Search

BACKGROUND Background: Heart failure (HF) is becoming a global epidemic. To promote healthy behaviors and facilitate the strengthening of the provision of health services in these patients, it is essential to prioritize their opinions and needs. Mobile health applications seem to be an effective tool in the care of these patients. User-centered design and the Information Systems Research (ISR) perspective are well-established approaches to developing mobile applications that are responsive to the needs of these patients. OBJECTIVE Objective: The aim of this study was to provide practical information regarding needs, preferences of content, and format of an App to assist the self-management in patients with multi-morbidity and HF. METHODS Methods: This three phases study was conducted in Spain. Six integrative reviews, a qualitative methodology based on Van Manen's hermeneutic phenomenology through semi-structured interviews and user stories were used. A total of 20 patients were included in this study. Data collection continued until data saturation was reached. All data were transcribed verbatim and analyzed using a framework approach. Thematic analysis technique following the methods of Braun and Clarke was used for emerging themes. RESULTS Results: The integrative reviews conducted included practical recommendations to include in the content and format of the App and helped create the interview guide. Interviews revealed 15 subthemes, related to the domains of food and nutrition, medication and treatment, rehabilitation and physical activity, signs and symptoms, self-management, and emotional management. These subthemes captured the meaning of narratives offering contextual insights into the development of the App. The main effective mechanisms of multicomponent interventions for patients with HF must contain: i) components that increase the patient's understanding of HF, ii) self-care, iii) self-efficacy, participation of the family / caregiver, iv) psychosocial well-being, and v) professional support and use of technology. User stories revealed that patients prioritized improvements in direct contact with health services in case of emergency (90%), in nutritional information (70%), type of exercises in order to improve their physical condition (75%), and information about food and drugs interaction (60%). As a transversal element, in a large part of the user stories, was highlighted the importance of motivation messages (60%). CONCLUSIONS Conclusions: A 3-phases process integrating theoretical basis, evidence from integrative reviews, and research findings from target users has been considered a guide for future App development. CLINICALTRIAL ClinicalTrials.gov NCT04725526 INTERNATIONAL REGISTERED REPORT RR2-10.2196/35945

Background: According to the current physical activity (PA) recommendations, children should accumulate 60 minutes of moderate to vigorous PA (MVPA) throughout the day, 30 minutes of MVPA during the school hours, and 50% of the recess time in MVPA. Our aim was to examine the temporal trends of accelerometer-based PA during the previously mentioned day segments and the proportion of children who met the PA recommendations. Methods: This was a cross-sectional study with 2 independent samples: 499 fourth graders (49.2% females) in 2011–2012 and 364 fourth graders (46.9% females) in 2017–2018. Hip-worn accelerometers were used to assess PA. Results: A decline in light PA, moderate PA, vigorous PA, MVPA, and total PA during whole day, and in the rate of compliance with daily MVPA recommendations in males (P P P P Conclusions: Interventions are needed to attenuate the temporal decrease in PA levels in children.

This research was funded by Ministry of Economy, Industry and Competitiveness in the 2017 call for R & D Projects of the State Program for Research, Development and Innovation Oriented to the Challenges of the Company; National Plan for Scientific and Technical Research and of Innovation 2013-2016 (DEP2017-88043-R); and the Regional Government of Andalusia and University of Cadiz: Research and Knowledge Transfer Fund (PPIT-FPI19)., Motor fitness and flexibility have been linked to several health issues. We aimed to investigate the predictive validity of motor fitness and flexibility tests in relation to health outcomes in adults and older adults. Web of Science and PubMed databases were screened for studies published from inception to November 2020. Two authors systematically searched, evaluated, and extracted data from identified original studies and systematic reviews/meta-analysis. Three levels of evidence were constructed: strong, moderate, and limited/inconclusive evidence. In total, 1182 studies were identified, and 70 studies and 6 systematic reviews/meta-analysis were summarized. Strong evidence indicated that (i) slower gait speed predicts falls and institutionalization/hospitalization in adults over 60 years old, cognitive decline/impairment over 55 years old, mobility disability over 50 years old, disability in instrumental activities of daily living (IADL) over 54 years old, cardiovascular disease risk over 45 years old, and all-cause mortality over 35 years old; (ii) impaired balance predicts falls and disability in IADL/mobility disability in adults over 40 years old and all-cause mortality over 53 years old; (iii) worse timed up&go test (TUG) predicts falls and fear of falling over 40 years old. Evidence supports that slower gait speed, impaired balance, and worse TUG performance are significantly associated with an increased risk of adverse health outcomes in adults., Ministry of Economy, Industry and Competitiveness, National Plan for Scientific and Technical Research and of Innovation DEP2017-88043-R, Junta de Andalucia, University of Cadiz PPIT-FPI19

Resumen Introduccion Un estilo de vida poco activo y una dieta inadecuada podrian influir en el desarrollo de futuras enfermedades cardiometabolicas. El objetivo principal fue determinar la asociacion entre capacidad aerobica y factores de riesgo cardiometabolicos y si dicha posible asociacion es independiente de la dieta mediterranea (DM). A su vez, se plantea como objetivo secundario estudiar el efecto combinado de la capacidad aerobica y la adherencia a la DM sobre el indice de riesgo cardiometabolico global (IRCM) en adultos. Metodos Se evaluo a 79 adultos (38% mujeres) entre 18 y 40 anos en Cadiz. Se midieron indicadores de adiposidad, presion arterial, trigliceridos, glucosa y perfil inflamatorio (interleucina-6 y factor de necrosis tumoral) y se desarrollo un IRCM. Se midio la capacidad aerobica mediante el consumo maximo de oxigeno a traves de una prueba de esfuerzo incremental en cicloergometro. La adherencia a la DM se evaluo mediante cuestionario. Se utilizo un modelo de regresion lineal para estudiar la asociacion entre capacidad aerobica y factores de riesgo cardiometabolicos con diferentes modelos de ajuste. Se analizo el efecto combinado de la capacidad aerobica y la adherencia a la DM sobre el IRCM mediante el test de ANOVA, con nivel de significacion de p Resultados Se observo asociacion negativa entre la capacidad aerobica y los factores de riesgo cardiometabolicos (todas p ≤ 0,05) en el modelo sin ajustar. La presion arterial y los trigliceridos perdieron la asociacion tras ajustar el modelo por sexo, edad y adherencia a la DM. Los participantes con alta capacidad aerobica y alta adherencia a la DM mostraron un menor IRCM (−1,083 ± 2,325 vs. 2,802 ± 1,759). Conclusiones La capacidad aerobica se asocia de forma inversa con factores de riesgo cardiometabolicos relacionados con la adiposidad, independientemente de la adherencia a la DM. Una alta adherencia a la DM podria influir en la modulacion de la presion arterial. Una alta capacidad aerobica podria reducir las consecuencias adversas de una baja adherencia a la DM.

