Nutrition and lifestyle in european adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study

Adolescent's Willingness to Adopt a More Plant-Based Diet: A Theory-Based Interview Study

A plant-based diet is more sustainable, and research suggests that adolescents obtain health benefits from adopting a more plant-based diet (e.g., improved weight control, increased cardiovascular health). However, it is still unclear what factors promote/hinder their intention to attain such a dietary habit. The aim of the present study was to examine factors affecting adolescents' willingness to consume more plant-based foods. In a theory-based interview study, using the Reasoned Action Approach as framework, adolescents were interviewed concerning their reasons for their (un)willingness to adopt a more plant-based diet. A total of 11 adolescents (15/16 years old; 7 girls, 4 boys) were recruited and interviewed at two secondary schools in the Dutch Province of Limburg, the Netherlands. None of the interviewees reported being vegan/vegetarian/flexitarian. The interviewed adolescents overall expressed little interest in adopting a more plant-based diet. They appeared to have little knowledge of what would comprise a more plant-based diet and showed a lack of awareness of the benefits for personal and planet health. Further, most participants indicated lacking skills to prepare plant-based meals. Despite that, they felt confident they would be able to consume a much more plant-based diet for a definite period. Most importantly, the low intention to consume more plant-based food options was explained by the perceived (or expected) poor taste of these foods. We conclude that education on the plant-based diet (i.e., increasing awareness of the benefits, and skills to procure or prepare a plant-based meal) might increase both knowledge and plant-based food familiarity. The latter being important as food familiarity is key in promoting its acceptance.

Eating habits, lifestyle factors and body weight status among Moroccan school adolescents (12–19 years): The case of Beni Mellal city

BACKGROUND: Overweight and obesity among children and adolescents are serious public health issues worldwide. A better understanding of the relationships between obesity and lifestyle factors is necessary for effective prevention and management of obesity in youth. AIMS: This study aimed to assess the prevalence of overweight/obesity and associated factors among schoolchildren aged 12–19 years at Beni Mellal city, Morocco. METHODS: A school based cross sectional study was carried out. A total of 516 children were included in the study. The nutritional status was classified according to the reference curves of WHO (2007). Multivariable logistic regression analysis was used to identify factors associated with overweight/obesity. The association between dependent and independent variables were assessed using odds ratio with 95% confidence interval and p value < 0.05 was considered statistically significant. RESULTS: The prevalence of overweight was 12.40% and that of obesity was 5.20%. Overweight and obesity were statistically associated with gender (Odds Ratio (OR) = 10.15[95% CI 1.37–3.81], p = 0.001); skipping breakfast (OR = 9.19 [95% CI 1.42–5.17], p = 0.002) and eating cake, pastry and biscuit 1 to 3 times per week (OR = 4.14 [95% CI 1.02–3.25], p = 0.04) and 4 or more times a week (OR = 7.83 [95% CI 1.31–4.66], p = 0.005). CONCLUSIONS: This study revealed that prevalence of overweight/obesity among school-aged children in Beni Mellal city was high. Thus, promoting healthy dietary practices, particularly improving fruit and vegetable intake is essential to reduce the burden of overweight and obesity. Furthermore, it is important to strengthen nutrition education about avoiding junk food consumption and encouraging regular physical activity.

Healthy Snacks in School: How Do Regulations Work? A Mixed-Design Study

BACKGROUND

School is an important setting to promote healthy eating habits for children. We compared the effects of 4 conditions on the nutritional quality of snacks brought to school. We also investigated teachers' opinions regarding the process, barriers, and facilitators in regulation implementation.

METHODS

We compared the nutritional quality of morning snacks based on 1958 photographs from schools divided into 4 conditions: regulation based on a list of permitted foods and beverages; regulation banning sweets, chips, and sugary drinks; information without regulation; or no intervention. Based on 5 focus groups (N = 18 participants), we investigated factors influencing regulation implementation.

RESULTS

In schools with a list of permitted foods and beverages, 76% of the children had a healthy snack, compared to 52% to 54% in the 3 other conditions (p < .01). They also brought less sweet foods compared to those in the other conditions (41% vs. 68% to 71%, p < .01). In focus groups, most teachers supported regulation but also expressed ambivalence about their legitimacy.

CONCLUSIONS

In this study, a regulation based on a list of permitted foods and beverages showed the best results. All actors should be involved in a progressive implementation process to increase acceptance of such regulation.

Percentage of energy contribution according to the degree of industrial food processing and associated factors in adolescents (EVA-JF study, Brazil)

OBJECTIVE

To evaluate energetic contribution according to the degree of industrial food processing and its association with sociodemographic, anthropometric, biochemical, clinical and behavioural characteristics in adolescents.

DESIGN

Cross-sectional study (Adolescent Lifestyle Study). Food consumption was assessed using 24-h dietary recalls, with foods classified by degree of industrial progressing. The usual diet was estimated using the Multiple Source Method. In a linear regression model, the energy percentage (E %) was associated with sociodemographic, anthropometric, biochemical, clinical and behavioural characteristics, after adjustment for sex and age.

SETTING

Juiz de Fora, Brazil.

PARTICIPANTS

Eight hundred and four adolescents, of both sexes, 14-19 years of age, enrolled in public schools.

RESULTS

The E % of unprocessed or minimally processed foods corresponded to 43·1 %, processed foods to 11·0 % and the ultraprocessed foods to 45·9 %. E % of unprocessed foods was associated with socio-economic stratum (adjusted β = -0·093; P = 0·032), neck circumference (adjusted β = 0·017; P = 0·049), screen time (adjusted β = -0·247; P = 0·036) and HDL-cholesterol (adjusted β = -0·156; P = 0·003). E % of ultraprocessed foods was associated with socio-economic stratum (adjusted β = 0·118; P = 0·011), screen time (adjusted β = 0·375; P = 0·003), BMI (adjusted β = -0·029; P = 0·025), neck circumference (adjusted β = -0·017; P = 0·028) and HDL-cholesterol (adjusted β = 0·150; P = 0·002).

CONCLUSIONS

There was a high E % of ultraprocessed foods in the diet of the adolescents. Actions are needed to raise the awareness of adopting healthy eating habits.

A sociodemographic, anthropometric and lifestyle-based prediction score for screening children with overweight and obesity for hepatic steatosis: The HEPAKID index

BACKGROUND

Hepatic steatosis (HS) is currently the most prevalent hepatic disease in paediatric population and a major risk factor for type 2 diabetes and cardiovascular diseases. The proper identification of children with HS is therefore of great public health interest.

OBJECTIVE

To develop a new prediction score using anthropometric, sociodemographic and lifestyle factors to identify children with HS (the HEPAKID index). Previously published biochemical paediatric screening tools were validated in the same cohort.

METHODS

A total of 115 pre-adolescent children aged 8 to 12 years with overweight/obesity, recruited at hospital paediatric units were enrolled in this cross-sectional study. HS (≥5.5% hepatic fat) was assessed by magnetic resonance imaging (MRI). Anthropometric, sociodemographic and lifestyle variables were collected by validated tests/questionnaires.

RESULTS

Forty-one children had MRI-diagnosed HS (35.6%, 49% girls). These children had (P < .01) a higher waist-height ratio, a lower cardiorespiratory fitness, a younger gestational age, and consumed more sugar-sweetened beverages than their HS-free peers. Children with HS were more likely to belong to an ethnic minority (P < .01) and to spend longer viewing screens than recommended (P < .05). The addition of these variables to the multivariate logistic regression model afforded a HEPAKID index with high discriminatory capacity (area under the receiver-operating characteristic curve: 0.808, 95% CI 0.715-0.901), and score of ≥25.0 was associated with high sensitivity (82%, 95% CI 68%-96%). Biochemical biomarker-based paediatric tools for identifying HS showed only moderate discriminatory capacity and low sensitivity (5%-41%) in this cohort.

CONCLUSIONS

The HEPAKID index is the first simple, non-invasive, sensitive, inexpensive and easy-to-perform screening that can identify children with overweight or obesity who have HS.

The Contribution of Foods and Beverages of Low Nutritional Value to the Diets of Swedish Adolescents, by Food Group, Time and Place. A Nationally Representative Study

Adolescence is a time in life when lifestyle behaviours are acquired. One indicator of poor diet quality is the intake of foods and beverages with a relatively low nutritional value. Using the Australian classification of such foods, termed "discretionary", we classified the intakes of Swedish adolescents who participated in the Riksmaten Adolescent 2016-17 national dietary survey. From selected schools, 3099 adolescents in age groups 11-12, 14-15 and 17-18 years provided two 24-h recalls. Intakes and healthy dietary scores were calculated. Plasma ferritin, folate and 25(OH)D were available for a third. Almost 40% of total energy came from discretionary foods/beverages. Adolescents with higher intakes were more likely to be female, older, from a low socioeconomic position-household and born in Sweden. Most discretionary foods/beverages were consumed on weekend days and during in-between meals, outside of the home and at school. Percent energy from discretionary intake was associated with healthy dietary scores but not nutritional status. A substantial amount of energy was obtained from discretionary foods/beverages, and we found that consumption is pervasive across sociodemographic factors, time and place. Addressing this pattern will require a comprehensive approach to food environments and behaviours to reach all adolescents in an equitable manner.

