Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies S. J. te Velde 1 , F. van Nassau 2 , L. Uijtdewilligen 2 , M. M. van Stralen 2 , G. Cardon 3 , M. De Craemer 3 , Y. Manios 4 , J. Brug 1 and M. J. M. Chinapaw 2 on behalf of the ToyBox-study group 1 EMGO Institute for Health and Care Research and the Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands; 2 EMGO Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands; 3 Ghent University, Department of Movement and Sports Sciences, Ghent, Belgium; 4 Department of Nutrition and Dietetics, Harokopio University, Athens, Greece Received 16 May 2011; accepted 7 October 2011 Address for correspondence: Saskia te Velde, EMGO Institute for Health and Care Research and the Department of Epidemiology and Biostatistics, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. E-mail: s.tevelde@vumc.nl Summary The current review aimed to systematically identify dietary, physical activity and sedentary behaviours in preschool children (4–6 years of age) that are prospec- tively related to overweight or obesity later in childhood. Prospective studies published between January 1990 and June 2010 were selected from searches in PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Library. Studies exam- ining the prospective association between at least one relevant behaviour mea- sured during preschool period (children aged 4–6 years at baseline) in relation to at least one anthropometric measurement at follow-up (age <18 years) were included. Harvest plots were used to summarize the results and draw conclusions from the evidence. Of the 8,718 retrieved papers, 23 papers reporting on 15 different study samples were included in this review. Strong evidence was found for an inverse associa- tion between total physical activity and overweight. Moderate evidence was observed for a positive association between television viewing and overweight. Because of the heterogeneity in the assessed dietary behaviours, insufficient evi- dence was found for an association between dietary intake or specific dietary behaviours and overweight. These results suggest that interventions aiming to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group. However, despite the lack of evidence for dietary behaviours from the present review, future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associ- ated with overweight. Keywords: BMI, dietary behaviour, physical activity, preschoolers. obesity reviews (2012) 13 (Suppl. 1), 56–74 Introduction The still-increasing prevalence of overweight and obesity in children worldwide is a threat to public health (1). Even among children below 5 years old, the prevalence rates of overweight increased from 7.9% in 1990 to 10.6% in 2005 in developed countries, and it was predicted that this rate will further increase to 14.1% in 2020 (2). Effective obesity reviews doi: 10.1111/j.1467-789X.2011.00960.x 56 © 2012 The Authors obesity reviews © 2012 International Association for the Study of Obesity 13 (Suppl. 1), 56–74