This project was supported by Ministry of Economy, Industry and Competitiveness in the 2017 call for R&D Projects of the State Program for Research, Development and Innovation Oriented to the Challenges of the Company; National Plan for Scientific and Technical Research and of Innovation 2017-2020 (DEP2017-88043-R); and the Regional Government of Andalusia and University of Cadiz: Research and Knowledge Transfer Fund (PPIT-FPI19)., We comprehensively assessed the criterion-related validity of existing field-based fitness tests used to indicate adult health (19–64 years, with no known pathologies). The medical electronic databases MEDLINE (via PubMed) and Web of Science (all databases) were screened for studies published up to July 2020. Each original study’s methodological quality was classified as high, low and very low, according to the number of participants, the description of the study population, statistical analysis and systematic reviews which were appraised via the AMSTAR rating scale. Three evidence levels were constructed (strong, moderate and limited evidence) according to the number of studies and the consistency of the findings. We identified 101 original studies (50 of high quality) and five systematic reviews examining the criterion-related validity of field-based fitness tests in adults. Strong evidence indicated that the 20 m shuttle run, 1.5-mile, 12 min run/walk, YMCA step, 2 km walk and 6 min walk test are valid for estimating cardiorespiratory fitness; the handgrip strength test is valid for assessing hand maximal isometric strength; and the Biering–Sørensen test to evaluate the endurance strength of hip and back muscles; however, the sit-and reach test, and its different versions, and the toe-to-touch test are not valid for assessing hamstring and lower back flexibility. We found moderate evidence supporting that the 20 m square shuttle run test is a valid test for estimating cardiorespiratory fitness. Other field-based fitness tests presented limited evidence, mainly due to few studies. We developed an evidence-based proposal of the most valid field-based fitness tests in healthy adults aged 19–64 years old., Ministry of Economy, Industry and Competitiveness, National Plan for Scientific and Technical Research and of Innovation 2017-2020 DEP2017-88043-R, University of Cadiz: Research and Knowledge Transfer Fund PPIT-FPI19, Junta de Andalucia

Objective:To investigate whether adherence to the adapted Mediterranean Diet Score for Adolescents (MDS_A) and the adapted Mediterranean Diet Quality Index for Adolescents (KIDMED_A) is associated with better food/nutrient intakes and nutritional biomarkers.Design:The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study is a cross-sectional study aiming to obtain comparable data on a variety of nutritional and health-related parameters in European adolescents aged 12·5–17·5 years.Setting:Nine European countries.Participants:European adolescents (n 2330) recruited to the HELENA study. Dietary intake was obtained with 24 h dietary recalls, an FFQ and a Food Choices and Preferences questionnaire. MDS_A was calculated as a categorical variable using cut-offs (MDS_A), as a continuous variable (zMDS_A) and with energy adjustments (zEnMDS_A). The KIDMED_A score was also calculated.Results:Multilevel linear regression analysis showed positive associations for zMDS_A and KIDMED_A with serum levels of vitamin D, vitamin C, plasma folate, holo-transcobalamin, β-carotene and n-3 fatty acids, while negative associations were observed with trans-fatty acid serum levels. For categorical indices, blood biomarkers showed few significant results. zMDS_A and KIDMED_A showed positive associations with vegetables and fruits intake, and negative associations with energy-dense and low-nutritious foods. zMDS_A and KIDMED_A were positively associated with all macronutrients, vitamins and minerals (all P < 0·0001), except with monosaccharides and PUFA for KIDMED_A and cholesterol for both indices (P < 0·05).Conclusions:zMDS_A and KIDMED_A have shown the strongest associations with the dietary indicators and biomarkers that have been associated with the Mediterranean diet before, and are therefore considered the most appropriate and valid Mediterranean diet scores for European adolescents.

Objective: The objective was to assess the effects of a nasal restriction device for inspiratory muscle training, called Feelbreathe&reg, added to a rehabilitation program (RP) on exercise capacity, quality of life, dyspnea and inspiratory muscle strength in patients with stable COPD. Methods: Patients were randomized into three groups, one performed a supervised RP using the Feelbreathe&reg, device (FB group), the second group developed the same RP with oronasal breathing without FB (ONB group) and the third was the control group (CG). We evaluated inspiratory muscle strength (PImax), dyspnea (mMRC), quality of life (CAT) and exercise capacity (6MWT) before and after 8-week of RP. Results: A total of 16 patients completed the study, seven in FB group, five in ONB group and four in the CG. After the RP, the FB group showed a significant increase in PImax (93.3 &plusmn, 19.1 vs. 123.0 &plusmn, 15.8 mmHg) and in the 6MWT distance (462.9 &plusmn, 71.8m vs. 529.1 &plusmn, 50.1 m) and a decrease in the CAT score (9.7 &plusmn, 6.5 vs. 5.9 &plusmn, 6.0) and in the mMRC dyspnea score. FB provides greater improvement in PImax, dyspnea, quality of life and 6MWT than ONB. Conclusions: The Feelbreathe&reg, device provides greater improvements in quality of life, dyspnea, exercise capacity and inspiratory muscle strength compared to patients that did not use it.

On behalf of the HELENA Study Group., The aim was to investigate whether there was an association between amino acid (AA) intake and physical fitness and if so, to assess whether this association was independent of carbohydrates intake. European adolescents (n = 1481, 12.5–17.5 years) were measured. Intake was assessed via two non-consecutive 24-h dietary recalls. Lower and upper limbs muscular fitness was assessed by standing long jump and handgrip strength tests, respectively. Cardiorespiratory fitness was assessed by the 20-m shuttle run test. Physical activity was objectively measured. Socioeconomic status was obtained via questionnaires. Lower limbs muscular fitness seems to be positively associated with tryptophan, histidine and methionine intake in boys, regardless of centre, age, socioeconomic status, physical activity and total energy intake (model 1). However, these associations disappeared once carbohydrates intake was controlled for (model 2). In girls, only proline intake seems to be positively associated with lower limbs muscular fitness (model 2) while cardiorespiratory fitness seems to be positively associated with leucine (model 1) and proline intake (models 1 and 2). None of the observed significant associations remained significant once multiple testing was controlled for. In conclusion, we failed to detect any associations between any of the evaluated AAs and physical fitness after taking into account the effect of multiple testing., The HELENA study took place with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT: 2005-007034).

ObjectiveThe present study aimed to examine the association between different breakfast consumption patterns and vitamin intakes and blood vitamin concentrations in European adolescents.DesignBreakfast consumption was assessed by a questionnaire. Vitamin intake was calculated from two 24 h recalls. Blood vitamin and total homocysteine (tHcy) concentrations were analysed from fasting blood samples.SettingThe European Commission-funded HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.SubjectsParticipants were 1058 (52·8 % females) European adolescents (aged 12·5–17·5 years) from ten cities.ResultsLower vitamin D and vitamin C concentrations were observed in male and female breakfast skippers than in consumers (PPPP6and vitamin E than occasional consumers (PConclusionsRegular breakfast consumption is associated with higher blood vitamin D and cobalamin concentrations in males and with higher vitamin D and holo-transcobalamin and lower tHcy concentrations in females. Moreover, breakfast consumption is associated with high intakes of vitamin D and total folate in both sexes, and with high intakes of vitamin B6and vitamin E in females.

