Dietary changes in Swedish adolescents

Snacking among shiftwork nurses related to non-optimal dietary intake

AIMS

To compare nurses' non-optimal eating behaviours across different shifts, to examine whether non-day shifts were related to deviation from optimal dietary behaviours compared with day shifts and whether such deviation was related to non-optimal macronutrient intake.

DESIGN

This is a 4-day intensive longitudinal study.

METHODS

A convenience sample of hospital nurses was recruited in Taiwan. From September 2018 through January 2019, 120 participants completed 4-days of 24-h dietary recalls. One-way ANOVA and Kruskal-Wallis H test were used to compare differences in energy and macronutrient intake and frequency of meals and snacking, respectively. Generalized linear regressions examined (1) the associations between shiftwork schedules and non-optimal eating behaviours and (2) associations between non-optimal eating and high energy contribution of non-optimal macronutrients.

RESULTS

Nurses consumed less energy on evening and night shifts compared with day shifts. However, energy intake from snacking was higher on evening and night shifts relative to day shifts. Nurses consumed less meals but had higher snacking frequency on non-day shifts. In addition, high energy intake from snacking was positively associated with high energy intake from saturated fat.

CONCLUSIONS

Nurses were more likely to have non-optimal eating behaviours on non-day shifts, which may contribute to an increased intake of saturated fat; thus, increasing their risk of chronic diseases. Strategies to improve non-day shift nurses' non-optimal eating behaviours may be beneficial to their health.

IMPACT

Shiftwork is known to affect nurses' eating behaviours; however, which shift is associated with unhealthy eating remains inconclusive. Despite lower energy intakes, nurses had higher intake by snacking on evening and night shifts. High snacking intake was associated with a high intake of saturated fat. Hospitals can increase the availability of healthy foods on evening or night shifts, which may improve non-day shift nurses' non-optimal eating behaviours.

Dietary Patterns and Fitness Level in Mexican Teenagers

BACKGROUND

Nowadays, the term "physical fitness" has evolved from sports performance to health status, and it has been considered a strong predictor of cardiovascular disease. In this sense, test batteries have been developed to evaluate physical fitness such as the ALPHA-FIT battery. On the other hand, the analysis of dietary patterns has emerged as an alternative method to study the relationship between diet and chronic noncommunicable diseases. However, the association between dietary patterns and the physical fitness level has not been evaluated in both adults and adolescents. This association is most important in adolescents due to the fact that establishing healthy dietary behaviors and a favorable nutritional profile in early stages of life prevents various chronic-degenerative diseases.

OBJECTIVE

To analyze the association between dietary patterns and the level of fitness in Mexican teenagers.

METHODS

We analyzed the relationship between dietary patterns and the fitness level of 42 teenage students in Toluca, Mexico. Students were weighed and measured, and their food intake was recorded for 2 weekdays and one weekend day. Dietary patterns were obtained by factorial analysis. The ALPHA-FIT battery was used to measure the fitness level.

RESULTS

Fifty percent of the students were found to have a low fitness level (62.1% men; 37.9% women). There was no association (X2 = 0.83) between the dietary patterns "high in fat and sugar," "high in protein", and "low in fat and protein" and the level of physical condition in teens.

CONCLUSIONS

In this study, all of teenagers with a very low level of fitness obtained a high dietary pattern in protein; however, 40% with a high level of physical condition resulted in the same pattern; that is why we did not find a relationship between the fitness level and the patterns investigated in this study.

Sources of saturated fat and sucrose in the diets of Swedish children and adolescents in the European Youth Heart Study: strategies for improving intakes

OBJECTIVE

To compare macronutrient intakes of Swedish children and adolescents to population goals; to identify the major sources of energy, fat, saturated fat and sucrose; and to simulate the effect adherence to current food-based dietary guidelines (FBDG) would have on saturated fat and sucrose intakes.

DESIGN

Cross-sectional study. From 24 h recall data, food groups contributing most to energy, fat, saturated fat and sucrose were identified. Based on the prevailing consumption of foods mentioned in the FBDG, we simulated five scenarios: changes in milk and yoghurt; cheese; energy-dense, nutrient-dilute foods; soft drinks; and burger and sausage consumption.

SETTING

Stockholm and Örebro (Sweden) in 1998-1999.

SUBJECTS

Children (n 551, 9·6 years) and adolescents (n 569, 15·5 years) participating in the European Youth Heart Study.

RESULTS

Intakes of saturated fat and sucrose exceeded population goals in all age and gender subgroups. Compliance to the goal for saturated fat was lower in children, particularly boys. Compliance to the sucrose goal was lower among adolescents. The major sources of energy, fat, saturated fat and sucrose in the diet reflect not only the traditional Swedish diet but also the influence of energy-dense, nutrient-dilute foods. The simulations suggest that a combination of FBDG is required to bring both saturated fat and sucrose intakes in line with recommendations.

CONCLUSIONS

Widespread adherence to a combination of FBDG could theoretically bring mean intakes in line with population goals. The effect on overall nutrient intakes as well as consumer acceptance of such changes needs to be considered.

How to find information on national food and nutrient consumption surveys across Europe: systematic literature review and questionnaires to selected country experts are both good strategies

The present research was conducted within the framework of the EURopean micronutrient RECommendations Aligned project. In order to identify the best practice in assessing nutrient intakes, a search strategy for collecting data from national food consumption surveys/studies in Europe was developed. Systematic literature searches were carried out on twenty-eight European and the four European Free Trade Association countries. A questionnaire was also sent to two to five experts in each country. Systematic reviews using PubMed yielded 12 703 abstracts that were reduced to 200 studies using inclusion and exclusion criteria. Similarly, a search of ministry web sites yielded 3033 hits, and subsequently reduced to nine surveys. Belgium, France, Germany, Ireland, Sweden, Spain and the United Kingdom were the countries with most data and Slovenia and Liechtenstein were those with the least. Seventy-eight expert questionnaires were obtained from all countries except for Liechtenstein, Luxembourg and Slovakia. Detailed results and references are given. A systematic search and questionnaires are equally good at identifying national surveys across countries. Literature searching provides globally accessible and objective information albeit limited, whereas the questionnaire provides information that, depending upon responders, can be more complete. A combination of both strategies is recommended.

Salt intakes around the world: implications for public health

BACKGROUND

High levels of dietary sodium (consumed as common salt, sodium chloride) are associated with raised blood pressure and adverse cardiovascular health. Despite this, public health efforts to reduce sodium consumption remain limited to a few countries. Comprehensive, contemporaneous sodium intake data from around the world are needed to inform national/international public health initiatives to reduce sodium consumption.

METHODS

Use of standardized 24-h sodium excretion estimates for adults from the international INTERSALT (1985-87) and INTERMAP (1996-99) studies, and recent dietary and urinary sodium data from observational or interventional studies--identified by a comprehensive search of peer-reviewed and 'grey' literature--presented separately for adults and children. Review of methods for the estimation of sodium intake/excretion. Main food sources of sodium are presented for several Asian, European and Northern American countries, including previously unpublished INTERMAP data.

