on behalf of the IDEFICS consortium OBJECTIVES: The aim of this study is to present age-and sex-specific reference values of insulin, glucose, glycosylated haemoglobin (HbA1c) and the homeostasis model assessment to quantify insulin resistance (HOMA-IR) for pre-pubertal children. METHODS: The reference population consists of 7074 normal weight 3-to 10.9-year-old pre-pubertal children from eight European countries who participated in at least one wave of the IDEFICS ('identification and prevention of dietary-and lifestyle-induced health effects in children and infants') surveys (2007)(2008)(2009)(2010) and for whom standardised laboratory measurements were obtained. Percentile curves of insulin (measured by an electrochemiluminescence immunoassay), glucose, HbA1c and HOMA-IR were calculated as a function of age stratified by sex using the general additive model for location scale and shape (GAMLSS) method. RESULTS: Levels of insulin, fasting glucose and HOMA-IR continuously show an increasing trend with age, whereas HbA1c shows an upward trend only beyond the age of 8 years. Insulin and HOMA-IR values are higher in girls of all age groups, whereas glucose values are slightly higher in boys. Median serum levels of insulin range from 17.4 and 13.2 pmol l − 1 in 3-< 3.5-year-old girls and boys, respectively, to 53.5 and 43.0 pmol l − 1 in 10.5-< 11-year-old girls and boys. Median values of glucose are 4.3 and 4.5 mmol l − 1 in the youngest age group and 49.3 and 50.6 mmol l − 1 in the oldest girls and boys. For HOMA-IR, median values range from 0.5 and 0.4 in 3-< 3.5-year-old girls and boys to 1.7 and 1.4 in 10.5-< 11-year-old girls and boys, respectively. CONCLUSIONS: Our study provides the first standardised reference values for an international European children's population and provides the, up to now, largest data set of healthy pre-pubertal children to model reference percentiles for markers of insulin resistance. Our cohort shows higher values of Hb1Ac as compared with a single Swedish study while our percentiles for the other glucose metabolic markers are in good accordance with previous studies.

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These findings suggest that promoting MVPA may be have a beneficial effect on attention capacity, an important component of cognition, in adolescents.

Background: The EFCOSUM (European Food Consumption Survey Methods) Project aims at harmonizing food consumption surveys in European countries within the perspective of an overall Public Health Monitoring Programme. Harmonization implies the need for a common framework of procedures and tools, that are applicable and feasible in all potentially interested countries. A major element in such a framework is the protocol for the operationalization of a food consumption survey, referring to all practical, logistical and material conditions that need to be fulfilled in order to guarantee a successful implementation of such a survey. Objective: The objective of this paper was to review a number of aspects of operationalization of food consumption surveys in detail. On the basis of the currently available knowledge and experience in Europe, consensus recommendations have been elaborated for an operationalization protocol that would be feasible for all European countries. Methods: The EFCOSUM recommendations with respect to operationalization of food consumption surveys in Europe are mainly based on three sources of information, which have been discussed at several ad hoc expert meetings: experience from previous collaborative epidemiological studies, literature searches and results of two questionnaires, distributed among representatives from 23 European countries -all experts affiliated with experienced organizations in the fields of nutrition research and related fields. Results: Consensus recommendations have been set up for the following topics: sampling, recruitment, fieldwork, biomarkers, interviewer qualifications and training and quality control. These recommendations have to be considered the best achievable common denominator within Europe at this time. In a number of cases, recommendations are presented in a hierarchical way, with a gradation from first choice options towards acceptable alternatives. Conclusions: It can be concluded that a high degree of standardization of fieldwork can be achieved within Europe. A number of specific problems and constraints will have to be solved in connection with the conduction of a real survey. These problems include, amongst others, country-specific decisions on, for example, target population, detailed sampling and recruiting procedures, interview setting and support. However, on the whole, these problems can be overcome and the main recommendations presented in this paper are considered feasible for every country in Europe. Application of the EFCOSUM operationalization protocol in European countries will contribute significantly to the quality and comparability of food consumption data across Europe. It is anticipated that the policy supporting and orienting potential of this type of databases -both at the national and at the EU supranational level -will be increased accordingly.

