Objectives: 1. to investigate whether 20 m multi-stage shuttle run performance (20mSRT), an indirect measure of aerobic fitness, could discriminate between healthy and overweight status in 9–10.9 yr old schoolchildren using Receiver Operating Characteristic (ROC) analysis; 2. Investigate if cardiometabolic risk differed by aerobic fitness group by applying the ROC cut point to a second, cross-sectional cohort. Design: Analysis of cross-sectional data. Participants: 16,619 9–10.9 year old participants from SportsLinx project and 300 11–13.9 year old participants from the Welsh Schools Health and Fitness Study. Outcome Measures: SportsLinx; 20mSRT, body mass index (BMI), waist circumference, subscapular and superilliac skinfold thicknesses. Welsh Schools Health and Fitness Study; 20mSRT performance, waist circumference, and clustered cardiometabolic risk. Analyses: Three ROC curve analyses were completed, each using 20mSRT performance with ROC curve 1 related to BMI, curve 2 was related to waist circumference and 3 was related to skinfolds (estimated % body fat). These were repeated for both girls and boys. The mean of the three aerobic fitness thresholds was retained for analysis. The thresholds were subsequently applied to clustered cardiometabolic risk data from the Welsh Schools study to assess whether risk differed by aerobic fitness group. Results: The diagnostic accuracy of the ROC generated thresholds was higher than would be expected by chance (all models AUC .0.7). The mean thresholds were 33 and 25 shuttles for boys and girls respectively. Participants classified as ‘fit’ had significantly lower cardiometabolic risk scores in comparison to those classed as unfit (p,0.001). Conclusion: The use of the ROC generated cut points by health professionals, teachers and coaches may provide the opportunity to apply population level ‘risk identification and stratification’ processes and plan for ‘‘at-risk’’ children to be referred onto intervention services. Citation: Boddy LM, Thomas NE, Fairclough SJ, Tolfrey K, Brophy S, et al. (2012) ROC Generated Thresholds for Field-Assessed Aerobic Fitness Related to Body Size and Cardiometabolic Risk in Schoolchildren. PLoS ONE 7(9): e45755. doi:10.1371/journal.pone.0045755 Editor: Robert L. Newton, Pennington Biomedical Research Center, United States of America Received May 16, 2012; Accepted August 24, 2012; Published September 21, 2012 Copyright: 2012 Boddy et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: The SportsLinx study was funded by Liverpool John Moores University, Liverpool City Council, and Liverpool Primary Care Trust. The Welsh Schools Health and Fitness study was funded by the National Institute for Social Care and Health Research within the Welsh Assembly Government. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: L.M.Boddy@ljmu.ac.uk

This study examined the effects of high intensity exercise on physical fitness components and cardiovascular disease (CVD) risk factors in youth. Forty-one participants (15-17 years) were divided into a control and an intervention (high intensity exercise, HIT) group. The HIT group (15 boys, 2 girls) performed three weekly sessions over seven weeks consisting of either four to six repeats of maximal sprint running with 20-30 s recovery. The control group (20 boys. 4 girls) continued their normal activity patterns. All participants had indices of obesity and blood pressure (BP) recorded in addition to four physical performance measures pre-and post-intervention: cardiorespiratory fitness, muscular power, sprint speed and agility. In the HIT group, significant improvements in cardiorespiratory fitness (P < 0.01) and agility (P < 0.05) were noted. Participants in the control group, meanwhile, experienced a significant decrease in counter movement jump performance. These findings demonstrate that brief, intense exercise interventions are useful for improving indices of physical fitness in a short period of time.

Background: This study examines obesity and factors associated with obesity in children aged 11-13 years in the UK.Methods: 1147 children from ten secondary schools participated in a health survey that included blood samples, fitness test and anthropometric measures. Factors associated with obesity were examined using multilevel logistic regression.Findings: Of the children examined (490 male; 657 female) a third were overweight, 1 in 6 had elevated blood pressure, more than 1 in 10 had high cholesterol, 58% consumed more fat than recommended, whilst 37% were classified as unfit. Children in deprived areas had a higher proportion of risk factors; for example, they had higher blood pressure (20% (deprived) compared to 11% (non-deprived), difference: 9.0% (95%CI: 4.7%-13.4%)). Obesity is associated with risk factors for heart disease and diabetes. Maintaining fitness is associated with a reduction in the risk factors for heart disease (high blood pressure and cholesterol) but not on risk factors for diabetes (insulin levels). In order of importance, the main risk factors for childhood obesity are being unfit, having an obese father, and being large at birth.Conclusion: The high proportion of children with risk factors suggests future interventions need to focus on community and policy change to shift the population norm rather than targeting the behaviour of high risk individuals. Interventions need to focus on mothers' lifestyle in pregnancy, fathers' health, as well as promoting fitness among children. Obesity was not associated with deprivation. Therefore, strategies should be adopted in both deprived and non deprived areas.