RESULTS

Sodium intakes around the world are well in excess of physiological need (i.e. 10-20 mmol/day). Most adult populations have mean sodium intakes >100 mmol/day, and for many (particularly the Asian countries) mean intakes are >200 mmol/day. Possible exceptions include estimates from Cameroon, Ghana, Samoa, Spain, Taiwan, Tanzania, Uganda and Venezuela, though methodologies were sub-optimal and samples were not nationally representative. Sodium intakes were commonly >100 mmol/day in children over 5 years old, and increased with age. In European and Northern American countries, sodium intake is dominated by sodium added in manufactured foods ( approximately 75% of intake). Cereals and baked goods were the single largest contributor to dietary sodium intake in UK and US adults. In Japan and China, salt added at home (in cooking and at the table) and soy sauce were the largest sources.

CONCLUSIONS

Unfavourably high sodium intakes remain prevalent around the world. Sources of dietary sodium vary largely worldwide. If policies for salt reduction at the population level are to be effective, policy development and implementation needs to target the main source of dietary sodium in the various populations.

Changes in consumption of sugars by English adolescents over 20 years

OBJECTIVE

Dietary surveys of 11- to 12-year-old Northumbrian children in 1980 and 1990 revealed that consumption of non-milk extrinsic sugars (NMES) was 16-17% of energy intake. This study reports dietary sugars consumption in 2000 and compares it with data collected in 1980 and 1990, using identical methods.

DESIGN

A repeat cross-sectional dietary survey of children aged 1-12 years attending the same schools as in the 1980 and 1990 surveys.

SETTING

Seven middle schools in south Northumberland.

SUBJECTS

All children aged 11-12 years old attending the seven schools.

METHOD

Food consumption was recorded using two 3-day diet diaries. Food composition tables were used to calculate energy and nutrient intakes. NMES, and milk and intrinsic sugars were calculated using previously described methods.

RESULTS

The numbers of children completing the surveys in 1980, 1990 and 2000 were 405, 379 and 424, respectively; approximately 60-70% of eligible children. Total sugars provided 22% of energy consistently over the three surveys. NMES consumption in 2000 provided 16% of energy compared with 16% in 1980 and 17% in 1990. Sources of NMES changed over the three surveys. NMES from soft drinks doubled from 15 to 31 g day(-1), and from breakfast cereals increased from 2 to 7 g day(-1) over the 20 years. Confectionery and soft drinks provided 61% of NMES. Over 20 years, the proportion of energy from fat decreased by 5% and from starch increased by 4%, creating a welcome tilt in the fat-starch see-saw, without an adverse effect on sugars intake.

CONCLUSIONS

Consumption of NMES in 2000 was substantially higher than recommended, and there has been little change over 20 years. Continued and coordinated efforts are required at a national, community and individual level to reduce the intake of NMES.

Fifteen-year time trends in energy and macronutrient intake in German children and adolescents: results of the DONALD study

The DONALD study (Dortmund Nutritional and Anthropometric Longitudinally Designed study) gives the opportunity to evaluate long-term food and nutrient intake data on the basis of 3 d weighed dietary records of infants, children and adolescents since 1985. In this paper, we examine changes in energy and macronutrient intakes (protein, fat, saturated, mono- and polyunsaturated fatty acids, carbohydrates and added sugars) of 795 2–18-year-old subjects between 1985 and 2000 (4483 records). No significant changes in intakes of energy and of protein, polyunsaturated fatty acids and added sugars (as % energy intake, E %) were found. Fat intake decreased significantly in all age groups (between -0·20 and -0·26 E %/year), as well as intake of saturated fatty acids (between -0·11 and -0·14 E %/year) and monounsaturated fatty acids (between -0·07 and -0·014 E %/year). This decline was compensated for by a significant increase in carbohydrate intake (between +0·18 and +0·27 E %/year). The changes in macronutrient intake were mainly due to a decreased consumption of fats–oils (between -0·29 and -1·26 g/year) and meat–fish–eggs (between -0·21 and -2·92 g/year), whereas consumption of bread–cereals (between +0·12 and +2·42 g/year) and potatoes–pasta–rice (between +0·15 and +2·26 g/year) increased slightly. However, since recommended fat intake and fatty acid composition was not reached at the end of the study period by far, further efforts will be necessary to improve macronutrient composition and to stabilize favourable dietary habits.

Dietary intake and nutritional status of children and adolescents in Europe

The objective of this project was to collect and evaluate data on nutrient intake and status across Europe and to ascertain whether any trends could be identified. Surveys of dietary intake and status were collected from across Europe by literature search and personal contact with country experts. Surveys that satisfied a defined set of criteria – published, based on individual intakes, post-1987, adequate information provided to enable its quality to be assessed, small age bands, data for sexes separated above 12 years, sample size over 25 and subjects representative of the population – were selected for further analysis. In a small number of cases, where no other data for a country were available or where status data were given, exceptions were made. Seventy-nine surveys from 23 countries were included, and from them data on energy, protein, fats, carbohydrates, alcohol, vitamins, minerals and trace elements were collected and tabulated. Data on energy, protein, total fat and carbohydrate were given in a large number of surveys, but information was very limited for some micronutrients. No surveys gave information on fluid intake and insufficient gave data on food patterns to be of value to this project. A variety of collection methods were used, there was no consistency in the ages of children surveyed or the age cut-off points, but most surveys gave data for males and females separately at all ages. Just under half of the surveys were nationally representative and most of the remainder were regional. Only a small number of local surveys could be included. Apart from anthropometric measurements, status data were collected in only seven countries. Males had higher energy intakes than females, energy intake increased with age but levelled off in adolescent girls. Intakes of other nutrients generally related to energy intakes. Some north–south geographical trends were noted in fat and carbohydrate intakes, but these were not apparent for other nutrients. Some other trends between countries were noted, but there were also wide variations within countries. A number of validation studies have shown that misreporting is a major problem in dietary surveys of children and adolescents and so all the dietary data collected for this project should be interpreted and evaluated with caution In addition, dietary studies rely on food composition tables for the conversion of food intake data to estimated nutrient intakes and each country uses a different set of food composition data which differ in definitions, analytical methods, units and modes of expression. This can make comparisons between countries difficult and inaccurate. Methods of measuring food intake are not standardised across Europe and intake data are generally poor, so there are uncertainties over the true nutrient intakes of children and adolescents across Europe. There are insufficient data on status to be able to be able to draw any conclusions about the nutritional quality of the diets of European children and adolescents.

Eating habits in relation to body fatness and gender in adolescents--results from the 'SWEDES' study

OBJECTIVE

To investigate if eating habits among adolescents are related to body fatness and gender.

DESIGN

Cross-sectional study.

SETTING

Obesity Unit, Huddinge University Hospital, Sweden, 2001-2002.

SUBJECTS

Two hundred and seventy-five girls and 199 boys, aged 16-17 years.

