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ACTA PæDIATRICA ISSN 0803-5253

ABSTRACTS

POSTER SESSION: NUTRITION, EPIDEMIOLOGY, PREVENTION CHAIRED POSTER PRESENTATIONS CPP01

ASSESSING OVERALL DIET QUALITY IN A NATIONALLY REPRESENTATIVE SAMPLE OF UK CHILDREN AGES 2–18 YEARS OLD IN THE NATIONAL DIET AND NUTRITION SURVEY 2008–2012 S Kranz Centre for Exercise, Nutrition and Health Sciences, School of Policy Studies, University of Bristol, UK Aim: To apply a composite diet quality assessment scoring scheme to national consumption data of UK children ages 2–18 years (N = 2073). Methods: Secondary data analysis using survey sample design corrected, weighted intake estimates to assess diet quality using a modified Revised Children’s Diet Quality Index (RC-DQI), reflecting UK dietary guidance. Logistic regression models were used to predict diet quality, controlling for age, sex, income, BMI and survey year. Results: Mean RC-DQI score was 61 of 90 possible points (range: 29.8–88.6). Only 4% of children met the recommendations for fruits and vegetables, 27% for NME sugar (added sugar), 39% for dietary fibre, 61% for total fat; 23% for saturated fat; 100% for trans fats, 4% for total fish, 66% for calcium, 42% for salt, 34% for iron, and 31% of the children were within 10% of their energy requirements (EER). On average, 6–11 year old children achieved the highest RC-DQI scores, followed by 2–5 year olds; while teenagers (12–18 years old) had the lowest scores (73%, 70%, and 62% of the max. 90 points, respectively). Conclusion: Dietary intake was inadequate (excessive or too low) in almost all of the examined components for large portions of the population. For fruits/vegetables and total fish more than 95% of the population were severely below the intake recommendations. Interestingly, older children and girls had lower diet quality; household income affected only some RC-DQI components. Revising the current UK dietary intake guidance may be needed to help improve the proportion of children with better diet quality. Keywords: diet quality, nutrition monitoring, paediatric nutrition, food intake, nutrition epidemiology.

Institutet, Stockholm, Sweden, 2Child and Adolescent Health Unit, Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden, 3 Public Health Agency of Sweden, Stockholm, Sweden, 4 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, 5Centre for Occupational and Environmental Medicine, Karolinska Institutet, Stockholm, Sweden Aim: To explore the relationship between determinants of overweight including obesity as well as the prevalence of overweight including obesity among children 8- and 12years of age in Sweden between 2003 and 2011. Methods: Two population-based cross-sectional surveys included information on 7728 and 12 882 12-year-old children, and 1198 and 2699 8-year-old children in 2003 and 2011 respectively. Data analyses included weighted multivariate-adjusted generalized linear models. Results: In 12-year-old children, we observed a lower overweight prevalence for girls compared to boys: Relative Risk, RR = 0.84 (95%CI = 0.77–0.92), and for girls with a higher versus lower educated mother: 0.76 (0.65–0.88), and a higher overweight prevalence in smaller municipalities compared to main cities: 1.52 (1.28–1.82), which was similar for boys. Eight-year-old girls living in Stockholm County had a lower prevalence of overweight in 2011 than in 2003 (0.76, 0.59–0.97), which was not apparent in 12-year-old children. This lower prevalence was strongest among 8-yearold girls with a low-educated mother (0.63, 0.47–0.86). Conclusion: This study supports a stabilization of the prevalence of overweight including obesity among Swedish children between 2003 and 2011. Although the gradients in determinants of overweight persist, which deserve attention, the less strong socioeconomic gradient in overweight in 8-year-old girls in 2011 is promising. Keywords: overweight, epidemiology, cross-sectional, national, children. CPP03 CHILDHOOD OBESITY: PREVALENCE, PREVENTION OBSTACLES, AND POTENTIAL IMPACT ON CHRONIC DISEASES IN THE UNITED ARAB EMIRATES

CPP02

A Abdulle1, A Al-Junaibi2, N Nagelkerke3

OVERWEIGHT PREVALENCE AND DETERMINANTS IN SWEDISH 8AND 12-YEAR OLD CHILDREN BETWEEN 2003 AND 2011

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J de Munter1, A Friedl2, S Lind1, M Kark3, M Carlberg2, N Andersson4, A Georgellis5, F Rasmussen1,2 1

Child and Adolescent Public Health Epidemiology, Department of Public Health Sciences, Karolinska

Public Health Research Center, New York University Abu Dhabi, UAE, 2Department of Paediatrics, Zayed Military Hospital, Abu Dhabi, UAE, 3Institute of Public Health, CMHS, UAE University, Al Ain, Abu Dhabi, UAE Aims: We investigated the prevalence, potential determinants, and impact of childhood obesity on blood pressure.

© 2015 The Author(s). © 2015 Foundation Acta Pædiatrica/Acta PÌdiatrica 2015, 104 (Suppl. 466), pp. 5–25

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Poster Presentations

Methods: We used two-stage sampling process to recruit students from 23 public schools (grade 1–12) in the Emirate of Abu Dhabi, UAE. Results: Of 1440 complete results, 1050 nationals were analyzed. We found a prevalence of underweight (8.3%), overweight (14.2%), and obesity (19.8%). Linear regression of BMI%ile showed a significant (P < 0.01) positive association with age and lack of dairy consumption. Moreover, 33.8% of all parents misclassified children’s’ weight; underestimating (27.4%) or overestimating (6.3%). Misclassification was highest among parents of overweight/obese children (63.5%). Parental perceptions were associated with true child’s BMI percentile (CDC); OR of 1.313 (95% CI: 1.209–1.425; P < 0.001) per percentile point, but not age, parental education, household income, and child’s sex. We show a prevalence of pre-HTN (10.5% and 11.4%) and HTN (15.4% and 17.8%) levels among boys and girls, respectively. BMI%ile correlated with waist circumference (WC) (r = 0.734, P < 0.01), systolic (r = 0.34, P < 0.001) and diastolic (r = 0.21, P < 0.001) standardized BP. WC percentile was less strongly correlated with standardized BP than BMI. Conclusion: The prevalence of obesity among children and adolescents is significantly high and is associated with age, sex, lack of dairy consumption and elevated parental BMI, but not self-reported exercise or family income. Parental misclassification of child’s weight status is common and may constitute an obstacle to prevention. The currently high level of BP, predominantly systolic, among obese children indicates the need for better prevention programmes. Keywords: childhood, obesity, prevalence, parental perceptions, hypertension. CPP04 ‘HEALTHY START – YOUNG FAMILY NETWORK’: EVALUATION OF THE GERMAN NATIONAL CONSENSUS RECOMMENDATIONS ON INFANT NUTRITION AND NUTRITION FOR BREASTFEEDING MOTHERS € tter2 P Kolip1, N Greif1, M Flothko 1

Bielefeld University, Bielefeld, Germany, 2Aid infodienst for Nutrition, Agriculture and Consumer Protection, Bonn, Germany Aim: The German ‘Healthy Start – Young Family Network’ has created a set of national consensus recommendations on infant nutrition and nutrition for breastfeeding mothers, together with the German Society of Paediatrics and Adolescent Medicine, the Professional Association of the Gynecologists|Germany and the German Midwifery Association. This study evaluates whether relevant healthcare professionals know of the recommendations, and whether they agree with them. Methods: Data were collected from December 2011 to February 2012 using a standardised online questionnaire.

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Results: 1311 healthcare professionals (midwives, gynaecologists, paediatricians, paediatric nurses, nutritionists, and members of related professional groups) filled out the questionnaire. 73.6% were aware of the recommendations. The level of acceptance towards the recommendations was analysed separately for each professional group. Acceptance was high among nutritionists and paediatricians (>95%), and moderate among gynaecologists and paediatric nurses (>83%). Low acceptance was found among midwives and ‘others’ (67%). Conclusion: The implementation of the recommendations into healthcare practice has not fully succeeded yet. To further increase acceptance, the network will continue to inform healthcare professionals about the recommendations so that they can pass them on to families. For individual recommendations with low acceptance, new communication strategies are being developed, aimed at both healthcare professionals and families. Keywords: evaluation, infant nutrition, national recommendations. CPP05 TRACKING OF BODY MASS INDEX FROM CHILDHOOD THROUGH ADULTHOOD J Aarestrup1, L G Bjerregaard1, M Gamborg1, A Tjønneland2, K Overvad3, A Linneberg4,5,6, M Osler4,7, E L Mortensen7,8, F Gyntelberg9, R Lund7, T I A Sørensen1,10,11, J L Baker1,10 1

Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, The Capital Region, Copenhagen, Denmark, 2Danish Cancer Society Research Center, Copenhagen, Denmark, 3Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark, 4Research Center for Prevention and Health, The Capital Region, Copenhagen, Denmark, 5Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark, 6Department of Clinical Experimental Research, Rigshospitalet, Glostrup, Denmark, 7Department of Public Health, University of Copenhagen, Denmark, 8Center for Healthy Aging, University of Copenhagen, Denmark, 9The Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark, 10Novo Nordisk Foundation Center for Basic Metabolic Research, Section on Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark, 11MRC Integrative Epidemiology Unit, Bristol University, UK Background: Overweight children are likely to remain overweight as adults, however, investigations beyond midadulthood, where chronic diseases emerge, is missing. Further, it is unknown whether these associations have changed across years of birth. Aim: To investigate if body mass index (BMI; kg/m2) tracks from childhood to late adulthood.