OBJECTIVES:1. to investigate whether 20 m multi-stage shuttle run performance (20mSRT), an indirect measure of aerobic fitness, could discriminate between healthy and overweight status in 9-10.9 yr old schoolchildren using Receiver Operating Characteristic (ROC) analysis; 2. Investigate if cardiometabolic risk differed by aerobic fitness group by applying the ROC cut point to a second, cross-sectional cohort. DESIGN:Analysis of cross-sectional data. PARTICIPANTS:16,619 9-10.9 year old participants from SportsLinx project and 300 11-13.9 year old participants from the Welsh Schools Health and Fitness Study. OUTCOME MEASURES:SportsLinx; 20mSRT, body mass index (BMI), waist circumference, subscapular and superilliac skinfold thicknesses. Welsh Schools Health and Fitness Study; 20mSRT performance, waist circumference, and clustered cardiometabolic risk. ANALYSES:Three ROC curve analyses were completed, each using 20mSRT performance with ROC curve 1 related to BMI, curve 2 was related to waist circumference and 3 was related to skinfolds (estimated % body fat). These were repeated for both girls and boys. The mean of the three aerobic fitness thresholds was retained for analysis. The thresholds were subsequently applied to clustered cardiometabolic risk data from the Welsh Schools study to assess whether risk differed by aerobic fitness group. RESULTS:The diagnostic accuracy of the ROC generated thresholds was higher than would be expected by chance (all models AUC >0.7). The mean thresholds were 33 and 25 shuttles for boys and girls respectively. Participants classified as 'fit' had significantly lower cardiometabolic risk scores in comparison to those classed as unfit (p<0.001). CONCLUSION:The use of the ROC generated cut points by health professionals, teachers and coaches may provide the opportunity to apply population level 'risk identification and stratification' processes and plan for "at-risk" children to be referred onto intervention services.

The prevalence of cardiovascular disease (CVD) is increasing around the globe and is the leading cause of death around the world. Though once thought of as an adult problem, it is now recognised that the early manifestations of disease may occur during childhood. Numerous risk factors have been linked to CVD with much of the research focusing on understanding the prevalence and relationship of traditional risk factors such as dyslipidemia, smoking, diabetes mellitus, hypertension, obesity, psychosocial stress, poor diet, physical inactivity and alcohol consumption to the early etiology of disease. While this line of investigation has greatly enhanced our understanding of the relationship between these risk factors and disease, they do not fully explain all cardiovascular events. To enhance our understanding and help with the management of CVD, investigations that involve the measurement of traditional as well as novel risk factors may be necessary. Public health strategies that aim to reduce the prevalence of obesity and overweight encourage youth to increase their physical activity levels as a means of protecting against poor cardiometabolic profiles. Interventions that increase physical activity levels and improve cardiorespiratory fitness cause a reduction in certain CVD risk factors but the lack of agreement between findings makes it impossible to give precise recommendations that will ensure CVD risk reduction. Yet it is important that research continues in order to establish the most appropriate means of improving the health and well-being of those at most risk of future CVD.

The aim of this study was to investigate differences in blood lactate accumulation following 10 and 20 sec of maximal cycle ergometer exercise. Body mass, stature, and age of the group was determined prior to testing (82.57 ± 5.94 kg 177 ± 5.94 cm and 21.42 ± 1.61 yrs, respectively). Eight male rugby union players performed two maximal sprints in a random fashion of 10 and 20 sec duration on a cycle ergometer. During the 10 and 20 sec trial, blood lactate levels measured were as follows 1.58 ± 0.78, 4.43 ± 1.4, and 3.5 ± 1.2 mmol.l−1 vs. 1.72 ± 0.65, 6.14 ± 2, and 5.68 ± 2.22 mmol.l−1, respectively. Differences were found (P < 0.01) from rest to 5 and 10 min postexercise in both groups. Differences in concentration also were found between groups at both postexercise stages (P < 0.01). The reduction in blood lactate concentrations observed between the 5 to10 min recovery stages were 0.91 ± 0.58 mmol.l−1 vs. 0.46 ± 0.48 mmol.l−1 following 10 and 20 sec of maximal exercise, respectively (P > 0.05). The concentrations observed are interesting and may influence recovery time and subsequent exercise performance.