METHOD

Questionnaires were used for dietary intake and meal frequency, BodPod for measuring body fatness (BF%). In all, 169 girls and 128 boys were classified as adequate reporters (AR) of energy intake, and were used in the dietary analyses. The whole sample was used in the meal frequency analyses.

RESULTS

The correlation between reported energy intake and weight in the AR group was 0.23 (P<0.01) for girls and 0.36 for boys (P<0.001). The correlations were inverse or not significant in the whole sample. The following variables correlated significantly with a high BF% (r (s)=+/-0.2): a low intake of milk in both girls and boys, a high intake of fibre and alcohol and a low intake of sugar in girls and a low intake of breakfast cereals in boys. Those with regular breakfast habits had healthier food choices than others, but this was not related to BF%. Boys had more meals per day (4.9 vs 4.6, P=0.02), especially early in the morning and late at night, whereas girls reported a higher relative intake of light meals and fruit and a lower intake of milk than boys.

CONCLUSIONS

A few associations between eating habits and body fatness were found, but without any obvious patterns. The true differences in eating habits between lean and overweight adolescents are probably very small.

Bone mineral density in relation to body mass index among young women: a prospective cohort study

AIM

To identify important predictors among lifestyle behaviours and physiological factors of bone mineral density (BMD) in relation to body mass index (BMI) among young women over a 2-year period. DESIGN, SAMPLE AND MEASUREMENTS: Data were collected in 1999 and 2001. Healthy young women (n=152) completed a questionnaire. BMD measurements were performed by DEXA in the calcaneus. The women were subdivided into three categories according to baseline BMI.

RESULTS

Baseline bodyweight explained 25% of the variability in BMD at follow-up in the BMI<19 category, and high physical activity seemed to hinder BMD development. In the BMI>24 category, a difference in time spent outdoors during winter between baseline and follow-up was the single most important factor for BMD levels. Overweight women with periods of amenorrhoea had lower BMD than overweight women without such periods.

CONCLUSIONS

Predictors and lifestyle behaviours associated with BMD are likely to be based on women of normal weight. BMI should be considered when advising on physical activity, since high physical activity seems to impair BMD development among underweight young women, possibly due to energy imbalance. Among overweight women, sleep satisfaction is the greatest predictor associated with BMD change and may indicate better bone formation conditions. Energy balance and sleep quality may be prerequisites of bone health and should be considered in prevention.

A school-based intervention to promote dietary change

PURPOSE

This study examined the effect of 2 school-based interventions on adolescents' consumption and knowledge of fish with the hypothesis that home economics education would enhance the effect of modifications in the school canteen. The school lunch intervention (SL) focused on changes in the school canteen, and the school lunch + home economics intervention (SL + HE) in addition consisted of changes in the home economics syllabus. Pupils in the 8th grade (n = 228) from 3 schools in Göteborg, Sweden, participated (control, n = 83; SL group, n = 58; SL + HE group, n = 87).

METHODS

A controlled design was used in which behavior and knowledge were assessed before and after the intervention. In contrast to much previous research of this type, measurement of behavior was based primarily on direct observation as opposed to self-reported intakes. Behavior (fish consumption) was measured individually by structured observations in the school canteen 5 times (once a week) when fish was served. Nutritional knowledge was measured by means of 10 items in a questionnaire. To analyze changes in behavior, a nonparametric statistical method assessing systematic change in paired ordered categoric variables was used.

RESULTS

At follow-up evaluation, consumption had increased significantly in the SL + HE group, a change that also differed from the control group. In addition, significant positive changes in knowledge were observed in both intervention groups, but not in controls.

CONCLUSIONS

The results suggest that dietary change was achieved by modifying conditions in the school canteen together with changing the home economics syllabus. This study shows the importance of the school in the promotion of dietary change among adolescents.

Young women's lifestyle behaviours and their bone mineral density changes: a grounded theory analysis

BACKGROUND

Only limited information is available on healthy young women's perspective of their own lifestyle behaviours. By lifestyle behaviours, e.g. smoking and physical activity, individuals have the possibility to influence bone mineral density (BMD). The aim of this study was to generate a theoretical model of lifestyle behaviours among young women with different BMD changes.

METHODS

Data were collected by interviewing with 11 women, and the material was analysed by means of the grounded theory.

FINDINGS

Two core categories were generated: (i) the respondents' outlook on life and (ii) their life situation. The respondents' outlook on life was either 'rigid' or 'relaxed'. Respondents who had a rigid outlook on life adjusted with others and had a decreased BMD while those with a relaxed outlook on life were doing things for fun and had an increased BMD level. Life situation also consisted of two categories: 'stagnation' and 'development'. Respondents in a static life situation did not pursue any active actions while in a developing life situation, the respondents were actively striving towards a goal. Four dimensions which characterized the respondents' outlook on life in relation to their life situation emerged: subordinating and enduring with a decreased BMD level or compromising and discerning with an increased BMD level.

CONCLUSION

It seems as if the outlook on life has a greater influence than the acted lifestyle behaviour for bone development. Further research is needed to generalize the findings of this study and to explore the importance of the outlook on life among women of all ages.

Longitudinal changes in diet from childhood into adulthood with respect to risk of cardiovascular diseases: The Cardiovascular Risk in Young Finns Study

OBJECTIVE

To assess nutrient intakes relevant in the prevention of cardiovascular diseases (CVD) among young adults in Finland and to find past and present determinants of quality of diet.

DESIGN

Prospective study, 21 years of follow-up.

SETTING

The Cardiovascular Risk in Young Finns Study, Finland.

SUBJECTS

At baseline in 1980: 3569 children aged 3-18 y participated (83% of those invited), and every second of them (1780) were selected to the dietary study. At follow-ups in 1986 and 2001: 1200 and 1037 of the original sample, respectively, participated.

METHODS

Food consumption was assessed using 48-h dietary recall. Intakes in 2001 were compared with those obtained in 1980 and 1986. Nutrients selected for further examination were those implicated in the risk of CVD: saturated, monounsaturated, polyunsaturated and n-3 fatty acids, fibre and salt. An index describing the quality of adulthood diet was constructed. Multivariate logistic regression was used to identify independent childhood and adulthood determinants of the quality index.

RESULTS

The average intakes showed substantial changes since 1980. Intakes of fat and saturated fat had decreased, while the consumption of vegetables and fruit had increased. However, a great disparity was present between the recommended levels and actual intakes for many of the nutrients, particularly salt, saturated fat and fibre. Intake of fat and consumption of vegetables in childhood and physical activity in adulthood were important health behavioural determinants of the cardiovascular quality of the adult diet. Socio-demographic factors, including education of the subject and their parents, had no significant associations with diet.

CONCLUSIONS

While intakes of energy and nutrients have changed favourably in Finnish young adults between 1980 and 2001 with regard to the risk of CVD, they are still far from recommended levels. Childhood diet is a significant determinant of adult diet even after 21 y.

SPONSORSHIP

This study was supported by the Academy of Finland (grant 77841) and Juho Vainio Foundation.