Introduction Unhealthy lifestyle and inadequate diet could influence the development of future cardiometabolic disease. The main aim of this study was to determine the association between aerobic fitness and cardiometabolic risk factors in adults, whether this relation is depends of adherence to Mediterranean diet (MD). A secondary aim was to study the combined effect of aerobic capacity and adherence to MD on global cardiometabolic risk score (CMRS). Method A total of 79 adults (38% women) enrolled between 18–40 year from Cadiz. We measured adiposity indicators, blood pressure, triglycerides, glucose and inflammatory profile (interleukin-6 and tumor necrosis factor) and was computed (CMRS). Aerobic fitness was measured by maximal oxygen comsuption through an incremental stress test by cycleergometer. The MD patterns was measured using the questionnaire of adherence to MD. The association between aerobic fitness and cardiometabolic risk factors was examined using a lineal regression and it was adjusted for different confounders. CMRS on the lifestyle was analyzed using the ANOVA test, with statistical significance level of p Results Linear regression showed inverse association between aerobic fitness and cardiometabolic risk factors (all p ≤ 0.05) in the model without adjustment. Blood pressure and triglycerides lost the association after adjust model for sex, age, and adherence to MD. Participants with high aerobic fitness and high adherence to MD show a lowest CMRS (−1.083 ± 2.325 vs. 2.802 ± 1.759). Conclusions Aerobic fitness was inversely associated with fatness risk factors, that relationship is independent to adherence to MD. A high adherence to MD could modulate blood pressure. A combination of high aerobic capacity and high adherence to MD could reduce the adverse consecuence of a low adherencie to MD.

Copyright © 2015 by the American Society for Biochemistry and Molecular Biology, Inc. Dietary n-3 long-chain PUFAs (LC-PUFAs) are associated with improvement in the parameters of the metabolic syndrome (MetS). Glucokinase regulatory protein (GCKR) is a key protein regulating intracellular glucose disposal. Our aim was to investigate: i ) the relationship between the GCKR rs1260326 (Pro446Leu) polymorphism and parameters of the MetS; and ii ) a potential influence of n-3 and n-6 LC-PUFA levels on this relationship in the HELENA study (1,155 European adolescents). Linear regression analyses were performed to study the association between rs1260326 and the outcomes of interest. Interactions between rs1260326 and LC-PUFA levels on outcomes were explored. The T allele of rs1260326 was associated with higher serum TG concentrations compared with the C allele. In contrast to n-6 LC-PUFA levels, a significant interaction ( P = 0.01) between rs1260326 and total n-3 LC-PUFA levels on serum TG concentrations was observed. After stratification on the n-3 LC-PUFA median values, the association between rs1260326 and TG concentration was significant only in the group with high n-3 LC-PUFA levels. In conclusion, this is the first evidence that n-3 LC-PUFAs may modulate the impact of the GCKR rs1260326 polymorphism on TG concentrations in adolescents. Several molecular mechanisms, in link with glucose uptake, could explain these findings.

[Purpose]: Breakfast consumption has been recommended as part of a healthy diet. Recently, ready-to-eat cereals (RTEC) became more popular as a breakfast item. Our aim was to analyse the dietary characteristics of an RTEC breakfast in European adolescents and to compare them with other breakfast options. [Methods]: From the European multi-centre HELENA study, two 24-h dietary recalls of 3137 adolescents were available. Food items (RTEC or bread, milk/yoghurt, fruit) and macro- and micronutrient intakes at breakfast were calculated. Cross-sectional regression analyses were adjusted for gender, age, socio-economic status and city. [Results]: Compared to bread breakfasts (39 %) and all other breakfasts (41.5 %), RTEC breakfast (19.5 %) was associated with improved nutrient intake (less fat and less sucrose; more fibre, protein and some micronutrients like vitamin B, calcium, magnesium and phosphorus) at the breakfast occasion. Exceptions were more simple sugars in RTEC breakfast consumers: more lactose and galactose due to increased milk consumption, but also higher glucose and fructose than bread consumers. RTEC consumers had a significantly higher frequency (92.5 vs. 50.4 and 60.2 %) and quantity of milk/yoghurt intake and a slightly higher frequency of fruit intake (13.4 vs. 10.9 and 8.0 %) at breakfast. [Conclusions]: Among European adolescents, RTEC consumers showed a more favourable nutrient intake than consumers of bread or other breakfasts, except for simple sugars. Therefore, RTEC may be regarded as a good breakfast option as part of a varied and balanced diet. Nevertheless, more research is warranted concerning the role of different RTEC types in nutrient intake, especially for simple sugars., The HELENA study was carried out with the financial support of the European Community Sixth RTD Framework Programme (Contract FOODCT-2005-007034).

The objective of this study was to identify clustering patterns of four energy balance-related behaviors (EBRB): television (TV) watching, moderate and vigorous physical activity (MVPA), consumption of fruits and vegetables (F&V), and consumption of sugar-sweetened beverages (SSB), among European and Brazilian adolescents. EBRB associations with different body fat composition indicators were then evaluated. Participants included adolescents from eight European countries in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescents) study (n = 2,057, 53.8% female; age: 12.5–17.5 years) and from the metropolitan region of Rio de Janeiro/Brazil in the ELANA study (the Adolescent Nutritional Assessment Longitudinal Study) (n = 968, 53.2% female; age: 13.5–19 years). EBRB data allowed for sex- and study-specific clusters. Associations were estimated by ANOVA and odds ratios. Five clustering patterns were identified. Four similar clusters were identified for each sex and study. Among boys, different cluster identified was characterized by high F&V consumption in the HELENA study and high TV watching and high MVPA time in the ELANA study. Among girls, the different clusters identified was characterized by high F&V consumption in both studies and, additionally, high SSB consumption in the ELANA study. Regression analysis showed that clusters characterized by high SSB consumption in European boys; high TV watching, and high TV watching plus high MVPA in Brazilian boys; and high MVPA, and high SSB and F&V consumption in Brazilian girls, were positively associated with different body fat composition indicators. Common clusters were observed in adolescents from Europe and Brazil, however, no cluster was identified as being completely healthy or unhealthy. Each cluster seems to impact on body composition indicators, depending on the group. Public health actions should aim to promote adequate practices of EBRB., The HELENA study was funded by the European Community Sixth RTD Framework Programmed (Contract FOOD-CT: 2005-007034), partially supported by the Spanish Ministry of Health, Maternal, Child Health and Development Network (number RD08/0072) (AMS-P, LAM). The ELANA study was funded by the National Council for Scientific and Technological Development (CNPq, grant 47667/2011-9), the Research Support Foundation of the State of Rio de Janeiro (FAPERJ, grants E26/110.847/2009, E-26/110.626/2011, and E-26/110.774/2013), and Coordination for the Improvement of Higher Education Personnel (CAPES, grant 23038.007702/2011-5).

