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The aim was to estimate national temporal trends in muscular fitness for French youth between 1999 and 2023. Data were obtained from five cross-sectional studies on 53,314 children and adolescents (age range: 6-16 years). Lower- and upper-body strength were assessed by standing broad jump (SBJ) and handgrip strength (HGS). BMI z-scores (BMIz) were calculated using WHO growth curves. We found a statistically significant negligible decline in SBJ performance (standardised effect size (ES) trend per decade [95%CI]: -0.08 [-0.10, -0.07] or -2.1 cm [95%CI: -2.4, -1.8]) and a statistically significant negligible improvement in HGS (ES trend per decade [95%CI]: 0.11 [0.08, 0.13]) or 0.6 kg [(95%CI: 0.4, 0.8]). We found evidence of significant increases in distributional variability and asymmetry, with poorer trends in the low performers (<25 th percentile) and better trends in the high performers (>75 th percentile) compared to the average performers. Our data suggest negligible trends in mean SBJ and HGS, coupled with increased distributional variability and asymmetry. Trends were not uniform across the population distribution with data suggesting an increase over time in the gap between low and high performers. These results reinforce the importance of interventions and programmes aiming at improving muscular fitness specifically in children and adolescents with low muscular strength.

Physical activity measured by accelerometry (PA-accelerometry) is used as an indicator of physical capacity in chronic diseases. Currently, only fragmented age ranges of reference percentile curves are available for European children and adolescents. This study aimed to provide age- and sex-specific percentiles for physical activity measured by hip-worn accelerometry derived throughout the full age range of European children and adolescents. Individual-level population-based PA data measured by accelerometry from HELENA and IDEFICS/I.Family studies were pooled and harmonized. Together these studies involved children and adolescents aged 2-18 years from 12 European countries. Primary outcomes included averaged counts per minute (CPM), sedentary time (SED), light PA (LPA) and moderate-to-vigorous PA (MVPA). Generalized Additive Models for Location, Scale and Shape were used to derive age- and sex-specific reference percentile curves for these outcomes. The combined cohort consisted of 11,645 children and adolescents aged 2 to 18 years who contributed 14,610 valid accelerometry recordings, with a median accelerometer wear time of 6 days. This dataset allowed for the construction of age- and sex-specific reference percentile curves for CPM, SED, LPA, and MVPA. The curves demonstrated varying trends and variability across age groups., Conclusions: This study provides age- and sex-specific percentile curves for PA-accelerometry in European children and adolescents, addressing a current gap in the availability of full-age range reference data. These curves based on healthy children and adolescents can be used by clinicians, researchers, and policymakers to interpret PA-accelerometry measurements, track physical activity trends, and evaluate treatment responses and health interventions., What Is Known: • Daily physical activity (PA) is considered an important measure in various paediatric conditions. Existing reference data for PA in European children based on hip-worn accelerometers are limited to specific age ranges, and comprehensive data covering the full age range are lacking., What Is New: • The study provides age- and sex-specific reference curves for PA derived by hip-worn accelerometers in European children and adolescents. These curves aid clinicians, researchers, and policymakers in interpreting PA measurements and tracking trends over time in European children., Competing Interests: Declarations. Ethics approval: All contributing studies have been approved by the appropriate ethics committees and have been performed in accordance with the ethical standards of the Declaration of Helsinki. The names of the approval committees/institutional review boards of HELENA were as follows: (1) Austria: Ethics Committee of the Medicine's University from Vienne; (2) Belgium: Ethics Committee of the Gent University Hospital; (3) France: Protection committees people from Lille; (4) Germany: Ethics Committee of the Medicine's University from Dortmund; (5) Greece: Ethics Committees of the Harokopio University from Athens and University of Crete School of Medicine from Heraklion; (6) Hungary: A Pecsi Orvostudomanyi és Egészségtudomanyi Központ Regionalis Kutatas-Etikai Bizottsaga from Pècs; (7) Italy: Ethics Committee of Medical Activities of the University of Naples Federico II; (8) Spain: Ethics Committee for Clinical Research of Aragon; (9) Sweden: Regional Ethics Committee from Stockholm. The names of the approval committees/institutional review boards of IDEFICS/I.Family were as follows: (1) Belgium: Ethics Committee of the Gent University Hospital; (2) Cyprus: Cyprus National Bioethics Committee; (3) Estonia: Tallinn Medical Research Ethics Committee; (4) Germany: Ethic Commission of the University of Bremen; (5) Hungary: Medical Research Council; (6) Italy: Ethics Committee of the Local Health Authority in Avellino; (7) Poland: Bioethical Committee of the University of Rzeszów; (8) Spain: Ethics Committee for Clinical Research of Aragon; (9) Sweden: Regional Ethics Research Board in Gothenburg. Consent to participate: All participants and/or their legal guardians have given informed consent prior to inclusion in the contributing studies. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background & Aims: Cardiovascular diseases are the leading cause of mortality worldwide, originating in the first decades of life. A better understanding of their early determinants would allow for better prevention. This study aimed to evaluate the impact of nutritional and activity-related characteristics during adolescence on young adult cardiovascular risk factors., Methods: The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study included adolescents (aged 12.5-17.5 years) in 10 European centres. Four centres designed a nested cohort including 236 participants who were reassessed as young adults (21-32 years). Food consumption was evaluated by dietary recalls, physical activity by accelerometers, physical fitness using physical tests and nutritional knowledge by questionnaires. Cardiovascular health was assessed by Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Study risk scores and its components. Factors associated with cardiovascular risk were identified using a multivariable regression model., Results: Higher Diet Quality Index (DQI, P = 0.012) and nutritional knowledge (P = 0.015) were significantly associated with lower modified PDAY risk scores. Ultra-processed foods were associated with a lower non-high-density lipoprotein (non-HDL) cholesterol (P = 0.003), whereas DQI (P = 0.014) and Planetary Health Diet Index (P = 0.016) were associated with a higher HDL cholesterol. Higher DQI was also related to a lower body mass index (BMI, P = 0.006). In addition, cardiorespiratory fitness was related to a lower BMI (P = 0.004)., Conclusions: Nutritional knowledge, diet quality and adherence to a sustainable diet in adolescence decrease cardiovascular risk in adulthood, whereas ultra-processed food consumption increases risk. These factors appear as targeted prevention tools for promoting a healthier adolescent lifestyle to decrease long-term cardiovascular risk., Clinical Trial Registry Number: Clinicaltrials.gov NCT02899416., Competing Interests: Conflicts of interest Pr. Frédéric Gottrand has received consulting fees from Nestlé. The remaining authors do not have any conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Cardiorespiratory fitness (CRF) is a strong marker of current and future health. The aim of this study was to assess the national temporal trends in CRF for French children and adolescents between 1999 and 2022., Methods: CRF data were obtained from several cross-sectional studies on 15 420 (51.1% boys) French children and adolescents aged 9-16 years between 1999 and 2022. The 20-m shuttle run test (20mSRT) estimated CRF. Body mass index (BMI) was calculated from measured height and body mass, with BMI z-scores (BMIz) calculated using WHO growth curves. The 20mSRT results were corrected for protocol and converted to z-scores (20mSRTz) using international sex- and age-specific norms. With additional adjustment for BMIz, temporal trends in mean 20mSRT performance (20mSRTz) were estimated using linear regression, with the distance max (D max ) method used to locate a breakpoint and linear segments fitted to points below and above the breakpoint. Trends in distributional characteristics were assessed visually and described as the ratio of the coefficients of variation (CVs)., Results: After adjustment for protocol, age, sex, and