Assessment of habitual meal pattern and intake of foods, energy and nutrients in Swedish adolescent girls: comparison of diet history with 7-day record

OBJECTIVE

To compare the diet history (DH) method to an estimated 7-day record (7-d) concerning meal pattern and intake of foods, energy and nutrients.

DESIGN

After the DH interview, subjects completed the 7-d.

SETTING

School setting, Göteborg, Sweden.

SUBJECTS

A total of 51 adolescent girls (15-16 y) recruited from 634 girls participating in The Göteborg Adolescence Study.

RESULTS

Two-thirds of the girls had identical or similar main meal pattern, while the number of in-between meals was higher using DH (P<0.001). Breakfast was the meal that agreed best and dinner during weekends. Energy intake (EI) was 8% higher in DH compared to 7-d (P=0.056). The ratio EI to basal metabolic rate was 1.35 (1.14, 1.65) using DH and 1.26 (1.08, 1.52) using 7-d, indicating under-reporting in both methods. Intake of vegetables, juice, sweets, soft-drinks and jam did not differ between the methods, but for the rest of the intake DH estimates were higher (P<0.05). The calculated nutrient intake was higher by DH, with exception of fat and sucrose. For the main food groups, energy and nutrients, except alcohol, ranking was similar between the methods. Adjusted for EI (10 MJ), intake of fat and sucrose were lower and protein, calcium and fibre were higher by DH (P<0.01). EI did not differ for lunch and dinner, but was higher in breakfast and in-between meals using DH. Intake of foods and nutrients in lunches and meat and fish for lunch and dinner did not differ.

CONCLUSIONS

The diet history seems to work well as a reference method for dietary assessments in this age group.

SPONSORSHIP

The Swedish Medical Research Council (project B94-19X-04721-19A), the Swedish Mill Industry, The Wilhelm and Martina Lundgren Foundation and The Swedish Nutrition Foundation.

Established and recently identified coronary heart disease risk factors in young people: the influence of physical activity and physical fitness

Epidemiological studies have identified several risk factors for coronary heart disease (CHD), many of which are present in young people. [For the purpose of this review, the phrase "young people" embraces both children and adolescents.] One such risk factor is hypertension. In adults, exercise is thought to have a positive effect on blood pressure levels; however, findings are inconclusive for young people. Despite its association with CHD, obesity is on the increase in Western society's young population; prevention and intervention during early years is needed. An active lifestyle is considered to have a beneficial effect on body fatness. Lipoprotein profiles are directly associated with CHD status. In adults, there is some evidence that physical activity and/or fitness have a favourable effect on lipoprotein levels. Although information regarding the younger population is more ambiguous, it tends to concur with these findings. High levels of lipoprotein(a), are considered an independent risk factor for CHD. Relatively little has been written on young people, although some studies have postulated a favourable relationship with physical activity. An inverse relationship between aerobic fitness and CHD has been confirmed in adults; an association is not as easily verified for young people. Physical activity is similarly deemed to have a beneficial effect on health status. A high-fat diet has been linked to CHD in adults, and evidence to date reports similar findings for young people. Smoking increases the risk of CHD and even moderate smoking during youth could have damaging long-term consequences. There is some evidence that smoking is related to physical activity and fitness levels in young people. In adults, high levels of homocyst(e)ine have been associated with CHD. As yet, little has been written on the relationship between physical activity or physical fitness and homocysteine status in young people. High levels of plasma fibrinogen have been linked to CHD. Several studies have explored the relationship between plasma fibrinogen and physical activity and/or fitness in adults, but findings are inconclusive; for young people, the ambiguity is even greater. C-reactive protein is a molecular marker for CHD but, to date, little attention has been given to this aspect, especially amongst young people. The link between high levels of plasminogen activator inhibitor-1 and CHD has been confirmed, although the essence of this relationship is not established. There is a paucity of data on the younger population and the relevance of collating such information is questionable. For the younger population, most research is limited to the established CHD risk factors and further investigations of recently identified CHD risk factors are needed.

Meal pattern, food choice, nutrient intake and lifestyle factors in The Göteborg Adolescence Study

OBJECTIVE

To relate meal pattern of Swedish adolescents to food choice, nutrient intake and other lifestyle factors.

DESIGN

Cross-sectional study including diet history and interview about smoking, ethnicity, social factors and retrospectively collected data of menarche and growth.

SETTING

School setting, Göteborg, Sweden.

SUBJECTS

A total of 611 boys and 634 girls in grade 9 (15-16 y).

RESULTS

The majority of the students, 65% of the boys and 52% of the girls, consumed three main meals daily. The in-between meals, however, contributed the major part of the energy intake. The energy intake was 12.9+/-3.5 MJ (mean+/-s.d.) for boys and 9.0+/-2.5 MJ for girls. Irregular breakfast eating, 12% of the boys and 24% of the girls, was related to negative lifestyle factors where smoking was the strongest, odds ratio 3.8 (95% CI: 2.6-5.4) and to irregular intake of lunch and dinner. These boys and girls had a food choice including a higher percentage of energy from snack food (26% vs 20% and 19% in boys and girls respectively, all P<0.001), mostly consumed between the main meals. These groups had significantly lower intakes of micronutrients, but higher intakes of sucrose and alcohol compared to the groups with regular breakfast intake. Girls omitting breakfasts and lunches (8%) also had a less healthy food choice and the poorest nutrient intake. These girls had matured earlier, with menarche age of 12.2+/-1.1 y vs 12.9+/-1.0 y (P<0.001) in girls with regular main meal intake.

CONCLUSIONS

Meal pattern with omission of breakfast or breakfast and lunch was related to a clustering of less healthy lifestyle factors and food choice leading to a poorer nutrient intake.

SPONSORSHIP

The Swedish Medical Research Council (project B94-19X-04721-19A), the Swedish Mill Industry and the Wilhelm and Martina Lundgren Foundation.

Time trends in the consumption of dairy foods in German children and adolescents

OBJECTIVE

Examination of time trends in the consumption of dairy food and their impact on fat and calcium intakes in German children and adolescents.

DESIGN

Dietary records from the DONALD Study (DOrtmund Nutritional and Anthropometric Longitudinally Designed Study).

METHODS

A total of 5068 3-day weighed dietary records from 914 1 to 13-y-old children and adolescents collected between 1986 and 2001 were analysed using a mixed linear model, in which the means of the data and the covariance structure specific to the DONALD Study were modelled.

RESULTS

During the study period, the consumption of 'milk products' in children and adolescents >/=4 y remained stable, since the reduced consumption of 'fluid milk' (between -2.8 and -7.4 g/day/study year) was compensated for by an increased consumption of 'yoghurt' (between +2.4 and +3.3 g/day/study year). The consumption of 'cheese' increased in subjects >/=4 y (between +0.2 and +0.7 g/day/study year). In 1 to 3-y-old children, the decreased intake of 'fluid milk' (-6.5 g/day/study year) was not compensated for by the increased intake of 'formula' (+3.5 g/day/study year). The percentage of 'low-fat milk products' significantly increased (although not significant in 9-13-y-old boys) to nearly 25% of milk products. The impact of dairy food on fat intake (as percentage of energy intake) remained stable with the exception of a slight reduction in 4-8 y olds, the impact of dairy on calcium (as percentage of US adequate intake) decreased only in 1-3 y olds.

