More physically active and leaner adolescents have higher energy intake

Physiologic and Behavioral Correlates of Energy Intake in Emerging Adulthood: Cross-Sectional Analysis of the RIGHT Track Health Study

BACKGROUND

Consistent findings have reported that FFM is associated with EI. However, conjoint assessments of physiologic (body composition, fasting serum leptin) and behavioral [eating behaviors and physical activity (PA)] correlates of EI during emerging adulthood have not been examined.

OBJECTIVES

We assessed associations between physiologic and behavioral correlates of EI within the context of one another in emerging adults (18-28 years old). We also assessed these associations in a subsample after the removal of probable EI underreporters.

METHODS

Cross-sectional data from 244 emerging adults (age = 19.6 ± 1.4 y; BMI = 26.4 ± 6.6 kg/m2; 56.6% female) from the RIGHT Track Health study were used. Measures included body composition (BOD POD), eating behaviors (Three-Factor Eating Questionnaire), objective and subjective PA (accelerometer-derived total activity counts and Godin-Shephard Leisure-Time Exercise Questionnaire), fasting serum leptin, and EI (three 24-hour dietary recalls). Correlates independently associated with EI were entered into a backward stepwise linear regression model. Correlates that met the criteria of P < 0.05 were retained. Analyses were repeated in a subsample after removing probable EI underreporters (n = 48). Effect modification by sex (male and female) and BMI (BMI < 25 kg/m2, BMI ≥ 25 kg/m2) categories was also assessed.

RESULTS

In the full sample, FFM (β: 18.4; 95% CI: 9.9, 26.8), leptin (β: -84.8; 95% CI: -154.3, -15.4), dietary restraint (β: -35.2; 95% CI: -59.1, -11.3), and subjective PA (β: 2.5; 95% CI: 0.04, 4.9) were significantly associated with EI. After the removal of probable underreporters, only FFM remained significantly associated with EI (β: 43.9; 95% CI: 27.2, 60.6). No evidence of effect modification by sex or BMI categories was noted.

CONCLUSIONS

Although physiologic and behavioral correlates were associated with EI in the full sample, only FFM remained a robust correlate of EI in a subsample of emerging adults after removing probable EI underreporters.

Assessment of Risk Factors for Development of Overweight and Obesity among Soldiers of Polish Armed Forces Participating in the National Health Programme 2016-2020

The aim of this study was to assess the prevalence of overweight and obesity among Polish Armed Forces soldiers and to analyze risk factors impacting body mass. In total, 1096 male, Caucasian soldiers (36.31 ± 8.03 years) participated in this study. Anthropometric data were obtained, and questionnaires evaluated sociodemographic, environmental, behavioral and biological factors known to be associated with obesity. Only 33% of the total number of participants had normal body weight, and 17.3% were considered obese (according to WHO criteria). The results showed that being 40 years or older, sleeping six hours or less per day, more frequent reaching for food in stressful situations, having a mother with excessive body weight, not exercising or exercising at most two days per week, and spending two hours a day or more in front of the TV increase the risk of obesity. Taken together, the results show that factors such as family history of obesity, dietary habits, physical activity, length of sleep and ability to cope with stress could be used to identify soldiers at higher risk of developing obesity in order to provide them with personalized prevention programs.

Is Energy Expenditure or Physical Activity Considered When Energy Intake Is Measured? A Scoping Review 1975-2015

The health-transitions humans have delivered during the 20th Century associated with the nutrition is that from undernutrition to obesity, which perseveres in the current years of the 21st Century. Energy intake (EI) is a contributing factor and therefore a fascination in nutritional sciences. However, energy expenditure (EE) has not been usually considered as a conjoint factor. Thus, this study aimed to review if studies on adults consider data on dietary intake, specifically EI, and included data on EE and physical activity (PA). A search of MEDLINE from 1975 to December 2015 was managed. Our scoping review consisted of keywords related to EI, dietary allowances, and nutritional requirements. From 2229 acknowledged articles, 698 articles were finally taken fulfilling inclusion and quality criteria. A total of 2,081,824 adults (53.7% females) were involved, and most studies had been conducted in EEUU (241), Canada (42), Australia (30), Japan (32), and Brazil (14). In Europe, apart from UK (64), the Netherlands (31) and France (26) led the classification, followed by Sweden (18), Denmark (17), and France (26). Mediterranean countries are represented with 27 studies. A total of 76.4% did not include EE and 93.1% did not include PA. Only 23.6% of the studies contained both EI and EE. A large methodological diversity was perceived, with more than 14 different methods regarding EI, and more than 10 for EE. PA was only analyzed in scarce articles, and scarcely considered for interpretation of data and conclusions. Moreover, PA was often measured by subjective questionnaires. Dietary surveys show a large diversity regarding methodology, which makes comparability of studies difficult. EE and PA are missing in around 80% of studies or are not included in the interpretation of results. Conclusions regarding EI or diet adequacy in adults should not be taken without analyzing EE and PA.

