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Longitudinal associations between diet quality, sedentary behaviours and physical activity and risk of overweight and obesity in preschool children: The ToyBox-study.
Miguel-Berges, ML, Mouratidou, T, Santaliestra-Pasias, A, Androutsos, O, Iotova, V, Galcheva, S, De Craemer, M, Cardon, G, Koletzko, B, Kulaga, Z, et al
Pediatric obesity. 2023;(10):e13068
Abstract
BACKGROUND Lifestyle behaviours related to diet and physical activity are associated with increased risk of obesity and evidence suggests that associations might be stronger when a synergetic effect is examined. OBJECTIVE To examine the cross-sectional and longitudinal associations between diet, screen time (ST) and step recommendations and risk of overweight and obesity in European preschoolers participating in the ToyBox-study. METHODS In this cluster-randomized clinical trial, 718 children (51.4% boys) from six European countries participated. Parents filled out questionnaires with information on socio-demographic status, step recommendations and ST. RESULTS Longitudinal results indicate that participants having a low Diet Quality Index (DQI), not meeting ST and step recommendations at T0 and T1 had higher odds of having overweight/obesity at T1 (odds ratio [OR] = 1.116; 95% confidence interval [CI] = 1.104-2.562) than those children having a high DQI and meeting ST and step recommendations at T0 and T1. Similarly, participants having a high DQI, but not meeting ST and step recommendations at T0 and T1 had increased odds of having overweight/obesity (OR = 2.515; 95% CI = 1.171-3.021). CONCLUSIONS The proportion of participants having a low DQI, not adhering to both step and ST recommendations was very high, and it was associated with a higher probability of having overweight and obesity.
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The Effect of Acute Pre-Workout Supplement Ingestion on Basketball-Specific Performance of Well-Trained Athletes.
Douligeris, A, Methenitis, S, Lazou, A, Panayiotou, G, Feidantsis, K, Voulgaridou, G, Manios, Y, Jamurtas, AZ, Giaginis, C, Papadopoulou, SK
Nutrients. 2023;(10)
Abstract
A pre-workout supplement's (PWS; 200 mg caffeine, 3.3 g creatine monohydrate, 3.2 g β-alanine, 6 g citrulline malate and 5 g branched chained amino acid (BCAA) per dose) acute effects on the alactic (jumping, sprinting, agility), lactic (Running-Based Anaerobic Sprint Test, RAST) and aerobic performance (Yo-Yo Intermittent Recovery Test Level 1, Yo-Yo IRL1 VO2max) of well-trained basketball players was investigated in this double-blind placebo-controlled study. Thirty players (age 18-31 years, height 166-195 cm, weight 70.2-116.7 kg, body fat 10.6-26.4%) were allocated to pre-workout (PWS, n = 15) or placebo (PL, n = 15) groups. Half of the participants in each group performed the evaluations without PWS or PL, while the rest consumed PWS or PL 30 min before the assessments (1st trial) and vice versa (2nd trial). Significant improvements in counter-movement jump (CMJ) (PWS: 4.3 ± 2.1%; PL: 1.2 ± 1.0%), agility (PWS: -2.9 ± 1.8%; PL: 1.8 ± 1.7%), RAST average (PWS: 18.3 ± 9.1%; PL: -2.2 ± 2.0%), minimum power (PWS: 13.7 ± 8.9%; PL: -7.5 ± 5.9%), and fatigue index (PWS: -25.0 ± 0.9%; PL: -4.6 ± 0.6%) were observed in the PWS group vs. the PL group (p < 0.05). No differences were found regarding sprinting, aerobic performance, and blood lactate concentrations. Thus, although players' alactic and lactic anaerobic performance could be improved, peak power, sprinting and aerobic performance are not.
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Developing a risk assessment tool for identifying individuals at high risk for developing insulin resistance in European adolescents: the HELENA-IR score.