CONCLUSIONS

The consumption of dairy food remained widely stable over time in >/=4-y-old children and adolescents, but decreased in 1-3 y olds. A further decline in this age group would be undesirable as is the shift from common milk to formula. The intake of 'low-fat milk products' increased and should be continuously promoted.

Risk factors for low iron intake and poor iron status in a national sample of British young people aged 4-18 years

OBJECTIVE

To examine the prevalence and dietary, sociodemographic and lifestyle risk factors of low iron intake and poor iron status in British young people.

DESIGN

National Diet and Nutrition Survey of young people aged 4-18 years.

SETTING

Great Britain, 1997.

SUBJECTS

In total, 1699 young people provided 7-day weighed dietary records, of which 11% were excluded because the participant reported being unwell with eating habits affected. Blood was obtained from 1193 participants, with iron status indicated by haemoglobin, serum ferritin and transferrin saturation.

RESULTS

Iron intakes were generally adequate in most young people aged 4-18 years. However, low iron intakes (below the Lower Reference Nutrient Intake) occurred in 44% of adolescent girls (11-18 years), being less prevalent with high consumption of breakfast cereals. Low haemoglobin concentration (<115 g l-1, 4-12 years; <120 or <130 g l-1, 13+ years for girls and boys, respectively) was observed in 9% of children aged 4-6 years, pubertal boys (11-14 years) and older girls (15-18 years). Adolescent girls who were non-Caucasians or vegetarians had significantly poorer iron status than Caucasians or meat eaters, independent of other risk factors. The three iron status indices were correlated significantly with haem, but not non-haem, iron intake.

CONCLUSIONS

Adolescent girls showed the highest prevalence of low iron intake and poor iron status, with the latter independently associated with non-Caucasian ethnicity and vegetarianism. Risk of poor iron status may be reduced by consuming (particularly lean red) meat or enhancers of non-haem iron absorption (e.g. fruit or fruit juice) in vegetarians.

Estimated energy intake, macronutrient intake and meal pattern of Flemish adolescents

OBJECTIVE

To describe the energy and macronutrient intake and the meal patterns of Flemish adolescents, aged 13-18 y.

METHODS

A 7 day estimated food record was administered to the whole sample.

SETTING

Secondary schools in the city of Ghent, Belgium.

SUBJECTS

A total of 341 adolescents (13-18 y) selected by a multistage clustered sampling (participation: 72.7%).

MAIN RESULTS

A significant increase with age was observed in total energy intake in adolescent boys (P<0.01), but not in girls. The energy distribution over the macronutrients showed no significant difference between boys and girls. On average, 35.7% (s.d. 4.81%) of energy came from total fat and 15.4% (s.d. 2.46%) from saturated fatty acids; 49.0% (s.d. 5.28%) from total carbohydrates with 25.1% (s.d. 4.49%) from complex carbohydrates and 23.9% (s.d. 5.86%) from free sugars. The energy contribution of alcohol in the 16-18 y-old-group was significantly higher as compared with the 13-15 y-old-group, for both boys and girls. Snacks between meals accounted for almost 20% of the total energy intake. Lunch and dinner were characterized by high total fat content.

CONCLUSION

These students consumed a diet high in total fat and in saturated fatty acids and also high in mono- and disaccharides. Observed mean intakes deviate considerably from the Belgian dietary guidelines. A low energy intake at breakfast was observed, while a higher proportion of energy was derived from snacks.

Dietary intake and nutritional status of young vegans and omnivores in Sweden

BACKGROUND

Adolescents sometimes become vegetarian for ethical rather than health reasons. This may result in health problems caused by lack of interest in and knowledge of nutrition.

OBJECTIVE

We compared the dietary intake and nutritional status of young Swedish vegans and omnivores.

DESIGN

The dietary intakes of 30 vegans (15 males and 15 females; mean age: 17.5 +/- 1.0 y) and 30 sex-, age-, and height-matched omnivores were assessed with the use of a diet-history interview and validated by the doubly labeled water method and by measuring nitrogen, sodium, and potassium excretion in urine. Iron status and serum vitamin B-12 and folate concentrations were measured in blood samples.

RESULTS

The diet-history method underestimated energy intake by 13% and potassium intake by 7% compared with the doubly labeled water method and 24-h urine excretion, respectively. Reported dietary nitrogen and sodium intakes agreed with the 24-h urinary excretion measure. Vegans had higher intakes of vegetables, legumes, and dietary supplements and lower intakes of cake and cookies and candy and chocolate than did omnivores. Vegans had dietary intakes lower than the average requirements of riboflavin, vitamin B-12, vitamin D, calcium, and selenium. Intakes of calcium and selenium remained low even with the inclusion of dietary supplements. There was no significant difference in the prevalence of low iron status among vegans (20%) and omnivores (23%). Two vegans with low intakes of vitamin B-12 had low serum concentrations.

CONCLUSION

The dietary habits of the vegans varied considerably and did not comply with the average requirements for some essential nutrients.

Blood lipids, fatty acids, diet and lifestyle parameters in adolescents from a region in northern Norway with a high mortality from coronary heart disease

INTRODUCTION

Students aged 13 and 14 y, in a region in northern Norway with high blood cholesterol levels and high mortality from coronary heart disease (CHD) in the adult population, were studied with respect to lifestyle, dietary habits, nutritional intake and blood lipids including fatty acids in serum. The students came from a coastal community with seawater fish as an important part of the traditional diet, and an inland community with meat from reindeer as a major constituent of the diet.

OBJECTIVE

To investigate whether the traditional diet was maintained among the adolescents and to evaluate the lifestyle and blood lipids. The study was followed up after 1 y.

RESULTS

The adolescents from the coastal region did not maintain the traditional diet. In the inland region the students had a high intake of meat, probably reflecting the traditional food culture. The inland boys had higher mean body mass index (BMI) than the coastal boys, and 12% had BMI>28, as compared to none of the coastal boys. Other findings showed that the students had higher levels of blood cholesterol than in the south of Norway and several other countries (about 25% had total cholesterol >5.2 mmol/l), higher intake of dietary sugar and fat than the national recommendations and little intake of seawater fish with corresponding low levels of n-3 fatty acids. This did not change after 1 y of follow up. Some 10-20% reported daily smoking and 8-13% reported that they rarely or never did physical exercise. About 30% of the students presented no factors negatively related to development of cardiovascular disease.

CONCLUSION

The findings demonstrate, in the majority of students at the age of 13 and 14 y, the appearance of factors contributing to development of cardiovascular disease (CHD).

SPONSORSHIP

This study was supported by the program 'Medisinsk forskning i Finnmark, University of Tromsø'.