Objective We studied in European adolescents (i) the association between cardiorespiratory fitness and ideal cardiovascular health as defined by the American Heart Association and (ii) whether there is a cardiorespiratory fitness threshold associated with a more favourable cardiovascular health profile. Methods Participants included 510 (n=259 girls) adolescents from 9 European countries. The 20 m shuttle run test was used to estimate cardiorespiratory fitness. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviours (smoking, body mass index, physical activity and diet) and three factors (total cholesterol, blood pressure and glucose). Results Higher levels of cardiorespiratory fitness were associated with a higher number of ideal cardiovascular health components in both boys and girls (both p for trend ≤0.001). Levels of cardiorespiratory fitness were significantly higher in adolescents meeting at least four ideal components (13% higher in boys, p

[Objectives]: Previous research showed that low concentration of biomarkers in the blood during adolescence (i.e., iron status; retinol; and vitamins B6, B12, C, and D) may be involved in the early stages of development of many chronic diseases, such as hypertension. The aim was to evaluate if iron biomarkers and vitamins in the blood are associated with blood pressure in European adolescents., [Methods]: Participants from the Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional study (N = 1089; 12.5–17.5 y; 580 girls) were selected by complex sampling. Multilevel linear regression models examined the associations between iron biomarkers and vitamins in the blood and blood pressure; the analyses were stratified by sex and adjusted for contextual and individual potential confounders., [Results]: A positive association was found in girls between RBC folate concentration and systolic blood pressure (SBP) (β = 3.19; 95% confidence interval [CI], 0.61–5.77), although no association between the vitamin serum biomarkers concentrations and diastolic blood pressure (DBP) was found. In boys, retinol was positively associated with DBP (β = 3.84; 95% CI, 0.51–7.17) and vitamin B6 was positively associated with SBP (β = 3.82; 95% CI, 1.46–6.18). In contrast, holotranscobalamin was inversely associated with SBP (β = −3.74; 95% CI, −7.28 to −0.21)., [Conclusions]: Levels of RBC folate and vitamin B6 in blood may affect BP in adolescents. In this context, programs aimed at avoiding high BP levels should promote healthy eating behavior by focusing on the promotion of vegetable proteins and foods rich in vitamin B12 (i.e., white meat and eggs), which may help to achieve BP blood control in adolescents., The HELENA Study was financially support by the European Community SixthRTD Framework Programme (contract FOOD-CT-2005-007034). The writing group takes sole responsibility for the content of this article. This study was also supported by a grant from the Spanish Ministry of Health: Maternal, Child Health and Development Network (number RD08/0072), grant from the Spanish Ministry of Education (EX-2008-0641; AP-2008-03806) and the Swedish Heart-Lung Foundation (20090635). ACdeM received scholarship from S~ao PauloResearch FoundationdFAPESP (proc. 2011/11137-1 and 2011/20662-2). LAM received scholarship of visiting professor from the Brazilian government by Science without Borders Program by CNPq (National Counsel of Technological and Scientific Development) and CAPES (Coordination of Improvement of Higher Education Personnel) (proc. 007/2012). The GENUD Research Group cofinancedby the European Regional Development Fund (MICINN-FEDER)

Summary What is already known about this subject Although there is no clear evidence of the role of dairy consumption on cardiovascular disease (CVD) risk development in adults, several studies have suggested dairy consumption to have a protective effect. Limited evidence on the relationship between milk and dairy products consumption and CVD risk factors among adolescents. What this study adds Dairy consumption was inversely associated with CVD risk in European adolescent girls. Higher dairy consumption was associated with lower adiposity and higher cardiorespiratory fitness in both genders. Objective To identify those food groups best discriminating individuals at high/low cardiovascular disease (CVD) risk and to investigate the relationship between dairy consumption and CVD risk factors (individual and scores) in adolescents (12.5–17.5 years) from eight European cities participating in the cross-sectional (2006–2007) HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) project. Methods Diet, waist circumference, skin-folds thickness, systolic blood pressure, insulin resistance, triglycerides, total cholesterol/high-density lipoprotein ratio and cardiorespiratory fitness (CRF) were assessed in 511 (49.9% boys) adolescents. Individual z-scores of CVD risk factors were summed to compute sex-specific clustered CVD risk scores. Results Dairy emerged as the food group best discriminating adolescents at low/high CVD risk. In both genders, waist circumference and sum of skin-folds were inversely associated with consumption of milk and yogurt, and milk- and yogurt-based beverages, whereas a positive association was observed with CRF. Moreover, CVD risk score (β = −0.230, P = 0.001) was also inversely associated with overall dairy consumption only in girls. Discussion Dairy consumption is associated with lower adiposity and higher CRF in these adolescents. An inverse association between CVD risk score and dairy consumption is also depicted in girls. The study adds further evidence to the scarce literature on the influence of milk and dairy products on adolescents' cardiovascular health.

This study aims to examine repeatability of reduced rank regression (RRR) methods in calculating dietary patterns (DP) and cross-sectional associations with overweight (OW)/obesity across European and Australian samples of adolescents. Data from two cross-sectional surveys in Europe (2006/2007 Healthy Lifestyle in Europe by Nutrition in Adolescence study, including 1954 adolescents, 12–17 years) and Australia (2007 National Children’s Nutrition and Physical Activity Survey, including 1498 adolescents, 12–16 years) were used. Dietary intake was measured using two non-consecutive, 24-h recalls. RRR was used to identify DP using dietary energy density, fibre density and percentage of energy intake from fat as the intermediate variables. Associations between DP scores and body mass/fat were examined using multivariable linear and logistic regression as appropriate, stratified by sex. The first DP extracted (labelled ‘energy dense, high fat, low fibre’) explained 47 and 31 % of the response variation in Australian and European adolescents, respectively. It was similar for European and Australian adolescents and characterised by higher consumption of biscuits/cakes, chocolate/confectionery, crisps/savoury snacks, sugar-sweetened beverages, and lower consumption of yogurt, high-fibre bread, vegetables and fresh fruit. DP scores were inversely associated with BMI z-scores in Australian adolescent boys and borderline inverse in European adolescent boys (so as with %BF). Similarly, a lower likelihood for OW in boys was observed with higher DP scores in both surveys. No such relationships were observed in adolescent girls. In conclusion, the DP identified in this cross-country study was comparable for European and Australian adolescents, demonstrating robustness of the RRR method in calculating DP among populations. However, longitudinal designs are more relevant when studying diet–obesity associations, to prevent reverse causality.

On behalf of the HELENA Study Group., This study aimed to examine the association between vitamin B6, folate and vitamin B12 biomarkers and plasma fatty acids in European adolescents. A subsample from the Healthy Lifestyle in Europe by Nutrition in Adolescence study with valid data on B-vitamins and fatty acid blood parameters, and all the other covariates used in the analyses such as BMI, Diet Quality Index, education of the mother and physical activity assessed by a questionnaire, was selected resulting in 674 cases (43 % males). B-vitamin biomarkers were measured by chromatography and immunoassay and fatty acids by enzymatic analyses. Linear mixed models elucidated the association between B-vitamins and fatty acid blood parameters (changes in fatty acid profiles according to change in 10 units of vitamin B biomarkers). DHA, EPA) and n-3 fatty acids showed positive associations with B-vitamin biomarkers, mainly with those corresponding to folate and vitamin B12. Contrarily, negative associations were found with n-6:n-3 ratio, trans-fatty acids and oleic:stearic ratio. With total homocysteine (tHcy), all the associations found with these parameters were opposite (for instance, an increase of 10 nmol/l in red blood cell folate or holotranscobalamin in females produces an increase of 15·85 Âmol/l of EPA (P value, The HELENA study received funding from the European Union’s Sixth RTD Framework Programme (contract FOODCT-2005-007034). Additional support was obtained from the Spanish Ministry of Education (AGL2007-29784-E/ALI), Axis-Shield Diagnostics Ltd (Oslo, Norway), Abbot Científica S.A. (Spain). This analysis was also supported by the Spanish Ministry of Science and Innovation (JCI-2010-07055) with the contribution of the European Regional Development Fund (FEDER). The first author is supported by a grant from the Spanish Carlos III Health Institute: RD08/0072/0025 (Red SAMID: Maternal, Child Health and Development Research Network).