Cardiometabolic Risk is Positively Associated with Underreporting and Inversely Associated with Overreporting of Energy Intake Among European Adolescents: The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study

BACKGROUND

Dietary misreporting is the main limitation of dietary assessments and has been associated with BMI during youth. However there are no prior studies assessing misreporting and cardiometabolic risks (CMRs) in adolescence.

OBJECTIVES

To examine the associations between dietary misreporting and CMR factors in adolescents and to assess the potential bias in the association between CMR and energy intake (EI) driven by dietary misreporting.

METHODS

Two 24-hour dietary recalls were obtained from 1512 European adolescents (54.8% girls) aged 12.5-17.5 years. Physical activity was measured by accelerometry. Cut-offs suggested by Huang were applied to identify misreporters. Height, waist circumference (WC), the sum of 4 skinfold thicknesses, diastolic blood pressure (DBP), systolic blood pressure (SBP), and cardiorespiratory fitness (CRF) measurements were taken and serum triglycerides and total-/high-density lipoprotein cholesterol ratio were analyzed. A sex- and age-specific clustered CMR score (n = 364) was computed. Associations were investigated by multilevel regression analyses adjusting for age, sex, center, socioeconomic status, and physical activity.

RESULTS

Underreporting (24.8% adolescents) was significantly (P < 0.05) associated with a higher WC, waist-to-height ratio (WHeR), and sum of skinfold thickness, whereas overreporting (23.4% adolescents) was significantly associated with a lower WC, WHeR, sum of skinfold thickness, and SBP. Associations between CMR factors and EI were significantly affected by misreporting, considering various approaches. Significant, positive associations became inverse after adjusting for misreporting for WC and WHeR. The opposite was true for the sum of skinfold thickness, SBP, and CMR score. The associations between EI and DBP and CRF did not remain significant after adjusting for misreporting.

CONCLUSIONS

CMR factors differed among misreporting groups, and both abdominal and total fat mass indicators were more strongly associated with all forms of misreporting than was BMI. Moreover, misreporting seems to bias EI and CMR associations in adolescents. Therefore, energy misreporting should be taken into account when examining diet-CMR associations.

Free Sugar Consumption and Obesity in European Adolescents: The HELENA Study

Few studies have evaluated the association between dietary free sugars intake (FSI) and obesity in adolescents. We examined the relation between FSI and their contributors from the main food groups and obesity in European adolescents. We included 843 adolescents (51.6% male) from the cross-sectional HELENA study with two completed 24 h recalls and anthropometric data. Linear mixed models were applied to investigate the relation between FSI and different anthropometric indices. Odds ratios for having a high body mass index (BMI) were also estimated by multilevel ordinal regression. Total FSI was higher in males than females (102.60 g and 87.58 g, respectively, p < 0.001). No effect was observed between free sugar from the main food groups and BMI. Consumers of FSI from "cakes, pies and biscuits" in males (odd ratio (OR) = 0.455; 95% Confidence interval (CI) 0.251, 0.824) and from "breakfast cereals" in females had a lower probability of having obesity (OR = 0.423; 95%CI 0.204, 0.878), whereas females consuming FSI from 'fruit and vegetables juices' had a higher probability of obesity (OR= 2.733; 95% CI 1.286, 5.810). This study provides no evidence that increased FSI is associated with obesity in adolescents. Further studies are needed to assess the longitudinal exposure to FSI and their effect on obesity development.