BMIz, a large decline in mean 20mSRT performance (trend per decade (95% CI): -1.42 SDs (-1.45, -1.39) or -18.4% (95% CI: -18.8, -18.0)) between 1999 and 2022 was found. D max located a breakpoint for the two-linear-segment model in year 2010. There was a large decline in mean 20mSRT performance pre-2010 (trend per decade (95% CI): -2.31 SDs (-2.39, -2.24)), which reduced 0.06-fold to a negligible decline post-2010 (trend per decade (95% CI): -0.15 SD (-0.20, -0.10)). We also found that the trend in mean 20mSRT performance was not uniform across the population distribution. Between 1999 and 2022, there was a small trend in distributional asymmetry, with slightly smaller declines experienced by the high performers (above the 75th percentile)., Conclusions: Our data suggest a large decline in the 20mSRT performance of French children and adolescents since 1999. This declining trend seems to have diminished considerably since 2010. Such declines in CRF could translate into declines in health status. Although a slowing in the declining trend in CRF in recent years is encouraging, more data are needed to confirm these findings., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: The need for monitoring regularly physical fitness in youth is well established for public health issues. The aim of this study was to assess the validity and reliability of the International Fitness Scale questionnaire (IFIS) to assess physical fitness in French children in the school context., Methods: A sample of 2 060 children (1054 boys), aged 10.6 ± 0.9 years, participated in the validation study while an independent sample of 366 children (175 boys), aged 9 to 11 years, participated in the assessment of reliability. Physical fitness was measured by a self-report of 5 questions with a 5-point Likert-scale (from very poor to very good) (IFIS), and also measured objectively by 4 field tests: cardiorespiratory fitness, muscular strength, speed/agility and flexibility. For the test-retest reliability assessment, children were instructed to complete the questionnaire twice, 1 week apart., Results: For all physical fitness components studied, children reporting a good or a very good physical fitness in the IFIS had better results in objective measurements of physical fitness tests compared to children reporting a very poor to an average physical fitness (p<0.001) without or with adjustments for sex, age and weight status. The reliability coefficients were acceptable for all components of physical fitness (0.59-0.72)., Conclusions: These results suggest that IFIS appears to be a useful instrument for teachers to estimate physical fitness levels of French children, possibly on a large scale., Competing Interests: Declaration of competing interest The remaining authors state no conflict of interest., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: Thinness in adolescence has not been studied as extensively as overweight or obesity. The aim of this study was to assess the prevalence, characteristics, and health impacts of thinness in a European adolescent population., Methods: This study included 2711 adolescents (1479 girls, 1232 boys). Blood pressure, physical fitness, sedentary behaviors, physical activity (PA), and dietary intake were assessed. A medical questionnaire was used to report any associated diseases. A blood sample was collected in a subgroup of the population. Thinness and normal weight were identified using the IOTF scale. Thin adolescents were compared with adolescents of normal weight., Results: Two hundred and fourteen adolescents (7.9%) were classified as being thin; the prevalence rates were 8.6% in girls and 7.1% in boys. Systolic blood pressure was significantly lower in adolescents with thinness. The age at the first menstrual cycle was significantly later in thin female adolescents than in those with normal weight. Upper-body muscular strength measured in performance tests and time spent in light PA were significantly lower in thin adolescents. The Diet Quality Index was not significantly lower in thin adolescents, but the percentage of adolescents who skipped breakfast was higher in adolescents with a normal weight (27.7% vs 17.1%). Serum creatinine level and HOMA-insulin resistance were lower and vitamin B12 level was higher in thin adolescents., Conclusions: Thinness affects a notable proportion of European adolescents with no physical adverse health consequences., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Physical activity (PA) is recognized as a marker of health. The aim was to investigate PA differences from adolescence to young adulthood. European adolescents included in the HELENA study were invited to participate in a follow-up study, 10 years later. The present study included 141 adults (25.0 ± 1.4 years) for whom valid accelerometer data were available in adolescence and adulthood. Changes in PA by sex, weight and maternal education level were explored with interactions. Time spent in sedentary activity, light PA (LPA) and moderate PA (MPA) increased by 39.1, 59.6 and 6.6 min/day, respectively, whereas the time spent in vigorous PA (VPA) decreased by 11.3 min/day compared with adolescent VPA (p < 0.05). Increases in MPA were greater on weekends compared with weekdays, but we found a greater decrease in VPA on weekdays compared with weekends. Moderate-to-vigorous PA (MVPA) decreased significantly on weekdays (-9.6 min/day; 95%CI, -15.9 to -3.4), while it increased on weekends (8.4 min/day; 95%CI, 1.9 to 14.8). Significant heterogeneity was found across sexes for VPA and MVPA, with a stronger decrease in VPA in males compared with females and a significant decrease in MVPA (-12.5 min/day; 95%CI, -20.4 to -4.5) in males but not in females (1.9 min/day; 95%CI, -5.5 to 9.2). No significant heterogeneity was found to be linked to maternal education level or weight, irrespective of PA level.  Conclusion: Our data suggest that the transition from adolescence to young adulthood is a critical period for lifestyle PA habits. A decline in VPA and an increasingly sedentary time were observed. The observed changes are worrying and may increase the risk of developing adverse health consequences later in life. What is Known: • The transition from adolescence to adulthood is marked by many life changes affecting lifestyle habits. Most studies tracking physical activity from adolescence to adulthood were done using PA questionnaires, which is a subjective method. What is New: • Our study bring first data on objective changes in PA patterns between adolescence and young adulthood, taking account of BMI, sex and maternal educational level. Our results suggest that the transition from adolescence to young adulthood is a critical period for lifestyle PA habits, especially for time spent on sedentary activities., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: From genome wide association study (GWAS) a large number of single nucleotide polymorphisms (SNPs) have previously been associated with blood pressure (BP) levels. A combination of SNPs, forming a genetic risk score (GRS) could be considered as a useful genetic tool to identify individuals at risk of developing hypertension from early stages in life. Therefore, the aim of our study was to build a GRS being able to predict the genetic predisposition to hypertension (HTN) in European adolescents., Methods: Data were extracted from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study. A total of 869 adolescents (53% female), aged 12.5-17.5, with complete genetic and BP information were included. The sample was divided into altered (≥130 mmHg for systolic and/or ≥80 mmHg for diastolic) or normal BP. Based on the literature, a total of 1.534 SNPs from 57 candidate genes related with BP were selected from the HELENA GWAS database., Results: From 1,534 SNPs available, An initial screening of SNPs univariately associated with HTN ( p  < 0.10) was established, to finally obtain a number of 16 SNPs significantly associated with HTN ( p  < 0.05) in the multivariate model. The unweighted GRS (uGRS) and weighted GRS (wGRS) were estimated. To validate the GRSs, the area under the curve (AUC) was explored using ten-fold internal cross-validation for uGRS (0.802) and wGRS (0.777). Further covariates of interest were added to the analyses, obtaining a higher predictive ability (AUC values of uGRS: 0.879; wGRS: 0.881 for BMI z -score). Furthermore, the differences between AUCs obtained with and without the addition of covariates were statistically significant ( p  <   0.05)., Conclusions: Both GRSs, the uGRS and wGRS, could be useful to evaluate the predisposition to hypertension in European adolescents., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Pérez-Gimeno, Seral-Cortes, Sabroso-Lasa, Esteban, Lurbe, Béghin, Gottrand, Meirhaeghe, Muntaner, Kafatos, Molnár, Leclercq, Widhalm, Kersting, Nova, Salazar-Tortosa, Gonzalez-Gross, Breidenassel, Sinningen, De Ruyter, Labayen, Rupérez, Bueno-Lozano and Moreno.)