Methods: From the Copenhagen School Health Records Register, children born 1930–1989 with data on measured heights and weights at 7 and/or 13 years were linked to Danish cohorts and registers with adult body size information. Child overweight (including obesity) was defined by IOTF criteria and adult overweight and obesity were defined by WHO criteria. Age- and sex-specific partial correlation analyses with an examination of birth cohort effects and logistic regression analyses were performed. Results: 72 970 boys and 25 252 girls had information on adult body size at ages 18–69 years. BMI at 7 years was moderately correlated with BMI at young adult ages (18– 29 years) (rmen = 0.54, rwomen = 0.49), and by late ages (60– 69 years) these weakened (rmen = 0.27, rwomen = 0.23). No birth year effects were observed. Compared with normalweight children at 7 years, overweight children had higher odds of being overweight in young adulthood (18– 29 years); odds ratios (ORmen = 13.09 (95% confidence interval [CI]: 11.85–14.47), ORwomen = 6.28 (95% CI: 5.34– 7.38). By late ages (60–69 years), the odds decreased (ORmen = 5.95 [95% CI 1.40–25.21], ORwomen = 1.54 (95% CI: 0.92–2.59)]. Correlations and ORs were generally stronger at 13 years compared with 7 years. Conclusion: Childhood BMI tracks into adult ages, attenuates with increasing adult ages, and does not vary by birth years. Keywords: body weights and measures, childhood, cohort studies, correlation studies, overweight. CPP06 REDUCTION OF EXCESS WEIGHT AND CHANGES IN BODY COMPOSITION IN PARTICIPANTS OF THE NATIONAL PROGRAMME FOR PREVENTION OF DIABETES AND NCDS ‘POZDRO!’ – PRELIMINARY RESULTS M Brzezinski1, M Mysliwiec1,2, K Szarejko3, M Radziwiłł3, ski1,4, T Anyszek1,5, L Czupryniak1,6 P Soszyn 1

Medicover Foundation Scientific Board, Warsaw, Poland, Department of Paediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, 3 Medicover Foundation, Warsaw, Poland, 4Medicover Poland, Warsaw, Poland, 5Synevo Central Lab Warsaw, Warsaw, 6Internal Medicine and Diabetology Department, Medical University of Lodz, Lodz, Poland 2

Aim: Main goal of ‘PoZdro!’ is to assess the health status of students entering middle school and involving children at highest risk of developing obesity and diabetes to the 2-year intervention programme. Methods: 3658 children, including 1880 girls (51.4%) and 1778 boys in 3 cities (Gdynia, Warszawa, Lublin) were screened in the period from March 2014 to February 2015. Most were 13-year-olds (n = 2916; 79.7%). For the interventional part of the programme ‘PoZdro!’ 575 (15.7%) children, including 270 girls (47.0%), whose BMI was above 90 percentile were qualified. 218 entered the first visit and 137 children

took at least 2 visits to specialists. Compared to the first visit during the second one (after 6 weeks) participants had a reduction in BMI (27.3 3.3 vs. 27.0 3.0 kg/m2, P < 0.001). BMI percentile reduction was observed in 59 (43.4%) children, growth in 14 (10.3%), and no change in 63 (46.3%). 14 (10.3%) children reported improvement in the assessment of body weight, and 4 (2.9%) – its deterioration. 57 out of 218 children (26.1%) has accomplished so far the fourth visit (after 6 months from the beginning of the programme). Being observed by the growth of muscle tissue (50.95 8.75 vs. 51.51 8.83 kg, P = 0.002) and lean body mass (53.65 9.18 kg vs. 54.24 9.26 kg; P = 0.002) Conclusions: The preliminary results indicate that in the first step of intervention occurs mainly in reduction of body fat, muscle growth takes time. Keywords: childhood obesity, intervention, prevention, treatment.

POSTERS PP01

INTAKE LEVEL OF FISH IN UK CHILDREN: AN ANALYSIS OF NATIONAL DIET AND NUTRITION SURVEY 2008–2012 S Kranz1, N R V Jones2, P Monsivais2 1

Centre for Exercise, Nutrition and Health Sciences, School of Policy Studies, University of Bristol, 2UKCRC Centre for Diet and Activity Research and Medical Research Council Epidemiology Unit, School of Clinical Medicine, University of Cambridge, UK Aim: To describe the consumption levels of oily fish and other dietary sources of long-chain fatty acids in UK children ages 2–18 years old (N = 2096). Methods: Secondary data analysis, using survey sample design corrected weighted intake estimates and logistic regression models were conducted to estimate the proportion of children meeting the fish intake recommendation of 280 g/week, of which 140 g should be from oily fish. Consumption patterns predicting meeting the fish intake recommendations were examined, controlling for age, sex, income, total energy intake, and survey year. Results: Only 4.2% of children met the total fish and 4.0% the oily fish intake recommendation; merely 2.4% of all children met both. Consuming the recommended amounts of fish was significantly and positively predicted by consuming the highest tertile of vegetables (OR = 2.5, 95% CI 1.30– 4.84) while consuming in the highest tertile of meat significantly reduced the odds of eating 280 g of fish per week (OR = 0.32, 95% CI 0.16–0.64). Approximately 63% of all n3 PUFA were from foods other than fish (nuts, seeds, eggs, meats etc.). Thus, children’s intake of long-chain n-3 PUFA such as EPA and DHA is likely severely insufficient. Conclusion: The majority of children in the UK do not meet the intake recommendations for fish. Current consumption patterns show that eating fish is associated with other, healthy intakes such as high intake of vegetables and


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low intake of meat. Public health messaging should focus on promoting higher fish consumption, especially oily fish, to promote better diet quality. Keywords: fish intake, nutrition monitoring, diet quality, paediatric nutrition. PP02 IS EXCESS WEIGHT IN LOW INCOME KINDERGARTEN CHILDREN ASSOCIATED WITH COGNITIVE ACHIEVEMENT, DEVELOPMENTAL SKILLS AND PHYSICAL FITNESS? J Kain, B Leyton, F Concha INTA, University of Chile, Santiago, Chile Aim: To compare in low income Chilean children if excess weight is associated with cognitive achievement, developmental skills and/or fitness. Methods: Cross-sectional study at the end of school year 2014 (N = 514 children, mean age 5.9 year). We collected: weight (wt), height (ht), 20 m sprint, handgrip strength (HGS), standing long jump (SLJ), percentiles (P) math and verbal test scores (from standardized tests), and developmental skills (with Battelle Developmental Inventory Screening Test). We compared by sex: BMI Z, % normal weight or N (BMI Z ≥ 1 and +1), % overweight or OW (BMI Z > +1 and +2), % obese or OB (BMI Z > +2) (WHO reference), % excess weight or EW (OW + OB), HGS/wt, SLJ/ht, % mild (DD 1) and moderate developmental delay (DD2) and also compared these variables in N versus EW by sex (t test/test of proportions). Results: In boys (N = 267) and girls respectively, mean BMI Z was 1.0 and 0.87 (P < 0.001); % OW, 22.5 and 32 (P < 0.01); % OB, 19.4 and 14.7 (P < 0.001). In N and EW respectively, 20 m was 5.3 and 5.2 s; HGS/wt, 0.45 and 0.36; (P < 0.001); SLJ/ht, 0.84 and 0.81; P math, 79.8 and 75.6; P verbal, 72.4 and 69.3; % DD1, 33 and 28.6; % DD2, 16.2 and 21.4. Conclusions: In 5 year-old low-income Chilean children, % obesity is very high. Apart for greater strength/wt by N children, no differences were found in either cognitive achievement, % of children with developmental delay or other fitness variables between N and EW. Keywords: children, Chile, development, excess weight, fitness. PP03 LEVELS AND PATTERNS OF OBJECTIVELY MEASURED PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOUR IN 4-YEAR-OLD SWEDISH CHILDREN D Berglind, L Hansson, P Tynelius, F Rasmussen Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden Background: Levels of physical activity (PA) affect health already at 4 years of age. The aims of this study were to describe levels and patterns of PA and sedentary