Kondakis, K, Grammatikaki, E, Kondakis, M, Molnar, D, Gómez-Martínez, S, González-Gross, M, Kafatos, A, Manios, Y, Pavón, DJ, Gottrand, F, et al
Journal of pediatric endocrinology & metabolism : JPEM. 2022;(12):1518-1527
Abstract
OBJECTIVES To develop and validate an easy-to-use screening tool for identifying adolescents at high-risk for insulin resistance (IR). METHODS Α total of 1,053 adolescents (554 females), aged 12.5 to 17.5 years with complete data on glucose and insulin levels were included. Body mass index (BMI), fat mass index (FMI) and the homeostasis model assessment for insulin resistance (HOMA-IR) were calculated. VO2max was predicted using 20 m multi-stage fitness test. The population was randomly separated into two cohorts for the development (n=702) and validation (n=351) of the index, respectively. Factors associated with high HOMA-IR were identified by Spearman correlation in the development cohort; multiple logistic regression was performed for all identified independent factors to develop a score index. Finally, receiver operating characteristic (ROC) analysis was performed in the validation cohort and was used to define the cut-off values that could identify adolescents above the 75th and the 95th percentile for HOMA-IR. RESULTS BMI and VO2max significantly identified high HOMA-IR in males; and FMI, TV watching and VO2max in females. The HELENA-IR index scores range from 0 to 29 for males and 0 to 43 for females. The Area Under the Curve, sensitivity and specificity for identifying males above the 75th and 95th of HOMA-IR percentiles were 0.635 (95%CI: 0.542-0.725), 0.513 and 0.735, and 0.714 (95%CI: 0.499-0.728), 0.625 and 0.905, respectively. For females, the corresponding values were 0.632 (95%CI: 0.538-0.725), 0.568 and 0.652, and 0.708 (95%CI: 0.559-0.725), 0.667 and 0.617, respectively. Simple algorithms were created using the index cut-off scores. CONCLUSIONS Paediatricians or physical education teachers can use easy-to-obtain and non-invasive measures to apply the HELENA-IR score and identify adolescents at high risk for IR, who should be referred for further tests.
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Prospective BMI changes in preschool children are associated with parental characteristics and body weight perceptions: the ToyBox-study.
Manios, Y, Lambert, KA, Karaglani, E, Mavrogianni, C, Moreno Aznar, LA, Iotova, V, Świąder-Leśniak, A, Koletzko, B, Cardon, G, Androutsos, O, et al
Public health nutrition. 2022;(6):1552-1562
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OBJECTIVE 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. DESIGN 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. SETTING Selected preschools within the provinces of Oost-Flanders and West-Flanders (Belgium), Varna (Bulgaria), Bavaria (Germany), Attica (Greece), Mazowieckie (Poland) and Zaragoza (Spain). PARTICIPANTS A sample of 6268 preschoolers aged 3·5-5·5 years (51·9 % boys). RESULTS 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. CONCLUSIONS 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.
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Effect of Vitamin D-Enriched Gouda-Type Cheese Consumption on Biochemical Markers of Bone Metabolism in Postmenopausal Women in Greece.
Moschonis, G, van den Heuvel, EG, Mavrogianni, C, Manios, Y
Nutrients. 2021;(9)
Abstract
Considering the role of bone metabolism in understanding the pathogenesis of osteoporosis, the aim of the present study was to examine the effects of vitamin D-enriched cheese on the serum concentrations of the parathyroid hormone (PTH) and certain bone remodeling biomarkers in postmenopausal women in Greece. In a randomised, controlled dietary intervention, 79 postmenopausal women (55-75 years old) were randomly allocated either to a control (CG: n = 39) or an intervention group (IG: n = 40), consuming 60 g of either non-enriched or vitamin D3-enriched Gouda-type cheese (5.7 μg of vitamin D3), respectively, daily and for eight weeks during the winter. The serum concentrations of 25-hydroxy vitamin D (25(OH)D), PTH, bone formation (i.e., osteocalcin, P1NP) and bone resorption (i.e., TRAP-5b) biomarkers were measured. Consumption of the vitamin D-enriched cheese led to higher serum 25(OH)D concentrations of 23.4 ± 6.39 (p = 0.022) and 13.4 ± 1.35 (p < 0.001) nmol/L in vitamin D-insufficient women being at menopause for less and more than 5 years, respectively. In vitamin D-insufficient women that were less than 5 years at menopause, consumption of vitamin D-enriched cheese was also associated with lower serum PTH (Beta -0.63 ± 1.11; p < 0.001) and TRAP-5b (Beta -0.65 ± 0.23; p = 0.004) levels at follow-up, compared with the CG. The present study showed that daily intake of 5.7 μg of vitamin D through enriched cheese increased serum 25(OH)D concentrations, prevented PTH increase and reduced bone resorption in vitamin D-insufficient early postmenopausal women, thus reflecting a potential food-based solution for reducing the risk of bone loss occurring after menopause.
