Familial Resemblance in Dietary Intakes of Children, Adolescents, and Parents : Does Dietary Quality Play a Role?

Information on familial resemblance is important for the design of effective family-based interventions. We aimed to quantify familial correlations and estimate the proportion of variation attributable to genetic and shared environmental effects (i.e., familiality) for dietary intake variables and determine whether they vary by generation, sex, dietary quality, or by the age of the children. The study sample consisted of 1435 families (1007 mothers, 438 fathers, 1035 daughters, and 1080 sons) from the multi-center I. Family study. Dietary intake was assessed in parents and their 2-19 years old children using repeated 24-h dietary recalls, from which the usual energy and food intakes were estimated with the U.S. National Cancer Institute Method. Food items were categorized as healthy or unhealthy based on their sugar, fat, and fiber content. Interclass and intraclass correlations were calculated for relative pairs. Familiality was estimated using variance component methods. Parent-offspring (r = 0.11-0.33), sibling (r = 0.21-0.43), and spouse (r = 0.15-0.33) correlations were modest. Parent-offspring correlations were stronger for the intake of healthy (r = 0.33) than unhealthy r = 0.10) foods. Familiality estimates were 61% (95% CI: 54-68%) for the intake of fruit and vegetables and the sum of healthy foods and only 30% (95% CI: 23-38%) for the sum of unhealthy foods. Familial factors explained a larger proportion of the variance in healthy food intake (71%; 95% CI: 62-81%) in younger children below the age of 11 than in older children equal or above the age of 11 (48%; 95% CI: 38-58%). Factors shared by family members such as genetics and/or the shared home environment play a stronger role in shaping children's intake of healthy foods than unhealthy foods. This suggests that family-based interventions are likely to have greater effects when targeting healthy food choices and families with younger children, and that other sorts of intervention are needed to address the intake of unhealthy foods by children.Peer reviewe

Confronting the epidemic, of childhood obesity in Cyprus: the Cyprus school and family intervention study