Nutrient status and growth in vegan children

Vegan diets have risen in popularity over the past 9 years. However, few studies have examined nutrient status and the effect of a vegan diet on the growth of children. This study analysed the existing literature on the health impact and growth impact of selected nutrients in vegan children. We assessed the intake of calories and protein, as well as the nutrients iron, calcium, vitamin D, cobalamin and folate. With a small percentage of outliers, vegan children showed normal growth and were less often obese. We found limited evidence that children on a vegan diet can obtain all the examined nutrients. Furthermore, as proper planning and supplementation by caregivers is needed, it is currently unknown how often vegan children follow well-planned diets. Deficiencies in cobalamin, calcium, and vitamin D seem to be the biggest risks associated with a poorly planned vegan diet. For a more definitive assessment, data on the intake and nutrient status of omega-3 fatty acids, zinc, iodine, and selenium in vegan children are needed. Future research should account for demographic shifts in those following a vegan diet, and should discriminate between vegan sub-populations that are open or closed towards scientific approaches, towards health in general, and toward supplementation. Studies should assess the modes and dosages of supplementation and the use of fortified foods or drinks, as well as adherence to the diet itself. Plant ferritin as a source of iron and endogenous cobalamin synthesis warrants further scientific inquiry. In summary, the current literature suggests that a well-planned vegan diet using supplementation is likely to provide the recommended amounts of critical nutrients to provide for normal progression of height and weight in children, and can be beneficial in some aspects. However, data on 5 critical nutrients are still missing, hampering a more definitive conclusion.

Social Inequalities in Changes in Diet in Adolescents during Confinement Due to COVID-19 in Spain: The DESKcohort Project

Adolescence is a critical period in the consolidation of healthy lifestyles that can last into adulthood. To analyze changes in food consumption and eating behaviors in high-school adolescents during the first confinement, a cross-sectional study was conducted at the end of confinement in Spain. Changes in the frequency or quantity of consumption of different types of food and food-related behaviors were analyzed. Socioeconomic and health-related variables were also considered. To determine whether dietary changes were related to socioeconomic position (SEP), Poisson regression models with robust variance were estimated. Overall, there were some changes towards a healthier diet such as an increase in fruit consumption (38.9%) and a decrease in the consumption of soft drinks (49.8%), sweets and pastries (39.3%), and convenience foods (49.2%). Some changes, however, were related to less healthy behaviors, such as a more irregular pattern of meal distribution (39.9%) or an increase in snacking between meals (56.4%). Changes towards less healthy eating were also related to students’ SEP. The risk of worsening the diet was found to be 21% higher in adolescents from a more disadvantaged SEP. Future public policies could be adapted to avoid increasing nutritional and health inequalities.

Eating habits of children and adolescents during the COVID-19 pandemic: The impact of social isolation

Background

The social isolation enforced as a result of the new coronavirus (COVID‐19) pandemic may impact families’ lifestyle and eating habits. The present study aimed to assess the behaviour and dietary patterns of Brazilian children and adolescents during the social isolation imposed by the COVID‐19 pandemic.

Methods

The present study was conducted using an online, anonymous cross‐sectional survey with 589 children and 720 adolescents from Brazil during a nationwide social isolation policy. The Mann–Whitney U‐test or the Kruskal–Wallis with the Dunn post‐hoc method and a radar chart were used to compare the weekly consumption of each food by age group and isolation status. p < 0.05 was considered statistically significant. Analyses were conducted using R statistical software, version 4.0.2 (R Foundation for Statisitical Computing).

Results

We found that isolated families showed breakfast eating habits and the consumption of raw salad, vegetables, beans and soft drinks. Lower‐class isolated families and those from the Northeast region consumed fruits, juices, vegetables and beans less frequently. Compared to children, adolescents were less isolated (p = 0.016), less active (p < 0.001), exposed to longer screen time (p < 0.001), showed an inadequate sleeping pattern (p = 0.002) and were from lower‐class families (p < 0.001).

Conclusions

Social isolation affected the eating habits of children and adolescents. Non‐isolated families presented a lower consumption of healthy food, especially those among the lower class, from Northeast Brazil, as well as adolescents.

Obesity, Nutrition and Heart Rate Variability

Heart rate variability (HRV) represents the activity and balance of the autonomic nervous system and its capability to react to internal and external stimuli. As a measure of general body homeostasis, HRV is linked to lifestyle factors and it is associated with morbidity and mortality. It is easily accessible by heart rate monitoring and gains interest in the era of smart watches and self-monitoring. In this review, we summarize effects of weight loss, training, and nutrition on HRV with a special focus on obesity. Besides weight reduction, effects of physical activity and dietary intervention can be monitored by parameters of HRV, including its time and frequency domain components. In the future, monitoring of HRV should be included in any weight reduction program as it provides an additional tool to analyze the effect of body weight on general health and homeostasis. HRV parameters could, for example, be monitored easily by implementation of an electrocardiogram (ECG) every two to four weeks during weight reduction period. Indices presumibly showing beneficial changes could be a reduction in heart rate and the number of premature ventricular complexes as well as an increase in standard deviation of normal-to-normal beat intervals (SDNN), just to name some.

Conocimientos, percepciones y uso del rotulado de alimentos y bebidas en un grupo de adolescentes de Argentina

Introducción El rotulado de alimentos es una herramienta importante para mejorar la nutrición y fortalecer la ciudadanía de los consumidores en las primeras etapas de la vida y en la adolescencia. Objetivo Explorar los conocimientos, percepciones y el uso del rotulado de alimentos y bebidas en un grupo de adolescentes de la Provincia de Buenos Aires, Argentina, para el año 2019. Metodología Diseño cualitativo con enfoque fenomenológico. La recolección de datos se realizó a través de una encuesta semiestructurada y grupos focales con selección de 29 estudiantes. Los resultados fueron analizados mediante la técnica de análisis de contenido. Resultados El rótulo de alimentos tuvo baja utilización. El grupo de adolescentes reconoció la importancia que tendría su uso en la salud de las personas. Se observó una baja potencial utilización a futuro. Se encontraron diferencias de género en la percepción sobre la importancia que se le asigna a la alimentación. Los adolescentes realizaron recomendaciones de posibles mejoras de las etiquetas que incluya una perspectiva inclusiva. Conclusión El nivel de conocimientos, el uso efectivo del rotulado de alimentos y la potencial utilización a futuro por parte de los/las adolescentes fue baja. Se recomienda repensar el diseño y generar estrategias de salud pública dirigidas a promover el uso de etiquetados nutricionales en grupos y contextos específicos.

Folate and Cobalamin Serum Levels in Healthy Children and Adolescents and Their Association with Age, Sex, BMI and Socioeconomic Status

This study proposes age- and sex-specific percentiles for serum cobalamin and folate, and analyzes the effects of sex, age, body mass index (BMI), and socioeconomic status (SES) on cobalamin and folate concentrations in healthy children and adolescents. In total, 4478 serum samples provided by healthy participants (2 months-18.0 years) in the LIFE (Leipzig Research Centre for Civilization Diseases) Child population-based cohort study between 2011 and 2015 were analyzed by electrochemiluminescence immunoassay (ECLIA). Continuous age-and sex-related percentiles (2.5th, 10th, 50th, 90th, 97.5th) were estimated, applying Cole's LMS method. In both sexes, folate concentrations decreased continuously with age, whereas cobalamin concentration peaked between three and seven years of age and declined thereafter. Female sex was associated with higher concentrations of both vitamins in 13- to 18-year-olds and with higher folate levels in one- to five-year-olds. BMI was inversely correlated with concentrations of both vitamins, whilst SES positively affected folate but not cobalamin concentrations. To conclude, in the assessment of cobalamin and folate status, the age- and sex-dependent dynamic of the respective serum concentrations must be considered. While BMI is a determinant of both vitamin concentrations, SES is only associated with folate concentrations.