Adolescence represents an important period for the development of executive functions, which are a set of important cognitive processes including attentional control. However, very little is known regarding the associations of nutrition with components of executive functions in adolescence. Thus, the aim of this study was to investigate associations of dietary patterns and macronutrient composition with attention capacity in European adolescents. This cross-sectional study included 384 (165 boys and 219 girls) adolescents, aged 12·5–17·5 years, from five European countries in the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Attention capacity was examined using the d2 Test of Attention. Dietary intake was assessed through two non-consecutive 24 h recalls using a computer-based self-administered tool. Three dietary patterns (diet quality index, ideal diet score and Mediterranean diet score) and macronutrient/fibre intakes were calculated. Linear regression analysis was conducted adjusting for age, sex, BMI, maternal education, family affluence scale, study centre and energy intake (only for Mediterranean diet score). In these adjusted regression analyses, higher diet quality index for adolescents and ideal diet score were associated with a higher attention capacity (standardised β =0·16, P =0·002 and β=0·15, P=0·005, respectively). Conversely, Mediterranean diet score or macronutrient/fibre intake were not associated with attention capacity (P >0·05). Our results suggest that healthier dietary patterns, as indicated by higher diet quality index and ideal diet score, were associated with attention capacity in adolescence. Intervention studies investigating a causal relationship between diet quality and attention are warranted. The HELENA project was supported by the European Community Sixth RTD Framework Programme (contract FOODCT-2005-007034). P. H. was supported by a grant from Henning and Johan Throne-Holst Foundation. F. B. O. and I. E.-C. were supported by the Spanish Ministry of Science and Innovation (RYC-2011-09011 and FJCI-2014-19563). H. H. was supported by grants from the Swedish Society of Medicine and the County Council of Östergötland, Sweden. In addition, this study took place under the umbrella of the ActiveBrains project, funded by the Spanish Ministry of Economy and Competitiveness (Ref. DEP2013-47540); it was further supported by the SAMID III network, RETICS, funded by the PN I + D + I 2017-2021 (Spain), ISCIII-Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (Ref. RD16/0022) and by the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence, Unit of Excellence on Exercise and Health.

11 páginas, 2 figuras, 3 tablas..-Valtueña, J.,Moreno, L.A, et al., Evidence indicates low 25-hydroxyvitamin D [(25(OH)D] concentrations in European adolescents. Identification of potential determinants is therefore essential to guide public health initiatives aiming at optimizing vitamin D status across Europe. The aim of the study was to identify potential influencing factors of 25(OH)D concentrations in European adolescents aged 12.5 to 17.5 y, participating in the multi-centre cross-sectional Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. A subset of 1,006 participants (46.8% males) was drawn from the main study. Measures of body composition, biochemical markers, socioeconomic status, dietary intake, physical activity, fitness, sleep time and vitamin D genetic polymorphism (rs1544410) were assessed. Stepwise multivariate linear regression analysis was conducted stratified by gender. In males, linear regression of 25(OH)D, suggested that (1) winter season (β= -0.364; p

To investigate the combined influence of diet quality and physical activity on cardiovascular disease (CVD) risk factors in adolescents, adolescents (n = 1513; 12.5-17.5 years) participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence study were studied. Dietary intake was registered using a 24-h recall and a diet quality index was calculated. Physical activity was assessed by accelerometry. Lifestyle groups were computed as: healthy diet and active, unhealthy diet but active, healthy diet but inactive, and unhealthy diet and inactive. CVD risk factor measurements included cardiorespiratory fitness, adiposity indicators, blood lipid profile, blood pressure, and insulin resistance. A CVD risk score was computed. The healthy diet and active group had a healthier cardiorespiratory profile, fat mass index (FMI), triglycerides, and high-density lipoprotein cholesterol (HDL-C) levels and total cholesterol (TC)/HDL-C ratio (all P ≤ 0.05). Overall, active adolescents showed higher cardiorespiratory fitness, lower FMI, TC/HDL-C ratio, and homeostasis model assessment index and healthier blood pressure than their inactive peers with either healthy or unhealthy diet (all P ≤ 0.05). Healthy diet and active group had healthier CVD risk score compared with the inactive groups (all P ≤ 0.02). Thus, a combination of healthy diet and active lifestyle is associated with decreased CVD risk in adolescents. Moreover, an active lifestyle may reduce the adverse consequences of an unhealthy diet.

Food-based dietary guidelines (FBDG) aim to address the nutritional requirements at population level in order to prevent diseases and promote a healthy lifestyle. Diet quality indices can be used to assess the compliance with these FBDG. The present study aimed to investigate whether the newly developed Diet Quality Index for Adolescents (DQI-A) is a good surrogate measure for adherence to FBDG, and whether adherence to these FBDG effectively leads to better nutrient intakes and nutritional biomarkers in adolescents. Participants included 1804 European adolescents who were recruited in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study. Dietary intake was assessed by two, non-consecutive 24 h recalls. A DQI-A score, considering the components' dietary quality, diversity and equilibrium, was calculated. Associations between the DQI-A and food and nutrient intakes and blood concentration biomarkers were investigated using multilevel regression analysis corrected for centre, age and sex. DQI-A scores were associated with food intake in the expected direction: positive associations with nutrient-dense food items, such as fruits and vegetables, and inverse associations with energy-dense and low-nutritious foods. On the nutrient level, the DQI-A was positively related to the intake of water, fibre and most minerals and vitamins. No association was found between the DQI-A and total fat intake. Furthermore, a positive association was observed with 25-hydroxyvitamin D, holo-transcobalamin and n-3 fatty acid serum levels. The present study has shown good validity of the DQI-A by confirming the expected associations with food and nutrient intakes and some biomarkers in blood. Copyright © 2012 The Authors.

Diabet. Med. 29, e369–e376 (2012) Abstract Aims To assess physical activity and fitness levels of young people with Type 1 diabetes compared with siblings without diabetes, and to investigate the association between physical activity, physical fitness and glycaemic control (HbA1c) in those young people with diabetes. Methods The study consisted of 97 young people aged 8 to 16 years (62% male) from a Paediatric Diabetes Service in South West England. Sixty participants (67% male) had Type 1 diabetes and 37 participants (54% male) were siblings without diabetes (control group). We measured weight, height and waist circumference, calculated BMI and waist–height ratio and recorded pubertal status, blood pressure and current insulin regimen information. We assessed physical activity by accelerometry, from which we calculated light and moderate-to-vigorous intensity activity. We measured physical fitness by multistage sub-maximal bicycle ergometer test. We obtained HbA1c by venipuncture. Results There were no differences between the young people with diabetes and siblings without diabetes in body composition, blood pressure, physical activity and fitness. Moderate-to-vigorous physical activity was associated with better glycaemic control, accounting for 30–37% (R2 = 0.295–0.374) of the variance for HbA1c. Physical fitness was not associated with HbA1c. Conclusions Moderate-to-vigorous physical activity was associated with better glycaemic control while fitness was not. Findings suggest that developing strategies to increased moderate-to-vigorous physical activity may prove an effective method of improving glycaemic control in young people with diabetes.