BACKGROUND:Puberty is a critical period in the development of obesity. Body mass index (BMI), waist circumference and skin-fold thickness are used generally as estimates of body fat in children and adults. AIM:To identify a marker of adiposity that is independent of pubertal status and determine its relationship to physical fitness in adolescence. SUBJECTS AND METHODS:Girls (n = 147) and boys (n = 100) from year 8 in three Welsh schools self-reported Tanner stages. Anthropometric measurements of adiposity were made and aerobic fitness estimated with a 20-metre shuttle-run test. RESULTS:Children in early and late puberty were of similar chronological age. BMI strongly correlated with height in early puberty in girls (r = 0.366, p < 0.001) and boys (r = 0.594, p < 0.001), but not in late puberty. Waist-to-height ratio adjusted for the effect of height on waist measurements; and correlated with percentage fat mass in early and late puberty in girls (r = 0.865 and r = 0.772, both p < 0.001) and boys (r = 0.868 and r = 0.877, both p < 0.001). Physical fitness score was inversely related to waist-to-height ratio, with similar regression lines in early and late puberty, in girls (r = - 0.545, p < 0.001 and r = - 0.362, p = 0.005) and boys (r = - 0.490, p < 0.001 and r = - 0.400, p = 0.003). CONCLUSION:Pubertal status should be taken into account in adjusting weight for height in adolescents. Waist-to-height ratio is a convenient and appropriate measure of adiposity during puberty.

Physical activity research has been dominated by traditional cognitive rationale paradigms utilized within other domains. Though this approach to physical activity behavior has greatly enhanced our understanding of the key determinants, it has done little to eradicate the health problems we currently face. In order to achieve lasting change though, multilevel interventions may prove effective. Ecological perspectives have been proposed as an effective approach in combating current physical inactivity levels. Nevertheless, this approach is in its infancy and much has still to be learned. The aim of this paper is to provide an overview of the main behavioral models used within the physical activity domain while proposing the need for further models that will embrace the principles presented by ecological and complexity theories.

BACKGROUND:To understand the key challenges and explore recommendations from teenagers to promote physical activity with a focus on ethnic minority children.METHODS:Focus groups with teenagers aged 16-18 of Bangladeshi, Somali or Welsh descent attending a participating school in South Wales, UK. There were seventy four participants (18 Somali, 24 Bangladeshi and 32 Welsh children) divided into 12 focus groups.RESULTS:The boys were more positive about the benefits of exercise than the girls and felt there were not enough facilities or enough opportunity for unsupervised activity. The girls felt there was a lack of support to exercise from their family. All the children felt that attitudes to activity for teenagers needed to change, so that there was more family and community support for girls to be active and for boys to have freedom to do activities they wanted without formal supervision. It was felt that older children from all ethnic backgrounds should be involved more in delivering activities and schools needs to provide more frequent and a wider range of activities.CONCLUSIONS:This study takes a child-focused approach to explore how interventions should be designed to promote physical activity in youth. Interventions need to improve access to facilities but also counteract attitudes that teenagers should be studying or working and not 'hanging about' playing with friends. Thus, the value of activity for teenagers needs to be promoted not just among the teenagers but with their teachers, parents and members of the community.