Development of a Genetic Risk Score to predict the risk of overweight and obesity in European adolescents from the HELENA study

Obesity is the result of interactions between genes and environmental factors. Since monogenic etiology is only known in some obesity-related genes, a genetic risk score (GRS) could be useful to determine the genetic predisposition to obesity. Therefore, the aim of our study was to build a GRS able to predict genetic predisposition to overweight and obesity in European adolescents. A total of 1069 adolescents (51.3% female), aged 11-19 years participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study were genotyped. The sample was divided in non-overweight (non-OW) and overweight/obesity (OW/OB). From 611 single nucleotide polymorphisms (SNP) available, a first screening of 104 SNPs univariately associated with obesity (p < 0.20) was established selecting 21 significant SNPs (p < 0.05) in the multivariate model. Unweighted GRS (uGRS) was calculated by summing the number of risk alleles and weighted GRS (wGRS) by multiplying the risk alleles to each estimated coefficient. The area under curve (AUC) was calculated in uGRS (0.723) and wGRS (0.734) using tenfold internal cross-validation. Both uGRS and wGRS were significantly associated with body mass index (BMI) (p < .001). Both GRSs could potentially be considered as useful genetic tools to evaluate individual's predisposition to overweight/obesity in European adolescents.

Mediterranean Diet, Screen-Time-Based Sedentary Behavior and Their Interaction Effect on Adiposity in European Adolescents: The HELENA Study

Childhood obesity is a worldwide epidemic. Mediterranean diet (MD) is inversely associated with childhood obesity, but the interaction with other environmental factors, such screen time, might influence the health benefits of a high MD adherence in adolescents. The aim of the present study was to assess whether an association between MD and screen time exists in European adolescents. Moreover, we also explored whether sedentary time has a modulatory effect on the association between MD and adiposity. Adherence to the MD (24 h recalls), screen time (questionnaire), pubertal development, body mass index (BMI), fat mass index (FMI) and waist circumference (WC) were evaluated in 2053 adolescents (54.7% females), aged 12.5–17.5 years. In females, MD adherence was associated with lower BMI and FMI only when they were exposed to less than 338 min/day of screen time (81.8% of females); MD adherence was also associated with lower WC only when females were exposed to less than 143 min/day of screen time (31.5% of females). No significant MD-screen time interaction was observed in males. In conclusion, screen-time-based sedentary behaviours had a modulatory effect in the association between MD adherence and adiposity in European female adolescents.

The Prevalence of Insulin Resistance and the Associated Risk Factors in a Sample of 14-18-Year-Old Slovak Adolescents

The prevalence of cardiometabolic risk factors has increased in Slovakian adolescents as a result of serious lifestyle changes. This cross-sectional study aimed to assess the prevalence of insulin resistance (IR) and the associations with cardiometabolic and selected lifestyle risk factors in a sample of Slovak adolescents. In total, 2629 adolescents (45.8% males) aged between 14 and 18 years were examined in the study. Anthropometric parameters, blood pressure (BP), and resting heart rate were measured; fasting venous blood samples were analyzed; and homeostasis model assessment (HOMA)-insulin resistance (IR) was calculated. For statistical data processing, the methods of descriptive and analytical statistics for normal and skewed distribution of variables were used. The mean HOMA-IR was 2.45 ± 1.91, without a significant sex differences. IR (cut-off point for HOMA-IR = 3.16) was detected in 18.6% of adolescents (19.8% males, 17.6% females). IR was strongly associated with overweight/obesity (especially central) and with almost all monitored cardiometabolic factors, except for total cholesterol (TC) and systolic BP in females. The multivariate model selected variables such as low level of physical fitness, insufficient physical activity, breakfast skipping, a small number of daily meals, frequent consumption of sweetened beverages, and low educational level of fathers as significant risk factors of IR in adolescents. Recognizing the main lifestyle risk factors and early IR identification is important in terms of the performance of preventive strategies. Weight reduction, regular physical activity, and healthy eating habits can improve insulin sensitivity and decrease the incidence of metabolic syndrome, type 2 diabetes, and cardiovascular disease (CVD).

Interaction Effect of the Mediterranean Diet and an Obesity Genetic Risk Score on Adiposity and Metabolic Syndrome in Adolescents: The HELENA Study

Obesity and metabolic syndrome (MetS) are worldwide major health challenges. The Mediterranean diet (MD) is associated with a better cardiometabolic profile, but these beneficial effects may be influenced by genetic variations, modulating the predisposition to obesity or MetS. The aim was to assess whether interaction effects occur between an obesity genetic risk score (obesity-GRS) and the MD on adiposity and MetS in European adolescents. Multiple linear regression models were used to assess the interaction effects of an obesity-GRS and the MD on adiposity and MetS and its components. Interaction effects between the MD on adiposity and MetS were observed in both sex groups (p < 0.05). However, those interaction effects were only expressed in a certain number of adolescents, when a limited number of risk alleles were present. Regarding adiposity, a total of 51.1% males and 98.7% females had lower body mass index (BMI) as a result of higher MD adherence. Concerning MetS, only 9.9% of males with higher MD adherence had lower MetS scores. However, the same effect was observed in 95.2% of females. In conclusion, obesity-related genotypes could modulate the relationship between MD adherence and adiposity and MetS in European adolescents; the interaction effect was higher in females than in males.

Weight loss programmes using low carbohydrate diets to control the cardiovascular risk in adolescents (Review)

Cardiovascular risk (CVR) is a broad term that includes traditional factors like hypertension, hyper lipidemia, abdominal obesity, hyperinsulinemia or overt type 2 diabetes mellitus (T2DM), and emerging ones such as hypothyroidism or inflammatory diseases. In epidemiologic studies, all of these factors are associated with atherogenesis and have complex interactions between them. They have in common an increased prevalence in the general population beginning in childhood, and are correlated with endothelial damage as demonstrated by echocardiographic modifications of the left ventricle or carotid intima-media thickness. Adolescence is a transition period where behavioural eating patterns develop and have a major impact on cardiovascular risk. To address these patterns, weight-loss programmes under medical supervision for overweight and obese adolescents are developed. It was observed that those who control the quality and quantity of their carbohydrates, by consuming more fruits and vegetables, associated with increased physical activity reduce their CVR. Some limited studies have shown that low carbohydrate diet (LCD) is safe and effective, but one should take into consideration the limited duration and the structure of the LCD. If there is a proper adherence to this type of nutritional intervention, it results in weight loss, improvement in insulin resistance, lipid profile and subclinical hypothyroidism reversal. We reviewed the literature starting from 2009 by searching all the observational, randomised clinical trials and meta-analyses on MEDLINE and SCOPUS databases regarding obesity and related metabolic diseases (dyslipidemia, type 2 diabetes, hypertension, hypothyroidism, LCD) in adolescents and synthesized the nutritional interventions for this population that could decrease CVR.

Energy intake and expenditure in children and adolescents, contributions of biological maturity

OBJECTIVE

The aim of this study was to examine the relationship between the ratio of energy intake (EI) and energy expenditure (EE) and body composition, physical activity and macronutrients intake, considering maturity as a moderator.

METHODS

The study involved 459 adolescents aged 10 to 17. Energy and macronutrients intake were estimated using a valid Food Frequency Questionnaire; basal metabolic rate (BMR) was predicted from Schofield equations and EE was estimated using BMR and physical activity level obtained through a Portuguese validated biosocial questionnaire. Body mass index, body composition, and bone age were objectively measured. Statistical analyses included independent samples t-tests, ANCOVA and Pearson correlations. All analyses were adjusted for chronological age, sex, and EI.

RESULTS

Body mass index, fat and fat-free mass, physical activity and protein intake were negatively correlated with EI/EE (P < .001). The study showed significant interactions between maturity and body mass index, fat-free mass and physical activity level. Maturity attenuated the negative relationships between EI/EE and body mass index, fat-free mass and physical activity, especially among early maturers. All categories of maturity showed implications in body mass index for values lower than 23.8 kg/m² . A significant EI/EE reduction was observed among late maturers with a fat-free mass above 39.8 kg.

CONCLUSIONS

Our findings suggest that maturity moderates the relationship between EI/EE and body mass index, fat-free mass and physical activity, especially evident among late maturers.

Gender differences in dietary behaviors among Japanese adolescents

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Few studies assessed a variety of adolescent dietary behaviours in Japan.

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The findings suggest that gender differences existed in dietary behaviors.

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Girls tended to adopt regular dietary behaviors as compared to boys.

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Schools support modeling and reinforcing healthy dietary behaviors.