Changes in food habits in healthy Swedish adolescents during the transition from adolescence to adulthood

OBJECTIVE

To investigate the change in food habits in Swedish adolescents between 15 and 21 y of age with reference to age, sex, region and socioeconomic background.

DESIGN

A longitudinal study from 1993 to 1999.

SETTING

Two different regions in Sweden, the university city of Uppsala and the industrial town of Trollhättan.

SUBJECTS

On three different occasions, 1993, 1995 and 1999, 208 adolescents, 96 males and 112 females, were studied.

METHODS

A food frequency questionnaire containing 29 different food groups was used. The questionnaire also contained questions about food habits and amounts of some food items and socioeconomic conditions of the participants and their families.

RESULTS

At 17 and 21 y of age, the adolescents consumed significantly more often pasta, vegetables, coffee and tea compared to age 15, while the frequency consumption of fat spread, milk, bread, potatoes, carrots and buns and biscuits decreased. The changes between 15 and 17 were smaller than between age 17 and 21. At age 21, the males decreased their intake of fruit, while the females decreased their intake of meat. No-meat consumers among females increased from 2 to 13%. Higher educational level of the mothers of the adolescents was associated with more frequent consumption of vegetables and pasta between ages 17 and 21. Milk consumption decreased significantly in both sexes. Breakfast habits did not change: 90% had breakfast five times/week or more.

CONCLUSIONS

Food habits change significantly during adolescence along with lifestyle changes. Therefore, health promotion during adolescence ought to be more supported by the society.

Dietary fat intake in healthy adolescents: inverse relationships between the estimated intake of saturated fatty acids and serum cholesterol

The objective of the present study was to describe the intake of dietary fatty acids among healthy 15-year-old boys and girls and to relate the intake of specific fatty acids and the fatty acid composition of the serum cholesterol esters to serum lipid, apolipoprotein (Apo) and insulin concentrations respectively. Fifty-two girls and forty-two boys were randomly selected from the official population register. Unexpectedly, significant inverse associations were found between the dietary content of saturated fatty acids with a chain length of four to fifteen C atoms, mainly derived from milk fat, as well as the corresponding fatty acids in the serum cholesterol esters, on the one hand and the serum concentrations of cholesterol and ApoB on the other. The estimated dietary intake of 4:0-10:0, 12:0 and 14:0 respectively, were all significantly inversely related to the serum cholesterol (r -0.32, r -0.31, r -0.30, all and ApoB (r -0.42, r -0.42, and r -0.40, all concentrations in girls and 12:0 to the ApoB concentration (r -0.55, in boys. The proportions of 12:0 and 15:0 in the serum cholesterol esters were negatively correlated with the serum cholesterol concentrations in both girls (r -0.34, r -0.32, and boys (r -0.53, r -0.32, and with the ApoB concentrations among boys (r -0.61, r -0.43, It is conceivable that milk fat contains or is associated with some component in the diet, or some other characteristics of the food intake, which counterbalances the expected positive relationships between saturated fat intake and lipid levels.

Consumo de energia e macronutrientes por adolescentes de escolas públicas e privadas

O objetivo deste trabalho foi avaliar a adequação do consumo de energia e macronutrientes em adolescentes de escolas públicas (EPU) e privadas (EPR) do município de Florianópolis, SC. A amostra constou de 797 estudantes: 466 (228 meninas e 238 meninos) de EPU e 331 (175 meninas e 156 meninos) de EPR. Os dados foram obtidos através do método recordatório de 24 horas. Observou-se que aproximadamente 50% dos adolescentes apresentaram consumo energético insuficiente e mais da metade tiveram um consumo adequado de carboidratos. Entre os adolescentes do sexo masculino que apresentaram alto consumo de carboidratos, houve maior prevalência na rede pública (12,6% EPU e 3,8% EPR). Mais da metade dos estudantes apresentaram alto consumo de proteínas (54,3% EPU e 58,9% EPR), havendo maior prevalência entre os de sexo masculino (61,7% masculino e 50,6% feminino). Apenas 30,5% dos estudantes das EPU e 36,5% das EPR apresentaram consumo adequado de lipídios; ressalta-se o elevado percentual de adolescentes com alto consumo deste nutriente (33,9% EPU e 39,0% EPR). Entre os estudantes que apresentaram baixo consumo de lipídios, houve maior prevalência dos adolescentes do sexo masculino (35,3% masculino e 26,8% feminino), estudantes da EPU (41,6% EPU e 25,6% EPR). Pode-se concluir que o padrão alimentar apresentado por estes adolescentes pode estar associado a riscos para a saúde na vida adulta.

International trends in adolescent nutrition

This paper addresses international trends in adolescent nutrition by reviewing the literature from English-language indexed journals and online sources from around the world. Information is presented by geographic region and by nation within region. The literature shows that malnutrition remains a significant problem for adolescents, worldwide, but that the types of nutritional problems impacting this group have changed significantly over the past two decades. While undernutrition and wasting are reported, these conditions, as well as growth stunting, seem to be on the decline. In developed countries, social pressures to achieve a distorted body image are creating a malnutrition of affluence among some groups of adolescents. There appears to be an increasing prevalence of obesity among adolescents worldwide, explained by widespread nutrition transitions to lipid-rich diets and a decrease in physical activity, especially among urban adolescents. These trends are of international importance as they imply the world will see a shift towards longer life spans for this adolescent cohort, with a concomitant increase in the prevalence of chronic diseases as it ages. The epidemiologic transition that will result may be a mixed blessing. It is likely to produce a larger and healthier international workforce, but it also has the potential of becoming a serious burden as demands for health care and support services for those with chronic diseases increase. To prevent inordinate health care demands on the international economy in the future, dietary recommendations with nutritional education programs that are culturally appropriate need to become national priorities.

Evaluation of lifestyle, food consumption and nutrient intake patterns among Irish teenagers

Lifestyle, food consumption and nutrient intake patterns from a randomly selected group of 390 secondary pupils aged between 12-18 were evaluated. Demographic information and anthropometric measurements included weight, height, and skinfold thickness were taken. Nutrient intake was assessed using the 7-day dietary history method, using a photographic atlas as an aid. Mean energy intakes for boys and girls aged 12-15 and 15-18 were 11.3MJ and 14MJ and 9.1MJ and 8.9MJ respectively. As percentage energy, protein fat and carbohydrate intakes varied little between the different age-sex groupings and were approximately 13.7-14.5, 35.4-37 and 46.8-50 per cent respectively. For boys micronutrient intake for iron and folate achieving only 83 and 78 per cent and 98 and 90 per cent of the recommended nutrient intake (R.N.I.) for ages 12-15 and 15-18 respectively. Mean dietary fibre intakes were approximately 19.6-25g/day for boys aged 12-18 and 17g/day for girls of a similar age. The main sources of energy were bread, meat and meat products, potatoes/chips, confectionery and preserves. Fruit and vegetable consumption was low for all groups. The majority of those surveyed consumed the traditional main meals. Snacking was also common practice. The snack foods consumed were generally of a high fat/high sugar content. 1.1 per cent boys and 2.6 per cent of girls aged 12-15 and 5.5 per cent and 8.2 per cent of boys and girls aged 15-18 respectively had a BMI greater than 26 indicating a risk of overweight. Greater than 68 per cent of girls and 79.5 per cent of boys surveyed participated in some form of sport. Boys were more physically active than girls and older girls less active than younger. In conclusion, changes from present day practices would be beneficial to reduce incidence of chronic disease for present day teenagers.

