Innovative Biomarkers for Obesity and Type 1 Diabetes Based on Bifidobacterium and Metabolomic Profiling.

The role of Bifidobacterium species and microbial metabolites such as short-chain fatty acids (SCFAs) and human milk oligosaccharides in controlling intestinal inflammation and the pathogenesis of obesity and type 1 diabetes (T1D) has been largely studied in recent years. This paper discusses the discovery of signature biomarkers for obesity and T1D based on data from a novel test for profiling several Bifidobacterium species, combined with metabolomic analysis. Through the NUTRISHIELD clinical study, a total of 98 children were recruited: 40 healthy controls, 40 type 1 diabetics, and 18 obese children. Bifidobacterium profiles were assessed in stool samples through an innovative test allowing high taxonomic resolution and precise quantification, while SCFAs and branched amino acids were measured in urine samples through gas chromatography-mass spectrometry (GC-MS). KIDMED questionnaires were used to evaluate the children's dietary habits and correlate them with the Bifidobacterium and metabolomic profiles. We found that B. longum subs. infantis and B. breve were higher in individuals with obesity, while B. bifidum and B. longum subs. longum were lower compared to healthy individuals. In individuals with T1D, alterations were found at the metabolic level, with an overall increase in the level of the most measured metabolites. The high taxonomic resolution of the Bifidobacterium test used meant strong correlations between the concentrations of valine and isoleucine, and the relative abundance of some Bifidobacterium species such as B. longum subs. infantis, B. breve, and B. bifidum could be observed.

Plant Sterols and Plant Stanols in Cholesterol Management and Cardiovascular Prevention.

Atherosclerotic cardiovascular disease (ASCVD) remains the major mortality cause in developed countries with hypercholesterolaemia being one of the primary modifiable causes. Lifestyle intervention constitutes the first step in cholesterol management and includes dietary modifications along with the use of functional foods and supplements. Functional foods enriched with plant sterols/stanols have become the most widely used nonprescription cholesterol-lowering approach, despite the lack of randomized trials investigating their long-term safety and cardiovascular efficacy. The cholesterol-lowering effect of plant-sterol supplementation is well-established and a potential beneficial impact on other lipoproteins and glucose homeostasis has been described. Nevertheless, experimental and human observational studies investigating the association of phytosterol supplementation or circulating plant sterols with various markers of atherosclerosis and ASCVD events have demonstrated controversial results. Compelling evidence from recent genetic studies have also linked elevated plasma concentrations of circulating plant sterols with ASCVD presence, thus raising concerns about the safety of phytosterol supplementation. Thus, the aim of this review is to provide up-to-date data on the effect of plant sterols/stanols on lipid-modification and cardiovascular outcomes, as well as to discuss any safety issues and practical concerns.

Perceived barriers to gluten-free diet adherence by people with celiac disease in Greece.

Background: In people with celiac disease (CD), many factors affect adherence to a gluten-free diet (GFD), and these may well differ among countries. In Greece, such data for the adult population are lacking. Thus, the present study aimed to explore the perceived barriers to compliance with a GFD that are faced by people with CD living in Greece, also taking into account the impact of the COVID-19 pandemic. Methods: Nineteen adults (14 females) with biopsy-proven CD, mean age 39±9 years and median time on GFD 7 (Q1-Q3: 4-10) years, participated in 4 focus groups, conducted through a video conference platform during the period October 2020 to March 2021. Data analysis followed the qualitative research methodology. Results: Eating outside the home was reported as the domain where most difficulties were faced: these were related to a lack of confidence in finding safe gluten-free food and to the lack of social awareness about CD/GFD. All participants highlighted the high cost of gluten-free products, which was mostly managed by receiving state financial support. Regarding healthcare, the vast majority of participants reported little contact with dietitians and no follow up. The COVID-19 pandemic eased the burden of eating out, as staying at home and allocating more time to cooking was experienced as a positive effect, although the shift to online food retailing impacted food variability. Conclusion: The main impediment to GFD adherence seems to stem from low social awareness, while the involvement of dietitians in the healthcare of people with CD warrants further investigation.