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Longitudinal Associations between Food Parenting Practices and Dietary Intake in Children: The Feel4Diabetes Study.
Flores-Barrantes, P, Iglesia, I, Cardon, G, Willems, R, Schwarz, P, Timpel, P, Kivelä, J, Wikström, K, Iotova, V, Tankova, T, et al
Nutrients. 2021;(4)
Abstract
Food parenting practices (FPPs) have an important role in shaping children's dietary behaviors. This study aimed to investigate cross-sectional and longitudinal associations over a two-year follow-up between FPP and dietary intake and compliance with current recommendations in 6- to 11-year-old European children. A total of 2967 parent-child dyads from the Feel4Diabetes study, a randomized controlled trial of a school and community-based intervention, (50.4% girls and 93.5% mothers) were included. FPPs assessed were: (1) home food availability; (2) parental role modeling of fruit intake; (3) permissiveness; (4) using food as a reward. Children's dietary intake was assessed through a parent-reported food frequency questionnaire. In regression analyses, the strongest cross-sectional associations were observed between home availability of 100% fruit juice and corresponding intake (β = 0.492 in girls and β = 0.506 in boys, p < 0.001), and between parental role modeling of fruit intake and children's fruit intake (β = 0.431 in girls and β = 0.448 in boys, p < 0.001). In multilevel logistic regression models, results indicated that improvements in positive FPPs over time were mainly associated with higher odds of compliance with healthy food recommendations, whereas a decrease in negative FPP over time was associated with higher odds of complying with energy-dense/nutrient-poor food recommendations. Improving FPPs could be an effective way to improve children's dietary intake.
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Personalised nutrition advice reduces intake of discretionary foods and beverages: findings from the Food4Me randomised controlled trial.
Livingstone, KM, Celis-Morales, C, Navas-Carretero, S, San-Cristobal, R, Forster, H, Woolhead, C, O'Donovan, CB, Moschonis, G, Manios, Y, Traczyk, I, et al
The international journal of behavioral nutrition and physical activity. 2021;18(1):70
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Food4Me is an internet-based personalised nutrition study that evaluates the effectiveness of personalized dietary advice in avoiding discretionary foods compared to conventional advice. In different countries, discretionary foods are classified differently. Therefore, this study included two measures of discretionary foods identified by the Food4Me Food Frequency Questionnaire, which covered 22 discretionary foods classified by Food Standards Scotland and 59 discretionary foods identified by Australian Dietary Guidelines. For six months, 1607 participants from seven European countries were randomly assigned to receive generalised dietary advice or one of three levels of personalised nutrition advice (based on diet [L1], phenotype [L2] and genotype [L3]). Personalised nutrition advice was found to be effective in reducing discretionary foods when categorisation included foods high in fat, added sugar and salt. There was a greater reduction in energy, sugar, salt, and saturated fat intakes in people who received personalised nutrition advice [L1-3] as compared to generalised dietary advice after six months. Results of this study can be used by healthcare professionals to support personalised nutrition strategies in the general population targeting discretionary foods to increase compliance with personalised nutrition strategies and achieve better health outcomes.