ObjectiveTo describe breakfast habits at food group level in European adolescents and to investigate the associations between these habits and sociodemographic factors.DesignCross-sectional study.SettingSecondary schools from nine European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Breakfast habits were assessed twice using a computer-based 24 h dietary recall. Adolescents who consumed breakfast on at least one recall day were classified as ‘breakfast consumers’ and adolescents who did not have anything for breakfast on either of the two recall days were considered ‘breakfast skippers’. A ‘breakfast quality index’ to describe breakfast quality was created based on the consumption or non-consumption of cereals/cereal products, dairy products and fruits/vegetables. The sociodemographic factors studied were sex, age, region of Europe, maternal and paternal education, family structure and family affluence.SubjectsAdolescents (n 2672, 53 % girls) aged 12–17 years.ResultsThe majority of the adolescents reported a breakfast that scored poorly on the breakfast quality index. Older adolescents, adolescents from the southern part of Europe and adolescents from families with low socio-economic status were more likely to consume a low-quality breakfast.ConclusionsThe study highlights the need to promote the consumption of a high-quality breakfast among adolescents, particularly in older adolescents, adolescents from southern Europe and adolescents from families with low socio-economic status, in order to improve public health.

The aim of this study was to evaluate the use of a non-wearing time activity diary (hereafter non-wear activity diary) when using accelerometry in adolescents to provide insight into their physical activity levels. In total, 213 Belgian adolescents (89 boys, 124 girls) were eligible for this study. Adolescents wore an accelerometer for seven consecutive days and kept a non-wear activity diary. On the last day, they completed the International Physical Activity Questionnaire for Adolescents. The differences between the accelerometer data with and without use of the non-wear activity diary were significant for all physical activity intensities according to the Wilcoxon signed rank test. Bland-Altman plots showed that with more time spent in any physical activity intensity, the difference between including and not including the non-wear activity diary increased. The correlation coefficient between the International Physical Activity Questionnaire for Adolescents and the accelerometer data increased when the non-wear activity diary was included. Differences in the percentage of adolescents reaching the physical activity recommendations between the accelerometer data only and the accelerometer with the non-wear activity diary were significant. We conclude that if the non-wear activity diary data are not included, some adolescents could be misclassified as not being physically active according to the physical activity recommendations. It is therefore recommended to use a non-wear activity diary for gaining insight into the physical activity levels of individuals.

The aim of this study was to determine the reliability, feasibility and safety of a health-related fitness test battery administered by Physical Education (PE) teachers in the school setting. Six PE teachers, from three primary schools and three secondary schools, assessed twice (7 days apart) the 20 m shuttle run, handgrip and standing long jump tests, as well as weight, stature, triceps and subscapular thickness and waist circumference in 58 children (age: 6-11 yr) and 80 adolescents (age: 12-18 yr). Feasibility and safety were assessed by researches by means of direct observation. Significant inter-trial differences were found for the standing long jump test (3.8+/-12.7 cm, P

This study examined the correlates of dietary energy under-reporting (UR) and over-reporting (OV) in European adolescents. Two self-administered computerised 24-h dietary recalls and physical activity data using accelerometry were collected from 1512 adolescents aged 12·5–17·5 years from eight European countries. Objective measurements of height and weight were obtained. BMI was categorised according to Cole/International Obesity Task Force (IOTF) cut-off points. Diet-related attitudes were assessed via self-administered questionnaires. Reported energy intake (EI) was compared with predicted total energy expenditure to identify UR and OV using individual physical activity objective measures. Associations between misreporting and covariates were examined by multilevel logistic regression analyses. Among all, 33·3 % of the adolescents were UR and 15·6 % were OV when considering mean EI. Overweight (OR 3·25; 95 % CI 2·01, 5·27) and obese (OR 4·31; 95 % CI 1·92, 9·65) adolescents had higher odds for UR, whereas underweight individuals were more likely to over-report (OR 1·67; 95 % CI 1·01, 2·76). Being content with their own figures (OR 0·61; 95 % CI 0·41, 0·89) decreased the odds for UR, whereas frequently skipping breakfast (OR 2·14; 95 % CI 1·53, 2·99) was linked with higher odds for UR. Those being worried about gaining weight (OR 0·55; 95 % CI 0·33, 0·92) were less likely to OV. Weight status and psychosocial weight-related factors were found to be the major correlates of misreporting. Misreporting may reflect socially desirable answers and low ability to report own dietary intakes, but also may reflect real under-eating in an attempt to lose weight or real over-eating to reflect higher intakes due to growth spurts. Factors influencing misreporting should be identified in youths to clarify or better understand diet–disease associations.

Current research in adults indicates that fruit and vegetable (FAV) consumption increases serum levels of vitamins C, E and folate of β-carotene and reduces homocysteine concentrations. The aim of the present study was to examine the association of FAV consumption on vitamin intakes and their impact on blood vitamin concentrations in European adolescents.This multi-center cross-sectional study included 702 (53.7% females) adolescents, aged 12.50-17.49 years, from 10 European cities. Two independent self-administered 24 h dietary recalls were used to estimate the adolescent's diet. The total energy, vitamins and FAV consumption were calculated. Adolescents were categorized into three groups: (i) very low FAV intake (200 g/day); (ii) low FAV consumption (200-399 g/day) and (iii) adequate FAV consumption (⩾400 g/day). Adolescent's fasted blood samples were taken for their analysis on vitamin concentrations.The main results showed that those adolescents meeting the FAV recommendation, classified as FAV adequate consumers, presented higher intake of energy and some vitamins as B6, total folic acid, C, E and β-carotene compared with FAV very low consumers (P0.05). Regarding their blood status, male adolescents who had a very low FAV consumption presented lower plasma folate, RBC folate blood concentrations compared with adequate FAV consumers (P0.05). Female adequate FAV consumers had higher concentrations of pyridoxal phosphate (PLP), plasma folate, RBC folate, vitamin C, β-carotene and α-tocopherol compared with very low and low consumers (P0.05).Having a FAV dairy intake above 400 g/day is associated with higher vitamin intake and blood vitamin concentrations, especially for antioxidant and B-vitamins concentrations.

International audience; Objective: To assess the relationships among physical activity, measured objectively, and attention capacity in European adolescents.Study design: The study included 273 adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Participants wore a uniaxial accelerometer for 7 days to measure physical activity. The d2 Test of Attention was administered to assess attention capacity. Multivariate analyses were used to study the association of attention capacity with each measure of physical activity. Receiver operating characteristic analysis was performed to determine thresholds that best discriminate between low and good attention capacity.Results: After controlling for potential confounding variables (age, sex, body mass index, parental educational level, fat mass, aerobic fitness, and center), adolescents' attention capacity test performances were significantly and positively associated with longer time spent in moderate or moderate-to-vigorous physical activity (MVPA) in free-living conditions (P < .05). Receiver operating characteristic curve analyses revealed that the physical activity thresholds that best discriminated between low/good attention capacities were ≥41 min·day−1 for moderate, ≥12 min·day−1 for vigorous, and ≥58 min·day−1 for MVPA.Conclusion:These findings suggest that promoting MVPA may be have a beneficial effect on attention capacity, an important component of cognition, in adolescents.