Background: Physical activity is associated with better health. Two sources of activity for children are walking to school and taking part in organised sports and activities. This study uses a large national cohort to examine factors associated with participation in these activities.Methods: The Millennium Cohort study contains 5 year follow-up of 17,561 singleton children recruited between 2000-2002 in the UK. All participants were interviewed in their own homes at 9 months, 3 years and 5 years follow-up and all measures were self reports. Logistic regression and likelihood ratio tests were used.Results: Children are less likely to walk to school as income and parental education increase [Adjusted odds: 0.7 (95% CI: 0.6-0.8) for higher income/education compared to low income/no qualifications]. However, if the parent plays with the child in high income families the child is more likely to walk to school [Adjusted odds: 1.67 (95% CI: 1.3-2.1)]. Children taking part in organised activities are from higher income, higher education families, with a car, in a "good" area with non-working mothers. However, in low socio-economic families where the parent plays with the child the child is more likely to take part in organised activities [Adjusted odds: 2.0 (95% CI: 1.5-2.7)].Conclusions: Income is an important determinant of the type of activity available to children. Families that report good health behaviours (non-smoking, low TV viewing) and play with their children show higher levels of physical activity. Thus, parenting practice appears to have a strong impact on their child's physical activity.

Child: Care, Health and DevelopmentVolume 38, Issue 1 p. 1-2 School-based physical activity interventions: challenges and pitfalls D. S. Buchan, Corresponding Author D. S. Buchan Health and Exercise Sciences, School of Science and Technology, University of the West of Scotland, HamiltonDuncan S. Buchan, Health and Exercise Sciences, School of Science and Technology, University of the West of Scotland, Hamilton ML3 0JB, UK, E-mail: [email protected]Search for more papers by this authorS. Ollis, S. Ollis Health and Exercise Sciences, School of Science and Technology, University of the West of Scotland, HamiltonSearch for more papers by this authorN. E. Thomas, N. E. Thomas Centre for Children and Young People's Health and Well-Being, School of Human and Health Sciences, Swansea University, Swansea, UK, andSearch for more papers by this authorR. M. Malina, R. M. Malina Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USASearch for more papers by this authorJ. S. Baker, J. S. Baker Health and Exercise Sciences, School of Science and Technology, University of the West of Scotland, HamiltonSearch for more papers by this author D. S. Buchan, Corresponding Author D. S. Buchan Health and Exercise Sciences, School of Science and Technology, University of the West of Scotland, HamiltonDuncan S. Buchan, Health and Exercise Sciences, School of Science and Technology, University of the West of Scotland, Hamilton ML3 0JB, UK, E-mail: [email protected]Search for more papers by this authorS. Ollis, S. Ollis Health and Exercise Sciences, School of Science and Technology, University of the West of Scotland, HamiltonSearch for more papers by this authorN. E. Thomas, N. E. Thomas Centre for Children and Young People's Health and Well-Being, School of Human and Health Sciences, Swansea University, Swansea, UK, andSearch for more papers by this authorR. M. Malina, R. M. Malina Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USASearch for more papers by this authorJ. S. Baker, J. S. Baker Health and Exercise Sciences, School of Science and Technology, University of the West of Scotland, HamiltonSearch for more papers by this author First published: 08 June 2011 https://doi.org/10.1111/j.1365-2214.2011.01258.xCitations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume38, Issue1January 2012Pages 1-2 RelatedInformation

OBJECTIVES:This article examines the effects of brief, intense exercise in comparison with traditional endurance exercise on both novel and traditional markers of cardiovascular disease (CVD) in youth.METHODS:Forty seven boys and ten girls (16.4 ± 0.7 years of age) were divided into a moderate (MOD), high intensity (HIT), or a control group. The MOD group (12 boys, 4 girls) and HIT group (15 boys, 2 girls) performed three weekly exercise sessions over 7 weeks. Each session consisted of either four to six repeats of maximal sprint running within a 20 m area with 20-30 s recovery (HIT) or 20 min continuous running within a 20 m area at ∼70% maximal oxygen uptake (VO(2) max).RESULTS:Total exercise time commitment over the intervention was 420 min (MOD) and 63 min (HIT). Training volume was 85% lower for the HIT group. Total estimated energy expenditure was ∼907.2 kcal (HIT) and ∼4410 kcal (MOD). Significant improvements (P ≤ 0.05) were found in systolic blood pressure, aerobic fitness, and body mass index (BMI) postintervention (HIT). In the MOD group, significant (P ≤ 0.05) improvements were noted in aerobic fitness, percentage body fat (%BF), BMI, fibrinogen (Fg), plasminogen activator inhibitor-1, and insulin concentrations.CONCLUSIONS:These findings demonstrate that brief, intense exercise is a time efficient means for improving CVD risk factors in adolescents.