Introduction: Childhood obesity is increasing in Cyprus but also in entire Europe. TheWestern lifestyle in combine to the economic crisis it is possible to negatively affect qualityof life and nutrition. Prevention of childhood obesity is considered as one of the mostimportant means to fight increasing obesity prevalence in childhood, adulthood and its healthconsequences to both age groups. Aim: The main goal of the current study was to conductand evaluate an intervention program on a school base and a family base, in order to lowerobesity rates and promote healthy lifestyle in relation to nutrition and physical activity.Methods: Children two to nine years of age from Pafos and Strovolos areas participated inIDEFICS (Identification and prevention of dietary and life style induced health effects inchildren and infants) study in Cyprus (n=2380). From the rest seven European countries of theIDEFICS study, 13884 participated at baseline study (2007-2008). The association ofbreastfeeding and the introduction of solid foods, was investigated from data coming from alleight European countries (n=11657. 50.3% males). Respectively, within the Europeanpopulation, the association of breakfast consumption and health indices was investigated(n=8863, 51.2% males) while on a national level, breakfast habits were studied in relation todaily nutrients intake. (n=1558, 50.3% males, 4-8 years). After the two year school based andfamily based intervention program (2007-2010) in Cyprus (school based family interventiontook place in Strovolos while family based intervention took place in Strovolos as well, in“Open Schools” with two hours-weekly sessions for exercise and family nutritionaleducation/intervention). In total, 1743 out of 2380 children participated in follow up study in2009-2010 (850 children from Strovolos intervention group, 865 children from Pafos controlgroup and 28 children from Open School intervention group (50.6% males for all groups).Results: The two years intervention study did not affect significantly Cyprus population’sobesity prevalence. Still, boys of Strovolos intervention group, significantly reduced their Total Cholesterol blood levels while boys and girls reduced their weekly consumption of junkfood, compared to control group. In Open School intervention group, boys reducedsignificantly their weekly consumption of junk food and girls increased significantly theirdaily consumption of fruits and vegetables. Within the European population of the study itwas found that exclusive breastfeeding for 4 to 6 months followed by solid food introduction isprotective over future obesity in childhood; early introduction of fruits as well, regardless of milkinfant feeding practices. Daily breakfast consumption was found to help controlling school agedchildren’s weight, lipid profile and promotes higher physical activity in boys. On a nationallevel, within the Cypriot study population girls who have breakfast on a daily basis had lowermean Body Mass Index and they were also less likely of having abnormal levels of serumtriglycerides, atheromatic index (Total Cholesterol to HDL-cholesterol ratio) and diastolic bloodpressure after controlling for several confounding factors. Within regular breakfast consumers, of both boys and girls, those having RTE cereals had a superior nutrient intake profile. Conclusions:According to results, early infant nutrition and breakfast habits are two significant nutritionareas that need to be further investigated; current data support that optimal breakfast habits,sufficient exclusive breastfeeding and timely introduction of solids during infancy play a keyrole for the prevention of future adiposity and/or abnormal cardiovascular risk factors duringchildhood. Intervention had light positive outcomes so the need for efficient interventionprograms in Cyprus remains as a challenge and it is urgently needed for such prevention andintervention programs to be stratified and implemented in public schools.Εισαγωγή: Το πρόβλημα της παιδικής παχυσαρκίας στην Κύπρο εδώ και δύο δεκαετίες,είναι μεγάλο και η ανάγκη πρόληψης και αντιμετώπισης του είναι πιο επιτακτική από ποτέ. Οδυτικός τρόπος ζωής στην εποχή της βαθιάς οικονομική ύφεσης και η μείωσης της ποιότηταςτου επιπέδου διαβίωσης του πολίτη, ενδέχεται να προκαλέσει μεγαλύτερα επίπεδαπαχυσαρκίας τόσο σε εθνικό όσο και σε διεθνές επίπεδο. Στόχοι: Ο πρωταρχικός στόχος τηςπαρούσας μελέτης ήταν η οικογενειακή εκπαιδευτική παρέμβαση για την πρωτογενήπρόληψη της παιδικής παχυσαρκίας αλλά και για την ελάττωση του επιπολασμού τωνυπέρβαρων και παχύσαρκων παιδιών στον υπό μελέτη πληθυσμό ηλικίας 2-9 ετών. Ηβελτίωση στις διατροφικές συνήθειες, η αύξηση της φυσικής δραστηριότητας αλλά και ησυμβολή του παρεμβατικού προγράμματος στην ενδυνάμωση των οικογενειακών δεσμώναποτέλεσαν τους τρεις άξονες της οικογενειακής παρέμβασης. Δεύτερος στόχος η συσχέτισηδιατροφικών μεταβλητών, που δεν έχουν μελετηθεί εκτενώς στη διεθνή βιβλιογραφία, με την παιδική παχυσαρκία και με τους γενικότερους δείκτες υγείας. Μεθοδολογία: Συνολικάσυμμετείχαν στην πρώτη φάση της μελέτης (2007-2008) 2380 παιδιά από την Κύπρο και13884 παιδιά ηλικίας 2 με 9 ετών από επτά άλλες Ευρωπαϊκές χώρες στα πλαίσια της μελέτηςIDEFICS (Identification and prevention of dietary and life style induced health effects inchildren and infants). Σύμφωνα με τις μετρήσεις και τις πληροφορίες που συλλέχθηκαν στηνπρώτη φάση του προγράμματος και στις οχτώ Ευρωπαϊκές χώρες, μελετήθηκε η συσχέτισητης παιδικής παχυσαρκίας στις ηλικίες 2-9 ετών ως προς τη διάρκεια θηλασμού και τον μήναεισαγωγής στερεάς τροφής (n=11657. 