The knowledge about the association of physical activity (PA) and sedentary behaviours (SB) with the most considered healthy dairy products consumption, as milk and yogurt, in childhood is scared.

To assess the longitudinal relationship between specific lifestyle behaviours (PA and SB) and combined dairy consumption (milk + yogurt) in a sample of European children.

Two measurements, with 2 years’ interval (T0 and T1), were conducted in 1 688 (50.8% boys) childrenfrom the IDEFICS study. Dietary information was parental-registered by a 24-hour dietary recall. At both time points, sedentary behaviour and objective estimation of PA was obtained by accelerometers. Different groups were defined according to the international children's PA and SB behaviours recommendations over time. The cut-offs for the SB and PA recommendations were established on 2hour/day of SB and 2 hour/day of moderate to vigorous PA. Multilevel ordinal logistic regression models were used to assess the group's association with the combined dairy consumption (milk + yogurt), adjusted for potential confounders (sex, body mass index zscore, intervention versus control region, parental education level, dietary quality index, energy intake and the consumption by each dairy group at T0).

Nine groups of meeting or not both recommendations (SB and PA) were obtained. Those children who meeting both lifestyle recommendations at both measurement points, had higher probability to consume more milk and yogurt (p < 0.05), in comparison to the rest of combinations.Those children who did not meet any recommendations at both time points were less likely to consume milk + yogurt (OR: 0.47, 95%CI:0.26–0.83) than those who met both recommendations at both time points. Those children which improved one behaviours (PA or SB) between both measurement point were associated with low consumption of milk + yogurt (OR:0.41, 95%CI 0.22;0.74; OR:0.40, 95%CI 0.22,0.72), compared with those who meet both lifestyle recommendations at both periods (T0 and T1). Also, those which improved both behaviours (PA and SB) were less likely to consume milk + yogurt (OR:0.34, 95%CI 0.15–0.80) than those who were physically active and low sedentary at both time points.

These results suggest that European children with a healthy lifestyle regarding PA and SB over time, had the highest milk and yogurt consumption in comparison with other children.

Out of the baseline sample of the IDEFICS Study, 2913 children aged 2–9 years were included in this study. Inclusion criteria was having available data of waist circumference (WC), diastolic and systolic blood pressure (DBP, SBP), high density lipoprotein (HDL) cholesterol, triglycerides (TG), glucose and insulin, to calculate the homeostasis model assessment index (HOMA); and hs-CRP as a marker of inflammation, at baseline (T0) and two years later (T1). hs-CRP was categorized into two categories as some children had lower concentration than the detection limit of 0.02mg/dL. Student t-test and logistic regression were used to assess these associations. Logistic regression was adjusted by age, sex, body mass index (BMI), socioeconomic level and country.

Differences of mean values of the components of the MetS and the two categories of hs-CRP were observed between both time points. Mean values of SBP, DBP, WC, TG and HOMA were significantly higher in children with a higher category of hsCRP (p < 0.005). In addition, MetS score was significantly higher in those with a higher category of hs-CRP (p < 0.001) at both measurement points, T0 and T1. Finally, logistic regression between components of MetS and categories of hs-CRP, at both time points, showed significant associations (p < 0.001) for WC (OR = 1.06 at T0 and OR = 1.04 at T1) and HDL (OR = 0.98 at T0 and OR = 0.98 at T1) and the MetS score (OR = 1.07) score at T1.

The association between MetS and inflammation is already present in children. Out of the components of the MetS, WC and HDL were the ones more associated with an inflammatory state at two times points. Also the MetS score, but only at the follow-up, was associated with the hs-CRP. Therefore, in order to prevent the inflammatory state in childhood, efforts to improve the metabolic profile, specially WC and HDL, need to be made.

Consumption of fruits and vegetables (F&V) among adolescents falls below recommendations in many Western countries. The impact of social and emotional aspects of family life on adolescent dietary behaviour may contribute to this, yet remains under-investigated. The present study examines the association between adolescents’ perceptions of emotional home atmosphere (EHA) and their F&V consumption frequency.

An FFQ was used to assess F&V consumption frequency. EHA was assessed by an eight-item measure with three subscales: perceived home warmth, strictness and relational tension. EHA subscales were used as binary variables: a score equal to or above the median value was considered as a higher perception, while a score below the median was considered as a lower perception of the EHA in question. Country differences in meeting the European 5-a-day recommendations were described. Further, the association between EHA and F&V consumption frequency was investigated using multiple linear regression.

Regional examination centres in eight European countries.

Adolescents (n 3196) aged 12–18 years.

The mean F&V consumption frequency was 3·27 (sd 2·84) times/d. Only 16·1 % of boys and 18 % of girls in our study sample met the recommendation of five F&V daily. After controlling for age, sex, education level of the parents and country of origin, perceived home warmth was associated with a 16 (95 % CI 9, 22) % higher F&V consumption frequency (P < 0·001).