Nutrient intake and weight development in children during chemotherapy for malignant disease

The aim of the study was to assess the actual daily oral intake of energy, protein, fat and carbohydrate in relation to current recommendations in children with malignant disease during chemotherapy and to follow their weight development. Dietary information was collected for 21 consecutive days via 7-day recording in 14 children, aged 5-16 years. The number of days with loss of appetite, vomiting, and the number of days on anti-emetic drugs were also recorded. The average daily energy intake decreased from 91% of the recommendation of the Swedish Nutrition Recommendations (SNR), before chemotherapy to 69% after start of chemotherapy. During days spent at home, the energy intake increased to 77% of SNR. Twenty-two per cent of the total energy intake during the hospital days came from sucrose. On average, the children experienced loss of appetite on 50% of the days, vomiting on 12%, and received anti-emetic drugs on 38%. On admission, the average SD score for body weight for the whole group was -0.09. The mean weight reduction after 1 week was 0.19 SD (P = 0.05) compared to the admission weight. The weight reduction 6 weeks (n = 10) and 3 months (n = 13) after the start of chemotherapy was 0.10 SD and 0.37 SD (P = 0.04), respectively.

Relation between dietary fat and energy and micronutrient intakes

Concern has been raised about the energy and nutrient adequacy of low fat diets for children that aim to prevent cardiovascular disease in Western populations. The diets of 174 randomly chosen schoolchildren aged 8-12 years from middle and high socioeconomic groups were analysed to determine their nutrient composition in relation to fat intake. The mean percentages of energy intake from fat and saturated fat were 31 and 13%, respectively, and 44% of all children reported consuming < 30% of their energy from fat. The energy intake did not change across the spectrum of fat intake. A decreased fat intake was associated with an increased sugar intake, but also with increased nutrient densities of thiamin, niacin, folate, vitamin C, magnesium, and iron, reflecting an increased intake of fruit, vegetables, and grains. Parental educational level was the most important determinant of fat intake (inverse relation). It is concluded that a self selected low fat intake among children from average to high socioeconomic backgrounds does not compromise their intake of major nutrients or energy.

Dietary iron intake and iron status in adolescents

The aim of this study was to evaluate the dietary iron intake of 15-year-old adolescents from two different regions of Sweden, in relation to their iron status. The study comprised 185 boys and 209 girls, randomly selected from the official population register. The iron intake was calculated from a 7-day record, and varied between 7 and 35 and 6 and 27 mg per day for boys and girls, respectively. The daily median intakes in boys and girls were 18.7 and 14.2 mg, respectively. S-ferritin, s-iron, and s-transferrin saturation, measured in all the subjects, did not differ significantly between the two regions. However, the mean serum ferritin concentration was significantly higher in the boys (36.4 micrograms l-1) than in the girls (29.4 micrograms l-1) (p < 0.001). Low s-ferritin levels, defined as s-ferritin < 12 micrograms l-1 were found in seven boys (3.7%) and in 29 girls (13.9%). None of the adolescents had iron deficiency anaemia, defined as Hb < 110 gl-1 in combination with s-ferritin < 12 micrograms l-1. Regression and correlation analyses did not show any significant correlation between dietary iron intake and s-ferritin, or between s-ferritin and haemoglobin (Hb), MCH and MCHC. A significant correlation was found, however, between s-ferritin and transferrin saturation (p < 0.005) in both sexes. When the adolescents who still had s-ferritin < 12 micrograms l-1 at a second blood examination were given a 6 weeks trial with oral iron therapy, all of them showed an increase both in s-ferritin and in blood Hb. The 95% confidence intervals of s-ferritin for 15-year-old Swedish boys and girls were defined as 11-90 and 7-85 micrograms l-1, respectively.

Cardiovascular risk indicators cluster in girls from families of low socio-economic status

We evaluated tobacco use, physical activity, dietary intake and cardiovascular risk indicators (s-lipids, s-insulin, s-ferritin, anthropometric measurements, blood pressure, physical fitness) in healthy 14- and 17-year-old Swedish adolescents in relation to socio-economic status (SES) of their parents. Girls reported more smoking than boys (14-year-olds 10 and 3%, 17-year-olds 27 and 18%, girls and boys, respectively). Daily smoking was associated to low SES of the family, but was most strongly associated to smoking in peers (OR = 58.7). Tobacco use was considerably higher among adolescents attending vocational programs at secondary high school as compared with theoretical programs. Daily smokers had a more unfavourable serum lipid profile compared with non-smokers. Adolescents from families with a low educational level of the mother had a higher relative dietary fat intake. Boys and girls from families of low SES had higher body mass index (BMI), and girls, but not boys, also had lower physical fitness. Clustering of high BMI, low physical fitness and daily smoking was more pronounced in girls from families of low SES. In conclusion, our study shows that in both boys and girls low SES and educational level of the parents are related to an unfavourable cardiovascular risk profile in Swedish adolescents. Furthermore, smoking in adolescents is more related to smoking in peers than to smoking in parents, implying that preventive efforts should focus on peer groups.

Food habits and energy and nutrient intake in Swedish adolescents approaching the year 2000

In 1993-94 a nutritional survey of 15-year-old adolescents was carried out in Uppsala, a university city in eastern Sweden, and in Trollhättan, an industrial town in the western part of the country. The study was the beginning of a longitudinal nutritional survey of 193 boys and 218 girls randomly selected from the official population register. The dietary methods used were a food frequency questionnaire (FFQ) and a combined estimated and weighed 7-day dietary record. According to the FFQ both boys and girls consumed cereals, butter or margarine and something from the group meat/fish/eggs every day. Milk, milk products, sweets and snacks were consumed more than once per day. Vegetables and fruit/roots were consumed less often. There was relatively good correlation between the FFQ and the 7-day record results. The mean daily energy intakes of the 15-year-old boys and girls were 10.2 and 8.3 MJ, respectively, in Uppsala, and 9.8 and 7.4 MJ in Trollhättan. The mean daily intakes of sucrose were 74 and 58 g in boys and 64 and 52 g in girls. The average daily dietary fibre intake was 1.8 g/MJ. The daily intake of energy obtained from breakfast was 18% on weekdays and 22% on weekends; 18 and 11% from prepared lunch; 24 and 30% from dinner, 21 and 14% from light meals; and 16 and 28% from snacks, in Uppsala and Trollhättan respectively. The lowest energy intake from a prepared lunch meal was noted during weekends. On both weekdays and weekends, considerable energy was obtained from light meals and snacks. However, nearly 40% of the girls and 28% of the boys had an energy intake from fat of < 30 energy%. The mean intakes of vitamin D and selenium and, in the case of girls, iron and zinc, were below the official Swedish Nutrition Recommendations. The daily median intake of iron was 18.7 mg in boys and 14.1 mg in girls. The iron intakes varied between 6 and 35 mg per day. Low serum ferritin concentrations, defined as s-ferritin < 12 micrograms/L, were found in 7 boys (3.7% and in 29 girls (13.9%). Significant negative correlations were found between smoking and frequency of consumption of vegetables, roots, fruits and meat. A negative correlation was also found between smoking and the intake of energy and a number of nutrients. Socioeconomic factors seem to be less important for the food habits of teenagers than for those noted during childhood. Only frequent consumption of vegetables was positively correlated to the mothers' educational level.

