title: Adherence to combined lifestyle factors and their contribution to obesity in the IDEFICS study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Pre-intervention adherence to key behaviours related to childhood obesity, namely water/sweetened drink, fruit/vegetable consumption, daily TV time, physical activity, family time and adequate sleep duration, was measured at baseline. Adherence to international recommendations was converted into a composite score ranging from 0 (none) to 6 (adhering to all). Data on adherence were available for 7,444 to 15,084 children aged 2-9.9 years, depending on the behaviour. By means of multi-level logistic regression models adjusted for age, sex and country, we calculated odds ratios (OR) and 95% confidence intervals (CI) to estimate the relationship between adherence to these recommendations and the risk of being overweight/obese.
  
  
  RESULTS
  Adherence ranged from 15.0% (physical activity) to 51.9% (TV time). As adherence increased, a lower chance of being overweight/obese was observed; adhering to only one key behaviour (score = 1) meant an OR = 0.81 (CI: 0.65-1.01) compared with non-adherence (score = 0), while adhering to more than half of the key behaviours (score ≥ 4) halved the chance for overweight/obesity (OR = 0.54, CI: 0.37-0.80). Adherence to physical activity, TV and sleep recommendations was the main driver reducing the chance of being overweight. Overweight/obese children were more likely not to adhere to at least one of the recommended behaviours (19.8%) than normal-weight/thin children (12.9%)
  
  
  CONCLUSIONS
  The selected key behaviours do not contribute equally to a reduced chance of being overweight. Future interventions may benefit most from moving more, reducing TV time and getting adequate sleep.
authors.affiliation: Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary.|Institute for Medical Information Processing Biometrics and Epidemiology, German Centre for Vertigo and Balance Disorders, Ludwig Maximilian University, Munich, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Kovács
authors.affiliation: Section for Epidemiology and Social Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Hunsberger
authors.affiliation: Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Reisch
authors.affiliation: Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark.
authors.forename: W
authors.initials: W
authors.lastname: Gwozdz
authors.affiliation: Section for Epidemiology and Social Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Eiben
authors.affiliation: Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: De Bourdeaudhuij
authors.affiliation: Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Russo
authors.affiliation: National Institute for Health Development, Tallinn, Estonia.
authors.forename: T
authors.initials: T
authors.lastname: Veidebaum
authors.affiliation: Research and Education Institute of Child Health, Strovolos, Cyprus.
authors.forename: C
authors.initials: C
authors.lastname: Hadjigeorgiou
authors.affiliation: Department of Preventive and Predictive Medicine, Nutritional Epidemiology Unit, National Tumor Institute, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Sieri
authors.affiliation: GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.
authors.forename: L A
authors.initials: LA
authors.lastname: Moreno
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.|Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Pigeot
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.|Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Ahrens
authors.affiliation: Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Pohlabeln
authors.affiliation: Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary.
authors.forename: D
authors.initials: D
authors.lastname: Molnár
mesh_terms: D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D004032:Diet; D004326:Drinking; D002149:Energy Intake; D005060:Europe / Q000453:epidemiology; D005260:Female; D005638:Fruit; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010349:Patient Compliance; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D011322:Primary Prevention; D040242:Risk Reduction Behavior; D012890:Sleep; D013997:Time Factors; D014675:Vegetables; D044465:White People / Q000706:statistics & numerical data
keywords: Children; diet; overweight; physical activity