50.3% αγόρια). Αντίστοιχα μελετήθηκε η συσχέτισητης κατανάλωσης πρωινού γεύματος στο σπίτι με την παχυσαρκία στις ηλικίες 2-9 ετών αλλάκαι τις μη φυσιολογικές τιμές λιπιδαιμικής εικόνας και αρτηριακής πίεσης στα παιδιά(n=8863, 51.2% αγόρια). Στον Κυπριακό πληθυσμό, πέρα από την συσχέτιση τηςκατανάλωσης πρωινούστο σπίτι σε σχέση με τους δείκτες υγείας (n=1558, 50.3% αγόρια, 4-8 ετών) μελετήθηκε επιπλέον και η πρόσληψη θρεπτικών συστατικών ως προς τις επιλογέςπρωινού. Τέλος, μετά το πέρας διετούς σχολικής και οικογενειακής παρέμβασης (δεύτερηφάση προγράμματος 2007-2010) στην Κύπρο σε σχολεία του Στροβόλου (οικογενειακή-σχολική παρέμβαση) και στην Ομάδα του Ανοικτού σχολείου (οικογενειακή παρέμβαση) απότα 2380 παιδιά ηλικίας 2-9 ετών, τα 1743 συμμετείχαν στην τρίτη φάση του προγράμματος(2009-2010) για αξιολόγηση των αποτελεσμάτων. Συνολικά στην Τρίτη φάση συμμετείχαν850 παιδιά από τον Στρόβολο, 28 παιδιά από το Ανοικτό Σχολείο ενώ 865 παιδιά αποτέλεσαντην ομάδα ελέγχου στην Πάφο της Κύπρου (συνολικά το 50.6% αγόρια). Αποτελέσματα: Ηεκπαιδευτική διετής παρέμβαση δεν επέφερε μείωση στα επίπεδα της παχυσαρκίας. Ωστόσο,τα αγόρια της ομάδας σχολικής παρέμβασης (Στροβόλου) είχαν μεγαλύτερη μείωση στηνΟλική Χοληστερόλη αίματος και μείωση στη συχνότητα εβδομαδιαίας κατανάλωσηςφαγητού σε ταχυφαγεία, σε σχέση με τα αγόρια της ομάδας ελέγχου. Αντίστοιχα, τα κορίτσια είχαν σημαντική μείωση στη συχνότητα εβδομαδιαίας κατανάλωσης φαγητού σε ταχυφαγεία.Στην ομάδα οικογενειακής παρέμβασης (Ανοικτού Σχολείου) παρατηρήθηκε μείωση τηςεβδομαδιαίας συχνότητας κατανάλωσης φαγητού σε ταχυφαγεία στα αγόρια, ενώ στακορίτσια αυξήθηκε η ημερήσια κατανάλωση φρούτων και λαχανικών. Σε ότι αφορά τησυσχέτιση θηλασμού και εισαγωγής στερεάς τροφής με την παχυσαρκία στην παιδική ηλικία,βρέθηκε πως τα παιδιά που θηλάζουν αποκλειστικά 4 με 6 μήνες και αμέσως μετά γίνεταιεισαγωγή στερεάς τροφής χωρίς να μεσολαβήσει περίοδος διατροφής με βρεφικές φόρμουλεςγάλατος αγελάδας, είχαν σημαντικά μικρότερη πιθανότητα να είναι υπέρβαρα ή παχύσαρκαστις ηλικίες των 2- 9 ετών. Η συνέχιση του θηλασμού μέχρι 12 μήνες μαζί με τηνκατανάλωση στερεάς τροφής έχει επίσης προστατευτικό ρόλο. Σημαντικό είναι να αναφερθείπως άσχετα με την περίοδο θηλασμού, βρέθηκε πως η εισαγωγή φρούτων στην ηλικία των 3 μηνών σχετίζεται με μικρότερα ποσοστά παχυσαρκίας στην παιδική ηλικία. Σε ότι αφορά τηνκατανάλωση πρωινού στο σπίτι, στον Κυπριακό πληθυσμό φάνηκε πως τα κορίτσια που καταναλώνουν καθημερινά πρωινό έχουν χαμηλότερο μέσο Δείκτη Μάζας Σώματος. Επίσης, τακορίτσια που δεν καταναλώνουν καθημερινά πρωινό έχουν μεγαλύτερο κίνδυνο για μη φυσιολογικέςτιμές λιπιδίων αίματος και ψηλότερη από το επιθυμητό αρτηριακή πίεση ανεξάρτητα από τη φυσικήτους δραστηριότητα και το Δείκτη Μάζας Σώματος των γονέων. Επίσης, μεταξύ των παιδιών πουκαταναλώνουν καθημερινά πρωινό, αγοριών και κοριτσιών, αυτά που επιλέγουν δημητριακά είχαν τηβέλτιστη διατροφική εικόνα σε θρεπτικά συστατικά στη συνολική ημερήσια πρόσληψη, σε αντίθεσημε τα παιδιά που για πρωινό καταναλώνουν αρτοποιήματα και γλυκά, καθώς βρέθηκε πως αυτά είχαντη χαμηλότερη ποιότητα διατροφής. Σε διεθνές επίπεδο, τα αποτελέσματα που προκύπτουν από ταπαιδιά και των οχτώ Ευρωπαϊκών χωρών της μελέτης IDEFICS, τόσο τα κορίτσια όσο και τα αγόριαφαίνεται να επωφελούνται από την καθημερινή κατανάλωση πρωινού στο σπίτι έχοντας μικρότεροκίνδυνο για παχυσαρκία/ κεντρική παχυσαρκία, καλύτερα επίπεδα HDL χοληστερόλης, καιχαμηλότερα επίπεδα τριγλυκεριδίων στο αίμα. Τα αποτελέσματα ωστόσο ήταν σημαντικά μόνο για τιςηλικίες 6-9 ετών. Αξίζει να σημειωθεί πως σημαντικό εύρημα ήταν και το γεγονός πως τα αγόρια 6-9 ετών που καταναλώνουν καθημερινά πρωινό στο σπίτι είχαν υψηλότερα επίπεδα Μέτριας προςΈντονης φυσικής δραστηριότητας στο σύνολο της ημέρας, έτσι όπως αυτή καταγράφτηκε μεεπιταχυνσιόμετρα. Συμπέρασμα: Τα αποτελέσματα της παρούσας μελέτης φέρνουν στο φωςκαινούργια δεδομένα για διατροφικούς και περιγεννητικούς παράγοντες που συμβάλλουνστην πρόληψη της παιδικής παχυσαρκίας και συναφών προβλημάτων, όπως η σωστήκατανάλωση πρωινού αλλά και η σημαντικότητα του αποκλειστικού θηλασμού μαζί με τηνέγκαιρη εισαγωγή στερεάς τροφής πλούσιας σε φυτικές ίνες στον 4ο με 6ο μήνα της ζωής. Τααποτελέσματα της παρέμβασης είναι λίγα, ωστόσο θετικά, επισημαίνοντας την ανάγκη γιαπερισσότερα αντίστοιχα προγράμματα με καλύτερη μεθοδολογία και σχεδιασμό γιαυιοθέτηση τους σε εθνικό επίπεδο από τους αρμόδιους δημόσιους φορείς