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behaviour (SB) in a sample of 4-year-old Swedish children and to assess the number of children achieving PA guidelines throughout the week. Methods: Data from 540 four-year old children enrolled in the population-based PRIMROSE trial was used. PA was measured for a period of 1 week by the tri-axial Actigraph GT3X+ accelerometer. Average PA, time spent in light PA, moderate-to-vigorous PA (MVPA) and SB were assessed. Differences in PA and SB between weekdays and weekends and between boys and girls were assessed. Results: Children spent 6.7% of the day in MVPA and 45% of the day being sedentary and 33% (n = 178) of the children met the PA guidelines of 60 min of MVPA per day. Boys spent 56.8 (SD 21.8) min/day in MVPA, while girls spent 43.0 (SD 18.1) min/day in MVPA (P < 0.001). In addition, boys were significantly less sedentary and engaged in more MVPA in 10 min-bouts compared to girls. Both boys and girls were more active on weekdays compared to weekends. Conclusions: Four-year-old children spent almost half of the day being sedentary and only one-third meet the recommended PA guidelines. This finding is alarming as higher levels of PA, already at 4 years of age, seem to reduce the risk of childhood obesity and provides long-term health benefits. Keywords: accelerometer, physical activity, sedentary behaviour, four-year old children. PP04 INTERSECTORAL TRAINING TO PREVENT CHILDHOOD OBESITY: HEALTH ASSETS IDENTIFICATION ~ ez2, G Longo3, S Toro2 B Gil1, A Lupian 1

Andalusian Health Service, Andalusia, Spain, Andalusian School of Public Health, Andalusia, Spain, 3 Health and Social Welfare Ministry, Andalusia, Spain 2

Introduction: Childhood obesity in Andalusia is a serious and complex health problem. One of the main objectives of the Andalusian Childhood Obesity Comprehensive Plan is to raise awareness, train and mobilize all the professionals who are dealing with childhood inside and outside the sanitary space in order to tackle this problem. Methods: In 2014, the Andalusian Childhood Obesity Comprehensive el Plan trained 500 professionals through a Masive Open On Line Course (MOOC). These professionals are educators, sociocultural mediators, professionals taking care of childhood at community level, social workers, and foot safety workers in Andalusia. During the development of the course, participants were required to identify – inside their neighbourhood or municipality – health assets that foster physical exercise and/or healthy diet within childhood. Participants were encouraged to provide photos and comments to the course forum following the photovoice methodology. Results: 425 participants provided a total of 593 resources from their environment that were identified as assets to prevent childhood obesity. Most of the resources were directed towards the practice of physical activity (87.8%).



Conclusion: The photovoice methodology is a useful tool to identify the resources to prevent childhood obesity. Keywords: childhood obesity, health assets, photovoice methodology. PP05 PREVALENCE AND RISK FACTORS OF OVERWEIGHT AND OBESITY AMONG PRESCHOOL CHILDREN IN POLAND A Mazur, E Łuszczki, K Deren Medical Faculty University of Rzeszow Aim: In this study, we evaluated the prevalence and risk factors associated with overweight and obesity in 400 preschool children in the south-eastern Poland. Methods: On the basis of consent obtained from the parents 400 children aged 3–6 were examined, including 188 boys and 212 girls. The study used a questionnaire that came with the programme: European Pilot Study Impact Assessment for Local Action Promotional Prevention of Obesity in Children Kindergarten. Overweight and obesity were defined according to sex- and age-specific body mass index (BMI) cut-points proposed by the International Obesity Task Force. Results: The prevalence of overweight among preschool was 11.3% for boys and 12.4% for girls. The obesity level was 11% for boys and 10.8% for girls. The factors significantly increasing the risk of obesity among the girls were the weight and BMI of the mother. It has been found that the most common risk factors are: the negative patterns of their parents’ eating behaviour, too low frequency of meals, eating high-calorie meals, a sedentary lifestyle etc. Conclusion: Knowledge about the living conditions conducive to overweight and obesity continues to be a prevalent health problem. Particular attention should be paid to the prevention of obesity in children of obese parent. Keywords: nutrition, obesity, overweight, preschool children. PP06 THE SECULAR TREND OF OVERWEIGHT AND OBESITY IN PRESCHOOL CHILDREN IN SOUTH-EASTERN POLAND , E Łuszczki A Mazur, K Deren Medical Faculty University of Rzeszow Aim: The aim of the study was to assess the prevalence of overweight and obesity in preschool children in southeastern Poland. Methods: Based on the results of studies conducted between 2008 and 2012 the trend has been characteristic of obesity and overweight occurring in a population of preschool children in south-eastern Poland. Weight and height were measured in 576 preschool children (302 girls and 274 boys) in 2008, and 400 preschool children (212 girls and 188 boys) in 2012. Children between the ages of 3– 6 were examined. On the basis of measurements their body mass index (BMI) was calculated. Overweight and obesity

were diagnosed according to the International Obesity Task Force criteria. Results: During a 4-year period the number of overweight and obese children has increased. The prevalence of overweight among preschool was 9.5% in 2008 and 11.9% in 2012. The obesity level was 7.8% in 2008 and 10.9% in 2012. The prevalence of overweight among preschool children increased approximately 2%, and obesity 3%. Conclusion: The study results indicate that particular attention should be put to prevent obesity among the preschool children. Keywords: obesity, overweight, preschool children, secular trend. PP07 BREAKFAST CONSUMPTION AND PREVALENCE OF OBESITY IN STUDENTS OF ELEMENTARY SCHOOLS. DATA FROM THE HELLENIC ACTION PLAN FOR THE ASSESSMENT PREVENTION AND TREATMENT OF CHILDHOOD OBESITY E Vlachopapadopoulou1, Y Manios2, T Psaltopoulou3, F Karachaliou1, D Koutsouki4, G Bogdanis4, V Karagianni5, A Kapsali6, T Sergentanis3, A Chatzakis3, S Michalakos1 1 Department of Endocrinology, Children’s Hospital P. A. Kyriakou, Athens, Greece, 2Department of Nutrition and Dietetics, Harocopion University of Athens, Athens, Greece, 3 Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, Greece, 4School of Physical Education and Sports Science, University of Athens, Athens, Greece, 5Department of Biometrics, Technological Educational Institute of Athens, Athens, Greece, 6Ministry of Health, Greece

Aim: To assess the prevalence of overweight/obesity of elementary school students and evaluate correlations with breakfast consumption. Methods: This is a cross-sectional study conducted from October 2012 to December 2013. A representative elementary school cohort (N = 11.850, age range 5.9–12.3 years) was derived, using stratification and PPS methodology. Parents responded to questionnaire and students were measured with high sensitivity methods (Ht 0.1 cm, Wt 0.1 kg, BMI calculated). IOTF cut offs were used to classify the children. Logistic regression was applied using STATA 11.0. Results: 25.8% of students were overweight and 10.37% were obese, for a total of 36.17% overweight/obese. 67.3% of the students reported daily breakfast consumption and this had a protective effect regarding overweight and obesity (OR = 0.85, 95%CI: 0.78–0.92). Children residing in suburban areas had higher consumption (P < 0.01). There was no difference according to sex but an age related difference was appreciated with the 6–10 age group having 59.2% and the 10–12 years age group 55.5% (P < 0.01). It is of interest that the protective effect is applicable for all type of foods. Higher percentage of overweight/obese children as compared to normal weight children consumed light dairy products. Daily breakfast consumption had a negative correlation with


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mother’s working hours (OR: 0.95, 95%CI: 0.93–0.97) and with father’s working hours (adjusted OR: 0.97, 95%CI: 0.95–0.99). Daily breakfast consumption was higher among students whose parents used to have breakfast and in particular when they had breakfast together with the child. Conclusion: Daily breakfast consumption exerts a protective effect towards obesity prevention. Breakfast consumption as a family habit intensifies the protective effect. Keywords: breakfast, elementary school, prevalence. PP08 DIAGNOSIS OF 21ST CENTURY B Atanasova1, M Atanasova2, D Naidenova3 1

Medicine at the Medical University of Pleven, 2Healthcare Management, Medical University of Varna, 3Department of Hygiene, Medical University of Varna Aim: The aim of this work is to summarize the data publications which analyze the non-genetic factors in the etiology of new diagnosis. In recent decades, a trend of increasing population overweight and obese even that unlock a new era of disease in the human genome. Stress, panic, eating disorders, autism are only some of the new diagnoses. This together the various specialists in medicine and science to develop their research skills in the direction of prevent and Decrease of ‘new’ diseases. Methods: This work is based on the summarize data from on-line based scientific publications and survey research in Bulgaria. Results: In Bulgaria mortality from CVD is 68% for 2014, while the diagnosis of autism worldwide rose by some 600% over the past decades, making it the leading positions in mental health and obesity. The results show that Globalization and food play leadership between healthy lifestyle and new diagnoses. ‘Your food may be poison but also medicine’ – Hippocrates. Conclusion: Stress is the scourge of the 21st century. Healthcare must be one step ahead of others in order to promote a new era of healthy and rational nutrition. Intervention programmes aimed at the population, would be effective strategies for reducing the risk of diagnosis – ‘21st Century’. Keywords: autism, eating disorders, obesity, super foods. PP09 MENTAL HEALTH PROBLEMS AS PREDICTORS OF WEIGHT CHANGE FROM ADOLESCENCE TO YOUNG ADULTHOOD, 11 YEARS FOLLOWUP. THE HUNT STUDY, NORWAY I L Holmen1,*, A M N Myren1*, S W Hystad2, P B Juliusson3, Y S Danielsen1 1