The objective was to perform a dioxin body burden estimate based on a probabilistic intake assessment of PCDDs, PCDFs and dioxin-like PCBs because of the so-called 1999 'Belgian dioxin incident'. Monte Carlo simulation techniques were used to combine detailed 7-day food intake data on the individual level from a sample of 14-18-year-old adolescents with 'background' and 'incident-related' food contamination data. In background conditions, 3% of the adolescents had an intake <1 pg TEQ kg(-1) bw day(-1), while 85% had <4 pg TEQ kg(-1) bw day(-1). Milk and other dairy products were the basic source of dioxin-like contaminants, while fish constituted the main source at the higher percentiles of intake. During the dioxin incident, the estimated median dioxin intake showed a moderate increase. At the 99th percentile, the highest intake level, and the 95% upper bound uncertainty level, peak body burden-23.73 ng TEQ kg(-1) bw-remained below body burdens that in the experimental animal or in man are accompanied by a population-based observable increase in the incidence of adverse effects. The 1999 Belgian dioxin incident most likely did not affect public health in Belgium in a measurable way, although exceptions remain possible on the individual level.

Objective: To examine the in¯uence of food consumption survey duration on estimates of percentage consumers, mean total population intakes and intakes among consumers only and to consider its relevance for public health nutrition and food safety issues. Design: Prospective food consumption survey. Setting: A multicentre study in ®ve centres in the European Union Ð Dublin, Ghent, Helsinki, Potsdam and Rome. Subjects: Teenage subjects were recruited through schools; 948 (80%) out of 1180 subjects completed the survey. Interventions: 14-day food diaries were used to collect the food consumption data. Results: For mean total population intakes, 53% of the foods had slopes signi®cantly different to 0 (P`0.05). In practical terms (gaday), these differences were small, with 41% of foods having differences of 1 gaday and a further 35% having differences of 1 ± 5 gaday. Estimates of percentage consumers based on 3 days and 14 days were 1.9 and 3.6 times the 1-day estimate, respectively. For 72% of foods, at least 50% of non-consumers on day 1 became consumers over the subsequent 13 days. Estimates of mean consumer only intakes based on 3 days and 14 days were 53% and 32% of the 1 day value. Conclusion: In practical terms, survey duration in¯uences estimates of percentage consumers and intakes among consumers only but not mean total population intakes. Awareness of this in¯uence is important for improved interpretation of dietary data for epidemiological studies, development of food-based dietary guidelines and food chemical intakes. Sponsorship: The Institute of European Food Studies, a non-pro®t research organization based in Trinity College Dublin.

While genetic factors play a role in the development of obesity, its dramatic increase in prevalence over the past few years strongly suggests an important environmental role. The results of a review on environmental opportunities and barriers for physical activity and dietary intake influencing the obesity epidemic among children and adolescents are presented. Although evidence clearly shows the impact of the environment on obesity-related lifestyle factors among children, evidence for effective strategies combating this obesogenic environment is scarce. Interventions aiming to change environmental factors to reduce childhood obesity may include providing extra sporting facilities and healthy foods/meals at school (e.g., provision of fruit), efforts to improve safety and accessibility of walking, cycling, and play areas, while at the same time attempting to influence social values attached to weight, food, or physical activity. Some level of institutionalization of systems that support the desired changes is required to sustain long-term environmental changes (e.g., ban of softdrinks at school). Better-designed and -conducted research on the true importance of environmental factors for obesogenic behavioral change is needed to achieve success of large-scale environmental change interventions.

on behalf of the IDEFICS consortium BACKGROUND: Measurement of cholesterol and triglyceride (TG) fractions in blood has become standard practice in the early detection of atherosclerotic disease pathways. Considerable attention is given nowadays to the presence of these risk factors in children and to start preventive campaigns early in life. In this context, it is imperative to have valid comparative frameworks for interpretation of lipid levels. The aim of this study is to present sex-and age-specific reference values on blood lipid levels in European children aged 2.0-10.9 years. METHODS: Fasting blood was obtained via either venipuncture or capillary sampling. In 13 579 European non-obese children (50.3% boys), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), TG and TC/HDL-C ratio levels were measured with a point-of-care analyser (Cholestech). Sex-and age-specific reference values were computed with the GAMLSS method with the statistical software R. RESULTS: Reference curves and 1st, 3rd, 10th, 25th, 50th, 75th, 90th, 97th and 99th percentile values are presented. HDL-C showed a positive trend with age, from 2 years onwards, but was relatively stable above the age of 7. For LDL-C and TC, linear but small age-related trends were seen. The TC/HDL-C values showed a gradual negative trend from the age of 2 up to 6 and were relatively stable afterwards. For TG, no age trend was found (P = 0.285). Boys had higher mean HDL-C values than girls (1.414 vs 1.368 mmol l