Factors Associated with the Prevalence of Diabetes Mellitus Among Elderly Men and Women Living in Mediterranean Islands: The MEDIS Study

BACKGROUND: The aim of the present work was to evaluate the relationships between socio-demographic, clinical, lifestyle and psychological characteristics and the presence of diabetes mellitus, among elderly individuals without known cardiovascular disease. METHODS: During 2005-2007, 1190 elderly (aged 65 to 100 years) men and women (from Cyprus, Mitilini, Samothraki, Cephalonia, Crete, Lemnos, Corfu and Zakynthos) were enrolled. Socio-demographic, clinical and lifestyle factors were assessed using standard procedures. Diabetes mellitus was defined as fasting blood glucose >125 mg/dl or use of special medication. RESULTS: 21% of males and 23% of females had diabetes. Only 70% of diabetic participants were on a special diet and 76% were receiving pharmaceutical treatment. Diabetic individuals had higher prevalence of hypertension (80% vs. 64%, p < 0.001) and hypercholesterolemia (63% vs. 51%, p < 0.001) and reported lower physical activity status (p < 0.001), compared with non-diabetic participants. After adjusting for various confounders, hypertension and hypercholesterolemia were associated with a 144% (95% CI, 1.37-4.35) and 83% (95% CI, 1.13-2.94) higher likelihood of having diabetes, while moderate and vigorous exercise correlated with a 82% (95% CI, 0.09-0.81) and 67% (95% CI, 0.11-0.97) lower likelihood of diabetes. CONCLUSIONS: A considerable proportion of our elderly sample had diabetes and other metabolic disorders, almost 25% of which were untreated. Promotion of physical activities, even in the elderly, may contribute to reducing their burden of diabetes and provide them with a better quality of living