Background and Aims: Blood pressure (BP) changes and insulin resistance (IR) are important cardiometabolic risk (CMR) factors; their early identification can contribute to the reduction of cardiovascular events in adulthood. This necessitates the search for more accessible and easily applied indicators for their prediction. Therefore, this study aimed to evaluate the predictive power of the indices, TyG, TG/HDL-c, height-corrected lipid accumulation product (HLAP), and visceral adiposity index (VAI), in identifying the CMR obtained by high BP and IR and to verify their relationship with biomarkers of endothelial dysfunction (ED) in European adolescents., Methods and Results: The anthropometric data and blood biomarkers of 744 adolescents (343 boys and 401 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS), with a mean age of 14.67 (SD 1.15) years, were assessed. The adolescents were then classified according to the presence or absence of high BP and IR. The cut-off points of the indices evaluated for the identification of CMR were determined. The relationship between CMR diagnosed using these indices and ED biomarkers was tested. The HLAP and TG/HDL-c were fair predictors of CMR obtained by IR in male adolescents. These indices showed association with hsCRP in sVCAM-1 in boys, but it lost significance after adjusting for age and body mass index., Conclusion: TG/HDL-c and HLAP indices showed a fair performance in predicting CMR, obtained by IR, in male adolescents. ED showed no association with the CMR identified by the indices., Competing Interests: Conflict of interest The authors declare no conflicts of interest., (Copyright © 2023 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Objectives: This study assessed the reliability and validity of the IMPACT-III questionnaire, a health-related quality of life (HRQoL) instrument, in French children with inflammatory bowel disease (IBD)., Methods: Eighty-four children and adolescents (45 boys, aged 14.3 ± 2.7 years) were included in a validation study of the IMPACT-III questionnaire. Patients completed 2 questionnaires for measuring HRQoL: the IMPACT-III and the Pediatric Quality of Life Inventory 4.0 Generic Core Scale (PedsQL). Internal consistency was assessed using Cronbach α. Factor analysis was performed on data from the IMPACT-III to help construct domains. Concurrent validity was assessed by calculating Spearman correlation coefficients., Results: Cronbach α for the PedsQL total score was good (0.89). The most robust factor solution was a 3-domain structure: (a) Concerns, (b) Body Image and Physical Condition, and (c) Symptoms and Socializing. All domains had good reliability (0.674-0.863). Only 2 items had to be removed. Discriminant validity was demonstrated by significant differences ( P < 0.001) in median IMPACT-III scores between inactive and active disease for the total score (83.3 vs 72.0), and for Concerns ( P < 0.002) and Symptoms and Socializing ( P < 0.001)., Conclusions: These results suggest that IMPACT-III appears to be a useful instrument for measuring HRQoL in French children with IBD., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Background: This study was conducted to assess the safety and adherence of the use of a PGT (Pressure Garment Therapy) Lycra® sleeve to treat upper limb unilateral cerebral palsy (UCP) in children., Methods: This study was conducted as a prospective, placebo-controlled, double-blinded, randomized monocenter study. Included in the study were 58 UCP children, 49 of whom were analyzed. 25 children (mean age 6.6 ± 1.6 years; 12 girls) were allocated to the active group vs. 24 (mean age 6.7 ± 1.6 years; 10 girls) in the placebo group. The intervention consisted of an active PGT Lycra® arm sleeve manufactured to generate a homogeneous pressure ranging from 15 to 25 mmHg. The placebo PGT Lycra® sleeve was manufactured to generate a homogeneous pressure under 7 mmHg. The time of wearing period was set at 3 h/day at minimum and 6 h/day at maximum, over the course of 6 months. The main outcome measures were safety outcomes including the number and intensity of Adverse Events of Special Interest (AESIs). AESIs were defined as adverse events imputable to compressive therapy and Lycra® wearing. Level of adherence was expressed in percentage of number of days when the sleeve was worn for at least 3 h per day compared to length of duration in days (start and end date of wearing period)., Results: Frequency of AESIs were very low and no different between groups (4.12 ± 11.32% vs. 1.83 ± 3.38%; p  = 0.504). There were no differences in adherence (91.86 ± 13.86% vs. 94.30 ± 9.95%; p  = 0.425)., Conclusion: The use of PGT Lycra® arm sleeve in children with UCP is safe and well-tolerated with a very good adherence. The low rate of AESIs is promising for further randomized clinical trials on efficacy., Competing Interests: YZ is CEO of Medical Z®. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Béghin, Mohammad, Fritot, Letellier, Masson, Zagamé, Donskoff, Toussaint-Thorin and Gottrand.)

Background/objectives: The mainstay treatment of cow's milk allergy (CMA) is to remove cow's milk proteins from children's dietary intake. In this context, dietary intake of children with CMA should be particularly checked and monitored. The objective of this study was to assess the applicability, usability, and accuracy of a new dietary intake (DI) assessment online tool (Nutricate© online application) for managing CMA in children., Subjects/methods: This study used a pre-existing database of DI from the Nutricate© online application. DIs from 30 CMA children were used to compare micro/macronutrients (energy, protein, calcium, and iron intakes) calculated by Nutricate© and NutriLog© as the reference method. Comparisons were performed using the Pearson correlation analysis and the Bland-Altman plot. The Nutricate© tool usability was assessed via a System Usability Scale questionnaire (SUSq)., Results: Correlation coefficient between the levels of micro/macronutrients obtained by Nutrilog© and Nutricate© software were highly significant ( p = 0.0001) and were well-correlated (R coefficient > 0.6), indicating a very good concordance between the two methods. This observation was reinforced by the Bland-Altman plot, indicating the absence of proportional or fixed bias for energy, protein, calcium, and iron intakes. The mean SUSq score obtained was 81 ± 14, which is considered to be an excellent score., Conclusions: Nutricate© online application is a reliable method to assess micro/macronutrient (energy, protein, calcium, and iron intakes) intake in CMA children. Applicability and usability of this new dietary intake assessment online tool is excellent.

