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Objective: The aim of the current study is to analyze the associations between breakfast consumption and adherence to diet quality index (DQI) and Mediterranean Diet Score (MDS) in European adolescents., Methods: A multinational cross-sectional study was carried out in 1804 adolescents aged 12.5-17.5 years. The Food Choices and Preferences questionnaire was used to ascertain breakfast consumption (consumers, occasional consumers and skippers), and two non-consecutive 24 h dietary recalls were used to estimate the total daily intake and to calculate the subsequent DQI and MDS. Mixed linear regression models were used to examine the relationship between breakfast consumption and DQI-A and MDS. Age, maternal education, BMI, country and total energy intake were included as covariates., Results: In both sexes, significant differences were observed among the breakfast consumption categories. In both boys and girls, breakfast consumers had significantly higher DQI indices than those adolescents who skipped breakfast regularly (p < 0.001). Regarding total MDS, in both boys and girls, breakfast consumers had a higher total MDS than breakfast skippers (p < 0.001), however, no associations were shown between occasional breakfast consumers and DQI indices and MDS., Conclusion: Breakfast consumption has been linked with better dietary quality scores compared with those children who usually skip breakfast. Promotion of regular breakfast consumption in adolescents could be an effective strategy to improve the overall diet quality., (© 2022. The Author(s), under exclusive licence to Springer Nature Limited.)

Background/objectives: Current research in adults indicates that fruit and vegetable (FAV) consumption increases serum levels of vitamins C, E and folate of β-carotene and reduces homocysteine concentrations. The aim of the present study was to examine the association of FAV consumption on vitamin intakes and their impact on blood vitamin concentrations in European adolescents., Subject/methods: This multi-center cross-sectional study included 702 (53.7% females) adolescents, aged 12.50-17.49 years, from 10 European cities. Two independent self-administered 24 h dietary recalls were used to estimate the adolescent's diet. The total energy, vitamins and FAV consumption were calculated. Adolescents were categorized into three groups: (i) very low FAV intake (<200 g/day); (ii) low FAV consumption (200-399 g/day) and (iii) adequate FAV consumption (⩾400 g/day). Adolescent's fasted blood samples were taken for their analysis on vitamin concentrations., Results: The main results showed that those adolescents meeting the FAV recommendation, classified as FAV adequate consumers, presented higher intake of energy and some vitamins as B6, total folic acid, C, E and β-carotene compared with FAV very low consumers (P<0.05). Regarding their blood status, male adolescents who had a very low FAV consumption presented lower plasma folate, RBC folate blood concentrations compared with adequate FAV consumers (P<0.05). Female adequate FAV consumers had higher concentrations of pyridoxal phosphate (PLP), plasma folate, RBC folate, vitamin C, β-carotene and α-tocopherol compared with very low and low consumers (P<0.05)., Conclusions: Having a FAV dairy intake above 400 g/day is associated with higher vitamin intake and blood vitamin concentrations, especially for antioxidant and B-vitamins concentrations.

Background/objectives: The objectives of this study were to investigate the relationship between inflammatory parameters (CRP, c-reactive protein; AGP, α1-acid glycoprotein), iron status indicators (SF, serum ferritin; sTfR, soluble transferrin receptor) and body mass index (BMI) z-score, fat-free mass (FFM) and fat mass (FM) in European adolescents. Differences in intake for some nutrients (total iron, haem and non-haem iron, vitamin C, calcium, proteins) were assessed according to BMI categories, and the association of nutrient intakes with BMI z-score, FM and FFM was evaluated., Methods: A total of 876 adolescents participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence-Cross Sectional Study were included in the study sample., Results: Mean CRP values (standard error; s.e.) were significantly higher in overweight/obese adolescents (1.7±0.3 and 1.4±0.3 mg/l in boys and girls, respectively) than in thin/normal-weight adolescents (1.1±0.2 and 1.0±0.1 mg/l in boys and girls, respectively) (P<0.05). For boys, mean SF values (s.e.) were significantly higher in overweight/obese adolescents (46.9±2.7 μg/l) than in thin/normal-weight adolescents (35.7±1.7 μg/l) (P<0.001), whereas median sTfR values did not differ among BMI categories for both boys and girls. Multilevel regression analyses showed that BMI z-score and FM were significantly related to CRP and AGP (P<0.05). Dietary variables did not differ significantly among BMI categories, except for the intake of vegetable proteins, which, for boys, was higher in thin/normal-weight adolescents than in overweight/obese adolescents (P<0.05)., Conclusions: The adiposity of the European adolescents was sufficient to cause chronic inflammation but not sufficient to impair iron status and cause iron deficiency.

Background/objectives: The objective of this study was to examine the relationship between amino acid (AA) intake and serum lipid profile in European adolescents from eight European cities participating in the cross-sectional (2006-2007) HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study, and to assess whether this association was independent of total fat intake., Subjects/methods: Diet, skinfold thickness, triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), TC/HDL-c ratio, low-density lipoprotein cholesterol (LDL-c), apolipoprotein B (Apo B), apolipoprotein A1 (Apo A1) and Apo B/Apo A1 ratio were measured in 454 12.5- to 17.5-year-old adolescents (44% boys). Intake was assessed via two non-consecutive 24-h dietary recalls. Data on maternal education and sedentary behaviors were obtained via questionnaires. Physical activity was objectively measured by accelerometry., Results: Alanine, arginine, asparaginic acid, glycine, histidine, lysine and serine intakes were inversely associated with serum TG concentrations in both boys and girls. Intake of other AA like alanine and/or arginine was also inversely associated with serum TC, LDL-c and Apo B/Apo A1 ratio only in girls. An inverse association was observed between intakes of alanine, isoleucine, leucine, methionine, serine, tryptophan, tyrosine and valine and TC/HDL-c ratio among female adolescents. Similar results were found in males for serine and tryptophan intakes. It is noteworthy, however, that associations were no longer significant in both genders when total fat intake was considered as a confounding factor., Conclusions: In this sample of adolescents, the association between AA intakes and serum lipid profile did not persist when dietary fat was considered. Therefore, dietary interventions and health promotion activities should focus on fat intake to improve lipid profile and potentially prevent cardiovascular disease.