Department of Clinical Psychology, University of Bergen, Bergen, Norway, 2Department of Psychosocial Science, University of Bergen, Bergen, Norway, 3Department of

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Clinical Medicine, Haukeland University Hospital, Bergen, Norway Aim: To study self-reported selfesteem, anxiety/depression and eating problems as predictors of weight change from adolescence to young adulthood. Methods: A number of 1582 adolescents (13–19 years old) with normal weight or waist circumference were followed from Young – HUNT1 (1995–1997) to young adulthood 11 years later in the HUNT3 Study (2006– 2008). Mental health problems were measured by selfreported questionnaires completed during a school hour. Height, weight and waist measures were performed by specially trained nurses using standardized protocols and equipment both in adolescence and adulthood. Linear regression was used for the analyses with standardized BMI or waist circumference as the dependent variables. Continuous scales were used, adjusted for sex and age in adulthood. Results: The variables selfesteem, anxiety/depression and eating problems were entered in the model. Lower selfesteem scores (P = 0.015, b = 0.074) and less symptoms of anorexia nervosa (P < 0.001, b = 0.126) significantly predicted higher BMI at follow-up. A significant association was found for reduced waist circumference and symptoms of anorexia nervosa (P < 0.001, b = 0.156) and increased waist circumference and bulimia nervosa (P = 0.007, b = 0.100). No statistic significant gender differences were found. Conclusion: Low selfesteem and eating problems in adolescence may predict changes in weight and waist circumference in young adulthood. This may be taken in account when treating teenagers with mental health problems. Keywords: adolescence, follow-up, mental health, weight change. *Both authors contributed equally PP10 CIP X CIOP GOOD SNACKS AT SCHOOL: LOW COST PROGRAMME TO IMPROVE THE EATING HABITS OF CHILDREN OF PRIMARY SCHOOL , M A Tomaselli, M Cammisa M Caroli, A Sturda UO Nutrition Unit, Department of Prevention ASL Brindisi, Italy Aim: To increase the use of healthy snacks during the morning break among children attending primary school by the up/down-stream strategy using the tool of ‘good snacks at school’. Methods: 16 primary schools belonging to the territory of ASL Brindisi accepted to participate to the project. 4265 children took part in both surveys [males (49.9%) females (50.1%)]. At the beginning of the school year a first survey of mid-morning snacks spontaneously brought by the children was performed. A weekly menu of healthy snacks allowed at the school was approved by the School Council,



composed by teachers and parents. The menu included 4 days in which the children were allowed only specific healthy snacks (fruit, yogurt, bread and tomatoes, no salty crackers) and a free day in which children were allowed to bring any preferred snack. A second survey was performed at the end of the school year during the free day. Statistical analysis: Mc Nemar test. Results: In the first survey in 2033 children (64.8%) used unhealthy snacks, the second survey showed that the children still having unhealthy snacks on the free day dropped to 1.734 (55.3%) (P < 0.001). Conclusions: The ‘good snacks at school’ is based on the educational education rules of: repeated offer, positive environment, role modelling by important adults, involvement of families, sustainability. The good snacks menu is a simple, cheap and effective way to increase the consumption of healthy foods as snacks at school by school age children. Keywords: childhood obesity, nutritional education, prevention, school, healthy snack. *Both authors contributed equally

Results: Associations between supervision style, physical activity and BMI will be presented. In line with evidence from the general parenting style literature, we expect childcare workers’ warmth to be positively associated with children’s physical activity, and an authoritative style to be negatively associated with children’s BMI. Conclusion: The current study will show the importance of childcare workers’ supervision style for the prevention of inactivity and overweight in very young children in the childcare setting. Keywords: accelerometer, childcare, overweight, physical activity, supervision style. PP12 NATIONAL PROGRAMME FOR PREVENTION OF DIABETES AND NCDS ‘POZDRO!’ AS A MULTIDISCIPLINARY DIABETES AND OBESITY TACKLING PROGRAMME – PRELIMINARY RESULTS ski2,3, M Radziwiłł1, M Brzezinski2, K Szarejko1, P Soszyn 2,4 2,5 2,6 T Anyszek , M Mysliwiec , L Czupryniak 1

PP11 THE ASSOCIATION BETWEEN CHILDCARE WORKERS’ SUPERVISION STYLE AND TODDLERS’ OBJECTIVELY ASSESSED PHYSICAL ACTIVITY AND BMI J S Gubbels1,2, D H H Van Kann1,3, E F C Sleddens1,2, K Stessen1,2, S P J Kremers1,2 1

Department of Health Promotion, Maastricht University, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 3CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands 2

Aim: Childcare use is associated with increased overweight risks. Moreover, children spend large proportions of the time at childcare being sedentary. The behaviour of childcare staff might explain part of this association. The aim of the current study was therefore to examine the association between childcare workers’ general supervision style (reflecting childcare workers’ general behaviour towards the children in the childcare setting), and young children’s physical activity and BMI. Methods: The cross-sectional study included a total of 127 children attending childcare (1–4 years old) from 16 childcare centres in the Netherlands. Childcare workers’ supervision style was assessed using questionnaires which included a selection of items from an adapted version of the Comprehensive General Parenting Questionnaire, an instrument to assess parents’ general parenting style. Children’s physical activity was objectively assessed using accelerometers, Actigraph GT3X+ (30 Hz). Weight and height were measured to assess BMI. Associations were examined using multi-level linear regression analyses.

Medicover Foundation, 2Medicover Foundation Scientific Board, Warsaw, 3Medicover Poland Warsaw, 4Synevo Central Lab Warsaw, 5Department of Paediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, 6Internal Medicine and Diabetology Department, Medical University of Lodz, Lodz, Poland Aim: ‘PoZdro!’ is a nationwide, multiannual programme, which aims to tackle diabetes, obesity and NCDs in children and youth of Polish big cities. It is aimed at students from middle schools and their families. Participation in the programme is completely voluntary and free of charge. It is one of the largest prevention programmes in Europe in terms of the study population. Methods: Since February 2014 until May 2015 5005 out of 9071 first classes children (55.17%) were examined by nurses in 78 schools in three big cities – Gdynia, Warszawa, Lublin. 16.4% of screened children has overweight and 4.5% has obesity. Out of screened group 69.5% had poor physical fitness. 779 (15.56%) were qualified to ‘PoZdro!’ interventional part as having BMI above 90 centile. In the qualified group of children 218 already underwent the first multidisciplinary consultation (dietician, physician, sport trainer, psychologist). The interventional part will last 2 years and consist of 7 visits (0, 6, 12weeks, 6, 12, 18, 24 months). Until May 2015 367 children underwent two visits and 150 underwent 4 visits. 152 parents took part in specially organized trainings and 63 children (17%) resigned from the programme. Conclusions: Multifocal and complex health programme ‘PoZdro!’ focused on children obesity and NCD’s as prevention of diabetes is well received in local communities and has a high effectiveness in screening and interventional part in the first year of existence. Keywords: childhood obesity, intervention, prevention, treatment.


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POSTER SESSION: COMORBIDITIES CHAIRED POSTER PRESENTATIONS CP07

CHILDHOOD OBESITY IN SPECIAL CARE – SEARCHING FOR A HEALTHY OBESE CHILD M Dalla Valle1,2, T Laatikainen3, T Kalliokoski2, P €nen4, J Ja €a €skela €inen2 Nyka 1

Department of Paediatrics, North Karelia Central Hospital, Joensuu, Finland, 2Department of Paediatrics, Clinical Nutrition, University of Eastern Finland, Kuopio, Finland, 3Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland, 4 Department of Paediatrics, Mikkeli Central Hospital, Mikkeli, Finland Aim: One in three obese adults is classified as metabolically healthy but there is less evidence on obese children. We studied the overall clinical presentation of Finnish obese children and the prevalence of cardiovascular risk factors with child-specific cut-offs. Methods: This is a cross-sectional register-based study of 2- to 18-year-old children (n = 900) evaluated for obesity in three hospitals in 2005–2012. Clinical and metabolic data were related to sex, age, puberty and obesity grade and analyzed using v2 and non-parametric tests. Results: In 80% (n = 649) of cases at least one cardiovascular risk factor was present and only 3% (n = 12) of subjects for whom complete all metabolic data were available (n = 360) had no metabolic disorder. About half the children (50.2%) had hypertensive systolic blood pressure and 14.5% had hypertensive diastolic blood pressure. The youngest children were most obese and obesity was more severe in boys than girls (P < 0.001). Prediabetes was present in 35.6% and it was more prevalent in boys than girls (P = 0.001). Hypertensive systolic blood pressure values (P = 0.012), prediabetes (P < 0.001), fatty liver (P < 0.001) and dyslipidemia (P = 0.025) were more prevalent in 15- to 18-year-old boys than girls. Conclusion: Almost all obese children in special care have cardiovascular risk factors and only a few are metabolically healthy; this indicates that earlier interventions are needed. Keywords: dyslipidemias, fatty liver, hypertension, paediatric obesity, prediabetic state. CP08