Objectives: This study aimed to investigate the associations between portion sizes (PSs) from different food groups and energy, as well as nutrient intakes in European adolescents., Methods: A sample of 1631 adolescents (54.2 % girls) were included from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional (HELENA) study. Mean food PS was calculated by dividing the total intake of the items by the number of eating occasions of these consumed items. To determine the key items for analysis, foods were ranked by frequency of consumption. A one-way between-groups analysis of covariance was used to test for significant differences in means across tertiles. A multivariable linear regression analysis was carried out, adjusting for age, sex, maternal education, body mass index, and using country as a level., Results: Energy intake increased with elevated intakes of energy-dense foods. Large portions of rice and other grains, starch roots and potatoes, and meat substitutes, nuts, and pulses were associated with increased carbohydrate and fiber intake. Larger portions of cheese and butter and animal fat were significantly associated with a higher fat intake. Lower intakes of some vitamins and micronutrients were noticed with consumption of larger portions of high energy-dense foods, such as desserts and pudding, margarine and vegetable oil, and butter and animal fat., Conclusions: Large food PSs may be associated with positive energy, as well as macro- and micronutrient intake. Moreover, the findings from this study may help the future development of dietary guidance in general and specific to PSs, and support targeted strategies to address intakes of certain nutrients in European adolescents., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Numerous studies reported a significant decline in physical activity level in adolescents as a result of the COVID-19 lockdown. Physical fitness is recognized as a powerful marker of health in youth. The aim of this study was to evaluate the impact of the COVID-19 pandemic lockdown on health-related physical fitness in French adolescents. Two cross-sectional studies were performed comparing two different groups of French adolescents, before (sample 1) and after the first lockdown (sample 2). A total of 1231 adolescents (aged to 16.5 ± 1.5 years) participated in the two cross-sectional studies. Complete data for physical fitness and anthropometrics data were obtained. Adolescents from sample 2 showed lower physical fitness levels compared to adolescents from sample 1. Regarding physical fitness for boys and girls, physical fitness levels were significantly lower in both sex between adolescents from the sample 1 and adolescents from the sample 2, except for cardiorespiratory fitness and flexibility for boys and girls, respectively. The physical fitness global score was also significantly lower between adolescents from the sample 1 and 2 for boys (-9.8%, p < 0.01) and girls (-16.2%; p < 0.01), respectively. Overall, the higher difference was found for performance in the speed body displacement test (-30%). A difference of 12.8% and 25% was observed for boys and girls, respectively.   Conclusion: COVID-19 pandemic lockdown had a negative impact on physical fitness in French youth. This study highlights the need to develop, in a near future, prevention programmes in order to improve the physical fitness in youth. What is Known: • COVID-19 pandemic deeply impacted lifestyle habits. A worrying decrease of physical activity, associated to a dramatic increase of time spent in sedentary behaviors was found in many coutries. What is New: • Our study bring first data on the health-related physical fitness consequences due to lockdown in French adolescents. Our study demonstrate the negative impact of COVID-19 pandemic lockdown on health-related physical fitness in French adolescents., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background and Aims: (Poly)phenols might contribute to prevent cardiovascular disease, but limited prospective studies exist among adolescents. This study aimed to evaluate within-subject longitudinal changes in (poly)phenols intakes and food group contributors while also exploring the association with metabolic syndrome risk (MetS) during 10 years of follow up in European adolescents becoming young adults., Methods and Results: In 164 participants (58% girls, 13-18 y at baseline) from Ghent, Zaragoza and Lille, longitudinal data (2006-2016) on (poly)phenol intake was retrieved via 2 or 3 24 h recalls. Linear and logistic longitudinal regression tested the association of (poly)phenols intake (total and classes) with Mets risk or its components (waist-height-ratio, HDL cholesterol, LDL cholesterol, triglycerides, blood pressure and insulin resistance index), adjusted for age, sex, country and other nutrient intakes. The total (poly)phenols intake was 421 ± 107 mg/day (192 mg/1000 kcal/day) at baseline, while 610 ± 101 mg/day (311 mg/1000 kcal/day) at follow-up. The three major food sources for (poly)phenols were 'chocolate', 'fruit and vegetable juices', 'cakes and biscuits' during adolescence and 'coffee', 'tea' and 'chocolate' during adulthood. Phenolic acid intake was associated with less LDL increase over time, while stilbene intake with a steeper increase in triglycerides over time., Conclusions: Differences in major (poly)phenols contributors over time were partially explained by age-specific dietary changes like increased coffee and tea during adulthood. Some significant (poly)phenols-MetS associations might argue for nutrition-based disease prevention during adolescence, especially since adolescents had low (poly)phenols intake., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated., (Copyright © 2022 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background/objectives: The study purpose was to assess the impact of birth weight and breastfeeding duration on physical fitness components., Subjects/methods: Study participants were 985 adolescents boys and 1246 girls (12.5-17.5 years) participating in the HELENA study. Standardised physical fitness procedures included: cardio-respiratory fitness, flexibility, upper body muscular strength, and lower body explosive strength. Birth weight and breastfeeding duration were assessed by parents' questionnaire. Associations between neonatal data and physical fitness were investigated using linear mixed models., Results: Significant associations between body muscular strength, and breastfeeding duration were observed in the unadjusted analyses for boys. When adjusting for potential confounding factors (z-score body mass index, fat-free mass, fat mass), only lower body muscular strength, by standing broad jump-a proxy measure of muscular explosivity- was positively associated with breastfeeding duration. Furthermore, significant associations were observed between upper body muscular strength (by hand grip),-a proxy measure of muscular power-in boys as well as in girls., Conclusions: Birth weight and breastfeeding duration have different effects on muscular strength components. The present results suggest that birth weight positively influences the development of muscular power, while breastfeeding duration positively influences muscular explosivity., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Cardiovascular diseases are the leading cause of mortality worldwide. These diseases originate in childhood, and a better understanding of their early determinants and risk factors would allow better prevention. The BELINDA (BEtter LIfe by Nutrition During Adulthood) study is a 10−14-year follow-up of the HEalthy Lifestyle in Europe by Nutrition in Adolescence study (the HELENA study, a European cross-sectional study in adolescents). The study aims to evaluate cardiovascular risk using the PDAY (Pathobiological Determinants of Atherosclerosis in Youth) risk score during young adulthood (21−32 years), and to examine the impact of risk factors identified during adolescence (12.5−17.5 years). Our secondary objective is to compare the characteristics of the BELINDA study population with the HELENA population not participating in the follow-up study. The HELENA study recruited 3528 adolescents during 2006−2007 and reassessed 232 of them 10−14 years later as young adults. We assessed clinical status, anthropometry, nutrition, physical activity (including sedentary behavior), physical fitness, and mental health parameters, and collected biological samples (blood, stool, and hair). Dietary intake, and physical activity and fitness data were also collected. A multivariable linear regression model will be used for the analysis of the primary outcome. A Chi-square and T-test were conducted for the comparison of the descriptive data (gender, age, weight, height, body mass index (BMI), and maternal school level) between participating and non-participating BELINDA adolescents. When comparing the 1327 eligible subjects with the 232 included in the BELINDA study, no significant differences regarding gender (p = 0.72), age (p = 0.60), height (p = 0.11), and weight (p = 0.083) at adolescence were found. However, the participating population had a lower BMI (20.4 ± 3.1 kg/m2 versus 21.2 ± 3.6 kg/m2; p < 0.001) and a higher maternal educational level (46.8% high school or university level versus 38.6%; p = 0.027) than the HELENA population who did not participate in the BELINDA study. The complete phenotyping obtained at adolescence through the HELENA study is a unique opportunity to identify adolescent risk factors for cardiovascular diseases. This paper will serve as a methodological basis for future analysis of this study.

Background: The aim of this study was to investigate the association of endothelial lipase gene (LIPG) polymorphisms with cardiovascular disease (CVD) risk factors in adolescents and their interaction with physical activity., Methods: Six polymorphisms of LIPG were genotyped in 1057 European adolescents (12-18 years old) enrolled in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study. CVD risk factors related to lipid profile, blood pressure, adiposity and glucose regulation were recorded. Physical activity was objectively measured by accelerometry., Results: The major C allele of rs2000813, the minor T allele of rs2276269 and the minor G allele of rs9951026 were associated with lower levels of several CVD risk factors related to lipid profile. We also found a significant association of the TTACA LIPG haplotype (rs2000812, rs2000813, rs8093249, rs2276269 and rs9951026) with higher concentrations of low-density cholesterol and apolipoprotein B. Finally, the interaction between physical activity and the polymorphisms rs2000813, rs2276269 and rs9951026 had a significant influence on several CVD risk factors., Conclusions: LIPG polymorphisms were significantly associated with CVD risk factors in European adolescents. Interestingly, alleles of these polymorphisms were associated with a better cardiovascular profile in physically active adolescents only. High physical activity may reduce the development of CVD, modulating its genetic risk., Impact: Using gene-phenotype and gene × environment analyses, we detected associations between the endothelial lipase gene and cardiovascular risk factors, along with interactions with physical activity. This study shows that physical activity may modulate the influence of LIPG gene on cardiovascular risk in adolescents. These results bring insights into the mechanisms by which physical activity positively influences CVD in adolescents., (© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Background: The association between high fructose consumption and elevated blood pressure continues to be controversial, especially in adolescence. The aim of this study was to assess the association between fructose consumption and elevated blood pressure in an European adolescent population., Methods: A total of 1733 adolescents (mean ± SD age: 14.7 ± 1.2; percentage of girls: 52.8%) were analysed from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study in eight European countries. Blood pressure was measured using validated devices and methods for measuring systolic blood pressure (SBP) and diastolic blood pressure (DBP). Dietary data were recorded via repeated 24 h recalls (using specifically developed HELENA-DIAT software) and converted into pure fructose (monosaccharide form) and total fructose exposure (pure fructose + fructose from sucrose) intake using a specific fructose composition database. Food categories were separated at posteriori in natural vs. were non-natural foods. Elevated BP was defined according to the 90th percentile cut-off values and was compared according to tertiles of fructose intake using univariable and multivariable mixed logistic regression models taking into account confounding factors: centre, sex, age and z-score-BMI, MVPA (Moderate to Vigorous Physical Activity) duration, tobacco consumption, salt intake and energy intake., Results: Pure fructose from non-natural foods was only associated with elevated DBP (DBP above the 10th percentile in the highest consuming girls (OR = 2.27 (1.17-4.40); p = 0.015) after adjustment for cofounding factors., Conclusions: Consuming high quantities of non-natural foods was associated with elevated DBP in adolescent girls, which was in part due to high fructose levels in these foods categories. The consumption of natural foods containing fructose, such as whole fruits, does not impact blood pressure and should continue to remain a healthy dietary habit.