F&V consumption frequency was suboptimal in the survey areas. Interventions targeting perceived warmth as a component of EHA could potentially have a positive effect on adolescents’ dietary behaviour.

To investigate whether adherence to the adapted Mediterranean Diet Score for Adolescents (MDS_A) and the adapted Mediterranean Diet Quality Index for Adolescents (KIDMED_A) is associated with better food/nutrient intakes and nutritional biomarkers.

The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study is a cross-sectional study aiming to obtain comparable data on a variety of nutritional and health-related parameters in European adolescents aged 12·5–17·5 years.

Nine European countries.

European adolescents (n 2330) recruited to the HELENA study. Dietary intake was obtained with 24 h dietary recalls, an FFQ and a Food Choices and Preferences questionnaire. MDS_A was calculated as a categorical variable using cut-offs (MDS_A), as a continuous variable (zMDS_A) and with energy adjustments (zEnMDS_A). The KIDMED_A score was also calculated.

Multilevel linear regression analysis showed positive associations for zMDS_A and KIDMED_A with serum levels of vitamin D, vitamin C, plasma folate, holo-transcobalamin, β-carotene and n-3 fatty acids, while negative associations were observed with trans-fatty acid serum levels. For categorical indices, blood biomarkers showed few significant results. zMDS_A and KIDMED_A showed positive associations with vegetables and fruits intake, and negative associations with energy-dense and low-nutritious foods. zMDS_A and KIDMED_A were positively associated with all macronutrients, vitamins and minerals (all P < 0·0001), except with monosaccharides and PUFA for KIDMED_A and cholesterol for both indices (P < 0·05).

zMDS_A and KIDMED_A have shown the strongest associations with the dietary indicators and biomarkers that have been associated with the Mediterranean diet before, and are therefore considered the most appropriate and valid Mediterranean diet scores for European adolescents.

To analyse the Nutritional Knowledge Test (NKT) using Item Response Theory (ITR) analysis and to assess the construct validity of the Nutritional Knowledge Scale (NKTS) and its associations with adolescent food group consumption and nutritional biomarkers.

Cross-sectional study.

Multicentre investigation conducted in ten European cities.

Adolescents aged 12·5–17·5 years (n 3215) who completed over 75 % of the NKT.

Factor analysis indicated that the NKT can be analysed with a one-dimensional model. Eleven out of twenty-three items from the NKT presented adequate parameters and were selected to be included in the NKTS. Nutrition knowledge was positively associated with consumption of fruits, cereals, dairy products, pulses, meat and eggs, and fish, as well as with blood concentrations of vitamin C, β-carotene, n-3 fatty acids, holo-transcobalamin, cobalamin and folate; nutrition knowledge was negatively associated with intake of olives and avocado, alcohol and savoury snacks.

The NKTS assessed nutritional knowledge adequately and it is proposed as a new tool to investigate this subject in future studies.

The present study investigated the association between sugar and fat intake in childhood in relation to alcohol use in adolescence. We hypothesized that early exposure to diets high in fat and sugar may affect ingestive behaviours later in life, including alcohol use.

Children from the European IDEFICS/I.Family cohort study were examined at ages 5–9 years and followed up at ages 11–16 years. FFQ were completed by parents on behalf of children, and later by adolescents themselves. Complete data were available in 2263 participants. Children’s propensities to consume foods high in fat and sugar were calculated and dichotomized at median values. Adolescents’ use of alcohol was classified as at least weekly v. less frequent use. Log-binomial regression linked sugar and fat consumption in childhood to risk of alcohol use in adolescence, adjusted for relevant covariates.

Five per cent of adolescents reported weekly alcohol consumption. Children with high propensity to consume sugar and fat were at greater risk of later alcohol use, compared with children with low fat and low sugar propensity (relative risk=2·46; 95 % CI 1·47, 4·12), independent of age, sex and survey country. The association was not explained by parental income and education, strict parenting style or child's health-related quality of life and was only partly mediated by sustained consumption of sugar and fat into adolescence.

Frequent consumption of foods high in fat and sugar in childhood predicted regular use of alcohol in adolescence.

To investigate dietary sources of Ca and vitamin D (VitD) intakes, and the associated sociodemographic and lifestyle factors, among European adolescents.

Linear regression mixed models were used to examine sex-specific associations of Ca and VitD intakes with parental education, family affluence (FAS), physical activity and television (TV) watching while controlling for age, Tanner stage, energy intake and diet quality.

The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA)Cross-Sectional Study.

Adolescents aged 12·5–17·5 years (n 1804).

