on behalf of the IDEFICS consortium OBJECTIVES: To provide sex-and age-specific percentile values for levels of physical activity (PA) and sedentary time of European children aged 2.0-10.9 years from eight European countries (Sweden, Germany, Hungary, Italy, Cyprus, Spain, Belgium and Estonia). METHODS: Free-living PA and sedentary time were objectively assessed using ActiGraph GT1M or ActiTrainer activity monitors in all children who had at least 3 days' worth of valid accelerometer data, with at least 8 h of valid recording time each day. The General Additive Model for Location Scale and Shape was used for calculating percentile curves. RESULTS: Reference values for PA and sedentary time in the European children according to sex and age are displayed using smoothed percentile curves for 7684 children (3842 boys and 3842 girls). The figures show similar trends in boys and girls. The percentage of children complying with recommendations regarding moderate-to-vigorous physical activity (MVPA) is also presented and varied considerably between sexes and country. For example, the percentage of study participants who were physically active (as assessed by MVPA) for 60 or more minutes per day ranged from 2.0% (Cyprus) to 14.7% (Sweden) in girls and from 9.5% (Italy) to 34.1% (Belgium) in boys. CONCLUSION: This study provides the most up-to-date sex-and age-specific reference data on PA in young children in Europe. The percentage compliance to MVPA recommendations for these European children varied considerably between sexes and country and was generally low. These results may have important implications for public health policy and PA counselling.

; for the IDEFICS Consortium IMPORTANCE Identifying associations between preschool-aged children's electronic media use and their later well-being is essential to supporting positive long-term outcomes. OBJECTIVE To investigate possible dose-response associations of young children's electronic media use with their later well-being. DESIGN, SETTING, AND PARTICIPANTS The IDEFICS (Identification and Prevention of Dietaryand Lifestyle-Induced Health Effects in Children and Infants) study is a prospective cohort study with an intervention component.

Objective: The purpose of the present study was to evaluate the effects of a school-based, 2-year, multi-component intervention on BMI, eating and physical activity behaviour in Flanders, Belgium, targeting children aged 3-6 years in communities of high and low socio-economic status (SES). Design: Cluster-randomized controlled trial. Setting: Thirty-one pre-primary and primary schools in three different intervention communities and three paired-matched (on SES profile) control communities in Flanders, Belgium. Subjects: BMI Z-scores at baseline and follow-up were calculated for 1102 children. Questionnaires with sociodemographic data and FFQ were available from 694 of these 1102 children. Results: No significant effects were found on BMI Z-scores for the total sample. However, there was a significant decrease in BMI Z-score of 0?11 in the low-SES intervention community compared with the low-SES control community, where the BMI Z-score increased by 0?04 (F 5 6?26, P 5 0?01). No significant intervention effects could be found for eating behaviour, physical activity or screen-time. There were no significant interaction effects of age and gender of the children on the outcome variables. Conclusions: Although no significant effects were found for BMI Z-scores in the total sample, this intervention had a promising effect in the low-SES community of reducing excess weight gain among young children.

BackgroundFrom a health perspective it is suggested to promote a positive balance between time spent in light intensity physical activity (LIPA) and sedentary behaviour (SB) (i.e. spending more time in LIPA than time spent in SB). However, no studies have reported prevalence rates of the LIPA-SB balance yet. The aim of this study was to objectively investigate the time spent in SB, in LIPA and moderate-to-vigorous intensity physical activity (MVPA) in four Belgian age groups and to explore which proportion of the population had a favorable balance between LIPA and SB and combined this with recommended amount of MVPA.MethodsAccelerometer data from 7 cross-sectional studies (N=2083) in four age groups (preschoolers, primary schoolchildren, secondary schoolchildren and adults) were aggregated. Differences in SB and PA between age groups and between men and women were determined by two-way MANCOVA. LIPA-SB balance was calculated and participants were categorized into one of four groups: (1) positive LIPA-SB balance (LIPA> SB) & sufficient MVPA (2) negative LIPA-SB balance & sufficient MVPA (3) positive LIPA-SB balance & insufficient MVPA (4) negative LIPA-SB balance & insufficient MVPA.ResultsFor the total sample, 55% of the waking time was spent in SB, 39% in LIPA and 6% in MVPA. Differences in SB between age groups was dependent from gender (p<0.001). Further, a positive LIPA-SB balance was assessed in 18% of the total sample and only 10% combined this positive balance with recommended amount of MVPA. Secondary schoolgirls were most at risk, with only 1% of the sample combining a positive LIPA-SB balance with sufficient MVPA. Another risk group was the large proportion (43%) of adult men who combined sufficient MVPA with a negative LIPA-SB balance.ConclusionA high proportion of the Belgian population is at risk if taking into account both SB and PA levels. Secondary schoolgirls have the unhealthiest SB and PA profile and are therefore an important target group for interventions both increasing MVPA and decreasing SB. In men more attention should be given in promoting a positive LIPA-SB balance independently from their compliance with the MVPA guidelines.