Abstract
BACKGROUND The effect of personalised nutrition advice on discretionary foods intake is unknown. To date, two national classifications for discretionary foods have been derived. This study examined changes in intake of discretionary foods and beverages following a personalised nutrition intervention using these two classifications. METHODS Participants were recruited into a 6-month RCT across seven European countries (Food4Me) and were randomised to receive generalised dietary advice (control) or one of three levels of personalised nutrition advice (based on diet [L1], phenotype [L2] and genotype [L3]). Dietary intake was derived from an FFQ. An analysis of covariance was used to determine intervention effects at month 6 between personalised nutrition (overall and by levels) and control on i) percentage energy from discretionary items and ii) percentage contribution of total fat, SFA, total sugars and salt to discretionary intake, defined by Food Standards Scotland (FSS) and Australian Dietary Guidelines (ADG) classifications. RESULTS Of the 1607 adults at baseline, n = 1270 (57% female) completed the intervention. Percentage sugars from FSS discretionary items was lower in personalised nutrition vs control (19.0 ± 0.37 vs 21.1 ± 0.65; P = 0.005). Percentage energy (31.2 ± 0.59 vs 32.7 ± 0.59; P = 0.031), percentage total fat (31.5 ± 0.37 vs 33.3 ± 0.65; P = 0.021), SFA (36.0 ± 0.43 vs 37.8 ± 0.75; P = 0.034) and sugars (31.7 ± 0.44 vs 34.7 ± 0.78; P < 0.001) from ADG discretionary items were lower in personalised nutrition vs control. There were greater reductions in ADG percentage energy and percentage total fat, SFA and salt for those randomised to L3 vs L2. CONCLUSIONS Compared with generalised dietary advice, personalised nutrition advice achieved greater reductions in discretionary foods intake when the classification included all foods high in fat, added sugars and salt. Future personalised nutrition approaches may be used to target intake of discretionary foods. TRIAL REGISTRATION Clinicaltrials.gov NCT01530139 . Registered 9 February 2012.
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The effect of a cluster-randomized controlled trial on lifestyle behaviors among families at risk for developing type 2 diabetes across Europe: the Feel4Diabetes-study.
Van Stappen, V, Cardon, G, De Craemer, M, Mavrogianni, C, Usheva, N, Kivelä, J, Wikström, K, De Miquel-Etayo, P, González-Gil, EM, Radó, AS, et al
The international journal of behavioral nutrition and physical activity. 2021;(1):86
Abstract
BACKGROUND This study investigated the effect of the Feel4Diabetes-intervention, a 2-year multilevel intervention, on energy balance-related behaviors among European families at risk for developing type 2 diabetes. Intervention effects on self-reported physical activity, sedentary behavior and eating behaviors were investigated across and within the participating countries: Belgium, Finland, Greece, Spain, Hungary and Bulgaria. METHODS Families were recruited through schools, located in low socio-economic status areas. In total, 4484 families at risk for developing type 2 diabetes were selected using the FINDRISC-questionnaire. Parents' and children's energy balance-related behaviors data were collected by questionnaires at three time points (baseline, mid- and post intervention). Families assigned to the intervention group were invited to participate in a 2-year school-, community-, and family-based intervention to promote a healthier lifestyle, including counseling sessions (first intervention year) and text messages (second intervention year). Families assigned to the control group received standard care, including medical check-up results and recommendations and tips regarding a healthy lifestyle. To assess the intervention-effects, Mixed Models were conducted using the R-Package "lmer "with R v3.2. RESULTS Significant intervention effects were found on a certain number of families' lifestyle behaviors. Significant favorable intervention effects were detected on parents' water consumption and consumption of fruit and vegetables, and on children's consumption of sweets and moderate-to-vigorous physical activity. Analyses by country revealed significant favorable intervention effects on water consumption and on moderate-to-vigorous physical activity in Belgian parents and on fruit and vegetable consumption among Belgian children, on sweets consumption among Spanish parents and children, and on moderate-to-vigorous physical activity among Finnish children. Unfavorable intervention effects were found on the consumption of soft drinks and sugar-containing juices among Hungarian children and parents, while when examining the intervention effects for the overall population and per country, 10 from the 112 investigated outcome variables were improved in the intervention group compared to the control group (9%). CONCLUSIONS The Feel4Diabetes-intervention managed to improve a certain number of targeted lifestyle behaviors while the intervention was not effective on a large number of targeted lifestyle behaviors. The findings of the current study are encouraging, but further research is needed on how we can further improve effectiveness of lifestyle interventions to prevent type 2 diabetes in families at risk. TRIAL REGISTRATION The Feel4Diabetes-study is registered with the clinical trials registry http://clinicaltrials.gov , ID: 643708.