Fact-based nutrition for infants and lactating mothers-The NUTRISHIELD study.

Background: Human milk (HM) is the ideal source of nutrients for infants. Its composition is highly variable according to the infant's needs. When not enough own mother's milk (OMM) is available, the administration of pasteurized donor human milk (DHM) is considered a suitable alternative for preterm infants. This study protocol describes the NUTRISHIELD clinical study. The main objective of this study is to compare the % weight gain/month in preterm and term infants exclusively receiving either OMM or DHM. Other secondary aims comprise the evaluation of the influence of diet, lifestyle habits, psychological stress, and pasteurization on the milk composition, and how it modulates infant's growth, health, and development. Methods and design: NUTRISHIELD is a prospective mother-infant birth cohort in the Spanish-Mediterranean area including three groups: preterm infants <32 weeks of gestation (i) exclusively receiving (i.e., >80% of total intake) OMM, and (ii) exclusively receiving DHM, and (iii) term infants exclusively receiving OMM, as well as their mothers. Biological samples and nutritional, clinical, and anthropometric characteristics are collected at six time points covering the period from birth and until six months of infant's age. The genotype, metabolome, and microbiota as well as the HM composition are characterized. Portable sensor prototypes for the analysis of HM and urine are benchmarked. Additionally, maternal psychosocial status is measured at the beginning of the study and at month six. Mother-infant postpartum bonding and parental stress are also examined. At six months, infant neurodevelopment scales are applied. Mother's concerns and attitudes to breastfeeding are registered through a specific questionnaire. Discussion: NUTRISHIELD provides an in-depth longitudinal study of the mother-infant-microbiota triad combining multiple biological matrices, newly developed analytical methods, and ad-hoc designed sensor prototypes with a wide range of clinical outcome measures. Data obtained from this study will be used to train a machine-learning algorithm for providing dietary advice to lactating mothers and will be implemented in a user-friendly platform based on a combination of user-provided information and biomarker analysis. A better understanding of the factors affecting milk's composition, together with the health implications for infants plays an important role in developing improved strategies of nutraceutical management in infant care. Clinical trial registration: https://register.clinicaltrials.gov, identifier: NCT05646940.

Joint Microbiota Activity and Dietary Assessment through Urinary Biomarkers by LC-MS/MS.

Accurate dietary assessment in nutritional research is a huge challenge, but essential. Due to the subjective nature of self-reporting methods, the development of analytical methods for food intake and microbiota biomarkers determination is needed. This work presents an ultra-high performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS) method for the quantification and semi quantification of 20 and 201 food intake biomarkers (BFIs), respectively, as well as 7 microbiota biomarkers applied to 208 urine samples from lactating mothers (M) (N = 59). Dietary intake was assessed through a 24 h dietary recall (R24h). BFI analysis identified three distinct clusters among samples: samples from clusters 1 and 3 presented higher concentrations of most biomarkers than those from cluster 2, with dairy products and milk biomarkers being more concentrated in cluster 1, and seeds, garlic and onion in cluster 3. Significant correlations were observed between three BFIs (fruits, meat, and fish) and R24h data (r > 0.2, p-values < 0.01, Spearman correlation). Microbiota activity biomarkers were simultaneously evaluated and the subgroup patterns detected were compared to clusters from dietary assessment. These results evidence the feasibility, usefulness, and complementary nature of the determination of BFIs, R24h, and microbiota activity biomarkers in observational nutrition cohort studies.

The effectiveness of technology-based interventions for weight loss maintenance: A systematic review of randomized controlled trials with meta-analysis.