Objective: To analyze the association between dietary protein and amino acids intake and systolic (SBP) and diastolic (DBP) blood pressure in European adolescents. Methods: Participants were from the cross-sectional study performed in Europe, Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA study; n = 1605; 12.5-17.5 years; 833 girls) selected by complex sampling. The associations between dietary protein and amino acids intake and SBP/DBP were examined by multilevel linear regression models (context variable by school); the analysis being stratified by sex. Cities, seasonality, age, socioeconomic level, parental education level, body mass index, waist circumference, Tanner stage and physical activity were used as covariates. Results: In boys, we found an inverse association between protein (animal and vegetable) intake and DBP; and a positive association between histidine and SBP. In girls, we observed a positive association among tryptophan, histidine with SBP and methionine with DBP. On the other hand, we observed an inverse association between tyrosine and both SBP and DBP levels in girls. Conclusions: The association between amino acids and BP levels is controversial and depends on the type of amino acids, and protein intake can help control the DBP in boys.

The purpose of this study was to identify the relevance of a set of risk factors for insulin resistance in adolescents from Europe and to consider their possible gender-specific associations. The Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS) was conducted in 1053 European adolescents (mean age, 14.9 years) in a school setting in 9 countries. Three anthropometric markers of body fat and a dietary index were calculated. Total energy intake was estimated from a questionnaire. C-reactive protein, leptin, and vitamin D were assessed, and physical activity, cardiorespiratory fitness, and muscular strength were measured. Center, socioeconomic status, pubertal status, and season were used as potential confounders. The main outcome was the homeostasis model assessment used as a marker of insulin resistance. Correlations, analyses of covariance, and logistic regression models were used. In males, leptin was the only risk factor for insulin resistance after adjusting for confounders including markers of body fat (odds ratios (ORs) from 1.49 to 1.60). In females, leptin, vitamin D, and fitness were the remaining independent risk factors for insulin resistance after adjustments (OR 2.11; 95% confidential interval (CI) 1.29-3.45; OR 0.50, 95% CI 0.31-0.80; and OR 0.54, 95% CI 0.33-0.87, respectively). Our observations suggest a gender dimorphism in the identification of risk factors for high insulin resistance. Preventive strategies should focus on improving modifiable factors such as cardiorespiratory fitness and on ensuring vitamin D sufficiency. Randomized controlled trials focusing on these strategies are necessary to test their efficacy.

12 páginas.- Ortega, Francisco B.; Marcos, Ascensión; Castillo, Manuel J.; et al., OBJECTIVE: Coordinated European projects relying on standardized methods are needed to identify health inequalities across Europe. This study aimed to compare fitness, fatness, and cardiometabolic risk between urban adolescents from the south and center-north of Europe and to explore whether physical activity (PA) and other factors might explain these differences., METHODS: The Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional project comprised 3528 adolescents from the south (4 cities) and central-north (6 cities) of Europe, 1089 of whom provided blood samples for analysis. Fitness (strength, speed-agility, and cardiorespiratory fitness), total and abdominal fatness (anthropometry and bioelectrical impedance), and cardiometabolic risk (z scores including fitness, fatness, blood lipids, insulin resistance, and blood pressure) were assessed. The analyses were adjusted for socioeconomic factors, objectively measured PA (accelerometry), total energy intake and diet quality, and genetic variants of the FTO rs9939609 polymorphism., RESULTS: Adolescents from southern Europe were less fit and fatter according to all markers (P < .001). Differences in cardiometabolic risk scores were not consistent. Adolescents from the south were less active and this would largely explain the differences observed in speed-agility and cardiorespiratory fitness. Differences in total and abdominal fatness could not be explained by PA, energy intake, diet quality, or FTO rs9939609 polymorphism., CONCLUSIONS: Fitness and fatness levels indicate that urban adolescents from the south are less healthy than those from central-northern Europe. Our data suggest that differences in PA might explain differences in important health-related fitness components, yet factors explaining the differences in fatness encountered remain unknown.

On behalf of the HELENA consortium., The present study aimed to assess the correlation between food and fatty acid (FA) intake and the serum phospholipid (PL) FA status in European adolescents and explored the percentage of variation in serum PL FA that could be attributed to dietary habits. Participants included 528 adolescents recruited in the HELENA Study. Dietary intake was assessed by two, self-administered, non-consecutive 24-h recalls. PL FA concentrations were measured in fasting venous serum samples. Reduced rank regressions were applied to examine the combined effect of food intakes. Results indicated that the variance in serum PL FA in adolescents, that could be explained by diet varied from 7.0 % for MUFA to 14.2 % for n-3FA. The variance in the long-chain n-3FA was mainly explained by fish intake but also by coffee and tea consumption. In conclusion this study indicated that dietary intake influences the serum PL FA status to a limited amount but that also other factors interfere. However, dietary intake is important as it is among those factors that could be modified. Furthermore, the results suggest that the overall dietary habits should be considered instead of only the consumption of single foods or nutrients, as the medium of the food or concomitant intake of foods and nutrients might interact and as such influence absorption or metabolism., The HELENA Study has taken place with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT-2005-007034). Krishna Vyncke is financially supported by the Research Foundation Flanders.

© 2014, Springer-Verlag Berlin Heidelberg. Purpose: To evaluate total, energy-adjusted dietary fiber (DF), water-soluble fiber (WSF), and water-insoluble fiber (WIF) intakes in European adolescents and to investigate their association with indicators of adiposity and serum biomarkers. Methods: This study, conducted from 2006 to 2007, included 1804 adolescents aged 12.5–17.5 years (47 % males) from eight European cities completing two non-consecutive computerized 24-h dietary recalls. GLM multivariate analysis was used to investigate associations. Results: Mean DF intake (20 g/day) of the sample met the European Food Safety Authority recommendation, but was below those of the World Health Organization and of the Institute of Medicine. Total DF, WSF and WIF intakes were higher in males (P, The HELENA-study took place with the financial support of the European Community Sixth RTD Framework Programme. This work was also partially supported by the European Union, in the framework of the Public Health Programme, the Swedish Council for Working Life and Social Research, the Spanish Ministry of Education, Spanish Ministry of Science and Innovation (AGL2007-29784-E) and the Spanish Ministry of Health, Maternal, Child Health and Development Network

Background/objectives:The objective of this study was to examine the relationship between amino acid (AA) intake and serum lipid profile in European adolescents from eight European cities participating in the cross-sectional (2006-2007) HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study, and to assess whether this association was independent of total fat intake.Subjects/methods:Diet, skinfold thickness, triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), TC/HDL-c ratio, low-density lipoprotein cholesterol (LDL-c), apolipoprotein B (Apo B), apolipoprotein A1 (Apo A1) and Apo B/Apo A1 ratio were measured in 454 12.5- to 17.5-year-old adolescents (44% boys). Intake was assessed via two non-consecutive 24-h dietary recalls. Data on maternal education and sedentary behaviors were obtained via questionnaires. Physical activity was objectively measured by accelerometry.Results:Alanine, arginine, asparaginic acid, glycine, histidine, lysine and serine intakes were inversely associated with serum TG concentrations in both boys and girls. Intake of other AA like alanine and/or arginine was also inversely associated with serum TC, LDL-c and Apo B/Apo A1 ratio only in girls. An inverse association was observed between intakes of alanine, isoleucine, leucine, methionine, serine, tryptophan, tyrosine and valine and TC/HDL-c ratio among female adolescents. Similar results were found in males for serine and tryptophan intakes. It is noteworthy, however, that associations were no longer significant in both genders when total fat intake was considered as a confounding factor.Conclusions:In this sample of adolescents, the association between AA intakes and serum lipid profile did not persist when dietary fat was considered. Therefore, dietary interventions and health promotion activities should focus on fat intake to improve lipid profile and potentially prevent cardiovascular disease. © 2014 Macmillan Publishers Limited.