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Assessing the acceptability of an adapted preschool obesity prevention programme: ToyBox-Scotland.
Malden, S, Reilly, JJ, Hughes, A, Bardid, F, Summerbell, C, De Craemer, M, Cardon, G, Androutsos, O, Manios, Y, Gibson, AM
Child: care, health and development. 2020;(2):213-222
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BACKGROUND Childhood obesity is a global public health issue. Interventions to prevent the onset of obesity in the early years are often implemented in preschool settings. The ToyBox intervention was delivered across Europe and targeted energy balance-related behaviours in preschools and children's homes through teacher-led activities and parental education materials and was adapted for use in Scotland. This study assessed the acceptability of the 18-week adapted intervention to both parents and teachers. METHODS Mixed methods were employed to collect both qualitative and quantitative data. Preschool staff and children's parents/caregivers completed post-intervention feedback surveys, from which acceptability scores were calculated and presented as proportions. Focus groups were conducted with preschool staff, whereas parents/caregivers participated in semi-structured interviews. A thematic analysis was applied to qualitative data following the development of a coding framework. Quantitative and qualitative data were analysed using SPSS and NVivo 10, respectively. RESULTS Preschool staff rated the intervention as highly acceptable based on post-intervention feedback surveys (80%; mean score 8.8/11). Lower acceptability scores were observed for parents/caregivers (49%; 3.9/8). Nine preschool practitioners participated in focus groups (n = 3). User-friendliness of the intervention materials, integration of the intervention with the curriculum, and flexibility of the intervention were identified as facilitators to delivery. Barriers to delivery were time, insufficient space, and conflicting policies within preschools with regard to changing classroom layouts. Parental interviews (n = 4) revealed a lack of time to be a major barrier, which prevented parents from participating in home-based activities. Parents perceived the materials to be simple to understand and visually appealing. CONCLUSIONS This study identified a number of barriers and facilitators to the delivery and evaluation of the ToyBox Scotland preschool obesity prevention programme, which should be considered before any further scale-up of the intervention.
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Lifestyle Changes Observed among Adults Participating in a Family- and Community-Based Intervention for Diabetes Prevention in Europe: The 1st Year Results of the Feel4Diabetes-Study.
Manios, Y, Lambrinou, CP, Mavrogianni, C, Cardon, G, Lindström, J, Iotova, V, Tankova, T, Rurik, I, Stappen, VV, Kivelä, J, et al
Nutrients. 2020;(7)
Abstract
The Feel4Diabetes intervention was a school and community-based intervention aiming to promote healthy lifestyle and tackle obesity and obesity-related metabolic risk factors for the prevention of type 2 diabetes (T2D) among families at risk of developing this disease. The current study aims to present the results on lifestyle behaviors obtained from parents during the first year of the Feel4Diabetes intervention. This multicomponent intervention had a cluster randomized design and was implemented in Belgium, Bulgaria, Finland, Greece, Hungary and Spain over two years (2016-2018). Standardized protocols and procedures were used by the participating centers in all countries to collect data on parents' lifestyle behaviors (diet, physical activity, sedentary behavior). The Feel4Diabetes intervention was registered at clinicaltrials.gov (registration number: NCT02393872). In total, 2110 high-risk parents participated in the baseline and 12-month follow-up examination measurements. Participants allocated to the intervention group reduced their daily consumption of sugary drinks (p = 0.037) and sweets (p = 0.031) and their daily screen time (p = 0.032), compared with the control group. In addition, participants in the intervention group in Greece and Spain increased their consumption of breakfast (p = 0.034) and fruits (p = 0.029), while in Belgium and Finland they increased their water intake (p = 0.024). These findings indicate that the first year of the Feel4Diabetes intervention resulted in the improvement of certain lifestyle behaviors in parents from high-risk families.