Associations between exclusive breastfeeding and physical fitness during childhood

PURPOSE: Exposure to breastfeeding improves the survival, health, and development of children; therefore, breast milk is recommended as the exclusive nutrient source for feeding term infants during the first 6 months. This cross-sectional study aimed to determine the possible association between exposure to exclusive breastfeeding and physical fitness performance in children and, if so, whether this association is influenced by the breastfeeding duration. METHODS: A total of 2853 (52.3 % girls) European children from the IDEFICS study aged 6-11 years with complete data on physical fitness (cardiorespiratory fitness, muscular strength, flexibility, balance, speed) and exclusive breastfeeding duration (never, 1-3, 4-6, 7-12 months) were included in the present study. Multivariate and mixed linear regression models were estimated and adjusted for sex, age, birth weight, diet, physical activity, body mass index, and parental factors (age, body mass index, educational attainment). RESULTS: We found a positive association between exclusive breastfeeding and lower-body explosive strength (β = 0.034) as well as flexibility (β = 0.028). We also found a positive association between breastfeeding and balance in boys (β = 0.039), while this association was negative in girls (β = -0.029). To improve lower-body explosive strength, 1-3 months of exclusive breastfeeding were enough; a longer duration did not lead to increasing benefit. In contrast, 4-6 months of breastfeeding were necessary to have any benefit on flexibility or balance, although this became nonsignificant after adjustment for body mass index and physical activity. CONCLUSIONS: Exclusive breastfeeding seems a natural way of slightly improving some physical fitness components (mainly lower-body muscle strength) and thus future health

Timing of solid food introduction and association with later childhood overweight and obesity : the IDEFICS study

This study investigated associations between timing of solid food introduction and childhood obesity and explored maternal characteristics influencing early feeding practices. Cross-sectional data from children 2-9years (n=10,808; 50.5% boys) residing in 8 European countries of the IDEFICS study (2007-2008) were included. Late solid food introduction (7months of age) was associated with an increased prevalence of later childhood overweight/obesity among exclusively breastfed children (OR [odds ratio]: 1.38, 95% CI [confidence interval] [1.01, 1.88]). In contrast, early solid food introduction (<4months of age) was associated with lower prevalence of overweight/obesity among children that ceased exclusive breastfeeding earlier than 4 months (OR: 0.63, 95% CI [0.47, 0.84]). Children that were introduced to solids right after 6months exclusive breastfeeding and continued to receive breastmilk (12months) were less likely to become overweight/obese (OR: 0.67, 95% CI [0.51, 0.88]) compared to children that discontinued to receive breastmilk. Analyses were adjusted for age, sex, country, birth weight, parental education level, parental body mass index, tobacco use in pregnancy, gestational weight gain, and gestational diabetes. Underweight mothers, overweight mothers, mothers who reported daily smoking during pregnancy, and low-educated mothers were less likely to follow recommendations on breastfeeding and timely solids introduction. Future studies should examine whether guidelines for solid food introduction timing have to distinguish between exclusively breastfed, formula fed, and too early exclusive breastfeeding-ceased infants. There is also need for more prospective studies; recall bias was an important current limitation. In conclusion, health professionals should emphasize benefits of breastfeeding and appropriate solid food introduction, especially to mothers that are less likely to follow recommendations