Department of Women’s and Children’s Health, Uppsala University, 2Uppsala University Children’s Hospital, Uppsala, Sweden, 3Department of Paediatrics, Paracelsus Medical University, 4Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria, 5Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden, 6 Academic Institute for Clinical Nutrition, Vienna, Austria Aim: To identify factors responsible for development of glucose intolerance in obese children and adolescents. Methods: 394 obese patients referred to paediatric obesity centers in Uppsala, Sweden (n = 220) and Salzburg, Austria (n = 174) underwent an oral glucose tolerance test that was analyzed according to WHO criteria. Results: Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) was in Salzburg patients observed in 0.57% and 11.9%, respectively. Corresponding percentages for the Uppsala patients were 20.6% and 40.3%, respectively. Combined IFG and IGT was present in 0.57% of the Salzburg patients but in no 90° = hypertension-h), HOMA-IR (p when > 2.5), HDL cholesterol (C p < 50 mg/dL), triglycerides (TGs p > 95°), fatty liver (NAFLD >1 when present), free fat measured with Bio Impedance Analysis (Human-IM BIA FAT%), TG-HDL-Cratio (p > 2) and IMT (–cut off value for age >0.46 mm = high –h). We considered for MS BMI or W/ Hr plus almost 2 out of 4/5 items: BP- HOMA-IR – TGHDL-C-r –NAFLD - (and in selected cases cIMT). Results: Out of 208 patients (107 males, 101 females, mean age 11 and 12 year – range 3–17), 154 were OC (74%), 44 overweight, 10 dyslipidemic; mean BMI z-Score 1.91 and 1.81, mean BIA FAT% 36.21 and 40.78; mean W/ Hr 0.53 and 0.54; p-HOMA-IR in 55%, p TG-HDL-C-r in 25%; hBP in 5%, NAFLD in 64% and in 130 patients examinated h-cIMT equal to 29%.


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Conclusion: Applying our criteria for MS, and considering NAFLD (mandatory in our opinion) in addition to the traditional ones, we found 52% of patients affected, i.e. a very high percentage; including also cIMT, our percentage of SM doesn’t change much (55%). Keywords: Intima-Media Thickness, NAFLD. PP15 THE PREVALENCE OF OVERWEIGHT AND OBESITY IN SCHOOL-AGE CHILDREN AND ADOLESCENTS WITH INTELLECTUAL DISABILITIES IN SOUTH-EASTERN POLAND rska-Bednarz, J Wyszyn ska, J Leszczak, A Mazur J Podgo w, Rzeszo w, Poland University of Rzeszo

1

Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark, 2Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals – a part of Copenhagen University Hospital, The Capital Region, Copenhagen, Denmark, 3Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, MI, USA, 4Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA, 5Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA, 6Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA

Aim: The aim of this study was to determine the prevalence of overweight and obesity in children and adolescents with intellectual disabilities in comparison to the control group, which accounted for healthy children and adolescents. Methods: The study included 588 intellectually disabled students aged from 7 to 18, attending special education institutions in south-eastern Poland. The control group consisted of 588 students (matched to the study group for age and gender) without mental disabilities, attending randomly selected elementary and secondary schools located in the same area. The examination included basic anthropometric measurements: body mass and body height. Based on these parameters BMI was calculated and used to classify body mass status of students (overweight ≥85 cc and 0.5 or high serum AST/ALT values, who underwent liver ultrasound scan. Patients were grouped along their scanning results (statosis yes/no, degree: light/mild/severe), and groups were compared as for IR-HOMA (3). Results: 229 patients (M = 92, age = 10.47 2.83, zBMI = 2 0.68, IR-HOMA = 3.44 2.49) showed no steatosis; the other 199 (M = 117, age = 11.25 2.87, zBMI = 2.08 0.48, IR-HOMA = 4.19 0.96) had it confirmed by ultrasound scan. IR-HOMA was statistically highly different (P = 0.002) in the two groups. No statistical difference however was found among the IR-HOMA values in the 3 sub-groups of steatotic patients (light: IRHOMA = 3.91 2.6; mild: IR-HOMA = 3.77 1.8; severe: IR-HOMA = 4.83 3.1). Conclusions: IR-HOMA is an effective index of NAFLD, and its alteration should prompt to perform an ultrasound liver scan. In our experience, though, this index does not correlate with steatosis’ severeness. More useful data might come from the evaluation of patients with IR-HOMA >0.5 but no clin/lab signs of NAFLD (clinical hepatomegaly, pathologic WtHR, pathologic transaminases). References: 1: Wabitsch M et.al. Eur J Pediatr. 2000;159 (Suppl1):S8–13. 2: Skelton JA et al. Acad Pediatr. 2009;9(5):322–9. 3: Shashaj B et al. Acta Diabetol. 2015 Jun13 (epub ahead of print). Keywords: NAFLD, transaminases, ultrasound scan, WtHR, waist-to-height-ratio. PP18 DIPEPTIDYL PEPTIDASE-4 IS ASSOCIATED WITH ELEVATED LIVER ENZYMES, IMPAIRED GLUCOSE TOLERANCE AND LOWERED GLUCAGON-LIKE PEPTIDE-1 IN OBESE CHILDREN R Stenlid1,2, H Manell1,2, A Forslund2,3, P Bergsten1 1 Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden, 2Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden, 3Uppsala University Children’s Hospital, Uppsala, Sweden

Aim: Declining glucagon-like peptide-1 (GLP-1) levels in the circulation have in adults been connected with obesity-related complications including type 2 diabetes mellitus (T2DM). Dipeptidyl peptidase-4 (DPP-4) rapidly cleaves and thereby inactivates circulating GLP-1. This study aimed to determine DPP-4 and GLP-1 concentrations and investigate their association to glucose tolerance and liver function in obese children.

Methods: Obese (n = 57) and lean (n = 22) children underwent an oral glucose tolerance test (OGTT) and glucose and GLP-1 concentrations were determined. DPP-4 and liver enzyme concentrations were determined at fasting. Results: In obese children the expected negative correlation between fasting plasma DPP-4 and GLP-1 concentrations was evident. Obese children either had normal (NGT; n = 27) or impaired (IGT; n = 30) glucose tolerance based on the 2-h glucose concentration with cutoff-point at 7.8 mmol/L. In the IGT group fasting DPP-4 concentration (955 232 ng/mL) was significantly higher than in the NGT group (845 303 ng/mL) and in the lean group (731 279 ng/mL) and a positive correlation was found between DPP-4 concentration and 2-h glucose concentration. The liver enzymes c-glutamyl transferase and ALAT were also positively correlated to fasting DPP-4 concentrations. Interestingly, there was a negative correlation between DPP-4 and age. Conclusion: Comorbidities in obese children are correlated with high DPP-4 concentrations. This adds DPP-4 to possible etiological factors in obesity-related diabetes development in children. Keywords: diabetes, DPP-4, GLP-1, incretin, obesity. PP19 SERUM ENDOTOXIN ACTIVITY LEVELS ARE NOT ASSOCIATED WITH METABOLIC SYNDROME IN EARLY-ONSET OBESITY H T Viljakainen1, M Lehto2, M Lipsanen-Nyman1, T €kitie1,2,3,4 Saukkonen1, O Ma 1

Clinical Departments, Children’s Hospital, University of € lsan Institute of Helsinki, Helsinki, Finland, 2Folkha € lsan Research Center, Helsinki, Finland, Genetics, Folkha 3 Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, 4 Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden Background: Endotoxins are suspected to trigger a lowgrade inflammation process, which in obese subjects enhances development of metabolic syndrome (MetS). The role of endotoxins in adolescent obesity is unknown. This study compared endotoxin concentration between severely obese young adults and normal-weight controls (NWC). Study design and subjects: Endotoxin concentration was determined for 59 subjects with childhood-onset severe obesity and 68 NWC. Risk factors for MetS, including lipid and glucose profiles and blood pressure (BP) were assessed. NCEP III ATP criteria for MetS were applied. Result: The obese and NWC were similar in age (mean 19.6 [SD = 2.6] years), but BMIs and waist circumferences differed (40 kg/m2 and 115 cm vs. 23 kg/m2 and 76 cm). Mean endotoxin activity did not differ between the groups (P = 0.97). Endotoxin concentration correlated with triglycerides (r = 0.239, P = 0.007) and diastolic BP


