (aged 3·5–5·5 years) and their parents/caregivers (n 7051).

Mean water intake was 1051 ml/d; plain water, 547 ml/d; plain milk, 241 ml/d; other fruit juice, 104 ml/d; pure fruit juice, 59 ml/d; soft drinks, 55 ml/d; tea, 45 ml/d; sugared and chocolate milk, 37 ml/d; smoothies, 15 ml/d; and light soft drinks, 6 ml/d. Boys had a higher water intake than girls due to a higher consumption of plain water, but more importantly to the consumption of beverages of less quality. Lower-SES pre-schoolers scored better on quantity than high-SES pre-schoolers, but as a consequence of consumption of sugared beverages. Nevertheless, the associations differed by country.

The water intake from beverages did not meet the European Food Safety Authority standard of 1280 ml/d; especially in Western European countries water intake from beverages was low. The most important water sources were plain water, milk and fruit juices. Interventions aiming at a proper and sufficient water intake should focus on both quantity and quality. Messages about water and water sources should be clear for everyone and interventions should be sufficiently tailored.

To evaluate the cost-effectiveness of the European community-based project ‘10 000 Steps Ghent’, an intervention that resulted in a significant decrease in sedentary time and a significant increase in step counts (896 steps/d) and self-reported walking (66 min/week).

An age- and gender-dependent Markov model, with a time horizon of 20 years and a cycle length of 1 year, estimating the development of diabetes, cardiovascular events and colorectal cancer.

All individuals started in a health state free of events. The effect of the intervention was based on published risk reductions related to increased walking time. Costs and utility decrements related to events were obtained from published literature. The impact of the uncertainty of the parameters on incremental costs and quality-adjusted life years (QALY) were assessed with one-way sensitivity analyses and a Monte Carlo analysis.

Cohort representing the population reached by the intervention (266 adults aged 25–75 years with a mean age of 48·2 (sd 13·1) years, 45·6 % men, 64·6 % highly educated, 70·0 % employed).

Implementing the community-based programme increased average QALY by 0·16 and 0·11 for men and women, respectively. The total costs decreased by approximately 576€ and 427€, respectively. Hence, for both genders the intervention programme was dominant. The sensitivity analyses did not change the conclusion of dominance.

The community-based ‘10 000 Steps Ghent’ campaign is a dominant intervention. Sensitivity analyses have proved the robustness of the results; hence implementing this intervention on a population-based level could lead to improved health outcomes and reduced costs.

The present study aimed to examine the impact of non-wear activities registered in diaries when using accelerometers to assess physical activity (PA) in young adolescents.

Data arise from a large-scale cross-sectional study on PA. PA was objectively assessed using Actigraph™ accelerometers (Actigraph MTI, Manufacturing Technology Inc., Pensacola, FL, USA) during seven consecutive days. Non-wear time activity diaries were provided to register the activities for which the accelerometer was removed. After correction to deal with over-reporting, the registered minutes of PA were used to replace periods of non-wear time measured by the accelerometer.

Between October 2008 and May 2009 adolescents were recruited by home visits in Ghent (Belgium).

Young adolescents (n 513; 48·6 % boys) aged 13 to 15 years.

Of the total sample, 49·9 % registered at least one activity of moderate to vigorous intensity in the non-wear time activity diary. More adolescents registered an activity performed on a weekday than on a weekend day and the registered mean number of minutes of moderate to vigorous PA were higher on weekend days. Repeated-measures (M)ANOVA tests revealed a significant difference between the mean minutes with and without non-wear activities for all PA intensities, regardless of adolescents’ socio-economic status or gender. More adolescents achieved the PA recommendations after inclusion of the non-wear activities irrespective of accelerometer thresholds used.

The collection of information regarding non-wear time by non-wear time activity diaries when using accelerometers in 13–15-year-old adolescents can lead to different PA outcomes at the individual level and therefore can improve the ability to accurately measure PA.

To explore gender-specific variations related to activity intensity in the relationship between physical activity (PA) and mental health (MH). Evaluating whether psychological well-being enhances with increases in PA at recommended levels and above, in the general population.

Cross-sectional.

Population-based, representative for Belgium.

A total of 6803 adults aged 25–64 years from the Belgian National Health Interview Survey.

Multiple logistic regression analyses showed that clearly different intensity levels characterised the PA that associated with MH in women and men. In men, inverse associations existed between participation in vigorous-intensity PA and feelings of depression (OR = 0·580; 95 % CI 0·405, 0·830), anxiety (OR = 0·547; 95 % CI 0·364, 0·821) and symptoms of somatisation (OR = 0·590; 95 % CI 0·398, 0·874). In women, positive associations existed between walking and emotional well-being (OR = 1·202; 95 % CI 1·038, 1·394) and inverse associations between participation in moderate-intensity PA and symptoms of somatisation (OR = 0·737; 95 % CI 0·556, 0·977). Secondary analyses confirmed that differences in psychological complaints were significant for vigorous PA in men, and for moderate PA in women, whereas differences in emotional well-being were significant for walking exclusively in women.

In the general population, the PA–MH relationship is always positive, regardless of activity intensity. In men, it addresses complaints (symptoms, palpable discomfort) and the optimal PA intensity is high. In women, it addresses complaints, but also distress (lowered mood, disturbing anxiety, altered well-being) and the PA intensity is mild.