Drivers of adolescent adiposity: Evidence from the Australian LOOK study

OBJECTIVES

To contribute to our understanding of the drivers of body composition during adolescence we sought to employ valid and reliable measures to investigate cross-sectional and longitudinal relationships between percentage body fat (%BF) and physical activity (PA), moderate and vigorous PA (MVPA), sedentary time (ST), total energy, sugar and fat intake.

DESIGN

Longitudinal cohort study.

METHODS

We measured 556 (289 male) participants at age 12.4 (SD 0.4) years, and 269 (123 males) at 16.3 (SD 0.4) years, for %BF (dual energy X-ray absorptiometry); habitual PA, MVPA, ST (accelerometry); and dietary intake ('multi-pass' weekday and weekend 24-h recall). Accounting for likely under-reporting of energy intake (Goldberg cut-off), general linear mixed modelling was used to generate relationships with %BF.

RESULTS

Cross-sectional analyses indicated that 10min more MVPA per day was associated with 0.6 lower %BF (95%CI 0.4-0.9, p<0.001), and 10min less ST/day with 0.07 lower %BF (95%CI 0.00-0.15, p<0.001), independently of PA. In contrast, %BF was unrelated to total energy (p=0.4), sugar intake (p=0.2) or fat intake (p=0.9). Longitudinal analysis showed that if PA was increased by 3% (10,000 counts/day) over the 4 years, then %BF was reduced by 0.08 (95%CI 0.05-0.12, p=0.06).

CONCLUSIONS

The independent relationships of %BF with PA and ST, but absence of relationships with energy, sugar or fat intake, suggest that general community campaigns in a developed country directed at reducing adolescent obesity through modifications to energy intake and output would benefit from a more concerted focus on the latter.

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.

Cardiorespiratory Fitness as a Mediator of the Influence of Diet on Obesity in Children

The association between diet and obesity has been widely studied and it continues to be controversial; however, the extent to which cardiorespiratory fitness (CRF) acts as a confounder or mediator in this relation has not been analyzed. The aim of this study is to examine if the relation between diet and obesity is mediated by CRF. In this cross-sectional study, fat mass (by electronic bioimpedance) was measured in 320 schoolchildren, aged 9–11 years. Diet was measured through two computerised 24-h dietary recalls and CRF was assessed by the 20-m shuttle run test. Simple mediation analyses were fitted. CRF acts as a partial mediator in the negative relationship between dietary factors (energy intake/weight, carbohydrate intake/weight, protein intake/weight, and fat intake/weight) and fat mass. The percentage of mediation ranged from 24.3 to 33.2%. Thus, Spanish schoolchildren with higher levels of energy and macronutrients intake had lower adiposity levels, especially when they had good levels of CRF.

High School Physical Education Requirements and Youth Body Weight: New Evidence from the YRBS

Previous research has found that high school physical education (PE) requirements are largely ineffective at reducing youth body weight. However, these studies were forced to rely on cross-state variation in PE requirements to identify their impacts, raising concerns that estimated policy effects may be confounded by state-level unobservables. Using data from the State and National Youth Risk Behavior Surveys and exploiting recent changes in state high school PE laws, we re-examine the effect of PE requirements on body weight. Our estimates show that a one-semester increase in PE requirements is associated with a 10 to 13% increase in minutes per week spent physically active in PE classes, but with no change in net vigorous exercise and little change in youth body weight. We conclude that substitution of in-school for outside-of-school physical activity and small resultant net energy expenditures can explain the absence of body weight effects. Copyright © 2016 John Wiley & Sons, Ltd.

Fruit and vegetables consumption is associated with higher vitamin intake and blood vitamin status among European adolescents

BACKGROUND/OBJECTIVES

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.

SUBJECT/METHODS

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.

RESULTS

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 (P<0.05). 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 (P<0.05). 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 (P<0.05).

CONCLUSIONS

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.

Effects of Tailored Health Education Program on Overweight Elementary School Students' Obesity-Related Lifestyle: A School-Based Interventional Study

OBJECTIVES

Overweight and obesity are regarded as one of the most serious health and nutrition issues worldwide. This is immediately recognizable in both children and adolescents. In this study, we aimed to determine the effects of tailored education on lifestyle modification in elementary school students in Isfahan.

METHODS

In a quasi-experimental study, two elementary schools in Isfahan District 3, Iran, were randomly selected to determine the intervention and comparison groups. Subsequently, 32 students from each school, 64 in total, were chosen arbitrarily and included in the study. They filled out the standardized questionnaire of physical activity and dietary behaviors before the intervention. Following one and four months' educational intervention, they were asked to complete the questionnaires once more.