Milk and cheese were the main sources of Ca (23 and 19 % contribution to overall Ca intake, respectively). Fish products were the main VitD source (30 % contribution to overall VitD intake). Ca intake was positively associated with maternal education (β=56·41; 95 % CI 1·98, 110·82) and negatively associated with TV viewing in boys (β=–0·43; 95 % CI −0·79, −0·07); however, the significance of these associations disappeared when adjusting for diet quality. In girls, Ca intake was positively associated with mother’s (β=73·08; 95 % CI 34·41, 111·74) and father’s education (β=43·29; 95 % CI 5·44, 81·14) and FAS (β=37·45; 95 % CI 2·25, 72·65). This association between Ca intake and mother’s education remained significant after further adjustment for diet quality (β=41·66; 95 % CI 0·94, 82·38). Girls with high-educated mothers had higher Ca intake.

Low-educated families with poor diet quality may be targeted when strategizing health promotion programmes to enhance dietary Ca.

Children may influence household spending through ‘pester power’. The present study examined pestering through parent–child food shopping behaviours in relation to children’s diet and weight status.

Cross-sectional and prospective analyses drawn from the IDEFICS study, a cohort study of parents and their children. Children’s height and weight were measured and their recent diets were reported by parental proxy based on the Children’s Eating Habits Questionnaire-FFQ at baseline and 2-year follow-up. Parents also completed questionnaires at both time points about pestering, including whether the child goes grocery shopping with them, asks for items seen on television and is bought requested food items.

Participants were recruited from eight European countries for the IDEFICS study (non-nationally representative sample).

Study participants were children aged 2–9 years at enrolment and their parents. A total of 13 217 parent–child dyads were included at baseline. Two years later, 7820 of the children were re-examined.

Most parents (63 %) at baseline reported ‘sometimes’ acquiescing to their children’s requests to purchase specific foods. Pestering was modestly associated with weight and diet. At baseline, children whose parents ‘often’ complied consumed more high-sugar and high-fat foods. Children who ‘often’ asked for items seen on television were likely to become overweight after 2 years (OR=1·31), whereas ‘never’ asking protected against overweight (OR=0·72).

Pestering was modestly related to diet and weight in cross-sectional, but not longitudinal analyses. Asking for items seen on television had the most robust relationships across child outcomes and over time.

To investigate the magnitude and country-specific differences in underestimation of children’s weight status by children and their parents in Europe and to further explore its associations with family characteristics and sociodemographic factors.

Children’s weight and height were objectively measured. Parental anthropometric and sociodemographic data were self-reported. Children and their parents were asked to comment on children’s weight status based on five-point Likert-type scales, ranging from ‘I am much too thin’ to ‘I am much too fat’ (children) and ‘My child’s weight is way too little’ to ‘My child’s weight is way too much’ (parents). These data were combined with children’s actual weight status, in order to assess underestimation of children’s weight status by children themselves and by their parents, respectively. Chi-square tests and multilevel logistic regression analyses were conducted to examine the aims of the current study.

Eight European countries participating in the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project.

A school-based survey among 6113 children aged 10–12 years and their parents.

In the total sample, 42·9 % of overweight/obese children and 27·6 % of parents of overweight/obese children underestimated their and their children’s weight status, respectively. A higher likelihood for this underestimation of weight status by children and their parents was observed in Eastern and Southern compared with Central/Northern countries. Overweight or obese parents (OR=1·81; 95 % CI 1·39, 2·35 and OR=1·78, 95 % CI 1·22, 2·60), parents of boys (OR=1·32; 95 % CI 1·05, 1·67) and children from overweight/obese (OR=1·60; 95 % CI 1·29, 1·98 and OR=1·76; 95 % CI 1·29, 2·41) or unemployed parents (OR=1·53; 95 % CI 1·22, 1·92) were more likely to underestimate children’s weight status.

Children of overweight or obese parents, those from Eastern and Southern Europe, boys, younger children and children with unemployed parents were more likely to underestimate their actual weight status. Overweight or obese parents and parents of boys were more likely to underestimate the actual weight status of their children. In obesity prevention such underestimation may be a barrier for behavioural change.

The purpose of the present study was to investigate the associations of family sociodemographic characteristics with children’s weight status and whether these potential associations are mediated by children’s breakfast habits.

A school-based survey among 10–12-year-old children was conducted in eight European countries. Children’s weight and height were measured and breakfast habits and family sociodemographic characteristics were self-reported by 5444 children and their parents. International Obesity Task Force cut-off points were used to categorize children as overweight/obese or normal weight. Mediation analyses were used to test the potential mediating effect of children’s breakfast consumption on the associations between family sociodemographic characteristics and children’s overweight/obesity.

Schools in eight European countries participating in the ENERGY (EuropeaN Energy balance Research to prevent excessive weight Gain among Youth) project.

Children aged 10–12 years and their parents (n 5444).

