- on behalf of the IDEFICS consortium -

Funded by the EC, FP 6, Contract No. 016181 (FOOD)

Improving knowledge of dietary factors, socialenvironment and lifestyle affecting European child

health

Developing, implementing, evaluating and validatingspecific interventions for reducing diet and lifestyle

related diseases and disorders

Wolfgang Ahrens & Iris Pigeot

EHF Gastein, Sep. 2009, Sessions III - EC projects contributing to the health inequalities debate

IDEFICS

European prevalence of overweight and obesity in school children aged 7-11

IOTF (Obesity Reviews 5(2004):1-104)

High prevalence in Southern Europe

Caveat:• Different studies• Different years• Different criteria

Obesity-related disorders

Neurological & psychiatric disordersHeadache, visual impairmentDepressionEating disorders

Cardiovascular systemLipid metabolism, elevated cholesterolHypertensionCoagulation disorder, thrombosisChronic blood vessel inflammationWater/ mineral imbalance

Hormone systemType-2 diabetesEarly pubertyOvary cystsTesticular atrophy

Psychosocial consequencePoor self-esteem

Respiratory tractSleep apnoeaAsthma

Gastro-intestinal tractGallstonesFatty liver disease

KidneyRenal insufficiency(due to diabetes)

Musculoskeletal disordersSplay-, skew-, flatfeetKnock knees, bowlegsFemural head luxationLower arm fracturesArthritisBack pain

Overweight & obesity in Europe

High prevalence of overweight and obesity, both, in adults and children in Europe (IOTF 2005)

~20% of all European children are overweight

~1/3 of them are obese (WHO 2006)

Children populations particularly affected:

Southern Europe

Low SES

Migrants

There is need for …

Data on overweight/ obesity that are comparable across Europe

Data on risk factors and morbidity that are comparable acrossEurope

Identification of determinants that are amenable to primaryprevention

Evidence-based prevention programmes

Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS

Integrated Project (EU 6th Framework Programme)

Objectives:- enhance knowledge of health effects of a changing diet & an altered social

environment & lifestyle of children, 2 to 10 years, in Europe, - develop, implement & validate specific intervention approaches in order to

reduce prevalence of diet- & lifestyle-related diseases & disorders.

~ 16,000 children

Approach through schools and kindergartens

IDEFICS

Participating countries

Ghent, BelgiumStrovolos, CyprusCopenhagen, DenmarkTallin, EstoniaGrenoble, FranceBremen, GermanyBremerhaven, GermanyDortmund, GermanyWuppertal, GermanyPécs, HungaryAvellino, ItalyCampobasso, ItalyMilan, ItalyNaples, ItalyZaragoza, SpainPalma de Mallorca, SpainGothenburg, SwedenBristol, United KingdomGlasgow, United KingdomLancaster, United Kingdom

Study design & timeline

intervention / control communities with similar socio-demographic profile (non-randomised)

Controlled:

comparison of baseline (T0) with follow-up (T1-2)Longitudinal:

Study design

Timeline of surveys and intervention activities

T0 = 16,222 children

BMI (Cole) by country

14,957 children 2 - 9 years

%

BMI (Cole) by income level(Dataset 19th of August 2009)

Younger children (2-<6 years)

11,8

15,9

13,4

9,4

13

12,1

71

72,9

79,5

67,4

72,6

78,2

10,7

7,6

5,2

14,4

10,8

7,6

6,4

3,6

2

8,9

3,6

2,1

0% 20% 40% 60% 80% 100%

Low income (N=853)

Average income (N=1513)

High income (N=921)

Low income (N=801)

Average income (N=1431)

High income (N=792)

Thin Normal weight Overweight Obese

Girls

Boys

BMI (Cole) by income level(Dataset 19th of August 2009)

Older children (6-<10 years)

6,2

9,2

12,1

7,1

11

9

60,6

70,2

74,4

58,4

65,7

74,1

16,8

13,4

9,3

19,6

15,4

13,3

16,3

7,2

4,3

14,9

7,9

3,6

0% 20% 40% 60% 80% 100%

Low income (N=1140)

Average income (N=1670)

High income (N=937)

Low income (N=1077)

Average income (N=1682)

High income (N=1016)

Thin Normal weight Overweight Obese

Girls

Boys

Indicators of obesity-related diseases

0

20

40

60

Thin Normalweight

Overweight Obese

51,539026,680211,046787,0757%N%N%N%N

ObeseOverweightNormal weightThin

DiabetesPercentage of 2-9-year-olds withElevated HOMA index (> 85%-perc.): %

90,0

100,0

110,0

Thin Normalweight

Overweight Obese

HypertensionSystolic blood pressure [mmHg] in 6-9-year-olds:

N Median N Median N Median N Median786 100,0 5692 102,0 1302 106,0 787 110,0

ObeseThinness Normal weight Overweight

13

Screentime (audiovisual media)

Percentage of 6–9-year-olds watching TV/video/DVD usually for > 1 h/day

30405060

Thin Normalweight

Overweight Obese

%

59,775955,3126950,0555945,5771

%N%N%N%N

ObeseOverweightNormal weightThin

0

10

20

Thin Normalweight

Overweight Obese

14

Family lifestyle

Percentage of parents reporting “quite boring weekends“%

17,363116,010069,346754,9636

%N%N%N%N

ObeseOverweightNormal weightThin

20,0

40,0

60,0

80,0

100,0

Thin Normalweight

Overweight Obese

Sleep duration(acc. to 24h dietary recall [SACINA])

Percentage of 6-9-years-old children with more than 10 hours sleep / night

81,76089,014688,782691,392%N%N%N%N

ObeseOverweightNormal weightThin

33,126638,427643,352642,138%N%N%N%N

ObeseOverweightNormal weightThin

Germany

Italy

Germany

Italy

%

Summary & conclusions

Identified key risk factors (preliminary findings)Low SESLiving in the South of EuropeIncreasing screen timeLack of sleepLess active family life(Unhealthy diet)

Further factors and their interplay currently analysedSelected genetic factorsSensory preceptionPhysical activityDietary behaviourConsumer behaviour

At the end of the day: new evidence for targeted interventions

www.idefics.euwww.bips.uni-bremen.de

The IDEFICS consortiumthanks for your attention

This paper was produced for a meeting organized by Health & Consumers DG and represents the views of its author on thesubject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumers DG's views. The European Commission does not guarantee the accuracy of the dataincluded in this paper, nor does it accept responsibility for any use made thereof.