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2.  Prevalence of negative life events and chronic adversities in European pre- and primary-school children: results from the IDEFICS study 
Archives of Public Health  2012;70(1):26.
Background
Children are not always recognized as being susceptible to stress, although childhood stressors may originate from multiple events in their everyday surroundings with negative effects on children’s health.
Methods
As there is a lack of large-scale, European prevalence data on childhood adversities, this study presents the prevalence of (1) negative life events and (2) familial and social adversities in 4637 European pre- and primary-school children (4–11 years old), using a parentally-reported questionnaire embedded in the IDEFICS project (‘Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS’).
Results
The following findings were observed: (1) Certain adversities occur only rarely, while others are very regular (i.e. parental divorce); (2) A large percentage of children is shielded from stressors, while a small group of children is exposed to multiple, accumulating adversities; (3) The prevalence of childhood adversity is influenced by geographical location (e.g. north versus south), age group and sex; (4) Childhood adversities are associated and co-occur, resulting in potential cumulative childhood stress.
Conclusions
This study demonstrated the importance of not only studying traumatic events but also of focusing on the early familial and social environment in childhood stress research and indicated the importance of recording or monitoring childhood adversities.
doi:10.1186/0778-7367-70-26
PMCID: PMC3552702  PMID: 23173879
Child; Life events; Adversity; Prevalence; Stress; Epidemiology
4.  Dietary exposure assessments for children in europe (the EXPOCHI project): rationale, methods and design 
Background/purpose
The number of dietary exposure assessment studies focussing on children is very limited. Children are however a vulnerable group due to their higher food consumption level per kg body weight. Therefore, the EXPOCHI project aims [1] to create a relational network of individual food consumption databases in children, covering different geographical areas within Europe, and [2] to use these data to assess the usual intake of lead, chromium, selenium and food colours.
Methods
EXPOCHI includes 14 food consumption databases focussed on children (1-14 y old). The data are considered representative at national/regional level: 14 regions covering 13 countries. Since the aim of the study is to perform long-term exposure assessments, only data derived from 24 hr dietary recalls and dietary records recorded on at least two non-consecutive days per individual were included in the dietary exposure assessments. To link consumption data and concentration data of lead, chromium and selenium in a standardised way, categorisation of the food consumption data was based on the food categorisation system described within the SCOOP Task report 3.2.11. For food colours, the food categorisation system specified in the Council Directive 94/36/EC was used.
Conclusion
The EXPOCHI project includes a pan-European long-term exposure assessment of lead, chromium, selenium and food colours among children living in 13 different EU countries. However, the different study methods and designs used to collect the data in the different countries necessitate an in-depth description of these different methods and a discussion about the resulting limitations.
doi:10.1186/0778-7367-69-4
PMCID: PMC3436650  PMID: 22958503
Food; dietary exposure assessment; children; Europe; design; concentration data; health risk; consumption data; lead; chromium; selenium; food colours
5.  Children’s Body composition and Stress – the ChiBS study: aims, design, methods, population and participation characteristics 
Archives of Public Health  2012;70(1):17.
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%).
Discussion
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.
doi:10.1186/0778-7367-70-17
PMCID: PMC3524083  PMID: 22958377
Stress; Child; Body composition; Obesity; Cortisol; Heart rate variability; Questionnaire; Food habits; Physical activity; Sleep
6.  Dietary sources of energy and macronutrient intakes among Flemish preschoolers 
This study aims to identify major food sources of energy and macronutrients among Flemish preschoolers as a basis for evaluating dietary guidelines. Three-day estimated diet records were collected from a representative sample of 696 Flemish preschoolers (2.5-6.5 years old; participation response rate: 50%). For 11 dietary constituents, the contribution of 57 food groups was computed by summing the amount provided by the food group for all individuals divided by the total intake of the respective nutrient for all individuals. Bread (12%), sweet snacks (12%), milk (6%), flavoured milk drinks (9%), and meat products (6%) were the top five energy contributors. Sweet snacks were among the top contributors to energy, total fat, all fatty acids, cholesterol, and complex and simple carbohydrates. Fruit juices and flavoured milk drinks are the main contributors to simple carbohydrates (respectively 14% and 18%). All principal food groups like water, bread and cereals, vegetables, fruit, milk and spreadable fats were under-consumed by more than 30% of the population, while the food groups that were over-consumed consisted only of low nutritious and high energy dense foods (sweet snacks, sugared drinks, fried potatoes, sauces and sweet spreads). From the major food sources and gaps in nutrient and food intakes, some recommendations to pursue the nutritional goals could be drawn: the intake of sweet snacks and sugar-rich drinks (incl. fruit juices) should be discouraged, while consumption of fruits, vegetables, water, bread and margarine on bread should be encouraged.
doi:10.1186/0778-7367-69-5
PMCID: PMC3436670  PMID: 22958525
7.  Main characteristics and participation rate of European adolescents included in the HELENA study 
Archives of Public Health  2012;70(1):14.
Background
Participation rate and response rate are key issues in a cross sectional large-scale epidemiological study. The objective of this paper is to describe the study population and to evaluate participation and response rate as well as the key nutritional status variables in male and female adolescents involved in the HELENA study.
Methods
A multi-stage random cluster sampling with a target sample of 3000 adolescents aged [12.5 to 17.5] years, stratified for geographical location and age, was carried out. Information for participants and non-participants (NP) was compared, and participation and response rates to specific questionnaires were discussed.
Results
3,865 adolescents aged [12.5 to 17.5] years (1,845 females) participated in the HELENA study, of whom 1,076 (568 females) participated in the blood sampling. 3,528 (1,845 females) adolescents were finally kept for statistical analysis. Participation rates for the schools and classes differed importantly between countries. The participation rate of pupils within the participating classes also differed importantly between countries. Sex ratio, mean age and BMI were similar between NP and participating adolescents within each centre, and in the overall sample. For all the questionnaires included in the database, the response rate of questionnaires was high (more than 80% of questions were completed).
Conclusion
From this study it could be concluded that participation rate differed importantly between countries, though no bias could be identified when comparing the key study variables between participants and non-participants. Response rate for questionnaires was very high. Future studies investigating lifestyle and health in adolescents can optimize their methods when considering the opportunities and barriers observed in the HELENA study.
doi:10.1186/0778-7367-70-14
PMCID: PMC3490738  PMID: 22958310

Results 1-7 (7)