Background: The aim of this study was to assess PA patterns among children and adolescents with inflammatory bowel disease (IBD)., Methods: Sixty participants with IBD (42 Crohn's disease [CD], 10 ulcerative colitis [UC], and 8 IBD-unclassified [IBD-U], 30 male patients) in remission (n = 45) or with mild disease (n = 15) were compared with 60 healthy age- and sex-matched controls. Each participant wore a triaxial accelerometer during 4 consecutive days for objective daily PA quantification., Results: Overall, there was no significant difference in daily PA patterns between patients with IBD and healthy controls, with 31.7% of patients with IBD and 38.3% of healthy controls fulfilling the recommendation of 60 min of moderate-to-vigorous physical activity (MVPA) daily (NS). Male patients with IBD spent significantly less time in MVPA compared with matched healthy controls (mean difference, 16.2 min day -1 ; p < 0.05). No difference was observed for female patients with IBD. No difference in sedentary pattern between male patients with IBD and controls was found., Conclusions: Children and adolescents with inactive or mildly active IBD have similar PA patterns compared with healthy controls, except for male patients who have reduced moderate-to-vigorous PA. By far, most patients with IBD do not fulfill the MVPA recommendations for health benefits., Impact: There is few data on PA patterns in pediatric patients with IBD. Methodological issues to assess PA limit the strengths of these studies. Pediatric IBD patients with inactive or mildly active IBD have similar physical activity patterns compared with healthy controls, except for male patients who have reduced moderate-to-vigorous PA. Most patients with IBD do not fulfill the MVPA recommendations for health benefits., (© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

We assessed the association between school time and physical fitness in adolescents. The study included 2,024 adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Health-related physical fitness components were assessed using the physical fitness tests battery. Cardiovascular risk was categorized using the sex-specific cut-offs for a healthy cardiorespiratory fitness level in adolescents proposed by FitnessGram®. School time was classified as short or long. Multivariate analysis accounted for confounding factors such age, sex, body mass index, time spent in moderate to vigorous physical activity, pubertal status, and parents' educational level. Cardiorespiratory fitness was higher in adolescents with a long school time than in those with a short school time (42.0 ± 7.6 vs 40.7 ± 7.2 mL.kg -1 .min -1 , respectively; p < 0.05). The percentage of adolescents at cardiovascular risk in adulthood was higher in the short than in the long time group (45.2% vs 31.7%, respectively) ( p < 0.05). These findings suggest that a long school day is associated with higher cardiorespiratory fitness in adolescents and that school time should be considered in interventions and health promotion strategies.

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., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Background & Aims: Microbiome-modulators can help positively steer early-life microbiota development but their effects on microbiome functionality and associated safety and tolerance need to be demonstrated. We investigated the microbiome impact of a new combination of bioactive compounds, produced by the food-grade microorganisms Bifidobacterium breve C50 and Streptococcus thermophilus ST065 during a fermentation process, and prebiotics in an infant formula. Tolerance and safety were also assessed., Methods: An exploratory prospective, randomized, double-blind, controlled, multi-centre study was designed to investigate the effect of bioactive compounds and prebiotics (short-chain galacto-oligosaccharides (scGOS)/long-chain fructo-oligosaccharides (lcFOS) 9:1). Experimental formulas containing these bioactive compounds and prebiotics (FERM/scGOS/lcFOS), prebiotics (scGOS/lcFOS), or bioactive compounds (FERM), were compared to a standard cow's milk-based control formula (Control). Exclusively breastfed infants were included as a reference arm since exclusive breastfeeding is considered as the optimal feeding for infants. The study lasted six months and included visits to health care professionals at baseline, two, four and six months of age. Stool SIgA concentration was the primary study outcome parameter., Results: There were 280 infants randomized over the experimental arms and 70 infants entered the breastfed-reference arm. Demographics were balanced, growth and tolerance parameters were according to expectation and adverse events were limited. At four months of age the median SIgA concentration in the FERM/scGOS/lcFOS group was significantly higher compared to the Control group (p = 0.03) and was more similar to the concentrations found in the breastfed-reference group. Bifidobacterium increased over time in all groups. The FERM/scGOS/lcFOS combination resulted in a microbiota composition and metabolic activity closer to the breastfed infants' microbiome., Conclusion: The FERM/scGOS/lcFOS combination showed a significant positive effect on SIgA levels. All formulas tested were associated with normal growth and were well-tolerated. Additionally, at four months of age the FERM/scGOS/lcFOS formula brought the microbiome composition and metabolic activity closer towards that of breastfed infants., Clinical Trial Registry: Registration number NTR2726 (Netherlands Trial Register; www.trialregister.nl/)., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

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.

Objectives: Cardiovascular diseases (CVDs) are responsible of 31% of all deaths worldwide. Genetic predisposition to CVDs in adolescents remains largely unknown. Aims of present research are to examine the association of ADIPOQ gene polymorphisms with cardiovascular disease risk factors in European adolescents., Methods: A total of 14 polymorphisms in the ADIPOQ gene were genotyped in 1057 European adolescents (12-18 years old) from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study. We measured serum lipids and a CVD risk score, along with weight, height, triceps, and subscapular skinfold thickness, leptin, insulin and other markers of glucose regulation., Results: The rs822393, rs822395 and rs7649121 polymorphisms of ADIPOQ gene were significantly associated with several CVD risk factors [i.e. high-density lipoprotein cholesterol (HDL-C), apolipoprotein (Apo) A1, SBP and CVD risk score] in European adolescents. We also found an association of the TGAAGT ADIPOQ haplotype (rs822393, rs16861210, rs822395, rs822396, rs12495941 and rs7649121) with HDL-C and ApoA1 levels., Conclusion: Several individual polymorphisms (rs822393, rs822395 and rs7649121) and a haplotype of ADIPOQ gene were significantly associated with cardiovascular disease risk factors in European adolescents.

Objectives: To examine the association of lipoprotein lipase (LPL) polymorphisms with cardiovascular disease (CVD) risk factors in European adolescents, along with the influence of physical activity on these associations., Methods: A total of 13 LPL polymorphisms were genotyped in 1.057 European adolescents (12-18 years old) from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study. Serum lipids, glucose, insulin, and leptin (LEP) levels were measured and a CVD risk score was computed. We also measured body weight and height, waist and hip circumferences, and triceps and subscapular skinfold thickness. Physical activity was objectively measured by accelerometry for 7 days., Results: The rs1534649, rs258, rs320, and rs328 polymorphisms were associated with several CVD risk factors (ie, body mass index, triglycerides [TG], LEP, and cholesterol/high-density lipoprotein [HDL], low-density lipoprotein [LDL]/HDL, TG/HDL ratios). TG and TG/HDL were associated with haplotype blocks 3 (rs282, rs285 polymorphisms) and 4 (rs3126, rs320, rs328, rs10099160 polymorphisms), being the latter also associated with the CVD risk score. Physical activity modulated the association of adiposity with rs1534649 and rs258 polymorphisms., Conclusions: Polymorphisms rs1534649, rs258, rs320 and rs328, and two haplotypes of LPL were significantly associated with CVD risk factors in European adolescents. Higher levels of moderate to vigorous physical activity may attenuate the effects of rs1534649 and rs258 polymorphisms on adiposity., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Preschool asthma/recurrent wheeze is a heterogeneous condition. Different clinical phenotypes have been described, including episodic viral wheeze (EVW), severe intermittent wheeze (SIW), and multiple-trigger wheeze (MTW)., Objective: To compare clinical, viral, and inflammatory/immune profiling at exacerbation between MTW, SIW, and EVW phenotypes., Methods: Multicenter, prospective, observational cohort (VIRASTHMA-2). Children (1-5 years) with preschool asthma were enrolled during hospitalization for a severe exacerbation. History and anamnestic data, plasma, and nasal samples were collected at exacerbation (T1) and at steady state, 8 weeks later (T2), and sputum samples were collected at T1., Results: A total of 147 children were enrolled, 37 (25%) had SIW, 18 (12.2%) EVW, and 92 (63%) MTW. They were atopic (47%), exposed to mold (22%) and cigarette smoke (50%), and prone to exacerbations (≥2 in the previous year in 70%). At exacerbation, at least one virus was isolated in 94% and rhinovirus in 75%, with no difference between phenotypes. Children with MTW and SIW phenotypes displayed lower plasma concentrations of IFN-γ (P = .002), IL-5 (P = .020), TNF-α (P = .038), IL-10 (P = .002), IFN-β (P = .036), and CXCL10 (P = .006) and lower levels of IFN-γ (P = .047) in sputum at exacerbation than children with EVW. At T2, they also displayed lower plasma levels of IFN-γ (P = .045) and CXCL10 (P = .013)., Conclusion: Among preschool asthmatic children, MTW and SIW, prone to exacerbations, display lower systemic levels of Th1, Th2 cytokines, pro- and anti-inflammatory cytokines, and antiviral responses during severe virus-induced exacerbation., (© 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