RESULTS

The average general lifestyle score, one and four months after education, was significantly different between the groups (p < 0.001). However, this difference was not significant before the intervention 
(p = 0.660). Furthermore, the average lifestyle scores related to nutrition and physical activity one and four months after education showed a significant difference between the groups (p < 0.001).

CONCLUSIONS

Providing overweight elementary school students with education about a healthy lifestyle improves their general lifestyle and reduces weight. Therefore, it is recommended that such interventions are applied to prevent complications associated with being overweight in children.

Variations in the Prevalence of Obesity Among European Countries, and a Consideration of Possible Causes

Over the last 10 years the prevalence of obesity across the European continent has in general been rising. With the exception of a few countries where a levelling-off can be perceived, albeit at a high level, this upward trend seems likely to continue. However, considerable country to country variation is noticeable, with the proportion of people with obesity varying by 10% or more. This variation is intriguing and suggests the existence of different profiles of risk or protection factors operating in different countries. The identification of such protection factors could indicate suitable targets for interventions to help manage the obesity epidemic in Europe. This report is the output of a 2-day workshop on the 'Diversity of Obesity in Europe'. The workshop included 14 delegates from 12 different European countries. This report contains the contributions and discussions of the materials and viewpoints provided by these 14 experts; it is not the output of a single mind. However, such is the nature of scientific analysis regarding obesity that it is possible that a different set of 14 experts may have come to a different set of conclusions. Therefore the report should not be seen as a definitive statement of a stable situation. Rather it is a focus for discussion and comment, and a vehicle to drive forward further understanding and management of obesity in Europe.

Diet misreporting can be corrected: confirmation of the association between energy intake and fat-free mass in adolescents

Subjective energy intake (sEI) is often misreported, providing unreliable estimates of energy consumed. Therefore, relating sEI data to health outcomes is difficult. Recently, Börnhorst et al. compared various methods to correct sEI-based energy intake estimates. They criticised approaches that categorise participants as under-reporters, plausible reporters and over-reporters based on the sEI:total energy expenditure (TEE) ratio, and thereafter use these categories as statistical covariates or exclusion criteria. Instead, they recommended using external predictors of sEI misreporting as statistical covariates. We sought to confirm and extend these findings. Using a sample of 190 adolescent boys (mean age=14), we demonstrated that dual-energy X-ray absorptiometry-measured fat-free mass is strongly associated with objective energy intake data (onsite weighted breakfast), but the association with sEI (previous 3-d dietary interview) is weak. Comparing sEI with TEE revealed that sEI was mostly under-reported (74 %). Interestingly, statistically controlling for dietary reporting groups or restricting samples to plausible reporters created a stronger-than-expected association between fat-free mass and sEI. However, the association was an artifact caused by selection bias – that is, data re-sampling and simulations showed that these methods overestimated the effect size because fat-free mass was related to sEI both directly and indirectly via TEE. A more realistic association between sEI and fat-free mass was obtained when the model included common predictors of misreporting (e.g. BMI, restraint). To conclude, restricting sEI data only to plausible reporters can cause selection bias and inflated associations in later analyses. Therefore, we further support statistically correcting sEI data in nutritional analyses. The script for running simulations is provided.

Body composition and energy intake - skeletal muscle mass is the strongest predictor of food intake in obese adolescents: The HEARTY trial

There has been renewed interest in examining the relationship between specific components of energy expenditure and the overall influence on energy intake (EI). The purpose of this cross-sectional analysis was to determine the strongest metabolic and anthropometric predictors of EI. It was hypothesized that resting metabolic rate (RMR) and skeletal muscle mass would be the strongest predictors of EI in a sample of overweight and obese adolescents. 304 post-pubertal adolescents (91 boys, 213 girls) aged 16.1 (±1.4) years with body mass index at or above the 95th percentile for age and sex OR at or above the 85th percentile plus an additional diabetes risk factor were measured for body weight, RMR (kcal/day) by indirect calorimetry, body composition by magnetic resonance imaging (fat free mass (FFM), skeletal muscle mass, fat mass (FM), and percentage body fat), and EI (kcal/day) using 3 day food records. Body weight, RMR, FFM, skeletal muscle mass, and FM were all significantly correlated with EI (p < 0.005). After adjusting the model for age, sex, height, and physical activity, only FFM (β = 21.9, p = 0.007) and skeletal muscle mass (β = 25.8, p = 0.02) remained as significant predictors of EI. FFM and skeletal muscle mass also predicted dietary protein and fat intake (p < 0.05), but not carbohydrate intake. In conclusion, with skeletal muscle mass being the best predictor of EI, our results support the hypothesis that the magnitude of the body's lean tissue is related to absolute levels of EI in a sample of inactive adolescents with obesity.