To compare physical activity (PA) reported through pedometer registrations (step counts) with PA reported in four different questionnaires; to compare step count thresholds (7500, 10 000 and 12 500 steps/d) with the PA guideline of 30 min of moderate to vigorous PA (MVPA) per day.

A sample of 310 healthy adults, mean age 38·7 (sd 11·9) years, volunteered to participate. Forty-seven per cent was male and 93 % of the sample was employed.

PA was assessed by interview (Minnesota Leisure Time Physical Activity Questionnaire (MLTPAQ)), three self-administered questionnaires (long version and short version of the International Physical Activity Questionnaire (long-form IPAQ, short-form IPAQ), Baecke questionnaire) and seven consecutive days of pedometer registration.

Step counts correlated positively with questionnaire-based PA. The strongest correlations were found between step counts and total PA reported in the long-form IPAQ (rs = 0·37), moderate PA reported in the short-form IPAQ (rs = 0·33), total and moderate PA reported in the MLTPAQ (rs = 0·32), and the total and leisure-time PA indices (excluding sport) reported in the Baecke questionnaire (rs = 0·44). According to step counts, 22·6 % of the participants were somewhat active, 18·7 % active and 39·4 % highly active. As assessed by the long-form IPAQ, short-form IPAQ and MLTPAQ, the guideline of 30 min MVPA/d was reached by respectively 85·4 %, 84·8 % and 68·0 % of participants.

Pedometer-based data offer adequate information to discriminate between levels of PA. Caution is needed when comparing active samples based on different PA recommendations.

To evaluate the effects of a comprehensive physical activity (PA) promotion programme in elementary schools on children's total PA levels, leisure-time PA, physical fitness and psychosocial correlates of PA.

A pre-test–post-test design over two school years.

Sixteen elementary schools (764 children, mean age: 11.2 ± 0.7 years) were randomly assigned to the intervention condition (n = 8) and the control condition (n = 8). The intervention included a health-related physical education programme, an extracurricular PA promotion programme and classroom-based PA education lessons. In the total sample, leisure-time PA, psychosocial correlates of PA and physical fitness were measured using a PA questionnaire and the Eurofit test battery. In a sub-sample, total PA levels were measured using an accelerometer.

According to accelerometer data, children's moderate PA and moderate-to-vigorous PA (MVPA) levels decreased less in the intervention schools than in the control schools (P < 0.01). The average time spent on MVPA decreased by 9 min per day in the intervention schools compared with 33 min per day in the control schools. Children in the intervention schools reported significantly more moderate PA in leisure time than the controls (P < 0.05). No overall improvement of physical fitness and no effects on the psychosocial correlates of PA were found.

The comprehensive PA promotion programme was successful in preventing a decline in children's total activity levels. Furthermore, the intervention increased children's PA engagement in leisure time. Therefore, implementation needs to be encouraged.

To investigate differences in reported physical activity levels and in perceived environmental and psychosocial correlates of activity between Portuguese and Belgian adults; and to analyse the relative contribution of environmental and psychosocial variables in explaining physical activity within different contexts in Portugal and Belgium.

Cross-sectional study.

One city in Portugal (Oeiras) and one in Belgium (Ghent).

In total 526 participants, 247 from Portugal and 279 from Belgium, completed the long International Physical Activity Questionnaire and a validated questionnaire on environmental and psychosocial correlates.

For the sum of all activities of at least moderate intensity, a significantly higher mean level of activity was found in Belgian adults (P < 0.001). However, comparable percentages of the Belgian (38%) and Portuguese (42%) samples did not meet the recommendation of 30 min per day. The variance explained by environmental factors was lower (1% to 8%) than by psychosocial factors (maximum 42%). Regression analyses showed activity-specific relations with environmental variables which were analogous in both countries. Walking/cycling for transportation and walking for recreation were related to social support from family and/or friends and to walkability and walking facilities in the neighbourhood. Recreational physical activity was mainly determined by social support, self-efficacy, and perceived benefits and barriers.

Activity campaigns addressing psychosocial determinants are needed to encourage leisure-time activity, while a combination of neighbourhood design changes and encouragement of social support in walking is warranted to increase walking in different contexts.

To evaluate gender differences for levels of physical activity, for sedentary behaviour and for psychosocial correlates in children, to evaluate whether psychosocial correlates cluster in meaningful ways and to examine whether physical activity and sedentary behaviour differ between children of clusters, differentiated by the level of perceived barriers and benefits, attitudes, social support and self-efficacy.

Cross-sectional study using the Flemish Physical Activity Questionnaire.

Questionnaires to be filled out by the children and one of their parents, contacted through the school system.

A sample of 1124 10- to 11-year-olds (579 boys and 545 girls).

Girls were found to be less active than boys, with boys scoring better for social support, perceived benefits and self-efficacy compared with girls. The way of clustering differed between boys and girls. Boys were allocated to three clusters: one cluster with positive correlates towards physical activity, labelled ‘positives’; one with negative correlates, labelled ‘negatives’; and one characterised mainly by high perceived barriers, labelled ‘hindered’;. In both genders the highest levels of physical activity were found in the ‘positives’;, the lowest in the ‘negatives’;. In girls a fourth cluster was identified, characterised mainly by low perceived barriers and low social support. Physical activity levels in the girls of this cluster, labelled ‘indifferents’;, were the second highest.

More research is needed to further characterise these clusters. To prevent the physical activity decline during the transition from childhood to adulthood, novel interventions need to be explored that focus on children of the clusters with the most negative correlates.