Correlates of dietary energy misreporting among European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

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

Physical Activity Is Associated with Attention Capacity in Adolescents

OBJECTIVE

To assess the relationships among physical activity, measured objectively, and attention capacity in European adolescents.

STUDY DESIGN

The study included 273 adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Participants wore a uniaxial accelerometer for 7 days to measure physical activity. The d2 Test of Attention was administered to assess attention capacity. Multivariate analyses were used to study the association of attention capacity with each measure of physical activity. Receiver operating characteristic analysis was performed to determine thresholds that best discriminate between low and good attention capacity.

RESULTS

After controlling for potential confounding variables (age, sex, body mass index, parental educational level, fat mass, aerobic fitness, and center), adolescents' attention capacity test performances were significantly and positively associated with longer time spent in moderate or moderate-to-vigorous physical activity (MVPA) in free-living conditions (P < .05). Receiver operating characteristic curve analyses revealed that the physical activity thresholds that best discriminated between low/good attention capacities were ≥41 min·day(-1) for moderate, ≥12 min·day(-1) for vigorous, and ≥58 min·day(-1) for MVPA.

CONCLUSION

These findings suggest that promoting MVPA may be have a beneficial effect on attention capacity, an important component of cognition, in adolescents.

Association of breakfast consumption with objectively measured and self-reported physical activity, sedentary time and physical fitness in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study

OBJECTIVE

To examine the association of breakfast consumption with objectively measured and self-reported physical activity, sedentary time and physical fitness.

DESIGN

The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Cross-Sectional Study. Breakfast consumption was assessed by two non-consecutive 24 h recalls and by a 'Food Choices and Preferences' questionnaire. Physical activity, sedentary time and physical fitness components (cardiorespiratory fitness, muscular fitness and speed/agility) were measured and self-reported. Socio-economic status was assessed by questionnaire.

SETTING

Ten European cities.

SUBJECTS

Adolescents (n 2148; aged 12·5-17·5 years).

RESULTS

Breakfast consumption was not associated with measured or self-reported physical activity. However, 24 h recall breakfast consumption was related to measured sedentary time in males and females; although results were not confirmed when using other methods to assess breakfast patterns or sedentary time. Breakfast consumption was not related to muscular fitness and speed/agility in males and females. However, male breakfast consumers had higher cardiorespiratory fitness compared with occasional breakfast consumers and breakfast skippers, while no differences were observed in females. Overall, results were consistent using different methods to assess breakfast consumption or cardiorespiratory fitness (all P ≤ 0·005). In addition, both male and female breakfast skippers (assessed by 24 h recall) were less likely to have high measured cardiorespiratory fitness compared with breakfast consumers (OR = 0·33; 95% CI 0·18, 0·59 and OR = 0·56; 95%CI 0·32, 0·98, respectively). Results persisted across methods.

CONCLUSIONS

Skipping breakfast does not seem to be related to physical activity, sedentary time or muscular fitness and speed/agility as physical fitness components in European adolescents; yet it is associated with both measured and self-reported cardiorespiratory fitness, which extends previous findings.

Lunch at school, at home or elsewhere. Where do adolescents usually get it and what do they eat? Results of the HELENA Study

Considering the lack of uniformity regarding school meals in Europe, information on adolescents' school lunch patterns is of public health importance. Thus, the aim of this analysis was to describe and evaluate lunchtime energy and food intake of European adolescents at different lunch locations. Data on nutritional and health-related parameters were derived from the HEalthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS). A sub-sample of 891 adolescents (47% male) with plausible data on total and lunchtime energy intake (2 × 24 h recall) as well as usual lunch location was considered. Food intake was compared to lunch of the Optimized Mixed Diet (OMD) for children and adolescents. Although energy intake was nearly in line with the recommendations, food intake was suboptimal compared to the OMD regardless of usual lunch location. Adolescents had more potatoes and less sweets at school, and more drinks (water, coffee and tea) and vegetables at home when each compared with the other locations. Food intake of adolescents getting their lunch elsewhere was characterized by the smallest amounts of potatoes and the highest amounts of sweets. Although lunch patterns may differ among countries, schools in Europe do not seem to reveal all their potential to offer access to a healthy lunch for adolescents yet.

Dietary intervention in breast cancer patients: effects on dietary habits and nutrient intake

Effects of dietary intervention on dietary habits and nutrient levels were studied in 240 women aged 50-65 years who had been operated for a stage I-II breast cancer. Following surgery the women who had participated in a dietary history interview were randomly assigned to one of two groups. The intervention group (n = 121) received individual dietary counselling aimed at reducing dietary fat intake to 20-25 per cent of energy (E per cent) while increasing intake of carbohydrates. No dietary advice was given to women assigned to the control group (n = 119). There was no significant difference between the groups in terms of base-line nutrient intake except for a higher energy intake in the control group (P less than 0.05). Sixty-three (52 per cent) of the women in the intervention group and 106 (89 per cent) of the women in the control group completed the 2-year follow-up. Energy intake decreased after 2 years in both groups and the difference between the groups remained (P less than 0.01). Total fat intake decreased in the intervention group by 12.9-23.3 E per cent after 2 years and by 3.1 E per cent in the control group. The intake of carbohydrates increased from 46.2 to 57.2 E per cent in the intervention group and from 46.2 to 48.9 E per cent in the control group. The study shows that dietary habits and intake of nutrients can be altered through dietary counselling to breast cancer patients, and that such changes are long lasting.

Dietary intervention as adjuvant therapy in breast cancer patients--a feasibility study

To evaluate the feasibility of using a low-fat diet (i.e. 20-25% of energy (E%) as fat) as a component of adjuvant therapy for breast cancer patients, 240 females aged 50-65 years and operated for a stage I-II breast cancer were entered into a randomized study. The intervention group (n = 121) was to reduce dietary fat intake to 20-25 E% and to increase the intake of carbohydrates. Dietary counselling complemented other adjuvant treatments and the patients were followed for two years. No dietary advice was given to patients in the control group (n = 119). There was no significant difference between the groups in terms of base-line nutrient intake except for higher energy intake in the control group (p less than 0.05). Only 52% of the patients in the intervention group followed through with the dietary regimen for two years, and 89% of the patients in the control group had a two-year follow-up. Energy intake decreased in both groups after two years, and the difference between the two groups remained (p less than 0.01). Total fat intake decreased from 36.2 E% to 22.2 E% after one year in the intervention group and remained at that level after two years. Total fat intake in the control group decreased by 3.6 E% after two years. The low compliance raises concern about the protocol design. The study nevertheless indicates that a long-term reduction of dietary fat intake can be implemented in breast cancer patients.