The purpose of this study was to examine the effects of exercising at different intensities over 7 weeks on components of physical fitness and CVD risk factors. Forty‐seven boys and 10 girls, (16.4±0.7 years of age) were divided into a moderate, high intensity, or a control group. All participants had indices of obesity and blood pressure recorded in addition to four physical performance measures pre‐ and post‐intervention. In addition, the intervention groups repeated the physical performance measures at the 4th week phase of the intervention. Following the intervention, significant improvements ( P <0.05) in the high‐intensity group were found in the 20 MSFT, agility, CMJ and 10 m sprint post‐intervention. Participants in the moderate intensity group displayed significant improvements ( P <0.05) in both the CMJ and 20 MSFT post‐intervention. Body fat % significantly improved ( P <0.01) in the moderate group only post‐intervention. Interestingly, Systolic blood pressure significantly improved post‐intervention (112±10 vs 106±11 mmHg) ( P =0.017) in the high intensity group. In conclusion, high‐intensity exercise over 7 weeks is a very time efficient means of improving important components of physical fitness in adolescents.

Active commuting to and from school is a convenient method of increasing children's physical activity and improving their health status. Limited evidence exists regarding health differences of children who commute actively (e.g., walk, cycle) compared to passively (e.g., car, bus, train). Most studies have focused primarily on body composition and fitness. PURPOSE: To compare active and passive school commuters on a variety of different markers of health. METHODS: A cohort of Caucasian schoolchildren (N =221; aged 12-14 yr) from three high schools in Wales were tested on a variety of health indicators. These included measures of cardiovascular fitness, body composition, inflammation, glucose regulation, resting blood pressure, and fasting blood lipids. Data were corrected for non-normality by log transformation, and sex-specific z-scores were computed for variables where there was a significant sex difference. Mean scores were compared using independent groups t-tests. Cohen's d was computed to interpret effect sizes. RESULTS: Only 32 children (14.5%) reported actively commuting at least one way (to and/or from school). In descending order of effect size, the active commuters were significantly (p <.05) healthier than passive commuters on the following variables (absolute values of d reported): HDL/Total cholesterol ratio (d = 0.73); HDL-cholesterol (d = 0.71); triglycerides (d = 0.45); fibrinogen (d = 0.45); waist circumference (d = 0.42); body mass index (d = 0.41); and LDL-cholesterol (d = 0.40). There were no significant group differences (p >.05) for sum of skinfolds, systolic and diastolic blood pressure, total cholesterol, fasting glucose, fasting insulin, adiponectin, C-reactive protein, and interleukin-6 (d ranged from 0.03-0.24). No health variables were significantly worse in active commuters. CONCLUSIONS: Based on self-reported commuting behavior, children who actively commute to and/or from school have healthier waist adiposity and body weight, cholesterol sub-fractions, blood lipids, and possibly inflammation. Further research is needed that purposively recruits larger samples of active commuters, and investigates the prospective effect of active commuting on children's health.

Multiple cardiovascular disease (CVD) risk factors have been identified in young people, often attributed to the increasing prevalence of obesity in this population. The metabolic syndrome (MetS), a cluster of interrelated factors, is recognized as an early indicator of CVD risk. The syndrome is often analyzed as a univariate construct, either by dichotomous classification (MetS present vs. absent), or via the use of a single composite MetS z-score. PURPOSE: To investigate the multivariate dimensionality and strength of the relationship between MetS and inflammation in adolescent children. METHODS: MetS components (diastolic and systolic blood pressure, fasting glucose, fasting triglycerides, fasting HDL-cholesterol, and waist circumference) and four markers of inflammation (fibrinogen, C-reactive protein, interleukin-6, and adiponectin) were measured in a cohort of Caucasian schoolchildren (N =231) aged 12-14 yr, from three high schools in Wales. The multivariate association between MetS and inflammation was investigated via canonical correlation analysis. Data were corrected for non-normality by log transformation, and sex-specific z-scores computed for variables where there was a significant sex difference. RESULTS: The pattern of results was similar regardless of whether the variables were adjusted for sex differences. The overall multivariate association between MetS and inflammation was significant (Wilks' Lambda =.54, p <.001), with 36% shared variance between the two sets of variables. The first canonical function was significant, and inspection of the canonical coefficients (CC) indicated that the relationship was explained primarily by the waist circumference component of MetS (CC =.87) and inflammatory markers of fibrinogen (CC =.52) and C-reactive protein (CC =.50). CCs between adiponectin (CC = -.21) and interleukin-6 (CC =.12) and the inflammation canonical variate were much lower. CONCLUSIONS: Of the different components of MetS, waist circumference appears to be the primary determinant of inflammation, and this relationship is primarily explained by fibrinogen and C-reactive protein. Central adiposity was the strongest predictor of the inflammatory aspect of CVD risk in Caucasian adolescents and may be a useful screening tool to identify future risk of CVD.

