Weight status of European preschool children and associations with family demographics and energy balance-related behaviours: a pooled analysis of six European studies M. M. van Stralen 1 , S. J. te Velde 2 , F. van Nassau 1 , J. Brug 2 , E. Grammatikaki 3 , L. Maes 4 , I. De Bourdeaudhuij 5 , V. Verbestel 5 , S. Galcheva 6 , V. Iotova 6 , B. V. Koletzko 7 , R. von Kries 8 , O. Bayer 8 , Z. Kulaga 9 , L. Serra-Majem 10,11 , A. Sánchez-Villegas 10 , L. Ribas-Barba 11 , Y. Manios 3 and M. J. M. Chinapaw 1 on behalf of the ToyBox-study group 1 The EMGO Institute for Health and Care Research and the Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands; 2 The EMGO Institute for Health and Care Research and the Department of Epidemiology and Biostatistics , VU University Medical Center, Amsterdam, The Netherlands; 3 Department of Nutrition and Dietetics, Harokopio University, Athens, Greece; 4 Department of Public Health, Ghent University, Ghent, Belgium; 5 Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium; 6 Department of Paediatrics and Medical Genetics, Varna Medical University, Varna, Bulgaria; 7 Division of Metabolic Diseases and Nutritional Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany; 8 Institute for Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians University of Munich, Munich, Germany; 9 Public Health Division, the Children’s Memorial Health Institute, Warsaw, Poland; 10 Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain; 11 Nutrition Research Foundation, Barcelona Science Park, Barcelona, Spain Received 16 May 2011; revised 1 September 2011; accepted 3 October 2011 Address for correspondence: MJM ChinaPaw, VU University Medical Center, EMGO Institute for Health and Care Research, and the Department of Public and Occupational Health, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. E-mail: m.chinapaw@vumc.nl Summary This study aimed to (i) gain insight in the prevalence of overweight indices in European preschoolers (4–7 years); (ii) identify energy balance-related behaviours associated with overweight/obesity; and (iii) identify children at risk for overweight/obesity. Secondary analyses of six European data sets were conducted according to standardized protocols. Based on objectively measured height and weight, prevalence of overweight and obesity across the countries ranged from 8% to 30% and 1% to 13%, respectively, with highest rates in Southern Euro- pean countries (i.e. Spain and Greece). Positive associations between sedentary behaviours and overweight indices were found. Physical activity and dietary behaviours were not associated, possibly because of methodological limitations. Children of parents with high body mass index or low socioeconomic status were at increased risk of overweight/obesity. In conclusion, large differences in preva- lence of overweight and obesity among preschoolers across Europe were observed. Future obesity prevention interventions in preschoolers should target screen time giving specific attention to children from overweight and/or low socioeconomic status parents. There is a need for high methodological quality studies, preferably with a long-term prospective design using sensitive, valid and reliable measures of behaviours, assessing whether and which physical activity and dietary behaviours are associated with overweight in preschoolers. Keywords: Behaviour, children, young children, Europe, obesity. obesity reviews (2012) 13 (Suppl. 1), 29–41 obesity reviews doi: 10.1111/j.1467-789X.2011.00959.x 29 © 2012 The Authors obesity reviews © 2012 International Association for the Study of Obesity 13 (Suppl. 1), 29–41