Relationship between lifestyle behaviors and obesity in children ages 9-11: Results from a 12-country study

OBJECTIVE

The aim was to assess associations between lifestyle behaviors and obesity in a multinational study of children from 12 countries representing a wide range of human development.

METHODS

The sample included 6,025 children 9-11 years of age. Behavioral risk factors included nocturnal sleep duration, moderate to vigorous physical activity (MVPA), television viewing (TV time), and healthy and unhealthy diet pattern scores. Multilevel analyses were used to obtain odds ratios for obesity expressed per standard deviation of each behavioral risk factor.

RESULTS

The odds ratios (95% confidence intervals) for obesity from multilevel, multivariable models were 0.79 (0.71-0.90) for nocturnal sleep duration, 0.52 (0.45-0.60) for MVPA, 1.15 (1.05-1.27) for TV time, 1.08 (0.96-1.20) for healthy diet score, and 0.93 (0.83-1.04) for unhealthy diet score in boys and 0.71 (0.63-0.80) for nocturnal sleep duration, 0.43 (0.35-0.53) for MVPA, 1.07 (0.96-1.19) for TV time, 1.05 (0.93-1.19) for healthy diet score, and 0.96 (0.82-1.11) for unhealthy diet score in girls.

CONCLUSIONS

Behavioral risk factors are important correlates of obesity in children, particularly low MVPA, short sleep duration, and high TV viewing.

Conceptual framework of a simplified multi-dimensional model presenting the environmental and personal determinants of cardiometabolic risk behaviors in childhood

Clinical manifestations of cardiometabolic risk (CMR) may be set early in childhood due to unfavorable behaviors or lifestyle patterns related to diet and physical activity. Several factors may determine the adoption of such lifestyle-related behaviors, which researchers have tried to cluster under certain frameworks or models. In this context, the framework developed and proposed by this review gathers all the present knowledge regarding these determining factors to date and groups them into three main categories related to personal characteristics and the social and physical environment. Based on the proposed framework, a large variety of personal, social and physical environmental factors can positively or negatively influence CMR-related behaviors (either directly or indirectly via their interrelations), thus leading to decreased or increased risk, respectively. This framework could be of great value to public health policy makers and legislators for designing and implementing interventional programs tailored to the needs of susceptible population groups who are most in need for such initiatives. Targeting the correlates as potential determinants of CMR-related behaviors, and not just on the behaviors themselves, has been shown previously to be the most effective approach for tackling health issues related to CMR starting from early life stages.

Comparison of body composition between professional sportswomen and apparently healthy age- and sex-matched controls

INTRODUCTION

In view of the relationship between physical activity and nutrition on body composition, we assessed lean and fat mass and BMC (total and regional) in professional Indian sportswomen and compared it with apparently healthy age- and sex-matched females.

MATERIALS AND METHODS

This cross-sectional study included 104 sportswomen and an equal number of age-matched normal healthy females (controls). They were evaluated for anthropometry and body composition (fat, lean mass, and bone mineral content (BMC) by DXA.

RESULTS

Mean age (19.1 ± 1.3 vs. 19.4 ± 1.5 years) and body mass index (21.34 ± 3.02 vs. 21.26 ± 4.05 kg/m(2)) were comparable in both groups. Sportswomen had higher intake of energy, macronutrients, calcium, phosphorus and magnesium. Total lean mass (33.67 ± 3.49 vs. 31.14 ± 3.52 kg, P < 0.0001), appendicular skeletal muscle index (5.84 ± 0.57 vs. 5.46 ± 0.63 kg/m(2); P < 0.0001) and BMC (2.27 ± 0.32 vs. 2.13 ± 0.34 kg, P < 0.002) was significantly higher and percentage fat mass was significantly lower (33.1 ± 7.5 vs. 37.0 ± 8.3; P < 0.0001) among sportswomen when compared to controls.