15


(r = 0.181, P = 0.046), but not with other MetS risk factors. We identified 23 subjects (22 obese/1 NWC) with MetS. Endotoxin concentration did not differ between those with (N = 23) or without MetS (N = 104) (0.18 [0.09] vs. 0.16 [0.06] EU/mL, P = 0.461), but subjects with MetS had higher BMI and they were somewhat older. Adjusting for these increased the group difference in endotoxin concentrations (0.20 vs. 0.16), but the difference remained statistically non-significant (P = 0.153). Conclusions: Endotoxin concentration does not differ between subjects with early-onset severe obesity and normal-weight controls. Endotoxins correlate with some of risk factors of MetS but do not differ between subjects with or without MetS. Further studies are needed to explore the role of endotoxins in obesity. Keywords: endotoxin, childhood-onset obesity, metabolic syndrome. PP20 EARLY ADIPOSITY REBOUND AND ITS ASSOCIATION WITH OBESITY AND NEUROPSYCHIATRIC DISORDERS A Norgren1, I Ciba1,2, H Manell1,3, R Stenlid1,3, M Dahlbom1, P Bergsten3, A Forslund1,2 1

Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden, 2Uppsala University Children’s Hospital, Uppsala, Sweden, 3Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden Aim: Children’s BMI development shows two distinct points, a BMI-peak during the first year and an adiposity rebound (AR) where BMI increases after its nadir, normally at 5–6 years of age. An early AR is associated with overweight. Neuropsychiatric disorders are overrepresented in obese children, but it is unknown whether there is a connection between the age of AR and a neuropsychiatric disorder in obese children. Methods: Growth curves including height, weight and BMI were collected from 79 obese children and 22 lean controls. Age at first BMI-peak (highest BMI value during first year of life) and age at AR (lowest BMI value between 1 and 12 years of age) were determined according to accepted definitions. Occurrence of neuropsychiatric disorder was determined from medical records. Results: Mean age for first BMI-peak did not differ between obese (0.613 0.208 years) and lean children (0.568 0.203 years). Mean age for AR was significantly lower in the obese group (2.41 1.323 years) than in lean controls (5.17 1.117 years). The prevalence of neuropsychiatric disorders was 17.7% in the obese children and 4.5% in the lean controls. There was a tendency towards an early AR in obese children with neuropsychiatric diseases, but results were not significant. Conclusions: AR occurs at an earlier age among obese children and obese children with neuropsychiatric disor-

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ders might have an earlier AR, which warrants further studies. Keywords: adiposity rebound, neuropsychiatry, obesity. PP21 CLINICAL INDICATIONS OF METABOLIC SYNDROME AND INSULIN RESISTANCE IN OBESE PREPUBERTAL CHILDREN E Vlachopapadopoulou1, I Dikaiakou1, E Anagnostou1, F Karachaliou1, I Patinioti1, A Fotinou2, V Petrou1, S Michalacos1 1

Department of Endocrinology, Growth and Development, Children’s Hospital P. & A. Kyriakou, Athens, Greece, 2 Department of Biochemistry, Children’s Hospital P. & A. Kyriakou, Athens, Greece Aim: To evaluate whether anthropometric indices and acanthosis nigricans can be useful markers for early detection of Insulin Resistance and Metabolic Syndrome (MetS) in overweight and obese children. Methods: Data from 510 prepubertal children (40% boys), 12.9% overweight and 87.1% obese with mean age 9.7 2.5 years were analyzed. Logistic regression analysis was used to investigate which factors were associated with HOMA-IR >3 and metabolic syndrome. Results: MetS was found in 12.9% of the children. HOMA-IR >3, was found in 14.3% of overweight and 39.8% of obese children. Among children with MetS, 50% had HOMA-IR >3 and they were all obese. The mean Body Mass Index (BMI) was greater in children with HOMA-IR >3 (29.3 3.1 vs. 26.1 3.1, P < 0.001) (OR:1.31, 1.20– 1.44). Also, children with HOMA-IR >3 had greater waist circumference (mean SD: 94.7 9.6 vs. 85.6 10.4, P < 0.001). Acanthosis Nigricans (OR = 2.42, 95% CI: 1.23–4.79, P = 0.011) and increased %fat (OR = 1.14, 95% CI: 1.05–1.25, P = 0.003) were associated with greater likelihood for HOMA-IR >3. Waist-to-height (WHtR) was associated with greater odds for HOMA-IR >3 (OR = 1.07, 95% CI: 1.02–1.18, P = 0.013). Furthermore, increased WHtR tended to be associated with the presence of MetS (OR = 1.07, 95% CI: 0.99–1.16, P = 0.100), while for 1 unit increase in BMI the likelihood for MetS was found to increase about 16% (P = 0.001). Conclusion: These data support the evidence that degree of BMI increase; increased WHtR as well as the presence of acanthosis nigricans are clinical indicators for increased metabolic risk. Keywords: Acanthosis Nigricans, insulin resistance, metabolic syndrome. PP22 THE IMPACT OF INSULIN RESISTANCE IN YOUTH M Cavali, M Escrivao, J Taddei, R S Brasileiro Nutrology Unit, Department of Paediatrics, Unifesp, o Paulo, Sao Paulo, Brasil Universidade Federal de Sa



Objective: To evaluate the effect of Insulin Resistance (IR) in adolescents with and without excess weight. Methods: This is a cross-sectional study with 334 adolescents of both sexes aged 14–19 years and Tanner stage >/4. BMI, arterial blood pressure, glycaemia, insulin, lipid profile, hepatic transaminases, steatosis by ultrasonography and body composition by Dual x-ray absorptiometry (DXA) were evaluated. IR was calculated by HOMA-IR. Results: Adolescents with IR had significantly higher risk (OR) for excess weight (24,67), presence of steatosis (5,41), hypertension (2,51) and low high-density lipoprotein cholesterol (HDLc) (2,22). Conclusions: The group of adolescents with IR had higher risks for metabolic disorders and elevated BMI. These results emphasize the need of early recognition and adequate treatment of excess weight. Keywords: adolescents, insulin resistance, obesity. PP23 MHEALTH INTERVENTIONS FOR CHILD AND ADOLESCENT OBESITY G O’Malley1,2, S Murphy1, A Brinkley1, I J Perry2, M Clarke3, A Burls4 1

Childhood Obesity Service, The Children’s University Hospital, Temple Street, Dublin, Ireland, 2Department of Epidemiology and Public Health, University College Cork, Cork, Ireland, 3MRC Hub for Trials Methodology Research, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, Northern Ireland, 4 School of Health Sciences, City University London, London, UK Aim: In the present study we systematically review and evaluate the efficacy of mobile-health obesity interventions for children and adolescents. Methods: We searched Medline, CINAHL, Academic Search Complete, Business Source Complete, EconLit, PsycARTICLES, PsycINFO, SPORTDiscus, and UK and Ireland Reference Centre for articles published in peerreviewed journals from January 1, 1970, through December 4, 2013. Following PRISMA guidelines, we included articles that provided descriptions of mHealth interventions designed to treat overweight and obesity in children and adolescents. We conducted a meta-analysis of treatment effects on BMI SDS at 12-months using a random effects models. Results: From 9103 titles, six were eligible for inclusion in the review. Studies used a range of mHealth tools including: interactive voice messaging systems; tailored text messaging; website interventions and telephone coaching. Four studies were combined in the meta-analysis and we observed an overall statistically insignificant change in BMI SDS of 0.03 (0.13, 0.06) at 12-months (P = 0.48). Conclusions: Results indicate that mHealth interventions may beuseful as adjunctsto treatment. Further studyis required to investigate the potential of mHealth tools in managing obesity in children and adolescents over the long-term.

Keywords: mobile health, telemedicine, paediatric obesity, cell phones, behaviour therapy, intervention studies.

POSTER SESSION: EATING BEHAVIOUR CHAIRED POSTER PRESENTATIONS CP10

THE ASSOCIATION OF EATING STYLES WITH WEIGHT CHANGE AFTER AN INTENSIVE COMBINED LIFESTYLE INTERVENTION FOR CHILDREN AND ADOLESCENTS WITH SEVERE OBESITY J Halberstadt1, T van Strien1,2, E de Vet1,3, I Eekhout4,5,6, C Braet7, J C Seidell1 1

Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands, 2Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands, 3Sub-Department Communication, Philosophy and Technology, Centre for Integrative Development, Chairgroup Strategic Communication, Wageningen University, Wageningen, The Netherlands, 4 Department of Epidemiology & Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands, 5 Brain Center Rudolph Magnus, University Medical Center Utrecht, The Netherlands, 6Research Centre-Military Mental Healthcare, Ministry of Defense, Utrecht, The Netherlands, 7Department of Developmental, Personality and Social Psychology, University of Gent, Gent, Belgium Aim: To determine whether eating styles after an intensive, partly inpatient, one year combined lifestyle intervention are associated with weight change in the following year in severely obese children and adolescents. Methods: A total of 120 participants (8–19 years) with an average SDS-BMI of 3.44 (SD = 0.36) was included in this prospective intervention study. Measurements were conducted at baseline (T0), at the end of treatment (T12) and at the end of follow up two years after baseline (T24). The primary outcome measurement was the DSDS-BMI between T12 and T24. As primary determinant of weight change after treatment, the participants eating styles were evaluated with the Dutch Eating Behaviour Questionnaire – child report that measures external, emotional and restraint eating. The association between outcome and determinant was assessed in linear regression analyses. Results: For girls a higher score on restraint eating at T12 (b = 0.09; CI 95% = 0.16 to 0.02; P = 0.018) and a higher score on external eating at T12 (b = 0.08; CI 95% = 0.16 to 0.01; P = 0.049) were associated with more weight (re)gain in the year after treatment. No statistically significant association with emotional eating