Unhealthy dietary behaviors in adolescence are an important public health problem. Gender differences in dietary behaviors have already appeared during adolescence. However, few studies have assessed a variety of adolescent dietary behaviors in Japan. We aimed to clarify gender differences in unhealthy dietary behaviors among Japanese adolescents. The participants consisted of 84,988 participants from seventh to 12th grades. Unhealthy dietary behaviors were defined according to the National Health and Nutrition Survey. Multivariable logistic regression was used to analyze a nationally representative sample of Japanese adolescents from the 2014 to 2015 Lifestyle Survey. The effective response rate was 51.4%. The prevalence of unhealthy dietary behaviors (skipping breakfast, snacking, eating out, skipping meals, eating alone at dinner, and subjectively poor diet quality) among boys and girls was 14.2% versus 12.4%, 19.6% versus 14.1%, 10.6% versus 7.0%, 7.9% versus 5.6%, 13.3% versus 12.1%, and 12.3% versus 15.8%, respectively. Compared with boys, girls were more negatively associated with skipping breakfast [OR = 0.76 (95% CI 0.73–0.79)], snacking [OR = 0.67 (95% CI 0.65–0.70)], eating out [OR = 0.62 (95% CI 0.59–0.66)], skipping meals [OR = 0.61 (95% CI 0.58–0.65)], and eating alone at dinner [OR = 0.79 (95% CI 0.76–0.83)]. However, girls were more positively associated with subjectively poor diet quality [OR = 1.19 (95% CI 1.14.1.24)]. The findings suggest that gender differences existed in dietary behaviors. Gender differences in dietary behaviors suggest opportunities for tailoring interventions related to dietary education in schools.

Temporal variation in food consumption of Brazilian adolescents (2009-2015)

BACKGROUND

Worldwide population has been increasingly exposed to ultra-processed foods, which are associated with obesity. Adolescence is a transition period of life and WHO recommends the surveillance of risk factors to the adolescents' health, such as diet, because experiences in this phase can result in health risks.

OBJECTIVE

To assess the trends in food consumption of adolescents from Brazilian capitals according to sociodemographic variables, based on data from the National Survey of School Health (PeNSE).

METHODS

Data from in 2009, 2012 and 2015 of a total of 173,310 9th graders enrolled in public and private schools in Brazilian capitals and in the Federal District were assessed. Food consumption was assessed from regular consumption (five or more times a week) of healthy eating markers (beans; vegetables; fruit) and unhealthy eating markers (sweets; soft drinks; fried salty snacks). For sociodemographic variables, we considered macro regions; age; race/ skin color; gender; school administrative status. We assessed these markers trends for the population and, additionally, the analyses were stratified by gender, race/ skin color, and school administrative status. Statistical significance of the temporal trends was assessed by linear regression model.

RESULTS

Over six years, three types of change in Brazilian adolescents' diet were observed: decreasing regular consumption of beans, sweets and soft drinks, increasing regular consumption of vegetables, and stable consumption of fruit and fried salty snacks.

CONCLUSION

Brazilian adolescents' diet composition has changed in a short period, and therefore it is necessary to monitor it to propose actions aimed at this public.

Relative validity of FFQ to assess food items, energy, macronutrient and micronutrient intake in children and adolescents: a systematic review with meta-analysis

FFQ are one of the most widely used tools of research into nutritional epidemiology, and many studies have been conducted in several countries using this dietary assessment method. The present study aimed to evaluate the relative validity of FFQ, in comparison with other methods, in assessing dietary intake of children and adolescents, through a systematic review. Four electronic databases (Embase, PubMed, Scopus and Web of Science) found sixty-seven articles, which met the inclusion criteria (healthy children and adolescents from 3 to 18 years of age; journal articles written in English, Spanish and Portuguese between 1988 and March 2019; results showing the comparison between the FFQ with other methods of assessment of dietary intake). The articles were analysed by two independent reviewers. A meta-analysis was conducted using correlation coefficients as estimate effects between the FFQ and the reference standard method. Subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity. In fifty-five of the sixty-seven studies, a single dietary assessment method was used to evaluate the FFQ; nine combined the two methods and three used three reference methods. The most widely used reference method was the 24-h recall, followed by the food record. The overall relative validity of the FFQ to estimate energy, macronutrient, certain micronutrient and certain food item intakes in children and adolescents may be considered weak. The study protocol was registered in PROSPERO under number CRD42016038706.

Comparing Methods from the National Cancer Institute vs Multiple Source Method for Estimating Usual Intake of Nutrients in the Hispanic Community Health Study/Study of Latino Youth

BACKGROUND

The Multiple Source Method (MSM) and the National Cancer Institute (NCI) method estimate usual dietary intake from short-term dietary assessment instruments, such as 24-hour recalls. Their performance varies according to sample size and nutrients distribution. A comparison of these methods among a multiethnic youth population, for which nutrient composition and dietary variability may differ from adults, is a gap in the literature.

OBJECTIVE

To compare the performance of the NCI method relative to MSM in estimating usual dietary intakes in Hispanic/Latino adolescents.

DESIGN

Data derived from the cross-sectional population-based Hispanic Community Health Study/Study of Latino Youth, an ancillary study of offspring of participants in the adult Hispanic Community Health Study/Study of Latino Youth cohort. Dietary data were obtained by two 24-hour recalls.

PARTICIPANTS/SETTING

One thousand four hundred fifty-three Hispanic/Latino youth (aged 8 to 16 years) living in four urban US communities (Bronx, NY; Chicago, IL; Miami, FL; and San Diego, CA) during 2012 through 2014.

MAIN OUTCOME MEASURES

The NCI method and the MSM were applied to estimate usual intake of total energy, macronutrients, minerals and vitamins, added sugar, and caffeine.

STATISTICAL ANALYSES

Mean, standard deviation, minimum and maximum values, coefficient of variation, variance ratio, and differences between NCI and MSM methods and the 2-day mean were estimated in several percentiles of the distribution, as well as concordance correlation coefficients and Bland-Altman plot analysis.

RESULTS

The distributions of all nutrients studied were very similar between NCI and MSM. The correlation between NCI and MSM was >0.80 for all nutrients (P<0.001), except dietary cholesterol, vitamin C, and n-3 fatty acids. In individual estimations, NCI method predicted higher estimates and lower variance than the MSM. The lowest level of agreement was observed in the values at the tails of the distribution, and for nutrients with high variance ratio.

CONCLUSIONS

Overall, both MSM and NCI method provided acceptable estimates of the usual intake distribution using 24-hour recall, and they better represented the usual intake compared with 2-day mean, correcting for intraindividual variability.

Total Polyphenol Intake Is Inversely Associated with a Pro/Anti-Inflammatory Biomarker Ratio in European Adolescents of the HELENA Study

BACKGROUND

Although high dietary polyphenol intake is negatively associated with risk of certain inflammation-associated chronic diseases, the underlying mechanisms are not fully understood and few studies have explored this in adolescents.

OBJECTIVE

This study aimed to evaluate the association between intakes of total polyphenols, polyphenol classes, and the 10 most commonly consumed individual polyphenols with inflammatory biomarkers in the blood of European adolescents.

METHODS

In the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study, 526 adolescents (54% girls; 12.5-17.5 y) had data on inflammatory biomarkers and polyphenol intake from 2 nonconsecutive 24-h recalls via matching with the Phenol-Explorer database. Inflammatory biomarkers in serum were IL-1, IL-2, IL-4, IL-5, IL-6, IL-10, transforming growth factor β1 (TGF-β1), TNF-α, IFN-γ, soluble vascular adhesion molecule 1 (sVCAM-1), soluble intercellular adhesion molecule 1 (sICAM-1), soluble E-selectin (sE-selectin), white blood cells, lymphocytes, T cells, and C-reactive protein. Multilevel linear models were used to test associations of polyphenol intake with a pro/anti-inflammatory biomarker ratio [(zTNF-α + zIL-6 + zIL-1)/3/zIL-10] as well as with separate inflammatory biomarkers, adjusted for sociodemographic variables, diet inflammation index, BMI z score, and serum triglycerides.

RESULTS

The pro/anti-inflammatory biomarker ratio was linearly inversely associated with the intake of total polyphenols (β = -0.11, P = 0.040). When other inflammation biomarkers were considered, the serum IL-10 concentration was inversely associated with total polyphenol (β = -0.12, P = 0.017) and flavonoid (β = -0.12, P = 0.013) intakes, findings that were inconsistent with the biomarker ratio results. However, the anti-inflammatory capacity of polyphenols was confirmed by positive associations of IL-4 with phenolic acid (β = 0.09 P = 0.049) and stilbene (β = 0.13, P = 0.019) intakes and the negative association of IL-1, IL-2, and IFN-γ with lignan intake (β = -0.10, P = 0.034; β = -0.09, P = 0.049; β = -0.11, P = 0.023).

CONCLUSIONS

The negative relation with the overall pro/anti-inflammatory biomarker ratio suggests a potential anti-inflammatory role of high polyphenol intakes among European adolescents. Nevertheless, associations are dependent on polyphenol type and the inflammatory biomarker measured.