BACKGROUND:Cardiovascular disease (CVD) is the main cause of mortality throughout the world. With accumulating evidence suggesting that CVD has its origins in childhood, it is unsurprising that research into obesity prevalence within school aged youth is burgeoning. Within this study our primary objective will be to examine whether high intensity interval training (HIT) improves the CVD risk profile of secondary school aged adolescents. Our secondary objective will be to identify the prevalence of CVD risk factors and examine factors associated with these in adolescents aged 15-18 years.METHOD/DESIGN:A South Lanarkshire school of low socioeconomic status (SES) was selected to participate in the study intervention. Participants from secondary 5 (15-17 years) and 6 (16-18 years) will be recruited for this study. Participants from secondary 6 will be randomly assigned to Group A (HIT) or Group B (moderate-vigorous) and will perform each protocol three times weekly. The secondary 5 participants will act as the control group. Data collection will take place during the Physical Education (PE) lessons and on school premises and will include: anthropometrical variables (height, weight, waist and hip circumferences, skinfold thickness at two sites), physiological responses (blood pressure, aerobic fitness, heart rate (HR) response, vertical jump performance, 10-metre (m) sprint, 50-m sprint and 505-agility test), diet (self-reported seven-day food diary), physical activity (Physical Activity Questionnaire for Adolescents (PAQ-A)) and blood tests (fasting glucose, insulin, total cholesterol (TC), high-density lipoprotein (HDL), high-sensitivity C-reactive protein (hs-CRP), fibrinogen (Fg), interleukin-6 (IL-6), adiponectin (high molecular weight), triglyceride and plasminogen activator inhibitor-1 (PAI-1). An environmental audit of the secondary school and the health related quality of life (HRQOL) of the participants will also be measured. Finally, all exercise sessions will be video recorded and rate of perceived exertion (RPE) and mood states will also be taken after each exercise session.DISCUSSION:Our study may be able to demonstrate a time efficient means of reducing CVD risk factors in adolescents.TRIAL REGISTRATION:NCT01027156.

BACKGROUND:Health is a result of influences operating at multiple levels. For example, inadequate housing, poor educational attainment, and reduced access to health care are clustered together, and are all associated with reduced health. Policies which try to change individual people's behaviour have limited effect when people have little control over their environment. However, structural environmental change and an understanding of the way that influences interact with each other, has the potential to facilitate healthy choices irrespective of personal resources. The aim of Environments for Healthy Living (EHL) is to investigate the impact of gestational and postnatal environments on health, and to examine where structural change can be brought about to optimise health outcomes. The baseline assessment will focus on birth outcomes and maternal and infant health.METHODS/DESIGN:EHL is a longitudinal birth cohort study. We aim to recruit 1000 pregnant women in the period April 2010 to March 2013. We will examine the impact of the gestational environment (maternal health) and the postnatal environment (housing and neighbourhood conditions) on subsequent health outcomes for the infants born to these women. Data collection will commence during the participants' pregnancy, from approximately 20 weeks gestation. Participants will complete a questionnaire, undergo anthropometric measurements, wear an accelerometer, compile a food diary, and have environmental measures taken within their home. They will also be asked to consent to having a sample of umbilical cord blood taken following delivery of their baby. These data will be complemented by routinely collected electronic data such as health records from GP surgeries, hospital admissions, and child health and development records. Thereafter, participants will be visited annually for follow-up of subsequent exposures and child health outcomes.DISCUSSION:The baseline assessment of EHL will provide information concerning the impact of gestational and postnatal environments on birth outcomes and maternal and infant health. The findings can be used to inform the development of complex interventions targeted at structural, environmental factors, intended to reduce ill-health. Long-term follow-up of the cohort will focus on relationships between environmental exposures and the later development of adverse health outcomes, including obesity and diabetes.