CONCLUSIONS

Indian sportswomen have a higher total and regional lean mass, BMC, and lower percentage fat mass when compared with healthy females. Physical activity, energy, protein and calcium intake were positively associated with lean mass and BMC.

Rationale and methods of a randomised cross-over cluster trial to assess the effectiveness of MOVI-KIDS on preventing obesity in pre-schoolers

BACKGROUND

Childhood obesity has become an alarming worldwide increasing public health problem. The earlier adiposity rebound occurs, the greater the risk of becoming obese during puberty and adolescence. It has been speculated about the potential influence of vigorous physical activity on modifying the age of onset of adiposity rebound. Moreover, studies aimed to evaluate the effectiveness of physical activity interventions programs on reducing adiposity and other cardiovascular risk factors in children younger than 6 years are scarce. This paper describes the rationale and methods of a study aimed to test the effectiveness of a two-years multidimensional pre-school intervention on preventing obesity and improving physical fitness during the adiposity rebound period.

METHODS/DESIGN

Twenty-one schools from the provinces of Cuenca and Ciudad Real, Spain, were randomised to an intervention and a control arm. In the first academic year, children in third grade of pre-school and first grade of primary school in the intervention group received the physical activity intervention (MOVI-KIDS). After an academic year schools were crossed over to the alternative arm. According to the socio-ecological model, the intervention included children, their parents and teachers, and the school environment where MOVI-KIDS was conducted. MOVI-KIDS consisted of: i) three-h/week sessions of recreational non-competitive physical activity in after-school time; ii) educational materials to parents and teachers about physical activity benefits and sedentary lifestyle risks; and iii) modifications in the playground to promote physical activity during recess. Baseline and post-intervention outcomes are going to be measured in both arms three times, at the beginning and at the end of first academic year, and at the end of the second academic year. Primary outcomes included body mass index, waist circumference, triceps skinfold thickness, percentage of both body fat and fat-free mass, and blood pressure. Secondary end points were physical activity, fitness, and carotid intima-media thickness.

DISCUSSION

This paper reports the design of a randomised cross-over cluster trial aimed at assessing the effectiveness of the multidimensional physical activity intervention (MOVI-KIDS) during two years in pre-school children.

TRIAL REGISTRATION

Clinical trials.gov: NCT01971840 . (Date of registration: Initial Release: 10/07/2013; Record Verification: 23/10/2013).

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

Adolescence is a critical period, because major physical and psychologic changes occur during a very short period of time. Changes in dietary habits may induce different types of nutritional disorders and are likely to track into adulthood. The aim of this review is to describe the key findings related to nutritional status in European adolescents participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. We performed a cross-sectional study in 3528 (1845 females) adolescents aged 12.5–17.5 y. Birth weight was negatively associated with abdominal fat mass in adolescents and serum leptin concentrations (in female adolescents), providing additional evidence for a programming effect of birth weight on energy homeostasis control. Breakfast consumption was associated with lower body fat content and healthier cardiovascular profile. Adolescents eat half of the recommended amount of fruit and vegetables and less than two-thirds of the recommended amount of milk and milk products but consume more meat and meat products, fats, and sweets than recommended. For beverage consumption, sugar-sweetened beverages, sweetened milk, low-fat milk, and fruit juice provided the highest amount of energy. Although the intakes of saturated fatty acids (FAs) and salt were high, the intake of polyunsaturated FAs was low. Adolescents spent, on average, 9 h/d of their waking time (66–71% and 70–73% of the registered time in boys and girls, respectively) in sedentary activities. Factors associated with adolescents’ sedentary behavior included the following: 1) age; 2) media availability in the bedroom; 3) sleeping time; 4) breakfast consumption; and 5) season. Sedentary time was also associated with cardiovascular risk factors and bone mineral content. In European adolescents, deficient concentrations were identified for plasma folate (15%), vitamin D (15%), pyridoxal 5′-phosphate (5%), β-carotene (25%), and vitamin E (5%). Scientists and public health authorities should raise awareness of the importance of a healthy and sustainable lifestyle as a foundation of the health of the European population, now and in the future.