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at T12 was found. In addition for girls a higher score on external eating at T0 was associated with more weight (re)gain in the year after treatment (b = 0.11; CI 95% = 0.18 to 0.04; P = 0.003). Conclusion: This study indicates that for girls the levels of restraint and external eating after treatment were associated with the weight change during the following year. Keywords: childhood obesity, eating behaviour, eating style, weight change. CP11 EMOTIONAL EATING IN ADOLESCENTS C Braet, J Van de Walle, K Van Durme Ghent University, Ghent, Belgium Although emotional eating is highly prevalent in adolescents and its relation with eating problems is recognized; its mechanisms are still not understood. We conducted two studies on the role of parents Study 1: The first study aims to shown an association between parenting and emotional eating in overweight youngsters 10–16 year (N = 100), seeking treatment. Analyses show when parental rejection is low, parental responsive feeding behaviour is negatively correlated with the child’s emotional eating. When parental rejection is high, we found the opposite effects on child’s emotional eating. The results suggest that the emotional climate in which the feeding interactions between parent and child take place, influences the effect parental interactions have on the emotional eating of the child. Surprisingly, when parents are generally dismissive, the involvement shown regarding the food intake of the child can inadvertently facilitate the emotional eating of the child. Study 2: A second study investigated associations between attachment towards mother and eating pathology in a group of early adolescents 10–16 year (N = 952), and whether these associations were mediated by maladaptive emotion regulation strategies. Results provided further evidence on the assumed associations between parenting and eating problems. More specific: The relation between attachment and eating pathology was partially mediated by maladaptive emotion regulation. These results assign an important role to maladaptive emotion regulation, in explaining the relationship between family climate and eating pathology. Future longitudinal research should replicate and elaborate on these findings. Keywords: children, emotional eating, parents, obesity. CP12 EFFECTIVENESS OF ADDING AN APPROACH AVOIDANCE TRAINING WITH GAME ELEMENTS TO A RESIDENTIAL CHILDHOOD OBESITY TREATMENT S Verbeken1, W J Boendermaker2, T Loeys3, E Moens1, L Goossens1, C Braet1 1

Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium,

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2

Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands, 3Department of Data Analysis, Ghent University, Ghent, Belgium Background: Most childhood obesity treatment and prevention programmes only result in moderate positive outcomes in the short term and do not reduce risk for future weight gain. Objective: The current study investigated the effects of an Approach Avoidance (AA) training with game-elements on weight loss maintenance in obese children, over and above the care as usual in an inpatient treatment programme. Methods: Forty-one children (aged 10–15 years) who were in the final months of a 10-month inpatient treatment programme in a medical paediatric centre were randomized to either the AA-training plus care as usual condition or to a care as usual only control group. The AA-training consisted of a 10 sessions in which the children were trained to approach healthy food stimuli and to avoid unhealthy food stimuli. Treatment outcomes were child performances on tasks of AA, implicit attitudes and attentional bias, as well as self-report ratings on craving symptoms and weight loss maintenance after leaving the clinic (12 week follow up). Results: No significant group differences were found on the measures of automatic processes and craving and on weight loss maintenance. Conclusions: Possible accounts for the null findings, including limitations of the setting and the control group, are discussed. Keywords: approach avoidance, attentional bias, childhood obesity, cognitive bias modification training, craving. CP13 OBSERVATION OF PARENTAL MODELLING AND ENCOURAGEMENT IN RELATION TO CHILDREN’S TASTING BEHAVIOUR OF UNKNOWN AND FAMILIAR FOOD E Moens, L Goossens, S Verbeken, C Braet Ghent University, Ghent, Belgium Introduction: The development of a varied balanced eating pattern deserves special attention, as it is seen as protective against childhood obesity. Children’s eating habits are mainly shaped by parental feeding practices. While maladaptive practices did already receive a lot of research attention, the effects of adaptive strategies are less explored. The current research presents two observational studies on how parents model and encourage their child to taste an unknown (study 1) and a familiar (study 2) food item. Methods: In study 1, 25 families with a child with overweight and 30 families with a child with healthy weight were observed when parents offered their child a vegetable juice. In study 2, 36 mothers with 2 sibling children visited the lab and were exposed to a variety of fruit items. In both studies parental modelling and encouragement behaviour were observed and questioned.



Results: Study 1 showed no differences in tasting behaviour of children with and without overweight and in parental modelling. Parental encouragement however was significantly more shown in parents of children without overweight. Study 2 showed that whereas parental modelling is part of the shared environment, especially maladaptive parental encouragement to taste seems to be related to differences in child characteristics. Conclusion: These results may shed new light on parental encouragement and how this strategy can be situated on a dimension from adaptive to maladaptive parental strategies to taste. Keywords: children, tasting behaviour, parental encouragement, parental modelling. CP14 No publication. CP15 No publication.

POSTERS PP24

ATTENTIONAL AND MOTOR IMPULSIVITY INTERACTIVELY PREDICT LOWER PERCEIVED SELF-REGULATORY SUCCESS IN DIETING IN CHILDREN AND ADOLESCENTS A Meule1, J Hofmann1,2,3, D Weghuber2,3, E ArdeltGattinger1,3, J Blechert1,3 1

University of Salzburg, Austria, 2Paracelsus Medical University, Salzburg, Austria, 3Obesity Academy Austria, Salzburg, Austria Aim: Impulsivity is a multifaceted construct and constitutes a common risk factor for a range of mental and physical disorders associated with poor self-control such as substance abuse, binge eating or obesity. The short form of the Barratt Impulsiveness Scale (BIS-15) measures impulsive behaviours related to attentional (inability to focus attention or concentrate), motor (acting without thinking), and non-planning (lack of future orientation or forethought) impulsivity. Over- or binge eating appears to be particularly related to increased attentional and motor impulsivity and recent findings suggest that interactive effects between these two facets may play a role in eatingand weight-regulation. Methods: Children and adolescents with a wide range of body mass (n = 91; Mage = 13.4–2.2 years; MzBMI = 1.5– 1.4; 51% male) completed the BIS-15 and the Perceived Self-Regulatory Success in Dieting Scale (PSRS). Results: Scores on attentional and motor impulsivity interactively predicted self-perceived dieting success: higher attentional impulsivity was predictive of lower dieting

success and this relationship was particularly strong when motor impulsivity was also high. Conclusion: Results support previous findings showing that non-planning impulsivity does not appear to play a role in eating-related self-regulation. Furthermore, this is the first study that shows interactive effects of different impulsivity facets when predicting dieting success in children and adolescents. Self-regulatory failure in eating-regulation (e.g., overeating) may particularly emerge when both attentional and motor impulsivity levels are elevated. Keywords: impulsivity, dieting success, self-regulation, children, adolescents. PP25 EMOTIONAL EATING AFTER AN INPATIENT WEIGHT LOSS TREATMENT FOR ADOLESCENTS: HOW CAN THIS BE EXPLAINED? J Vandewalle, E Moens, C Braet Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium Aim: Regarding adolescent obesity treatments, evidence recommends long lasting multidisciplinary treatments consisting of three components: maintaining a healthy diet, increasing physical activity, and learning behavioural strategies through psychotherapy. This last component should help the patient to tackle unhealthy eating styles like emotional eating (EE). However, research has shown that EE does not significantly change after a 10-month inpatient multidisciplinary treatment for obese youngsters. As such, it seems important to investigate how treatment can be altered to better deal with EE. Research in obese youngsters showed that EE is related to maternal rejection (MR) via maladaptive emotion regulation strategies (MERS) of the youngster (mediator). This suggests youngsters may use food to deal with negative emotions caused by MR. In this study we want to investigate when youngsters are back in their family environment after inpatient treatment, if MR, MERS and EE have changed, and how these variables are related at follow-up. Methods: Participants were 55 youngsters between the ages of 11 and 17 years. Participants were asked to complete questionnaires assessing MR, MERS and EE, before the start of treatment and 4 months after the treatment. Results: There were no differences in MR, MERS and EE between pretest and follow-up. At follow-up, MR was related to EE, but not via MERS. Conclusion: Results suggest that after inpatient treatment, MR affects the EE-style of the youngsters. Therefore, treatment should focus more on improving the emotional family climate of youngsters experiencing emotional eating. Keywords: adolescents, emotional eating, emotion regulation, inpatient treatment, parental rejection.


