title: Children's Body composition and Stress - the ChiBS study: aims, design, methods, population and participation characteristics.
abstract: BACKGROUND
  The last decades, the prevalence of childhood obesity has increased. Apart from other lifestyle factors, the effect of chronic psychosocial stress on the development of obesity has been recognized. However, more research is needed into the influence of chronic stress on appetite regulation, energy balance and body composition, as well as on the interaction with physical activity/sedentary behavior, diet and sleep in children. In this regard, the ChiBS study (Children's Body composition and Stress) was designed at the Ghent University. Within this paper, we describe the aims, design, methods, participation and population characteristics of the ChiBS study.
  
  
  METHODS
  The influence of chronic stress on changes in body composition is investigated over a two-year follow-up period (February-June 2010, 2011 and 2012) in primary-school children between 6 and 12 years old in the city Aalter (Flanders, Belgium).Stress is measured by child- and parent-reported stress-questionnaires, as well as by objective stress biomarkers (serum, salivary and hair cortisol) and heart rate variability. Body composition is evaluated using basic anthropometric measurements and air displacement plethysmography. Additional information on socio-economic status, medical history, physical activity, dietary intake and sleep are obtained by questionnaires, and physical activity by accelerometers.
  
  
  RESULTS
  The participation percentage was 68.7% (N = 523/761), with 71.3% of the children willing to participate in the first follow-up survey. Drop-out proportions were highest for serum sampling (12.1%), salivary sampling (8.3%) and heart rate variability measurements (7.4%).
  
  
  CONCLUSIONS
  The ChiBS project is unique in its setting: its standardized and longitudinal approach provides valuable data and new insights into the relationship between stress and changes in body composition in a large cohort of young children. In addition, this study allows an in-depth investigation of the validity of the different methods that were used to assess stress levels in children.
authors.affiliation: Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 2 Blok A, B-9000 Ghent, Belgium. nathalie.michels@ugent.be.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Michels
authors.forename: Barbara
authors.initials: B
authors.lastname: Vanaelst
authors.forename: Krishna
authors.initials: K
authors.lastname: Vyncke
authors.forename: Isabelle
authors.initials: I
authors.lastname: Sioen
authors.forename: Inge
authors.initials: I
authors.lastname: Huybrechts
authors.forename: Tineke
authors.initials: T
authors.lastname: De Vriendt
authors.forename: Stefaan
authors.initials: S
authors.lastname: De Henauw