OBJECTIVE: To systematically review and meta-analyze randomized controlled trials on the effects of technology-based interventions for maintenance of lost weight. METHODS: A systematic literature search was performed to identify randomized controlled trials with at least one intervention arm delivered through the internet or mobile application, published in English until September 2021. Weight change at the end of the weight loss maintenance phase was considered the primary outcome. RESULTS: Twelve manuscripts with 2941 adults were included in the review; 10 studies were meta-analyzed. Included interventions had a duration of 3-30 months and were tested compared with minimum interventions (no contact with the study staff or intervention with only a limited number of features) or in-person groups. Technology-based interventions resulted in similar weight regain when compared with minimum interventions (ES = -0.07 kg; 95% CI = [-0.57, 0.42]; p = 0.770). However, when compared with in-person interventions, technology-based interventions were found to lead in significantly higher weight regain (ES = 1.36 kg; 95% CI = [0.29, 2.43]; p = 0.010). CONCLUSION: Web- and app-based interventions for weight loss maintenance produced similar results with minimum interventions and resulted in greater weight regain compared with in-person interventions. Appropriate interventions for weight loss maintenance provide benefits against weight regain, only when provided in-person.

Digital Health Interventions for Weight Management in Children and Adolescents: Systematic Review and Meta-analysis.

BACKGROUND: Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. OBJECTIVE: The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. METHODS: A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. RESULTS: In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference -0.61, 95% CI -1.10 to -0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference -0.36, 95% CI -0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. CONCLUSIONS: The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations.

The validity of technology-based dietary assessment methods in childhood and adolescence: a systematic review.

Technology-based dietary assessment has promising benefits on improving accuracy and reducing cost of dietary data collection. The validity of technology-based tools in children/adolescents was examined. A systematic literature search was performed to identify studies published till September 2019. In total, 26 studies with 29 validation-related estimations were selected; 13 web-based 24-hdietary recalls (image assisted; n = 12, drop-down food list; n = 13), 4 mobile applications and 3 web-based dietary records (image based; n = 2 and image assisted; n = 1, drop-down food list; n = 3) and 6 web-based food frequency questionnaires (FFQs) (image assisted; n = 3). Fourteen studies were addressed to adolescents, ten studies to children (principally 9-11 years old) and two studies to mixed study samples. Validation was mostly performed through 24-h dietary recalls and dietary records while in some cases objective methods were used. Image-assisted 24-h dietary recalls presented good level of agreement with paper-based methods, yet principally in adolescents. Mobile-application dietary records with image-based facilities and drop-down food lists were found to accurately record dietary intake even when compared with objective methods. FFQs, mainly examined in adolescents, had good level of agreement with the "gold standard" dietary records method. The validity of technology-based methods could be supported yet various technical/methodological issues need better clarification.

Feeding the preterm infant: an overview of the evidence.

Feeding from own mother's milk is not always an option for preterm infants, and choosing between alternative means of feeding should be made in light of their effect on infants' health. In this work, we aimed to present evidence regarding feeding pre-term infants with human milk, either own mother's or donor milk (DM), and the potential effects on growth and other health related outcomes. Exclusive breastfeeding (BF) remains the optimal option, whereas feeding with DM as a sole diet or supplemental to maternal milk confers immunological advantages and fewer rates of necrotising enterocolitis against preterm formula feeding, yet the latter results in greater growth velocity. Literature gaps in the use of DM, practical suggestions for choosing suitable feeding means (i.e. continuous support of BF, adequate education regarding feeding preterm infants, including DM), and future perspectives on the potential effects of dietary manipulations of the maternal diet, are also discussed.

Body Weight of Cartoon Characters in Children Series Is Associated to Food Consumption, Attractiveness, and Physical Activity Engagement.

BACKGROUND: Research is lacking regarding the eating habits of cartoon characters in relation to their body weight. The present study explored the context of food consumption and the cartoon characters' traits, according to body weight. Studies show that slim cartoon characters are usually considered as attractive; however, little is known regarding the type of messages projected about their physical appearance. METHOD: One hundred episodes of ten series with high TV audience rates were reviewed. Characters' body weight status was classified into underweight, normal weight, and overweight, and food consumed as processed and less processed. Characters' traits such as physical activity and attractiveness were classified as positive, negative, or neutral. Comments made by the characters themselves regarding their proper physical appearance or the appearance of partner characters were recorded and classified as positive or negative. RESULTS: Results show that characters' body weight was related to both type and quantity of foods consumed, as 58% of the non-core and 48% of all foods were actually eaten by oversized characters. Positive characters' traits, as defined by attractiveness and physical activity engagement, referred consistently to slim characters, with nine out of ten shown as good-looking and physically active. In addition, the majority (51 out of 58) of the positive comments on physical appearance were recorded for slim and attractive characters, either expressed by fellow actors or the characters themselves. CONCLUSION: Body weight of cartoon characters seems to follow stereotypic perceptions which value slimness and relate unhealthy food consumption with overweight.