Insulin resistance syndrome in adolescents

To explore whether the so-called insulin resistance syndrome can be identified in adolescents, serum insulin level was measured in 842 healthy Swedish adolescents (462 boys and 380 girls) and the values were related to current serum lipoprotein and apolipoprotein values (triglyceride [TG], total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C), low-density lipoprotein cholesterol [LDL-C], apolipoprotein [apo] A-I, apo B, and lipoprotein(a)), blood pressure (BP), and anthropometric measurements and previous physical growth. Mean serum insulin values were higher in 14-year-olds as compared with 17-year-olds and were highest in midpuberty. Adolescents with a high serum insulin had a higher attained height and weight during infancy and childhood. Obesity (body mass index [BMI] > 30 kg/m2) was found in 1% of both boys and girls, and hypertensive BP levels were found in 3% of the boys and 1% of the girls. Controlling for age, serum insulin correlated positively with BMI (r = .36 and .25 in boys and girls, respectively), TG (r = .32 and .14), LDL-C (r = .17 and .24), and apoB (r = .23 and .23) and negatively with HDL-C (r = -.13 and -.21). High serum insulin, TG, LDL-C, and BP and low HDL-C clustered in adolescents with high BMI. In conclusion, the findings of this study indicate that features typical of the insulin resistance syndrome are already present in adolescents.

Does puberty alter dietary habits in adolescents living in a western society?

PURPOSE

Puberty is considered to be a period with major behavioral changes and alterations in lifestyle. It is also assumed that important modifications in food habits would occur during pubertal maturation, particularly in affluent societies. To test this hypothesis, we conducted a prospective survey in 193 adolescents (95 females and 98 males) aged 9-19 years.

METHODS

Food intake was assessed using a 5-day dietary diary method with weighing of most food intakes. Diaries were analyzed for macronutrient consumption with a nutrition determination software integrating food composition tables and 103 local food items. The stage of puberty or sexual maturity was clinically assessed and rated from stage P1 (prepubertal) to P5 (adult).

RESULTS

The total energy intake which was within the recommended dietary allowances (RDA) was significantly influenced by both pubertal maturation and sex when expressed in absolute terms, but by pubertal stages only when adjusted per kilogram of body weight. Compared with RDA, the macronutrient distribution of the total energy intake showed an excessive quantity of fat (especially saturated fatty acids) and an insufficient amount of carbohydrate-rich fibers. The intakes of proteins, of which two out of three came from animal sources, were above RDA. Overall, these inadequacies in the macronutrient intake distribution were constant throughout pubertal maturation.

CONCLUSION

This study indicates that the type of diet which has been linked with several chronic diseases in adults living in developed countries already prevails before pubertal maturation. This dietary pattern changes marginally during pubertal development. Therefore, our investigation does not support the notion that "bad" food habits become particularly worse during the years of pubertal maturation.

Serum lipid values in adolescents are related to family history, infant feeding, and physical growth

Total serum cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoprotein A-I (apo A-I), apolipoprotein B (apo B), and lipoprotein (a) (Lp(a)) were analysed in 879 14- and 17-year-old healthy adolescents (477 boys and 402 girls), and related to family history of cardiovascular disease, early feeding, weight and length at birth, and physical growth during infancy and childhood. Mean TC was significantly higher in girls than in boys (4.4 and 4.2 mmol/l, respectively, both age-groups together). High TC values ( > 5.2 mmol/l) were more prevalent in girls than in boys: 14% and 17% compared to 6% and 12% in 14- and 17-year-old girls and boys, respectively. Mean TC and LDL-C values were lower during mid-puberty in both boys and girls while, in boys but not in girls, mean HDL-C values decreased and TG values increased successively with increasing pubertal stage. Girls who were taking oral contraceptives had higher mean values of TC (4.91/4.39 mmol/l), TG (1.32/0.83 mmol/l), and apo B (0.89/0.73 g/l). Boys with a family history of early deaths ( < 55 years) from myocardial infarction and girls with a family history of cerebral haemorrhage/thrombosis in fathers had higher mean values of TC (4.55/4.17 and 5.03/4.40 mmol/l, for boys and girls, respectively), LDL-C (2.84/2.47 and 3.08/2.56 mmol/l), and apo B (0.73/0.70 and 0.86/0.73 g/l). Adolescents with short duration of breast feeding ( < 6 months), or early introduction of infant formula, had higher mean values of TC (4.29/4.14 mmol/l) and apo B (0.72/0.68 g/l). There were no significant correlations between serum lipid values and body weight or length at birth, but adolescents with high LDL-C (upper quartile) seemed to have lower attained heights during infancy and childhood. In conclusion, this study shows that serum lipids in adolescence are primarily related to age and sex but also to early determinants like family history of cardiovascular diseases, infant feeding, and early physical growth.

A nutrition study in juvenile elite gymnasts

Twenty-two female teenagers engaged in elite gymnast training and 22 healthy girls of comparable age were studied with regard to nutritional intake. The mean daily intakes of most nutrients in both groups were in accordance with the Swedish Nutritional Recommendations; exceptions were iron and dietary fibre which were too low in both groups. The individual variation was large in both groups and many subjects had an intake below the nutritional recommendations. Both the gymnasts and the reference group had an energy intake significantly below the estimated energy need. The mean daily energy intake was 725 kcal less than the energy need in the gymnast group and 450 kcal less in the reference group. The clinical investigation revealed that several gymnasts had delayed menarche or irregular menstruation as well as less body fat than the reference group. Among the gymnasts, girls with a regular menstrual pattern had more body fat than those who had not started to menstruate. The higher energy expenditure of the gymnasts could partly explain their smaller amounts of body fat, late pubertal development and menstrual patterns.

Actual daily dietary intake of selenium in Belgium, using duplicate portion sampling

The dietary selenium (Se) intake in Belgium has been re-evaluated. Duplicate meal collection, wet acid destruction and flow injection hydride generation atomic absorption spectrometry were used as techniques. The daily intake ranged from 28.4 micrograms (Liège, Walloon part of the country) to 61.1 micrograms (Vilvoorde, central part of the country). Compared with intakes recently published for other countries, the actual Belgian value corresponds to intermediate ranges of Se intake.