Design Features Associated with User Engagement in Digital Games for Healthy Lifestyle Promotion in Youth: A Systematic Review of Qualitative and Quantitative Studies

User engagement in digital (serious) games may be important to increase their effectiveness. Insights into how to create engaging games for healthy lifestyle promotion are needed, as despite their potential, not all digital (serious) games are highly engaging. This study systematically reviewed game features that were associated with higher user engagement among youth. A systematic search was conducted in PubMed, Web of Science, CINAHL, and PsycARTICLES databases. Qualitative and quantitative studies were included, if they documented game features associated with youth engagement. Coding of game features was performed using the mechanics-dynamics-aesthetics (MDA) framework. A total of 60 studies met the inclusion criteria and were included in the registered systematic review (No. CRD42018099487). Results showed that various game features were associated with user engagement in digital (serious) games: an attractive storyline, adaptable to gender and age, including diverse (antagonist) characters the user may identify with, high-end realistic graphics, well-defined instructions, which can be skipped, in combination with clear feedback and a balance of educational and fun content. This review underpinned the relevance of investigating engaging game features specifically for youth, as deviations were found with characteristics that are engaging for other populations.

Hábitos alimentares, atividade física e comportamento sedentário entre escolares brasileiros: Pesquisa Nacional de Saúde do Escolar, 2015

RESUMO: Introdução: A urbanização e a industrialização colaboraram para a alteração nos padrões de alimentação, bem como para o surgimento de comportamentos sedentários e a redução da atividade física. Objetivos: Identificar e descrever a prevalência de hábitos alimentares, prática de atividade física e comportamento sedentário em escolares brasileiros e analisar sua associação com as características sociodemográficas. Métodos: Foram utilizados dados da Pesquisa Nacional de Saúde do Escolar de 2015. Foram calculadas prevalências, razões de prevalências e intervalos de 95% de confiança (IC95%). As análises foram ajustadas para idade escolaridade materna. Resultados: A maioria consumia feijão (65,1%) e guloseimas (52,3%), teve mais de três dias de aula de Educação Física escolar (50,7%), realizava atividade física fora da escola por mais de três dias (55,4%), tinha comportamento sedentário (73,3%) e realizava atividade física durante 60 min/dia por menos de quatro dias na semana (72,7%). Em geral, as meninas estavam mais expostas a práticas alimentares não desejáveis e ao comportamento sedentário, e o melhor nível socioeconômico associou-se a maiores prevalências dos indicadores estudados. Elevado consumo de alimentos não saudáveis, aumento do comportamento sedentário e redução na prática de atividade física. Conclusão: Observou-se associação de atitudes não saudáveis com características sociodemográficas entre os escolares. Estratégias que foquem na redução desses comportamentos irão contribuir para ações de promoção da saúde nos ambientes escolar e familiar.

Association between Adherence to the Mediterranean Diet and Physical Fitness with Body Composition Parameters in 1717 European Adolescents: The AdolesHealth Study

Obesity, low levels of physical fitness, and unhealthy eating patterns are responsible for part of the health problems of adolescents today. The current study aimed at examining the association between the adherence to the Mediterranean diet (MD), through each answer to the items of the Adherence to the MD Questionnaire (KIDMED), and physical fitness with body composition parameters (body mass index (BMI), percentage of body fat, and waist circumference) in 1717 European adolescents (N = 900 boys, N = 817 girls). Data of body composition, physical fitness results, and the answers to KIDMED were analyzed by the Student’s t-test. Additionally, the effect size (ES) was calculated and a Chi-square test analyzed the proportion of participants with and without over waist circumference, overfat, and overweight in each KIDMED question. The relative risk of suffering over waist circumference, overfat and overweight in relation to the responses was calculated by Odd-Ratio. Adherence to the MD did not influence the condition of over waist circumference, overfat and overweight, although certain dietary habits were identified as risk factors for their development. Over waist circumference, overfat, and overweight boys and girls presented higher levels of body mass, waist circumference, body fat percentage, and BMI (p < 0.001; ES = 1.73–3.38), as well as lower levels of all the parameters of the physical fitness analyzed (p < 0.001; ES = 0.45–1.08), except the handgrip test. A direct relationship between fitness and over waist circumference, overfat, and overweight was found.

Promoting healthy teenage behaviour across three European countries through the use of a novel smartphone technology platform, PEGASO fit for future: study protocol of a quasi-experimental, controlled, multi-Centre trial

Background

Behaviour change interventions targeting physical activity, diet, sleep and sedentary behaviour of teenagers show promise when delivered through smartphones. However, to date there is no evidence of effectiveness of multicomponent smartphone-based interventions. Utilising a user-centred design approach, we developed a theory-based, multi-dimensional system, PEGASO Fit For Future (PEGASO F4F), which exploits sophisticated game mechanics involving smartphone applications, a smartphone game and activity sensors to motivate teenagers to take an active role in adopting and maintaining a healthy lifestyle. This paper describes the study protocol to assess the feasibility, usability and effectiveness (knowledge/awareness and behavioural change in lifestyle) of the PEGASO system.

Methods

We are conducting a quasi-experimental controlled cluster trial in 4 sites in Spain, Italy, and UK (England, Scotland) over 6 months. We plan to recruit 525, in a 2:1 basis, teenagers aged 13–16 years from secondary schools. The intervention group is provided with the PEGASO system whereas the comparison group continues their usual educational routine. Outcomes include feasibility, acceptance, and usability of the PEGASO system as well as between and within group changes in motivation, self-reported diet, physical activity, sedentary and sleeping behaviour, anthropometric measures and knowledge about a healthy lifestyle.

Discussion

PEGASO F4F will provide evidence into the cross-cultural similarities and differences in the feasibility, acceptability and usability of a multi-dimensional smartphone based behaviour change intervention for teenagers. The study will explore facilitating factors, challenges and barriers of engaging teenagers to adapt and maintain a healthy lifestyle when using smartphone technology. Positive results from this ICT based multi component intervention may have significant implications both at clinical level, improving teenagers health and at public health level since it can present an influential tool against the development of chronic disease during adulthood.

Trial registration

https://clinicaltrials.gov Registration number: NCT02930148, registered 4 October 2016.

Rationale and design of the school-based SI! Program to face obesity and promote health among Spanish adolescents: A cluster-randomized controlled trial

Unhealthy habits in adolescents are increasing at an alarming rate. The school offers a promising environment in which to implement effective preventive strategies to improve adolescents' lifestyle behaviors. The SI! Program is a multilevel multicomponent school-based health-promotion intervention aimed at all stages of compulsory education in Spain. We present the study design of the SI! Program for Secondary Schools, targeting adolescents aged 12 to 16 years.

AIM

The main goal of this study is to evaluate the impact of the SI! Program educational intervention on adolescent lifestyle behaviors and health parameters.

METHODS

The study was designed as a cluster-randomized controlled intervention trial and enrolled 1326 adolescents from 24 public secondary schools in Spain, together with their parents/caregivers. Schools and their students were randomly assigned to the intervention group (the SI! curriculum-based educational program over 2 or 4 academic years) or to the control group (usual curriculum). The primary endpoint will be the change from baseline at 2-year and 4-year follow-up in the composite Ideal Cardiovascular Health (ICH) score, consisting of four health behaviors (body mass index, dietary habits, physical activity, and smoking) and three health factors (blood pressure, total cholesterol, and glucose). Secondary endpoints will include 2-year and 4-year changes from baseline in ICH score subcomponents, the Fuster-BEWAT health scale, adiposity markers (waist circumference and body composition), polyphenol and carotenoid intake, and emotion management.

DISCUSSION

The overarching goal of the SI! Program is to instill healthy behaviors in children and adolescents that can be sustained into adulthood. The SI! Program for Secondary School is a comprehensive health-promotion intervention targeting 12-16-year-old adolescents and their immediate environment. The present study addresses the optimal timing and impact of the educational intervention on health in adolescence.

Prevalence and factors associated with excess weight in adolescents in a low-income neighborhood - Northeast, Brazil

Abstract Objectives: to study the prevalence of excess weight and associated factors among adolescents from a low-income neighborhood located in the city of Recife, Pernambuco. Methods: cross-sectional study, in which behavioral, socioeconomic and demographic information was collected from June to December 2014. Excess weight was calculated based on body mass index for age and the cut-off points, by the World Health Organization (2007). To analyze associations between predictor variables and the outcome, multivariate data analysis was performed following the Poisson Regression (Prevalence Ratio - PR) with their respective 95% confidence intervals (95%CI). Results: twenty-five adolescents participated in the study, with a prevalence of 36.4% of excess weight: 20.4% overweight (95%CI=15.1-25.7) and 16.0% obesity (95%CI= 11.2-20.8), predominantly in female gender (42.5%; p=0.031). The outcome was associated with internet access (PR=1.20; 95%CI=1.01-1.43), the number of people in the family (PR= 1.12; 95%CI=1.01-1.28) and screen time (PR=1.13; 95%CI=1.01-1.27), but only in male gender. Conclusions: the prevalence found was higher than that of other national researches, especially for the female gender. In the male gender, not having internet access, a lesser number of family members and a longer screen time proved to be factors associated with being excess weight.