Background & Aims: Bone health is an important concern in patients with inflammatory bowel disease (IBD). Low bone mineral density (BMD) is a powerful predictor of fracture risk in IBD patients. Physical activity (PA) plays an important role in bone health. However, PA data for children and adolescents with IBD are scarce. The primary aim is to evaluate the relationship between PA and BMD in children with IBD. The secondary aim was to assess the relationship between PA and quality of life., Methods: Eighty-four IBD paediatric patients (45 boys) aged 14.3 ± 2.7 years were included (disease activity: (i) remission, n = 62; (ii) mild, n = 18; (iii) severe disease, n = 1). BMD was measured using dual-energy X-ray absorptiometry and expressed as age- and sex-based Z-scores. Each patient wore a triaxial accelerometer for seven consecutive days for objective PA quantification. Quality of life was assessed using the PedsQL™ and energy intake was assessed prospectively for three days using a dietary diary., Results: BMD Z-score was -0.96 ± 1.11. Only five patients (6%) fulfilled the recommendation of 60 min of daily moderate-to-vigorous PA (MVPA). The proportion of children with osteopenia and osteoporosis was 51% and 4%, respectively. After adjustment for confounders (pubertal status and body mass index), total PA and time in MVPA were positively associated with BMD (regression coefficient per one standard deviation increase in PA parameters = 0.26; P < 0.05). There was no association between time spent in MVPA and total PA, and total quality of life score., Conclusions: PA likely is associated with improved bone health in IBD children. Intervention studies investigating a causal relationship between PA and BMD in paediatric patients with IBD are warranted., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Objective: To examine the association between polymorphisms of the ciliary neurotrophic factor gene (CNTF) and total and central adiposity markers in adolescents., Study Design: This cross-sectional study involved 1057 European adolescents aged 12-18 years enrolled in the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study. Five polymorphisms of CNTF were genotyped, and the weight, height, waist and hip circumference, and triceps and subscapular skinfold thickness of the subjects were measured and recorded., Results: The T allele of rs2509914, the C allele of rs2515363, and the G allele of rs2515362 were significantly associated (after Bonferroni correction) with higher values for several adiposity markers under different inheritance models. The CNTF CCGGA haplotype (rs2509914, rs17489568, rs2515363 rs1800169, and rs2515362) was also significantly associated with lower body mass index, waist circumference, waist/height ratio, and waist/hip ratio values compared with the TCCGG haplotype under several inheritance models., Conclusions: Three polymorphisms-rs2509914, rs2515363, and rs2515362-and the CCGGA haplotype of CNTF were significantly associated with adiposity in European adolescents. These results suggest the potential role of CTNF in the development of obesity-related phenotypes., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Despite the development of novel therapies, inflammatory bowel diseases remain an innovative treatment challenge. Helminth therapy is a new promising approach, and a key issue is the identification of helminth-derived anti-inflammatory mediators. P28 glutathione-S-transferase (P28GST), a protein derived from schistosomes, a trematode parasitic helminth, was shown to reduce intestinal inflammation in experimental colitis by down-regulating the Th1/Th17 response. In this multicenter, open-label, pilot Phase 2a study, we evaluated the safety of P28GST administered to patients with mild Crohn's disease (CD). We enrolled 10 patients with a baseline Crohn's disease activity index (CDAI) value <220. Eight patients received two to three subcutaneous injections of recombinant P28GST with adjuvant. This three-month treatment was followed by a nine-month monitoring period. The primary endpoints were the monthly rate and seriousness of adverse events (AEs). Secondary endpoints were clinical recurrence, assessed with the CDAI as well as the levels of immunologic and inflammatory blood and tissue markers. The most common AEs were local or regional events at the injection site and gastrointestinal disorders. At three months after the first injection, CDAI scores and blood calprotectin levels decreased in parallel. These results indicate that P28GST showed promise as a safe and new therapeutic option for treating CD.

Background: We compared differences in physical activity (PA) between pre/mid-pubertal and post-pubertal participants according to gender., Methods: The study included a total of 1842 healthy participants aged 12.5-17.4 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Participants wore a uniaxial accelerometer (ActiGraph© GT1M, Pensacola, FL, USA) attached to their lower back for seven consecutive days to measure PA. Pubertal status was assessed by physical examination and the population was classified as pre/mid-pubertal (Tanner stages 1-3) or post-pubertal (Tanner stages 4-5). PA was compared between these groups according to gender during the whole week, on school-free days and on school days, before and after school, and during lessons and recesses., Results: When comparing the pre/mid-pubertal group with the post-pubertal group, girls' total PA did not differ between groups. However, a slight difference was observed in boys, among whom PA on school-free days showed a difference of 17.6% between the pre/mid-pubertal group and the post-pubertal group (679 kcounts vs 564 kcounts, respectively; P = 0.0007) and 20% (162 kcount vs 135 kcounts; P = 0.006) for school recess. There was no difference among girls., Conclusions: A reduced level of PA in the post-pubertal groups was only observed in boys during non-organized times such as on school-free days and during school recesses, with a moderate impact on total PA., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: Palmitate in breast milk is predominantly located in the triacylglycerol sn-2 position, while infant formulae contain palmitate predominantly in the sn-1 and sn-3 positions. During digestion, palmitate in the sn-1 and sn-3 positions is hydrolyzed to free palmitic acid that can subsequently complex with calcium to form insoluble soaps; this may partially explain why formula-fed infants have harder stools than breast-fed infants., Methods: This large (n = 488) randomized, double-blind, multicentre trial investigated whether increasing the sn-2 palmitate content of infant formula improves stool consistency and bone mineral content (measured by dual-energy x-ray absorptiometry), without affecting growth or health. From ∼1 week to 4 months of age, infants were exclusively fed one of three formulae: i) control formula (CF; 16% of total palmitate at sn-2; n = 162), (ii) experimental formula 1 (EF1; 43% of total palmitate at sn-2; n = 166) or (iii) experimental formula 2 (EF2; 51% of total palmitate at sn-2; n = 160)., Results: Intention-to-treat analysis showed softer stools in both EF groups (vs. CF) at ages 2 weeks and 1 and 2 months (p ≤ 0.01), but not 3 and 4 months. At 4 months, all groups had similar growth outcomes while bone mineral content was significantly higher in EF1 (p = 0.0012) and EF2 (p = 0.0002) compared with CF. Comparison of reported adverse events up to 12 months revealed no differences among groups. All 3 infant formulae exhibited equally good digestive tolerance., Conclusions: Formulae enriched in sn-2 palmitate fed in early infancy are safe, improve stool consistency (from 2 weeks to 2 months) and increase bone mineral content (at 4 months)., (Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Accelerometers are widely used to measure sedentary time and daily physical activity (PA). However, data collection and processing criteria, such as non-wear time rules might affect the assessment of total PA and sedentary time and the associations with health variables. The study aimed to investigate whether the choice of different non-wear time definitions would affect the outcomes of PA levels in youth., Methods: Seventy-seven healthy youngsters (44 boys), aged 10-17 years, wore an accelerometer and kept a non-wear log diary during 4 consecutives days. We compared 7 published algorithms (10, 15, 20, 30, 60 min of continuous zeros, Choi, and Troiano algorithms). Agreements of each algorithm with the log diary method were assessed using Bland-Altmans plots and by calculating the concordance correlation coefficient for repeated measures., Results: Variations in time spent in sedentary and moderate to vigorous PA (MVPA) were 30 and 3.7%. Compared with the log diary method, greater discrepancies were found for the algorithm 10 min (p < 0.001). For the time assessed in sedentary, the agreement with diary was excellent for the 4 algorithms (Choi, r = 0.79; Troiano, r = 0.81; 30 min, r = 0.79; 60 min, r = 0.81). Concordance for each method was excellent for the assessment of time spent in MVPA (> 0.86). The agreement for the wear time assessment was excellent for 5 algorithms (Choi r = 0.79; Troiano r = 0.79; 20 min r = 0.77; 30 min r = 0.80; 60 min r = 0.80)., Conclusions: The choice of non-wear time rules may considerably affect the sedentary time assessment in youth. Using of appropriate data reduction decision in youth is needed to limit differences in associations between health outcomes and sedentary behaviors and may improve comparability for future studies. Based on our results, we recommend the use of the algorithm of 30 min of continuous zeros for defining non-wear time to improve the accuracy in assessing PA levels in youth., Trial Registration: NCT02844101 (retrospectively registered at July 13th 2016).