Children’s reported daily breakfast consumption varied from 56 % in Slovenia to 92 % in Spain on weekdays and from 79 % in Greece to 93 % in Norway on weekends. Children of native parents, with both parents employed and with at least one parent having more than 14 years of education were more likely to consume breakfast daily and less likely to be overweight/obese. Finally, mediation analyses revealed that the association of parental nationality and parental educational status with children’s overweight/obesity was partially mediated by children’s daily breakfast consumption.

The study shows that the lower likelihood of being overweight/obese among 10–12-year-old children of native background and higher parental educational status was partially mediated by children’s daily breakfast consumption.

To estimate the prevalence of physical activity and sedentary behaviours in European children, and to evaluate the relationship between media availability in personal space and physical activity in relation to total screen time.

Data from the baseline IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) cross-sectional survey. Information on hours of television/digital video disk/video viewing and computer/games-console use (weekday and weekend days), media device availability in personal space, sports club membership, hours of active organized play and commuting (to and from school) were assessed via a self-reported parental questionnaire. Total screen time was defined as the sum of daily media use and subsequently dichotomized into meeting or not meeting the guidelines of the American Academy of Pediatrics.

Eight survey centres (Italy, Estonia, Cyprus, Belgium, Sweden, Germany, Hungary and Spain).

Children (n 15 330; 51 % males) aged 2–10 years.

Percentage of children engaged in total screen time for >2 h/d was higher on weekend days (52 % v. 20 % on weekdays) and in the older group (71 % in males; 57 % in females), varying by country. Children with a television set in their bedroom were more likely not to meet the screen time recommendations (OR = 1·54; 95 % CI 1·60, 1·74).

Approximately a third of the children failed to meet current screen time recommendations. Availability of a television set in personal space increased the risk of excess total screen time. This information could be used to identify potential targets for public health promotion actions of young population groups.

To analyse the association between family structure and adiposity in children.

Cross-sectional and longitudinal analysis of the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study cohort.

Primary schools and kindergartens.

Children (n 12 350; aged 7·9 (sd 1·8) years) for the cross-sectional analysis and children (n 5236; at baseline: normal weight, aged 5·9 (sd 1·8) years) for the longitudinal study underwent anthropometry. Family structure was analysed as (i) number and type of cohabiting adults and (ii) number of siblings.

In the cross-sectional analysis, after controlling for covariates, children living with grandparents had significantly higher BMI Z-score than those living with both parents (0·63; 95 % CI 0·33, 0·92 v. 0·19; 95 % CI 0·17, 0·22; P < 0·01); in addition, the higher the number of siblings, the lower the BMI Z-score (only child = 0·31; 95 % CI 0·24, 0·38; 1 sibling = 0·19; 95 % CI 0·16, 0·23; 2 siblings = 0·15; 95 % CI 0·09, 0·20; >2 siblings = 0·07, 95 % CI 0·04, 0·19; P < 0·001). Over the 2-year follow-up, differences in weight gain were observed across family-structure categories. Further, the risk of incidence of overweight/obesity was significantly lower the higher the number of siblings living in the household (v. only child: 1 sibling = 0·74, 95 % CI 0·57, 0·96; 2 siblings = 0·63, 95 % CI 0·45, 0·88; >2 siblings = 0·40, 95 % CI 0·21, 0·77), independently of confounders.

The study suggests that an independent association between family structure and childhood obesity exists.

To examine the association of breakfast consumption with objectively measured and self-reported physical activity, sedentary time and physical fitness.

The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Cross-Sectional Study. Breakfast consumption was assessed by two non-consecutive 24 h recalls and by a ‘Food Choices and Preferences’ questionnaire. Physical activity, sedentary time and physical fitness components (cardiorespiratory fitness, muscular fitness and speed/agility) were measured and self-reported. Socio-economic status was assessed by questionnaire.

Ten European cities.

Adolescents (n 2148; aged 12·5–17·5 years).

Breakfast consumption was not associated with measured or self-reported physical activity. However, 24 h recall breakfast consumption was related to measured sedentary time in males and females; although results were not confirmed when using other methods to assess breakfast patterns or sedentary time. Breakfast consumption was not related to muscular fitness and speed/agility in males and females. However, male breakfast consumers had higher cardiorespiratory fitness compared with occasional breakfast consumers and breakfast skippers, while no differences were observed in females. Overall, results were consistent using different methods to assess breakfast consumption or cardiorespiratory fitness (all P ≤ 0·005). In addition, both male and female breakfast skippers (assessed by 24 h recall) were less likely to have high measured cardiorespiratory fitness compared with breakfast consumers (OR = 0·33; 95 % CI 0·18, 0·59 and OR = 0·56; 95 %CI 0·32, 0·98, respectively). Results persisted across methods.

Skipping breakfast does not seem to be related to physical activity, sedentary time or muscular fitness and speed/agility as physical fitness components in European adolescents; yet it is associated with both measured and self-reported cardiorespiratory fitness, which extends previous findings.