Dietary Habits and Physical Activity of 18-Year-Old Adolescents in Relation to Overweight and Obesity

BACKGROUND

The purpose of this study was to evaluate the correlations between the nutritional status, nutritional habits, and physical activity in the representative population of 18-year-old students.

METHODS

A total of 1,631 participants aged 18 years, originating from secondary schools/senior high schools in the city of Bialystok, Szpitalna, Bialystok, Poland were enrolled. Participants completed anonymous questionnaires, and their body mass index was assessed. Data were analyzed using standard statistical procedures with Statistical PL 12.0.

RESULTS

The analysis showed that consumption of only one to two or three meals was associated with an increased risk of overweight and obesity-in case of one or two meals among girls, OR=1.78 (P<0.05), in case of one or two meals among boys, OR=2.325 (P<0.01), and in case of three meals, OR=1.771 (P<0.05). First breakfast was consumed by 82.1% of boys with normal BMI and 73.1% overweight and obesity (OR=0.593; P<0.05). 24.5% of the eutrophic compared to only 20.3% of adolescents with elevated BMI reported attending all PE classes. Physical activity undertaken after school was associated with a 35.9% decrease risk of overweight and obesity among girls and 57.7% among boys.

CONCLUSION

A specific pattern of nutritional habits, that is, decreased meal frequency in adolescents, skipping meals, appear the most frequent nutritional mistakes associated with overweight and obesity. Insufficient physical activity and exposure to sedentary behaviors among adolescents are disturbing. The obesity problem requires monitoring, prevention and the change of nutritional habits and physical activity early in childhood.

Evaluation of lifestyle of female adolescents through latent class analysis approach

BACKGROUND

Lack of regular physical activity, high sedentary behavior and presence of unbalanced alimentary practices are attitudes associated with an inadequate lifestyle among female adolescents.

OBJECTIVE

to assess the lifestyle of female adolescents based on measurements of behavioral variables.

METHODS

Cross-sectional study with 405 female adolescents between 14 and 19 years old, resident and attending public schools in Viçosa (state of Minas Gerais). Their lifestyle was analyzed by the Physical Activity Recall, number of steps, screen time (ST), cellphone time (CT), sitting time, food frequency questionnaire (FFQ), and alcohol and tobacco consumption. With multiple correspondence analysis it was possible to observe dispersion and approximation of the variables' categories. Latent class analysis (LCA) was used for modeling the "lifestyle" variable, having been conducted in the poLCA (Polychromous Variable Latent Class Analysis) package of the R statistical software.

RESULTS

The mean age was 15.92 ± 1.27 years. Most of the adolescents were considered physically inactive (78%) and with low number of steps (82.57%); 41.45% reported not performing Moderate to Vigorous Physical Activities (MVPA) adequately. Sedentary behavior was found high when assessing ST (72.90%) and CT (65.31%). It was found the best fitted latent class model for the lifestyle (p-G² = 0.055, p-χ² = 0.066) featured three latent classes and one covariate (alcohol): Class 1, 'Inactive and Sedentary' (γ = 77.5%); Class 2, 'Inactive and Non-sedentary lifestyle (γ=16.31%); and Class 3, 'Active and sedentary' (γ=6.19%). Female adolescents that had 'never consumed alcohol' were 2.26 times as likely (log OR = 0.8174; p = 0.033) to belong to class 3 (Active & Sedentary lifestyle) than to class 1 (Inactive & Sedentary lifestyle).

CONCLUSION

Latent class analysis model with five manifest variable (MVPA, number of steps, ST, sitting time and number of meals) and alcohol consumption like covariate showed itself to be an accurate and objective method in the assessment of female adolescents' lifestyle. Female adolescents that had 'never consumed alcohol' were more as likely to belong to class 'Active & Sedentary lifestyle' than to class Inactive & Sedentary lifestyle. An inactive and sedentary lifestyle is coupled to other unhealthy behaviors during adolescence, possibly carrying over into adult life.

Protein Intake Estimated from Brief-Type Self-Administered Diet History Questionnaire and Urinary Urea Nitrogen Level in Adolescents

Our aim was to assess the validity of the brief-type self-administered diet history questionnaire (BDHQ15y) to estimate the protein intake in 248 Japanese secondary school students (mean age = 14.2 years), using urinary biomarkers as references. Participants provided three samples of overnight urine for measurement of urea nitrogen and creatinine levels, underwent anthropometric measurements, and answered the questionnaires. Additionally, 58 students provided 24-h urine specimens. A significant correlation was observed between excretion of urea nitrogen in overnight and 24-h urine specimens (ρ = 0.527; p < 0.001), with biases ≤5.8%. The mean daily protein intake estimated from urinary biomarkers was 76.4 ± 20.4 g/d in males and 65.4 ± 16.9 g/d in females, and the mean protein intake estimated from the BDHQ15y (PRTbdhq) was 89.3 ± 33.7 g/d in males and 79.6 ± 24.6 g/d in females. Crude and energy-adjusted coefficients of correlation between PRTbdhq and protein intake estimated from urinary biomarkers were 0.205 (p = 0.001; 0.247 for males and 0.124 for females), and 0.204 (p = 0.001; 0.302 for males and 0.109 for females), respectively. The BDHQ15y is a low-cost tool to assess protein intake of a large population, instead of a weakness of overestimation.

French and Mediterranean-style diets: Contradictions, misconceptions and scientific facts-A review

The determination of appropriate dietary strategies for the prevention of chronic degenerative diseases, cancer, diabetes, and cardiovascular diseases remains a challenging and highly relevant issue worldwide. Epidemiological dietary interventions have been studied for decades with contrasting impacts on human health. Moreover, research scientists and physicians have long debated diets encouraging alcohol intake, such as the Mediterranean and French-style diets, with regard to their impact on human health. Understanding the effects of these diets may help to improve in the treatment and prevention of diseases. However, further studies are warranted to determine which individual food components, or combinations thereof, have a beneficial impact on different diseases, since a large number of different compounds may occur in a single food, and their fate in vivo is difficult to measure. Most explanations for the positive effects of Mediterranean-style diet, and of the French paradox, have focused largely on the beneficial properties of antioxidants, among other compounds/metabolites, in foods and red wine. Wine is a traditional alcoholic beverage that has been associated with both healthy and harmful effects. Not withstanding some doubts, there is reasonable unanimity among researchers as to the beneficial effects of moderate wine consumption on cardiovascular disease, diabetes, osteoporosis, and longevity, which have been ascribed to polyphenolic compounds present in wine. Despite this, conflicting findings regarding the impact of alcohol consumption on human health, and contradictory findings concerning the effects of non-alcoholic wine components such as resveratrol, have led to confusion among consumers. In addition to these contradictions and misconceptions, there is a paucity of human research studies confirming known positive effects of polyphenols in vivo. Furthermore, studies balancing both known and unknown prognostic factors have mostly been conducted in vitro or using animal models. Moreover, current studies have shifted focus from red wine to dairy products, such as cheese, to explain the French paradox. The aim of this review is to highlight the contradictions, misconceptions, and scientific facts about wines and diets, giving special focus to the Mediterranean and French diets in disease prevention and human health improvement. To answer the multiplicity of questions regarding the effects of diet and specific diet components on health, and to relieve consumer uncertainty and promote health, comprehensive cross-demographic studies using the latest technologies, which include foodomics and integrated omics approaches, are warranted.

Imagem corporal de adolescentes do sexo feminino e sua associação à composição corporal e ao comportamento sedentário

Resumo O objetivo deste artigo é avaliar a imagem corporal e sua associação à composição corporal, indicadores antropométricos e comportamento sedentário de adolescentes do sexo feminino. Estudo transversal com adolescentes do sexo feminino de Viçosa, MG. A imagem corporal foi avaliada por meio do Body Shape Questionnaire (BSQ) e pela Escala de Silhuetas. O percentual de gordura (%GC) e outros parâmetros antropométricos foram aferidos. O comportamento sedentário (CS) foi avaliado a partir da soma do tempo de tela (TT) e do tempo de celular (TC). A amostra foi composta por 274 adolescentes, a maioria com IMC adequado (81,6%), porém, 53,9% apresentaram o % GC elevado. Mais da metade das adolescentes apresentaram o CS elevado, 68,2% com o TT e 54,7% com o TC acima de 2h. A insatisfação corporal manifestou-se em 45,7%, e 50,2% desejaram uma silhueta diferente da atual. O perímetro da cintura (PC) (OR = 11,94, IC = 2,744 – 51,728) e a relação cintura-estatura (RCE) (OR = 10,535, IC = 3,109 – 35,698) foram as medidas mais associadas à insatisfação corporal. Todas as medidas de composição corporal apresentaram associação significativa com a insatisfação corporal, sendo o PC e o RCE os fatores mais condicionantes. O CS mostrou-se elevado, no entanto, não se associou com a avaliação negativa da imagem corporal.