Schoolteachers' Nutrition Knowledge, Beliefs, and Attitudes Before and After an E-Learning Program.

OBJECTIVE: Το explore teachers' nutrition knowledge, beliefs, and attitudes and to examine the effectiveness of an electronic learning (e-learning) program in teachers' nutrition knowledge. DESIGN: Cross-sectional and experimental design. SETTING: The study took place in Greece, while schoolteachers were invited by e-mail. PARTICIPANTS: Teachers of primary and secondary education, with no exclusion criteria, were enrolled in the study between March, 2015 and 2016. MAIN OUTCOME MEASURES: Schoolteachers' nutrition knowledge, beliefs, and attitudes. INTERVENTION: Teachers completed a 36-item nutrition questionnaire and then a subgroup participated in an e-learning program. After the intervention, teachers completed the same questionnaire. ANALYSIS: Principal component analysis and multivariate logistic regression were used for data analysis. RESULTS: A total of 1,094 teachers completed the questionnaire; 619 participated in the e-learning program. Teachers showed moderate nutrition knowledge scores (ie, 65% correct answers) before the intervention, whereas their attitudes regarding acting as role models and their belief in the importance of the role of nutrition were associated with 74% (odds ratio, 1.28; 95% confidence interval, 1.13-1.45) and 79% (odds ratio, 1.21; 95% confidence interval, 1.07-1.37) increased possibility of having good nutrition knowledge, respectively. The e-learning program was effective in strengthening teachers' nutrition knowledge (P < .001) and improving their beliefs and attitudes (P < .05). CONCLUSIONS AND IMPLICATIONS: Future research is needed to validate the current results, which can be used to design and implement similar educational programs to teachers as a means of creating health-promoting schools.

Adherence to a DASH-style diet and cardiovascular disease risk: The 10-year follow-up of the ATTICA study.

BACKGROUND: Recent findings suggest a protective role of the DASH dietary pattern on cardiovascular disease (CVD) incidence and mortality. AIM: In this direction, we aimed at investigating the relationship between adherence to a DASH-style diet and CVD risk in a Greek cohort. METHODS: This sub-sample from the ATTICA epidemiological study consisted of 669 adults with a complete dietary profile at baseline, adequate to calculate DASH-diet score, and complete 10-year follow-up (2002-2012). Demographic, clinical and lifestyle parameters were thoroughly assessed at baseline and CVD incidence was recorded upon medical records at follow-up. Adherence to the DASH-style diet was assessed by a DASH-style diet score developed for the study (range 9-45). RESULTS: Mean value (SD) of the DASH-diet score was 27.1 (5.1) (range 13-41). Adherence to a DASH-style diet was associated neither with the 10-year CVD risk nor with baseline clinical parameters. Multiple regression analysis revealed that, after appropriate adjustments, only age (46% increase per 5-life-years) and BMI (9.7% increase per unit of BMI) were associated with 10-year CVD events. CONCLUSIONS: In this small cohort of a Mediterranean population, a cardioprotective effect of a DASH-style diet was not detected.

Food consumption and related messages in animated comic series addressed to children and adolescents.

OBJECTIVE: To analyse the food content in animated comic series addressed to young audiences both in terms of the kinds of foods presented and the cues accompanying them. DESIGN: One hundred episodes of ten animated cartoon series with high television audience viewing (based on Average Minute Rating %) were reviewed and food items were classified into ten categories. In each episode, food cues (i.e. every mention of food, visual, oral or referring to foods consumed) was noted down and characterized as positive, negative or neutral. The rate of overall consumption and the food categories shown to be consumed were also recorded. SETTING: Greece. RESULTS: In ninety-four episodes one or more food cues were recorded; the total number of cues was 361, of which 209 referred to cues where food was shown or discussed and 152 referred to food items consumed. Out of the positive cues measured, almost half referred to sweets and snacks (sixty-one out of 125). Nevertheless, the majority of cues were of neutral character (n 213). Snacks, sweets and soft drinks were seen to be consumed in more episodes compared with other food categories. Moreover, in episodes where a higher frequency of food consumption was recorded, then consumption of sweets, snacks and soft drinks was significantly higher, with consumption of soft drinks often occurring in conjunction with that of snacks. CONCLUSIONS: Food cues are present in children's series, with an emphasis on sweets and snacks, which are projected in an attractive way, whether depicted, discussed or consumed, between cartoon characters.