This study aimed to (i) gain insight in the prevalence of overweight indices in European preschoolers (4-7 years); (ii) identify energy balance-related behaviours associated with overweight/obesity; and (iii) identify children at risk for overweight/obesity. Secondary analyses of six European data sets were conducted according to standardized protocols. Based on objectively measured height and weight, prevalence of overweight and obesity across the countries ranged from 8% to 30% and 1% to 13%, respectively, with highest rates in Southern European countries (i.e. Spain and Greece). Positive associations between sedentary behaviours and overweight indices were found. Physical activity and dietary behaviours were not associated, possibly because of methodological limitations. Children of parents with high body mass index or low socioeconomic status were at increased risk of overweight/obesity. In conclusion, large differences in prevalence of overweight and obesity among preschoolers across Europe were observed. Future obesity prevention interventions in preschoolers should target screen time giving specific attention to children from overweight and/or low socioeconomic status parents. There is a need for high methodological quality studies, preferably with a long-term prospective design using sensitive, valid and reliable measures of behaviours, assessing whether and which physical activity and dietary behaviours are associated with overweight in preschoolers.

Background and objectives: The European UnionFas well as other parts of the worldFfaces a major challenge of increasing incidence of overweight/obesity. In particular, the increase in childhood obesity gives rise to a strong imperative for immediate action. Yet, little is known about the effectiveness of community interventions, and further research in this field is needed. There is, however, a growing consensus that such research should start from the paradigm that the current living environments tend to counteract healthy lifestyles. Questioning these environments thoroughly can help to develop new pathways for sustainable health-promoting communities. Against this background, the IDEFICS (Identification and prevention of dietary-and lifestyleinduced health effects in children and infants) study developed and implemented innovative community-oriented intervention programmes for obesity prevention and healthy lifestyle primarily in children aged 2-10 years in eight European countries: Sweden, Estonia, Germany, Belgium, Hungary, Italy, Spain and Cyprus. Materials and methods: The IDEFICS community-oriented intervention study mobilised an integrated set of interventional efforts at different levels of society, with the aim of facilitating the adoption of a healthy obesity-preventing lifestyle. The overall programme has been composed of 10 modules: three at community level, six at school level and one for parents. The main focus was on diet, physical activity and stress-coping capacity. The sphere of action encompassed both children and their (grand) parents, schools, local public authorities and influential stakeholders in the community. All materials for the interventions were centrally developed and culturally adapted. Results: So far, the following has been achieved: focus group research, literature review and expert consultations were done in an early phase as a basis for the development of the intervention modules. The intervention mapping protocol was followed as guide for structuring the intervention research. The overall intervention programme's duration was 2 years, but a longer-term follow-up programme is under development. Conclusions: This large-scale European effort is expected to contribute significantly to the understanding of this major public health challenge.

Objective: The aim of the present study was to evaluate the effects of a 1-year family-based healthy lifestyle intervention implemented through day-care centres on toddlers' BMI Z-scores and reported activity-and dietary-related behaviours. Design: Pilot cluster-randomized controlled trial. Setting: Seventy child-care centres in three different intervention communities and three paired-matched control communities in Flanders, Belgium. Subjects: A sample of 203 Belgian toddlers aged 9-24 months was included in the study. Objectively assessed weight and height were used to calculate BMI Z-scores. A parental-report questionnaire was used to assess children's lifestyle behaviours. Results: Positive intervention effects were found on BMI Z-score. No intervention effects were found for activity-and dietary-related behaviours targeted by the intervention. In both intervention and control groups, daily consumption of water, soft drinks, sweets and savoury snacks increased while daily consumption of fruit and vegetables decreased over 1 year. Daily physical activity remained stable but screen-time behaviour increased in both groups over time. Conclusions:The study showed that a family-based healthy lifestyle intervention implemented through day-care centres can lead to healthier weight outcomes in toddlers. In both groups, an unhealthier lifestyle pattern was observed over 1 year which underlines the importance of the early childhood period as the focus of future behavioural interventions.

Summary Background/Objectives Childhood obesity is a major public health concern but evidence‐based approaches to tackle this epidemic sustainably are still lacking. The Identification and prevention of Dietary‐ and lifestyle‐induced health EFfects In Children and infantS (IDEFICS) study investigated the aetiology of childhood obesity and developed a primary prevention programme. Here, we report on the effects of the IDEFICS intervention on indicators of body fatness. Subjects/Methods The intervention modules addressed the community, school and parental level, focusing on diet, physical activity and stress‐related lifestyle factors. A cohort of 16,228 children aged 2–9.9 years – about 2000 per country – was equally divided over intervention and control regions. (Participating countries were Sweden, Germany, Estonia, Hungary, Cyprus, Italy, Spain and Belgium.) We compared the prevalence of overweight/obesity and mean values of body mass index z‐score, per cent body fat and waist‐to‐height ratio over 2 years of follow‐up. Mixed models adjusting for age and socioeconomic status of the parents and with an additional random effect for country accounted for the clustered study design. Results The prevalence of overweight and obesity increased in both the intervention and control group from 18.0% at baseline to 22.9% at follow‐up in the control group and from 19.0% to 23.6% in the intervention group. The difference in changes between control and intervention was not statistically significant. For the cohort as a whole, the changes in indicators of body fatness did not show any clinically relevant differences between the intervention and control groups. Changes in favour of intervention treatment in some indicators were counterbalanced by changes in favour of the control group in some other indicators. Conclusions Over the 2‐year‐observation period, the IDEFICS primary prevention programme for childhood obesity has not been successful in reducing the prevalence of overweight and obesity nor in improving indicators of body fatness in the target population as a whole.