Emerging data indicate that higher levels of insulin resistance (IR) are common among children and adolescents and are related to cardiometabolic risk; therefore, IR requires consideration early in life. In addition, there is a lack of conclusive evidence regarding the role of dietary nutrients on IR. The Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS) was conducted in European adolescents aged 12·5–17·5 years. A total of 637 participants with valid homeostasis model assessment (HOMA) index data and who completed at least a 2 d 24 h dietary recall were included in the study (60 % of the total HELENA-CSS sample). There were two dietary indices calculated, with the only difference between them being the inclusion or not of physical activity (PA). Markers of IR such as HOMA and the quantitative insulin sensitivity check index (QUICKI) were calculated. Pubertal status, BMI and cardiorespiratory fitness (CRF) were measured as potential confounders. The dietary index including PA was inversely associated with HOMA and directly with the QUICKI in females, but not in males, after adjusting for pubertal status, centre, BMI and CRF. In conclusion, the present study indicates that considering PA as part of the dietary index is of relevance as the resulted index is inversely related to IR independently of potential confounders including CRF. Overall, these findings suggest that intervention studies aimed at preventing IR in young people should focus on increasing the quality of the diet and also on including an optimal PA level in healthy adolescents.

Objective There is a substantial interest in the potential role of chocolate in the prevention of cardiovascular diseases. It has been recently reported that a higher frequency of chocolate intake is linked to lower body mass index (BMI) in adults. The aim of the present study was to determine if higher chocolate consumption also is associated with lower BMI, as well as other markers of total and central body fat, in adolescents. Methods This study comprised 1458 adolescents (ages 12.5–17.5 y) participating in HELENA-CSS (Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study). Dietary intake was self-registered using a computer-based tool for 24-h dietary recall on 2 non-consecutive days. Weight and height were measured, and BMI was calculated. Adiposity was estimated using skinfolds (Slaughter's equation) and bioelectrical impedance analysis (BIA). Waist circumference was measured. Sexual maturation also was recorded. Physical activity was measured by accelerometry. Results Higher chocolate consumption was associated with lower levels of total and central fatness, as estimated by BMI, body fat estimated from skinfolds and BIA, and waist circumference, regardless of potential confounders ( P ≤ 0.01). Conclusion Our results demonstrate that a higher chocolate consumption was associated with lower total and central fatness in European adolescents.

9 páginas,1 figura, 4 tablas, BACKGROUND/OBJECTIVES: To assess dietary patterns (DPs) in European adolescents and to examine their relationship with several indicators of sedentary behaviour. SUBJECTS/METHODS: A multinational cross-sectional study was carried out in 2202 adolescents (45.4% boys) aged 12.5¿17.5 years. A self-reported questionnaire with information on sedentary behaviours, separately for weekdays and weekend days, and two non-consecutive 24 h-recalls were used. Principal component analysis was used to obtain DPs, and linear regression examined the association between DPs scores and sedentary behaviour. RESULTS: Four DPs for boys (`plant based¿, `snacking¿, `breakfast¿ and `health conscious¿) and five DPs for girls (`confectionary and snacking¿, `plant based¿, `breakfast¿, `animal protein¿ and `health conscious¿) were obtained. Boys who spent 44 h/day watching television (TV) had lower adherence to the `plant based¿, `breakfast¿ and `health conscious¿ DPs, and higher adherence to the `snacking¿ DP. Higher computer use and internet use for recreational reason were associated with higher adherence to the `snacking¿ DP. In girls, TV viewing and using internet for recreational reasons for 44 h/day was associated with higher adherence to the `confectionary and snacking¿ and lower adherence with `health conscious¿ DP. Also, studying between 2 and 4 h during weekend days was associated with lower adherence to the `snacking¿ and with higher adherence to the `plant based¿ and `breakfast¿ DPs. CONCLUSION: Adolescents¿ DPs are related with the time spent in several sedentary behaviours. Such findings may help to generate interventions focusing on decreasing unhealthy dietary habits and specific sedentary behaviours.

ObjectiveAn adequate nutritional intake in childhood and adolescence is crucial for growth and the prevention of youth and adult obesity and nutrition-related morbidities. Improving nutrient intake in children and adolescents is of public health importance. The purpose of the present study was to describe and evaluate the nutrient intake in a European sample using the D-A-CH nutrient intake recommendations and the Nutritional Quality Index (NQI).DesignThe HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study is a cross-sectional study, the main objective of which is to obtain comparable data on a variety of nutritional and health-related parameters in adolescents aged 12·5–17·5 years.SettingEight cities in Europe.SubjectsThe initial sample consisted of 3528 European adolescents. Among these, 1590 adolescents (54 % female) had sufficient and plausible dietary data on energy and nutrient intakes from two 24 h recalls using the HELENA-DIAT software.ResultsThe intakes of most macronutrients, vitamins and minerals were in line with the D-A-CH recommendations. While the intakes of SFA and salt were too high, the intake of PUFA was too low. Furthermore, the intakes of vitamin D, folate, iodine and F were less than about 55 % of the recommendations. The median NQI was about 71 (of a maximum of 100).ConclusionsThe intakes of most nutrients were adequate. However, further studies using suitable criteria to assess nutrient status are needed. Public health initiatives should educate children and adolescents regarding balanced food choices.

Background: Physical activity (PA) is suggested to contribute to fat loss not only through increasing energy expenditure “per se” but also increasing muscle mass; therefore, it would be interesting to better understand the specific associations of PA with the different body’s components such as fat mass and muscle mass. The aim of the present study was to examine the association between objectively measured PA and indices of fat mass and muscle components independently of each other giving, at the same time, gender-specific information in a wide cohort of European adolescents. Methods: A cross-sectional study in a school setting was conducted in 2200 (1016 males) adolescents (14.7 ±1.2 years). Weight, height, skinfold thickness, bioimpedance and PA (accelerometry) were measured. Indices of fat mass (body mass index, % fat mass, sum of skinfolds) and muscular component (assessed as fat-free mass) were calculated. Multiple regression analyses were performed adjusting for several confounders including fat-free mass and fat mass when possible. Results: Vigorous PA was positively associated with height (p?0.05) in males, whilst, vigorous PA, moderate-vigorous PA and average PA were negatively associated with all the indices of fat mass (all p?