Celiac disease and non-celiac gluten or wheat sensitivity and health in later life: A review.

Celiac disease (CD) and non-gluten (or wheat) sensitivity (NCGS) are two gluten-related disorders, the treatment of which relies on dietary withdrawal of gluten (absolute and lifelong in the case of CD patients). However, these conditions differ in their pathophysiology and impact on health. CD is an autoimmune disorder of the intestine, and is associated with a wide range of disorders, pre- and post-diagnosis. Its autoimmune and inflammatory nature raises concerns about its potential effects on mortality and morbidity. Here we review the data on the health impact CD or NCGS may have prospectively, and report on the role of a gluten-free diet (GFD) in this respect. Since study designs have been heterogeneous, we focus on studies of treated patients with a biopsy-proven diagnosis of CD, to eliminate possible bias from misdiagnosis. The review revealed a moderately increased mortality risk among CD patients, mainly attributed to cardiovascular disease and malignancy. Other long-term morbidities of CD include autoimmune disorders, nutritional deficiencies, impaired bone health, reproductive abnormalities, and neurologic and neuropsychiatric disorders, which are substantially improved, and some of them even completely treated, after strict adherence to a GFD. For NCGS, the literature is too limited and its long-term complications are unknown.

Repeatability of food frequency assessment tools in relation to the number of items and response categories included.

BACKGROUND: Accuracy of measurement is a cornerstone of research in order to make robust conclusions about the research hypothesis. OBJECTIVE: To examine whether the number of items (questions) and the number of consumption responses (the coding used to measure the frequency of consumption) included in nutritional assessment tools influence their repeatability. METHODS: During 2009, 400 participants (250 from Greece, mean age 37 +/- 13 years, 34% males, and 150 from Spain, mean age 39 +/- 17 years, 41% males) completed a diet index with 11 items and binary (yes/ no) responses, a diet index with 11 items and 6-scale responses, and 36-item and 76-item food frequency questionnaires (FFQs) with 6-scale responses. The participants completed these tools twice, with 15 days between the two administrations of the tools. The Spearman-Brown coefficient (r(sb)), Kendall's tau coefficients, and the Bland-Altman method were applied to answer the research hypothesis. RESULTS: The highest repeatability coefficient was observed for the diet index with 11 items and binary (yes/no) responses (r(sb) = 0.948, p < .001), followed by the diet index with 11 items and 6-scale responses (r(sb) = 0.943, p < .001), the 36-item FFQ with 6-scale responses (r(sb) = 0.936, p < .001), and the 76-item FFQ with 6-scale responses (r(sb) = 0.878, p < .001). Statistical comparisons revealed no significant differences between repeatability coefficients of the first three tools (p > .23), whereas these three tools had significantly higher repeatability coefficients than the 76-item FFQ (p = .002). Subgroup analyses by sex, education, smoking, and clinical status confirmed these results. CONCLUSIONS: Repeatability was found for all food frequency assessment tools used, irrespective of the number of items or the number of responses included.

Parental involvement does not augment the effectiveness of an intense behavioral program for the treatment of childhood obesity.