Objective: To examine the associations between adolescents' diet quality and their perceived relatives' and peers' diet engagement and encouragement., Design: Cross-sectional study performed in European countries. Diet quality was scored using the Diet Quality Index for Adolescents (DQI-A) based on four components: quality, diversity, balance and meal frequency. Perceived diet quality engagement and perceived encouragement of the relatives/peers were assessed using the questions 'How healthy is each of the following persons' diet?' and 'How often does each of the following persons encourage you to eat a healthy diet?', Setting: Vienna, Ghent, Lille, Athens, Heraklion, Pecs, Rome, Dortmund, Zaragoza and Stockholm., Subjects: Healthy adolescents (n 2943)., Results: The perceived engagement level of the mother, father and sister was each positively associated with the DQI-A (P<0·05). A positive association was found for the perceived engagement level of siblings, father and mother with all specific components (P<0·05). DQI-A was negatively associated with the perceived encouragement level from a best friend and positively associated with the encouragement level of the mother and father (P<0·05). Diversity, balance and quality components were positively associated with the perceived encouragement level from the mother and father (P<0·05), whereas the best friend's perceived encouragement was negatively associated with the meal frequency component (P<0·01)., Conclusions: These findings highlight the role of social engagement and encouragement of relatives and peers in adolescents' diet quality. Intervention or promotion programmes aimed at enhancing diet quality in adolescents should target both family and peers.

The aim of this study was to assess physical activity (PA) awareness of adolescents and to identify anthropometric and psychosocial factors that can lead to under or overestimation of PA. This study included 2044 adolescents. Participants wore a uniaxial accelerometer for 7 days to measure PA and completed a self-rated questionnaire about PA. Adolescents were classified into four PA awareness subgroups (realistically active, overestimators, underestimators and realistically inactive) according to the self-rated and objective assessment of PA. Characteristics and psychosocial factors of the self-rated physically active groups were compared using bivariate and multivariate mixed logistic regression models. Forty-five percent of adolescents reported their PA levels correctly (34.8% realistically active and 10.1% realistically inactive). Among the 59.4% who were objectively inactive, 82.9% tended to overestimate their PA level. Adolescents who overestimated their PA level were older (P < .05), had more support from mother and a best friend (P < .05) and had higher cardiorespiratory fitness (P < .001) compared with those who were realistically active. A significant number of adolescents believe that they are physically active when they are not. Improving awareness, especially in the high-risk groups identified here, might help to bring about behavioural changes in physically inactive adolescents.

Background & Aims: The aim of this study was to assess the diet quality awareness and associated factors in a large sample of European adolescents., Methods: The study included 3389 healthy adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study. The adolescents' diet quality was based on repeated 24 h recalls and scored into a Diet Quality Index for Adolescents (DQI-A) considering four components: meal, equilibrium, diversity and quality. A self-rated diet quality questionnaire was administered to adolescents to assess their dietary awareness. The association of DQI-A with dietary awareness was studied using a linear mixed model including the center as the random effect and dietary awareness as the fixed effect., Results: There was a positive association between DQI-A scores and diet quality perception levels (p < 0.0001). The mean DQI-A was 59.0 (SD = 14.8) in adolescents with a low dietary awareness compared with 65.4 (SD = 12.6) in adolescents with high dietary awareness (p < 0.0001). Similar results were found for all the DQI components. When analyses were stratified, we found a significant heterogeneity across the nutritional status, with no significant association between DQI-A and dietary awareness level in obese adolescents, but a positive association in overweight, normal and undernourished groups. We found also a significant heterogeneity associated with the lunch location (school or home). No other factor affected dietary awareness (gender, pubertal status and maternal educational level)., Conclusion: European adolescents evaluate well their food quality whatever their pubertal status, gender and parental educational level, except for the obese who are not able to assess their diet quality. Improving the dietary awareness in obese adolescents might help to induce behavioral changes., (Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

The purpose of this study was to determine whether there is a difference in physical activity assessment between a wrist-worn accelerometer at the dominant or non-dominant arm. The secondary purpose was to assess the concurrent validity of measures of physical activity from the wrist-worn accelerometer and the waist-worn accelerometer. Forty adults wore three accelerometers simultaneously, one on the waist and one each on the non-dominant wrist and dominant wrist, respectively, for 24 consecutive hours of free-living conditions. Data were uploaded from the monitor to a computer following a 1-day test period. There were no significant differences in physical activity when comparing the dominant versus the non-dominant wrist, regardless of axis (P>0·05). Mean daily accelerometer output data from both wrists were strongly correlated with average counts per minute from the ActiGraph worn around the waist (r = 0·88, P<0·001). Findings suggest that the choice to wear the accelerometer on the non-dominant or dominant wrist has no impact on results. Data from this study contribute to the knowledge of how to best assess physical activity habits., (© 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.)

The aim was to assess the relationship between school rhythm and physical activity (PA) in adolescents. The study included 2024 adolescents (12.5-17.4 years). Participants wore an accelerometer for 7 days. A short school rhythm was defined as a short time at school with short recesses and less time in teaching per day (Group 1). A long school rhythm was defined as a longer time at school with more time in teaching and recess (Group 2). Adolescents in Group 1 performed less moderate to vigorous PA (MVPA) than those in Group 2 per week (P < .0001), especially during school days (recess: 3.9 ± 4.0 vs. 9.8 ± 7.9 min · day -1 ; P < .0001; teaching hours: 14.5 ± 9.8 vs. 19.1 ± 12.0 min · day -1 ; P < .0001). Adolescents in Group 1 were less likely to meet the PA recommendations than were adolescents in Group 2: 30.7% vs. 34.1% (P < .0001). During school days, the percentage of adolescents who spent more than 2 h · day -1 in sedentary activities was greater in the Group 1 (P < .001). Our results suggest that leisure-time out-of-school hours is used mainly for sedentary activities, and that school time provides a good opportunity for promoting PA.

Background: This study aimed to investigate whether awareness of being monitored by an accelerometer has an effect on physical activity in young people., Methods: Eighty healthy participants aged 10-18 years were randomized between blinded and nonblinded groups. The blinded participants were informed that we were testing the reliability of a new device for body posture assessment and these participants did not receive any information about physical activity. In contrast, the nonblinded participants were informed that the device was an accelerometer that assessed physical activity levels and patterns. The participants were instructed to wear the accelerometer for 4 consecutive days (2 school days and 2 school-free days)., Results: Missing data led to the exclusion of 2 participants assigned to the blinded group. When data from the blinded group were compared with these from the nonblinded group, no differences were found in the duration of any of the following items: (i) wearing the accelerometer, (ii) total physical activity, (iii) sedentary activity, and (iv) moderate-to-vigorous activity., Conclusions: Our study shows that the awareness of wearing an accelerometer has no influence on physical activity patterns in young people. This study improves the understanding of physical activity assessment and underlines the objectivity of this method., Trial Registration: NCT02844101 (retrospectively registered at July 13th 2016).