Dairy consumption at snack meal occasions and the overall quality of diet during childhood : Prospective and cross-sectional analyses from the idefics/i.family cohort

There is scarce information on the influence of dairy consumption between main meals on the overall diet quality through childhood, constituting the main aim of this research. From the Identification and prevention of Dietary-and lifestyle induced health EFfects In Children and infantS (IDEFICS) study, and based on the data availability in each period due to drop outs, 8807 children aged 2 to 9.9 years from eight European countries at baseline (T0: 2007–2008); 5085 children after two years (T1); and 1991 after four years (T3), were included in these analyses. Dietary intake and the Diet Quality Index (DQI) were assessed by two 24 hours dietary recalls (24-HDR) and food frequency questionnaire. Consumption of milk and yogurt (p = 0.04) and cheese (p &lt; 0.001) at snack meal occasions was associated with higher DQI scores in T0; milk and yogurt (p &lt; 0.001), and cheese (p &lt; 0.001) in T1; and cheese (p = 0.05) in T3. Consumers of milk (p = 0.02), yogurt (p &lt; 0.001), or cheese (p &lt; 0.001) throughout T0 and T1 at all snack moments had significantly higher scores of DQI compared to non-consumers. This was also observed with the consumption of cheese between T1 and T3 (p = 0.03). Consumption of dairy products at snack moments through childhood is associated with a better overall diet quality, being a good strategy to improve it in this period. consortia on behalf of the IDEFICS/I.Family</p

Dietary Diversity and Its Association with Diet Quality and Health Status of European Children, Adolescents, and Adults : Results from the I.Family Study

Dietary diversity (DD) plays a crucial role in fostering high-quality diets, but its association with health outcomes, particularly body adiposity and non-communicable diseases (NCDs), is inconsistent. This may be due to a lack of a standardized method for estimating DD. Our study investigates the association between two DD indices, namely the dietary diversity score (DDS) and food variety score (FVS), and anthropometric measures, biochemical parameters, and diet quality in a large population sample from the I.Family study across research centers in eight European countries. In our cross-sectional analysis of 3035 participants, DDSs varied among countries, with a higher prevalence in the third DDS tertile among those with higher education. DDS showed a positive association with diet quality across all age groups. Higher DDS tertile individuals showed increased fiber, fruit, and vegetable intake, greater meal frequency, and lower ultra-processed food consumption. No relevant biochemical differences were observed across DDS tertiles, and a higher DDS was associated with lower overweight/obesity prevalence only in adults. No significant associations were found with FVS. Our findings emphasize the need to consider food groups for a more accurate estimation of diet quality. This aligns with studies suggesting DDS alone is not an independent risk factor for obesity in children and adolescents. Public health programs should prioritize food diversity to promote improved nutrition and overall well-being in communities. CC BY 4.0 DEED© 2023 by the authorsCorrespondence Address: F. Lauria; Institute of Food Sciences, National Research Council, Avellino, 83100, Italy; email: [email protected] are grateful for the participation of European children and their parents in this examination. We acknowledge the support received from school boards, headmasters, and communities. We gratefully acknowledge Rosaria Tremigliozzi for her support in statistical analysis. Finally, we acknowledge the support of the CNR project NUTRAGE FOE-2021 DBA.AD005.225 and the National Recovery and Resilience Plan (NRRP), Mission 4 Component 2 Investment 1.3—Call fortender No. 341 of 15 March 2022 of the Italian Ministry of University and Research, funded by the European Union—NextGenerationEU; award number: project code PE00000003, concession decree no. 1550 of 11 October 2022 adopted by the Italian Ministry of University and Research, project title “ON Foods—Research and innovation network on food and nutrition Sustainability, Safety and Security—Working ON Foods”. The pan-European IDEFICS/I.Family children cohort is registered under ISRCTN62310987.</p