Adequacy of usual macronutrient intake and macronutrient distribution in children and adolescents in Spain: A National Dietary Survey on the Child and Adolescent Population, ENALIA 2013-2014

Objectives

To describe the nutritional profile and assess the National Dietary Survey on the Child and Adolescent Population project in Spain (ENALIA) regarding usual total energy and macronutrient intake.

Methods

A cross-sectional nationally representative sample of 1862 children and adolescents (age 6 months to 17) was surveyed between 2013 and 2014 following European methodology recommendations. Dietary information was collected using two methods, dietary records (for children from age 6 months to 9 years) and 24-h dietary recall (participants age 10 and older). Usual intake was estimated by correcting for within-person intake variance using the Iowa State University (ISU) method. A probability analysis was used to assess compliance with dietary reference intakes in the target population.

Results

Protein consumption in the age 1–3 group as a percentage of total energy exceeded the upper limit of the Acceptable Macronutrient Distribution Range (AMDR) by 4.7% for boys and 12.1% for girls. 42.9% of girls age 4–8 were under the lower limit of the AMDR for carbohydrates. 43.4% of boys and 46.9% of girls between 4 and 17 exceeded the AMDR in total fat intake, saturated fatty acids (SFAs) accounting for 12.3% of total energy.

Conclusions

The results suggest that Spanish children and adolescents could improve macronutrient distribution by reducing fat and increasing carbohydrate intake across all age groups, and decreasing protein intake, especially in young children.

Electronic supplementary material

The online version of this article (10.1007/s00394-018-1676-3) contains supplementary material, which is available to authorized users.

BODY DISSATISFACTION, PHYSICAL ACTIVITY, AND SEDENTARY BEHAVIOR IN FEMALE ADOLESCENTS

Objective:

To evaluate the association of body image with physical activity level, body composition, and sedentary behavior (SB) of female adolescents.

Methods:

Exploratory cross-sectional study conducted with 120 female adolescents aged between 14-19 years, from the city of Viçosa, Minas Gerais, Southeast Brazil. Body image was evaluated with a Body Silhouette Scale (BSS) and a Body Shape Questionnaire (BSQ). Weight, height, and waist circumference values were analyzed, as well as the waist-to-height ratio and body fat percentage. The physical activity level (PAL) was assessed by 24-hour Physical Activity Recall and SB by screen time, that is, time spent in front of a TV, playing video game, on the computer and using tablets, and, separately, the cell phone time.

Results:

Mean age was 16.5±1.5 years, and most adolescents were eutrophic (77.6%), sedentary/low PAL (84.2%), with high screen time (85.2%) and cell phone time (58.7%). Body dissatisfaction was stated in 40.6% of BSQ and 45.8% of BSS evaluations. Body distortion was identified in 52.9% of participants. All body composition measures, along with cell phone time and PAL, were associated with body dissatisfaction, the more active adolescents presenting higher levels of dissatisfaction.

Conclusions:

This study concluded that female adolescents with higher cell phone time also present higher body dissatisfaction, as well as the most physically active ones. All body composition measurements were associated with body dissatisfaction, mainly body mass index, waist circumference, and waist-to-height ratio.

Comportamento sedentário e consumo de alimentos ultraprocessados entre adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2015

Estudo transversal com o objetivo de investigar a associação entre comportamento sedentário e consumo de alimentos ultraprocessados (AUP) em adolescentes brasileiros. Foram utilizados dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) realizada em 2015. O consumo diário de pelo menos um grupo de AUP representou o desfecho, e a exposição principal foi o tempo diário de comportamento sedentário (horas em atividades sentado, excluído o tempo dispendido na escola). Foram calculadas prevalências, razões de prevalências e intervalos de 95% de confiança (IC95%). As análises foram ajustadas para sexo, idade, cor da pele, escolaridade materna, índice de bens, região geográfica e dependência administrativa da escola. Cerca de 40% dos escolares reportaram consumo diário de pelo menos um grupo de AUP (39,7%; IC95%: 39,2-40,3) e 68,1% (IC95%: 67,7-68,7) referiram > 2 horas/dia de comportamento sedentário. Entre os escolares com comportamento sedentário > 2 horas/dia, a prevalência de consumo diário de AUP foi de 42,8% (IC95%: 42,1-43,6%), maior do que entre os sem comportamento sedentário (29,8%; IC95%: 29,0-30,5%). Quanto maior o tempo de comportamento sedentário, maior a prevalência de consumo de AUP (valor de p para tendência linear < 0,001). Estratégias que promovam a alimentação saudável e a diminuição de comportamentos sedentários, bem como regulamentações da publicidade de AUP, tornam-se necessárias a fim de evitar que estilos de vida não saudáveis perdurem à idade adulta.

The effects of fatty fish intake on adolescents' nutritional status and associations with attention performance: results from the FINS-TEENS randomized controlled trial

Background

Adolescence involves changes in dietary habits that may induce imbalances in the intake of different nutrients. Fish is an important dietary source of omega-3 (n-3) long-chain polyunsaturated fatty acids (LCPUFAs), vitamin D, several minerals and high-quality protein. By using secondary outcomes and exploratory analyses, the aims of this paper were to evaluate if nutritional biomarkers (red blood cell fatty acids, serum (s)-25(OH)D, s-ferritin and urinary iodine concentration (UIC)) were altered during a dietary intervention, and if they mediated previously reported changes in attention performance. In addition, to examine the status of the biomarkers and explore associations between dietary pattern, biomarkers and attention performance cross-sectionally at baseline.

Methods

The Fish Intervention Studies-TEENS (FINS-TEENS) was a three-armed intervention trial, including adolescents from eight secondary schools (n = 415; age: 14–15y) in Bergen, Norway. Participants were individually randomized to receive either fish meals, meat meals or n-3 LCPUFA supplements, three times a week for a total of 12 weeks. Blood and urine samples were collected pre and post intervention and attention performance was assessed with the d2 test of attention. Analyses of covariance (ANCOVA) assessed differences between groups in changes of biomarkers and linear mixed models were applied in analyses of attention performance and biomarkers. The trial is registered in ClinicalTrials.gov (NCT02350322).

Results

At baseline, the mean omega-3 index was 5.8 ± 1.3% and deficient status were identified for s-25(OH)D (54%), s-ferritin (10%) and UIC (40%). The intervention resulted in an increase in DHA and the omega-3 index which was larger in the supplement group compared to the fish and meat group (P < 0.01), and in the fish group compared to the meat group (P < 0.01). No differences between the groups were observed for changes in 25(OH)D, s-ferritin or UIC. None of the biomarkers mediated performance in the d2 test. The intake of fatty fish and a healthy dietary pattern was associated with scores in processing speed at baseline.

Conclusions

These results show that Norwegian adolescents have insufficient status of important nutrients, which may be improved with fatty fish consumption or n-3 LCPUFA supplements. However, nutritional status was not associated with scores in the d2 test of attention.

Promoting physical activity and improving dietary quality of Singaporean adolescents: effectiveness of a school-based fitness and wellness program

Limited data are available on the effectiveness of the school-based structured fitness and wellness program to influence dietary quality and physical activity levels in Singaporean adolescents. The study examined if a 20-h (over 10 weeks) school-based structured fitness and wellness module affects the diet quality indices, energy intakes, physical activity levels and the associated energy expenditures in a group of healthy, male adolescents with low diet quality and physical activity levels. Participant demography, anthropometry, dietary intake and daily physical activity were obtained at the beginning, mid-point and end of the 10-week program. Physical activity levels were assessed accelerometrically over a 1-weekday period. Dietary intake were taken using a structured 7-day food diary, and diet quality assessed using the Diet Quality Index-International (DQI-I). The 31 enrolled participants (age 19.8 ± 0.6 years) with body mass index (BMI) (19.8 ± 0.6 kg/m2) followed diets of low diet quality scores (48.3 ± 9.6 out of 100) and engaged in 3.87 ± 2.00 h of physical activity daily before the start of the intervention. Their dietary quality and physical activity levels did not change significantly throughout the intervention period. They scored poorly in the moderation and overall balance components of the diet quality assessment. The physical activity duration correlated inversely to the diet quality scores. Our results suggest that the prescribed school-based fitness and wellness module was ineffective in influencing the diet quality and physical activity levels of Singaporean male adolescents with low diet quality and physical activity levels.