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PP26 ASSESSMENT OF DISCREET PARENTAL CONTROL OF CHILD’S FOOD BEHAVIOUR M J Lagoa1,2, G Silva1, J Mota1, L Aires1,2 1

Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, 2University Institute of Maia, ISMAI, Portugal Introduction: Parental involvement can contribute to the success of overweight interventions in children. However, the assessment of parents’ contributions regarding children’s health and behaviour change strategies is of the most relevance. The aim of this study was to evaluate the internal consistency of the ‘discreet control’ (DC) factor in a Portuguese model of the Child Feeding Questionnaire (CFQ). Methods: Parents (85% mothers and 15% fathers) of 345 children completed the CFQ. Children’s body fat (%BF) was measured. Varimax rotation and Kaiser criteria were used for the factor extraction. A standardized Cronbach’s alpha coefficient was used for identifying the internal reliability (IR) for DC (included items: ‘I intentionally keep some foods out of my child’s reach’; ‘If I did not guide or regulate my child’s eating, she would eat too many junk foods’; ‘If I did not guide or regulate my child’s eating, she would eat too much of her favourite foods’). The IR values of DC were compared according to %BF using Pearson’s correlation to test the validity of the factor. Results: Factor item loading ranged from 0.61 to 0.85 (P < 0.005). IR results were acceptable (mean SD: 3.575 1.212; a: 0.70). DC factor was correlated with % BF, together and separately for boys and girls (total: 0.205, P < 0.01; girls: 0.255, P < 0.01; boys: 0.166, P < 0.01). Conclusion: DC factor is a valid and important factor for evaluation of parental control and may remain undetected by the child but still results in restriction, therefore, should be included in CFQ analysis. Keywords: childhood obesity, discreet parental control. Funding: Supported by FCT (SFRH/BD/101410/2014 and UID/DTP/00617/2013).

POSTER SESSION: TREATMENT CHAIRED POSTER PRESENTATIONS CP16

YOUTH WITH EXTREME OBESITY STUDY (YES): A PROSPECTIVE STUDY TO IMPLEMENT BARIATRIC SURGERY: EXPERIENCES FROM ONE RESEARCH CENTRE B Dieris, A Geisler, C Langrock, T Reinehr Vestische Kinder- und Jugendklinik Datteln, Germany Aim: The ‘Youth with Extreme Obesity’-(YES-) Study was set up in Germany in five specialised treatment centres

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to gain empirically informed knowledge concerning medical and psychosocial implications of adolescent extreme obesity. One study aim is to implement a rational procedure to identify adolescents with BMI >35 kg/m2, who are suitable for bariatric surgery. Methods: Before bariatric surgery extreme obese adolescents need to fulfil three requirements: First, all adolescents have to participate in a classical lifestyle intervention training for 3–6 months. Second, all adolescents have to participate in a bariatric surgery preparation training concerning methods of bariatric surgery, side effects, necessary changes in eating behaviour, lifelong vitamin and micronutrient supplementation etc. Third, a psychological examination has to be performed. Results: We present preliminary results as the YES-Study is still running. In our research centre in Datteln 62 extreme obese adolescents were included in the study until October 2014. Only five (8.1%) adolescents finalized both the lifestyle intervention and the bariatric surgery preparation training. Two of these adolescents (3.2%) were excluded from bariatric surgery due to psychiatric diseases or lack of motivation. One adolescent (1.6%) refused bariatric surgery after training course, in one (1.6%) adolescent bariatric surgery is planned and in one adolescent (1.6%) bariatric surgery was performed (sleep gastrectomy). Conclusion: Since only >97thc, was admitted as in-patient due to severe obesity and respiratory distress. In anamnesis: gestational hypertension; pre-term (36 weeks) spontaneously delivered; low birth weight (kg 1.7). His mother refers 3 previous spontaneous abortions. Symptomatic GER in the first 3 months of life. The evident growth acceleration (97thc BMI at 9 months) seems unjustified by the over-feeding, yet reported in anamnesis, being also in contrast with the referred frequent episodes of vomit and regurgitation. Clinical examination: No dysmorphisms; normal psychomotor development. All the common and less common endocrinologic, metabolic, haematologic, and genetic overgrowth syndromes were ruled out. Since parents referred

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difficult sleeping with frequent severe sleep apnea, the ROHAAD syndrome (Rapid-onset Obesity with Hypothalamic dysfunction, Hypoventilation and Autonomic Dysregulation) was then hypothesized, but the polysomnogram quickly excluded it. A strict nutritional programme was started, with detailed qualitative/quantitative indications. A behavioural re-education of the mother as the feeding figure and a strict follow-up of the patient were also started out. In a very short time (2 months) a first BMI reduction could be seen (T0 = 31.2, T1 = 26.5, T2 = 26.1 kg/m2), addressing to a case of early obesity due to maternal feeding misbehaviour. Conclusions: Families, especially when coming from countries with high malnutrition mortality, should be strongly supported to avoid reactive overfeeding. Keywords: BMI, early overgrowth, feeding behaviour, ROHAAD. PP31 EATING HABITS AND LIFESTYLE OF OVERWEIGHT CHILDREN AND ADOLESCENTS tra2,3, I DzivıteO Maslova1,2, I Napituhina2,3, A Ve 2,4 2 se2,3, J Gailite2,4 Krisane , K Agad zanjana , O Gluza2, I Ta Faculty of Public Health and Social Welfare, Rıgas Stradin ß s University, 2Children’s Clinical University Hospital, 3Department of Rehabilitation, Rıgas Stradin ß s University, 4Department of Paediatrics, Rıgas Stradin ß s University, Riga, Latvia 1

Aim: Unbalanced diet and inactivity has negative impact on health of the children and adolescents. Methods: Data about anthropometric parameters (weight, height, body-mass index [BMI]), eating habits and physical activities was collected and analyzed by a multidisciplinary team in Children’s Clinical University Hospital (Riga, Latvia) and medicine centre ‘FP’, (Jelgava, Latvia) between August 2014 and April 2015. Results: 71 children participated in the research, 41 participant in Weight Control Programme (WCP) and 30 children in control group (CG). WCP mean age is 13.12 (SD 2.51, years). Mean weight 83.18 (SD 21.62, kg), height 157.41 (SD 17.99, cm), BMI was 30.48 (SD 4.97, kg/m2), which in relation to age and gender is above 95 percentile. CG mean age 13.03 (SD 3.49, years), height 157.41 (SD 17.99, cm), weight 49.23 (SD 17.85, kg), BMI 19.19 (SD 3.88, kg/m2), which in relation to age and gender is above the 50th percentile. Conclusion: Overweight children refuse to eat breakfast, while children with normal weight skip dinner. Overweight children spend more time in front of TV or PC than children with normal weight. Children, who spend more than 3 h/ day watching TV or PC, often, eat while watching TV/PC. Children with normal weight have an objective self-esteem and have less expressed emotional eating than overweight children from WCP. Keywords: obesity, adolescents, eating habits.



PP32 CARDIOMETABOLIC COMORBIDITY IN CHILD AND ADOLESCENT OBESITY G O’Malley1,2, S Killeen1, A Brinkley1, N Sheridan1, N Kelly1, S Doyle1, A Burls3, M Clarke4, A Carroll5, I J Perry2, N Murphy5, S Murphy1 1

Childhood Obesity Service, Temple Street Children’s University Hospital, Dublin, 2Department of Epidemiology and Public Health, University College Cork, Cork, Ireland, 3 Department School of Health Sciences, City University London, London, 4MRC Hub for Trials Methodology Research, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, Northern Ireland, 5Department of Paediatric Endocrinology, Temple Street Children’s University Hospital, Dublin, Ireland Aim: This study estimated the prevalence of cardiometabolic co-morbidity in a consecutive series of children with obesity and to describe the extent to which abnormalities increase as obesity increases. Methods: 267 children were prospectively recruited from a national tertiary paediatric obesity centre (BMI >98th centile). A standard examination was carried out including measurement of blood pressure, height, weight, and fasting blood tests. Hypertension was defined based on

paediatric guidelines. Insulin resistance was defined as having a homeostatic model assessment value above 2.5 and paediatric metabolic syndrome was defined using Weiss criteria. Children were classified according to severity of obesity and the prevalence of comorbidity was compared across obesity class. Results: 85% (n = 227, 132 girls) of patients were included in the study. Children who did not complete blood testing (n = 40, 15%) were excluded from the analysis. Mean BMI was 31.9 kg/m2 (95% CI 31.1 kg/m2, 32.7 kg/m2), mean BMI SDS was 3.2 (95% CI 3.2, 3.3) and mean BMI centile was 99.8 (95% CI 99.7, 99.9). Hypertension was identified in 48.5% (95% CI 39%, 58%); the metabolic syndrome in 15% (95% CI 10.8%, 20.6%), and insulin resistance in 66% (95% CI 57.5%, 73.1%). Hyperglycaemia was present in 10.3% (95% CI 6.2%, 16.4%) and glycated haemoglobin levels indicated a risk of diabetes in 2.8% (95% CI 0.8%, 7.1%). With increasing BMI, there were increases in the prevalence of hypertension (P = 0.01), metabolic syndrome (P = 0.03) and hyperglycaemia (P = 0.03). Conclusion: Children who are obese present with multiple cardiometabolic co-morbidities that should be urgently addressed and require follow up. Keywords: metabolic syndrome, obesity, paediatric, insulin resistance; hypertension; co-morbidity.


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