OBJECTIVE: To evaluate the effectiveness of active parental involvement in a lifestyle intervention for the management of childhood obesity. DESIGN: Forty-two overweight children (32 girls and 10 boys), aged 9.2 +/- 0.2 years and with percent overweight 39.8 +/- 2.7%, were randomly allocated either to a child-and-parent group (N = 23) or a child-alone group (N = 19). Both groups attended a 3-month multidisciplinary program extended by booster sessions during follow-up, which involved many cognitive behavioral therapy principles and assigned high self-regulation to the children, but differed in parental involvement. Percent overweight was evaluated at baseline, and at 3, 6, and 18 months thereafter. RESULTS: There was no significant interaction between time and group or a significant difference between groups. Percent overweight decreased by 4.9 +/- 1.4 at 18 months (p < 0.001); the reduction occurred during the active phase of the treatment (0-3 months) and was maintained thereafter. CONCLUSION: In the setting of the present study, the active parental involvement did not significantly modify the results of lifestyle interventions for children's overweight management.

Low energy reporting related to lifestyle, clinical, and psychosocial factors in a randomly selected population sample of Greek adults: the ATTICA Study.

OBJECTIVE: Aim of the present study was to identify potential dietary, lifestyle, psychosocial and clinical correlates of underreporting in a population-based sample. METHODS: Following a random multistage sampling, 1514 men (46+/-13 years old) and 1528 women (45+/-13 years old) from the Attica area, in Greece, participated in this study. All participants underwent a standard assessment procedure that included clinical, psychosocial and lifestyle parameters. Food consumption was assessed through a validated semi-quantitative food frequency questionnaire. The ratio of energy intake to estimated basal metabolic rate (EI/BMR) and the Goldberg cut-off points were used for the classification of subjects as low energy reporters (LERs) and non-LERs. RESULTS: LERs represented 12.2% of the sample. This percentage was higher in obese subjects compared to overweight or normal weight (20.6 % vs. 9.9 % vs. 10.6 %, p = 0.05), as well as in women compared to men (14.6% vs. 9.9%, p<0.001). Data analysis was stratified by gender, since a significant interaction was observed between gender and LER group on several dietary parameters. Female LERs had higher Med Diet Score compared to non-LERs (30.6 +/- 8.2, 95%CI 30.2-31.04 vs. 26.9 +/- 6.3, 95%CI 26.05-27.7, p<0.001). Multiple regression analysis revealed that lower EI/BMR values were associated with younger age (p<0.001), higher BMI (p<0.001), presence of diabetes mellitus (p=0.012) and lower depression score (p=0.056) in women, whereas with younger age (p<0.001), higher BMI (p<0.001), higher education level (p=0.046) and higher anxiety score (p=0.08) in men. CONCLUSION: Several psychosocial and clinical characteristics operate in low energy reporting in both genders. Nutrition-related professionals should be aware of these gender-specific trends in dietary assessment procedures.

Physical activity patterns and sedentary behaviors of children from urban and rural areas of Cyprus.

BACKGROUND: A sedentary lifestyle among children is becoming increasingly common and has been linked to future risk of degenerative diseases. Urban residence has been suggested to be a contributing factor to a less active lifestyle; however, not all available studies support this link. In the present study we examined the physical activity patterns and sedentary behaviours of children living in urban and rural areas of Cyprus, where major demographic shifts have occurred the last decades. METHODS: We studied 1140 children (531 boys; 609 girls), aged 10-12 years, registered in 24 selected elementary public schools from five urban and rural districts of Cyprus. Children completed a semi-quantitative physical activity questionnaire regarding frequency and duration of everyday physical and sedentary activities. Weight and height of the children, as well as demographic and socioeconomic information was collected from children and their guardians. RESULTS: Rural children reported being slightly more active after school and occupied weekly with outdoors chores compared to urban children, who on the other hand reported engaging in sports on a weekly basis more than their rural peers (all p < 0.10). However, the average weekly time spent by urban and rural children on vigorous (8.6 +/- 4.7 and 9.1 +/- 4.8 h/w, respectively; p = 0.193) or moderate-to-vigorous (14.9 +/- 7.6 and 15.2 +/- 7.6 h/w, respectively; p = 0.612) activities, as well as total screen time, were not different. The distribution of children with regards to most other physical activity and inactivity pursuits was similar between urban and rural areas. CONCLUSION: We found no substantial differences in the physical activity habits and sedentary behaviours among children living in urban and rural areas of Cyprus. Hence public health awareness directed to enhance physical activity and decrease sedentary lifestyle among youngsters should focus equally to urban and rural children.