Physical Activity, Physical Fitness, Body Composition, and Nutrition Are Associated with Bone Status in University Students

Understanding the modifiable factors that improve and maximize peak bone mass at an early age is necessary to design more effective intervention programs to prevent osteoporosis. To identify these modifiable factors, we analyzed the relationship of physical activity (PA), physical fitness, body composition, and dietary intake with bone stiffness index (SI), measured by quantitative ultrasonometry in young university students (18–21 years). Moderate-to-vigorous PA (MVPA) was the strongest predictor of SI (β = 0.184; p = 0.035). SI was most closely related with very vigorous PA in males (β = 0.288; p = 0.040) and with the number of steps/day in females (β = 0.319; p = 0.002). An association between thigh muscle and SI was consistent in both sexes (β = 0.328; p < 0.001). Additionally, extension maximal force was a bone SI predictor factor in females (β = 0.263; p = 0.016) independent of thigh muscle perimeter. Calcium intake was the only nutrition parameter that had a positive relationship with SI (R = 0.217; p = 0.022). However, it was not included as a predictor for SI in our regression models. This study identifies predictors of bone status in each sex and indicates that muscle and bone interrelate with PA and fitness in young adults.

Skipping breakfast and associated factors among Brazilian adolescents

ABSTRACT Objective To analyze the prevalence and factors associated with breakfast skipping among adolescents. Methods Cross-sectional study, with adolescents aged 10-17 years, evaluated between 2009 and 2011, belonging to a cohort study in the Central-West region of Brazil. Breakfast skipping was considered as not having breakfast every day. Demographic, socioeconomic, and lifestyle factors were evaluated through a questionnaire. Anthropometric assessment included measurement of weight and height, which were used to classify weight status using body mass index. Poisson regression was used to assess the association of breakfast skipping with demographic and socioeconomic variables, lifestyle factors, and weight status. Results Among 1,716 Brazilian adolescents evaluated, 36.2% reported not consuming breakfast every day, with the highest prevalence among girls (p=0.03). After adjusting for age and economic class, breakfast skipping was associated with not consuming breakfast with parents and morning shift at school, in both genders, and with obesity only in boys. Lifestyle factors such as alcohol consumption, physical activity, diet quality, and smoking were not associated with skipping breakfast. Conclusion The omission of breakfast was observed in more than a third of adolescents, being associated with demographic and lifestyle factors. In the public health perspective, the importance of encouraging the consumption of this meal is highlighted, with actions involving the school environment and the family.

A Web-Based Lifestyle Medicine Curriculum: Facilitating Education About Lifestyle Medicine, Behavioral Change, and Health Care Outcomes

BACKGROUND

Lifestyle medicine is the science and application of healthy lifestyles as interventions for the prevention and treatment of disease, and has gained significant momentum as a specialty in recent years. College is a critical time for maintenance and acquisition of healthy habits. Longer-term, more intensive web-based and in-person lifestyle medicine interventions can have a positive effect. Students who are exposed to components of lifestyle medicine in their education have improvements in their health behaviors. A semester-long undergraduate course focused on lifestyle medicine can be a useful intervention to help adopt and sustain healthy habits.

OBJECTIVE

To describe a novel, evidence based curriculum for a course teaching the concepts of Lifestyle Medicine based on a web-based course offered at the Harvard Extension School.

METHODS

The course was delivered in a web-based format. The Lifestyle Medicine course used evidence based principles to guide students toward a "coach approach" to behavior change, increasing their self-efficacy regarding various lifestyle-related preventive behaviors. Students are made to understand the cultural trends and national guidelines that have shaped lifestyle medicine recommendations relating to behaviors. They are encouraged to engage in behavior change. Course topics include physical activity, nutrition, addiction, sleep, stress, and lifestyle coaching and counseling. The course addressed all of the American College of Preventive Medicine/American College of Lifestyle Medicine competencies save for the competency of office systems and technologies to support lifestyle medicine counseling.

RESULTS

The course was well-received, earning a ranking of 4.9/5 at the school.

CONCLUSIONS

A novel, semester-long course on Lifestyle Medicine at the Harvard Extension School is described. Student evaluations suggest the course was well-received. Further research is needed to evaluate whether such a course empowers students to adopt behavior changes.

A School-Based, Peer-Led, Social Marketing Intervention To Engage Spanish Adolescents in a Healthy Lifestyle ("We Are Cool"-Som la Pera Study): A Parallel-Cluster Randomized Controlled Study

BACKGROUND

Encouraging adolescents to adopt healthy lifestyles can be challenging. The aim of the "Som la Pera" study was to engage adolescents by applying new strategies to increase both their fruit and vegetable consumption and their physical activity (PA) while reducing their sedentary behavior.

METHODS

In disadvantaged neighborhoods of Reus (Spain), two high schools were randomly assigned to the intervention (n = 170 adolescents 13- to 16-year-olds) and two were assigned to the control group (n = 223 adolescents 13- to 16-year-olds). The intervention, which lasted 12 months and spanned 2 academic years (2013-2015), used social marketing (SM) to improve healthy choices. The peer-led strategy involved 5 adolescents who designed and implemented 10 activities as challenges for their 165 school-aged peers. The control group received no intervention. To assess self-reported lifestyles in both groups, the Health Behavior in School-Aged Children Survey was used at baseline and end of study.

RESULTS

After 12 months, intervention adolescents showed an increase of 28.9% in ≥1 fruit/day (p < 0.01) and of 18.5% in ≥6 hours/week of PA (p < 0.01) compared with controls. Additionally, intervention group males had an increase of 28.8% in ≥1 vegetable/day (p < 0.01) and of 15.6% in ≤2 hours/day of sedentary activity (p = 0.01) compared with controls.

CONCLUSIONS

A school-based, peer-led, SM intervention developed by adolescents attending high schools in low-income neighborhoods effectively improved the healthy choices of their school-aged peers, leading to increased fruit consumption and PA in adolescents of both genders. Furthermore, adolescent males were more sensitive to improvements in healthy choices, showing increased vegetable consumption and decreased sedentary behavior.

Obesity

Excessive fat deposition in obesity has a multifactorial aetiology, but is widely considered the result of disequilibrium between energy intake and expenditure. Despite specific public health policies and individual treatment efforts to combat the obesity epidemic, >2 billion people worldwide are overweight or obese. The central nervous system circuitry, fuel turnover and metabolism as well as adipose tissue homeostasis are important to comprehend excessive weight gain and associated comorbidities. Obesity has a profound impact on quality of life, even in seemingly healthy individuals. Diet, physical activity or exercise and lifestyle changes are the cornerstones of obesity treatment, but medical treatment and bariatric surgery are becoming important. Family history, food environment, cultural preferences, adverse reactions to food, perinatal nutrition, previous or current diseases and physical activity patterns are relevant aspects for the health care professional to consider when treating the individual with obesity. Clinicians and other health care professionals are often ill-equipped to address the important environmental and socioeconomic drivers of the current obesity epidemic. Finally, understanding the epigenetic and genetic factors as well as metabolic pathways that take advantage of 'omics' technologies could play a very relevant part in combating obesity within a precision approach.

Vitamin D status among infants, children, and adolescents in southeastern China

OBJECTIVE

Vitamin D deficiency and insufficiency are global public health problems, which must first be identified before they can be appropriately addressed, and yet information is strikingly lacking in most parts of the Asia and Pacific region. The study aimed to document and account for the actual situation in Wenzhou on the southeastern coast of China.

SUBJECTS AND METHODS

Serum 25-hydroxyvitamin D levels among a total of 5845 infants, preschool children, school children, and adolescents aged 1-18 years were examined between March 2014 and February 2015.

RESULTS

Their mean levels were (110.2±26.8), (77.5±25.7), (55.6±15.4), and (47.2±13.9) nmol/L, respectively. Older age groups were involved in increasing risk of vitamin D deficiency and insufficiency. There were significant seasonal differences in its median level and prevalence of deficiency and insufficiency among school children and adolescents, but there was no significant sex difference in mean level and prevalence in any age group.

CONCLUSIONS

Vitamin D deficiency and insufficiency were prevalent among infants, preschool children, school children, and adolescents in Wenzhou. A vitamin D-rich diet and outdoor activities for 1-2 h per day under the natural conditions favorable to its endogeous synthesis do not suffice. The vitamin D status in Wenzhounese infants excelling over that in the US was the result of its supplementation thanks to the Chinese Medical Association recommendations, which should be consequently extended to more age groups. Life style shaped by socio-economic environments affects vitamin D status. Knowledge on the importance of vitamin D for healthy growth should be popularized.