The aim of this study was to establish sex- and age-specific physical fitness percentiles in French youth. A sample of 11,186 children and adolescents (5,546 boys and 5,640 girls), aged between 10 and 15 years, was assessed in the French national BOUGE study. Participants were tested for their cardiorespiratory fitness, muscular endurance, speed, flexibility, and agility using the following tests: 20-m shuttle run tests, curl-ups test, 50-m sprint test, back-saver sit and reach test, and 10 × 5-m shuttle run test. Percentile values were estimated for French youth as a function of age stratified by sex using the generalized additive model for location, scale, and shape (GAMLSS). In general, physical fitness was better in boys than in girls, except for the back-saver sit and reach test, in which girls performed better. Except for the back-saver sit and reach test and 10 × 5-m shuttle run test, physical fitness performance was significantly associated with age. Sex- and age-specific normative values for physical fitness tests in French youth expressed as percentiles from the fifth to the 95th are provided. Reference values provide normative data for French youth. The data are useful in identifying special needs for appropriate intervention programs.

Objective: To determine the prevalence of underweight, overweight and obesity in French youth from 2009 to 2013 and to determine if there are differences in weight categories according to socio-economic status., Design: Cross-sectional study performed in different regions of France. Physical measures included weight, height and BMI. Underweight, overweight and obesity were defined according to age- and sex-specific BMI cut-off points from the International Obesity Task Force., Setting: France., Subjects: Children and adolescents (n 9670; 4836 boys, 4834 girls) from the French national BOUGE Program between 2009 and 2013., Results: The prevalence of obesity was higher in boys than girls (P0·05) and remained unchanged in boys (7·1-7·3 %) between 2009 and 2013. Overweight and obesity were higher in low socio-economic families (P<0·0001)., Conclusions: Findings suggest that the prevalence of overweight was stable although high in French children and adolescents, while the prevalence of obesity increased significantly. Changes in underweight, although not significant, were high in girls and merit further attention. Improving public health interventions, especially in high-risk low socio-economic populations, may help to modify the behaviour that contributes to underweight, overweight and obesity in young boys and girls.

Background & Aims: Mitochondrial OXPHOS disorders (MODs) affect one or several complexes of respiratory chain oxidative phosphorylation. An increased fat/low-carbohydrate ratio of the diet was recommended for treating MODs without, however, evaluating its potential benefits through changes in the respective contributions of cell pathways (glycolysis, fatty acid oxidation) initiating energy production. Therefore, the objective of the present work was to compare Resting Energy Expenditure (REE) under basal diet (BD) and challenging diet (CD) in which fat on sugar content ratio was doubled. Diet-induced thermogenesis (DIT) and body compositions were also compared. Energetic vs regulatory aspects of increasing fat contribution to total nutritional energy input were essentially addressed through measures primarily aiming at modifying total fat amounts and not the types of fats in designed diets., Methods: In this randomized cross-over study, BD contained 10% proteins/30% lipids/60% carbohydrates (fat on sugar ratio = 0.5) and was the imposed diet at baseline. CD contained 10% proteins/45% lipids/45% carbohydrates (fat on sugar ratio = 1). Main and second evaluation criteria measured by indirect calorimetry (QUARK RMR ® , Cosmed, Pavona; Italy) were REE and DIT, respectively. Thirty four MOD patients were included; 22 (mean age 13.2 ± 4.7 years, 50% female; BMI 16.9 ± 4.2 kg/m 2 ) were evaluated for REE, and 12 (mean age 13.8 ± 4.8 years, 60% female; BMI 17.4 ± 4.6 kg/m 2 ) also for DIT. OXPHOS complex deficiency repartition in 22 analysed patients was 55% for complex I, 9% for complex III, 27% for complex IV and 9% for other proteins., Results: Neither carry-over nor period effects were detected (p = 0.878; ANOVA for repeated measures). REE was similar between BD vs CD (1148.8 ± 301.7 vs 1156.1 ± 278.8 kcal/day; p = 0.942) as well as DIT (peak DIT 260 vs 265 kcal/day; p = 0.842) and body composition (21.9 ± 13.0 vs 21.6 ± 13.3% of fat mass; p = 0.810)., Conclusion: Doubling diet fat on sugar ratio does not appear to improve, per se, energetic status and body composition of patients with MODs., (Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Background: A high level of physical fitness is associated with cardiovascular health in adolescents. The aims of this study were to assess the levels of physical fitness of French adolescents and to determine the prevalence of these adolescents below the minimum level of cardiorespiratory fitness needed to guarantee future favorable cardiovascular profile., Methods: Participants were 12,082 French children and adolescents (5975 boys, 6107 girls) aged to 9 from 16 years. Cardiorespiratory fitness, muscular endurance, speed, flexibility and speed agility were tested. The associations of physical fitness measures with adolescent's characteristics were analyzed using Student t test, one-way ANOVA, or Pearson correlations as appropriate., Results: Boys were physically fitter than girls, expected for flexibility (P<0.0001). Subjects of normal weight adolescents had significantly better results than overweight or obese adolescents (P<0.05 for all comparisons), but also in comparison with underweight adolescents for muscular endurance, flexibility, cardiorespiratory fitness test (P<0.05). Our findings indicate that, on the basis of cardiorespiratory fitness, 16% of French boys and 7.7% of French girls have a risk of future cardiovascular disease (P<0.0001). This subgroup also performed poorly in all other tests of physical fitness used (P<0.0001). Aerobic fitness decreased significantly with the age (r=-0.168 for boys; r=-0.261 for girls)., Conclusions: Our results indicate that the physical fitness of French adolescents must be improved to help protect against cardiovascular disease in adulthood, especially in boys. The study showed also a dramatically decrease of the cardiorespiratory fitness during the adolescence period. Developing and introducing a health promotion curriculum in the French schools is suggested to improve health and physical fitness., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

The aim was to examine the reliability of health-related physical fitness tests that were used in a French health promotion program 'Move…A priority for your health'. Participants were 174 French youth (88 children and 86 adolescents) aged 8·2-16·2 years. Aerobic fitness, muscular strength, speed and flexibility were tested using 20-m shuttle run test, ½ mile run test, basketball throw, standing long jump, shoulder stretch and 20/30/50-m sprint tests. Reliability was calculated for the basketball throw, standing long jump, shoulder stretch and sprint tests. The tests were performed two times, 1 week apart on the same day of the week. Reliability was examined with intraclass correlation coefficients (ICCs) and Bland-Altman analysis. With the exception of the ½ mile run test, which resulted in moderate agreement (0·66), all tests had high reliability. ICCs were 0·97, 0·93, 0·91 and 0·93 for the sprint test, basketball throw, shoulder stretch and the standing long jump, respectively. The differences obtained between the first and the second trial were non-significant. Results from this study indicate that the BOUGE health-related physical fitness battery, administrated by physical education teachers, was reliable for measuring health-related components of fitness in children and adolescents in a school setting., (© 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.)

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., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Nutritional status, an important measure in health promotion and certain childhood and adolescent pathologies, includes anthropometric, diet and physical activity evaluation. Choosing the best assessment of nutritional status for your research must consider objectives of clinician, study design, number of subjects, frequency of measurement, and cost. The purpose of this paper is to present reliable and valid field techniques available for pediatric ambulatory clinical research. These techniques do not interfere with free living conditions and represent a good alternative compared to reference assessment. The techniques are compatible with the quality assurance and ethics in clinical and epidemiological research requirements.

Unlabelled: Early menarche has been associated with adult overweight, cardiovascular risk factors, and other diseases. Little is known about the determinants of menarcheal age (MA). Therefore, the main aim of this study was to examine the associations between early life programming factors and menarcheal age in European adolescents. Secondly, the influence of sociodemographical factors on menarcheal age was also studied. A total of 1,069 European girls from the HELENA cross-sectional study, aged 12.5-17.5 years, were included in this study. Using multilevel linear regression models, a possible association between birth weight and length, ponderal index at birth, gestational age, duration of exclusive breastfeeding, and menarcheal age was examined. Associations between geographical gradient, number of siblings, physical activity (PA), dietary factors, and menarcheal age were also examined. After adjustment, menarcheal age was positively associated with birth weight and length (p = 0.01 and p = 0.01)., Conclusion: These findings confirm that birth weight and length may have a programming effect on menarcheal age. Next to this finding, sociodemographic factors were not associated with menarcheal age.