Background/objectives: To provide a detailed lipid profile of a European adolescent population considering age, gender, biological maturity, body mass index (BMI), fat mass (FM) and percentage body fat (BF)., Subjects/methods: Within Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA), a cross-sectional study was conducted to determine fasting serum concentrations of lipids, lipoproteins and apolipoproteins in 1076 adolescents aged 12.5-17.49 years from ten European centres., Results: All serum lipid concentrations were significantly higher in girls than in boys. In boys, age was negatively correlated with high-density lipoprotein (HDL)-cholesterol and total cholesterol (TC), and positively associated with triacylglycerides (TAG) (P < 0.01) whereas no significant associations were observed in girls. Biological maturity was negatively associated with TC, HDL-, low-density lipoprotein (LDL)- and non-HDL cholesterol in boys (all P<0.05) and negatively correlated with HDL-cholesterol in girls (P<0.05). BMI, FM and BF were significantly correlated with HDL-cholesterol, LDL-cholesterol, non-HDL cholesterol, apolipoprotein (apo) A1, apoB and TAG in both boys and girls., Conclusions: The lipid profile in adolescents is strongly determined by gender. Biological maturity, FM and percentage BF contribute to the variance in lipid concentrations and should be considered in future evaluations of lipid status.

Background/objectives: Our objective was to describe the fluid and energy consumption of beverages in a large sample of European adolescents., Subjects/methods: We used data from 2741 European adolescents residing in 8 countries participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS). We averaged two 24-h recalls, collected using the HELENA-dietary assessment tool. By gender and age subgroup (12.5-14.9 years and 15-17.5 years), we examined per capita and per consumer fluid (milliliters (ml)) and energy (kilojoules (kJ)) intake from beverages and percentage consuming 10 different beverage groups., Results: Mean beverage consumption was 1611 ml/day in boys and 1316 ml/day in girls. Energy intake from beverages was about 1966 kJ/day and 1289 kJ/day in European boys and girls, respectively, with sugar-sweetened beverages (SSBs) (carbonated and non-carbonated beverages, including soft drinks, fruit drinks and powders/concentrates) contributing to daily energy intake more than other groups of beverages. Boys and older adolescents consumed the most amount of per capita total energy from beverages. Among all age and gender subgroups, SSBs, sweetened milk (including chocolate milk and flavored yogurt drinks all with added sugar), low-fat milk and fruit juice provided the highest amount of per capita energy. Water was consumed by the largest percentage of adolescents followed by SSBs, fruit juice and sweetened milk. Among consumers, water provided the greatest fluid intake and sweetened milk accounted for the largest amount of energy intake followed by SSBs. Patterns of energy intake from each beverage varied between countries., Conclusions: European adolescents consume an average of 1455 ml/day of beverages, with the largest proportion of consumers and the largest fluid amount coming from water. Beverages provide 1609 kJ/day, of which 30.4%, 20.7% and 18.1% comes from SSBs, sweetened milk and fruit juice, respectively.

Objective: To determine reference values for body mass index (BMI), sum of six skinfolds (sigma6 skinfolds) and body fat percentage (BF%) in Spanish adolescents aged 13-18 years, included in the AVENA Study (Alimentación y Valoración del Estado Nutricional en Adolescentes: Food and Assessment of the Nutritional Status of Adolescents)., Design: Multicentre cross-sectional study., Setting: Representative sample of Spanish adolescents., Subjects: The population was selected by means of a multiplestep, simple random sampling. The final number of subjects included in the AVENA Study was 2859 adolescents; 2160 adolescents had a complete set of anthropometric measurements and were then included in this study (1109 males and 1051 females)., Interventions: Weight, height and six skinfold thicknesses were measured. As indices of total adiposity, we calculated BMI, summation sigma6 skinfolds and BF% with the formulas described by Slaughter et al., Results: Sigma6 skinfolds and BF% in each age group were significantly higher in females than in males. In males, age showed a significant effect for BMI, sigma6 skinfolds and BF%; however, in females, the effect was only significant for BF%. The percentile distribution was more disperse towards higher sigma6 skinfolds and BF% values in males when compared with females., Conclusions: The presented percentile values will help us to classify adolescents in comparison with a well-established reference population, and to estimate the proportion of adolescents with high or low adiposity amounts., Sponsorship: The AVENA-Study was supported by the Spanish Ministry of Health (FIS 00/0015), and grants from Panrico SA, Madaus SA and Procter and Gamble SA. This study was also supported by Instituto de Salud Carlos III (Spain), RCESP (C03/09) and Spanish Ministry of Education (AP2003-2128).

During the last few years, magnesium (Mg) has been subject of research due to its functionality in the organism. It is one of the most important micronutrients, and therefore its role in biological systems has been extensively investigated. Particularly, Mg has a strong relation with the immune system, in both nonspecific and specific immune response, also known as innate and acquired immune response. The aim of this paper is to review the state of the art about the interactions between Mg and the immune system. We discuss the link between dietary Mg and inflammation, apoptosis and alterations in number and function of innate immune cell populations, described in animal models. Furthermore, the immune system can be compromised in human populations under certain circumstances, including athletes and elderly people. The importance of a balanced Mg homeostasis and its interaction with the immune system in these groups has also been reviewed. Although emerging data support the relevant role of Mg in the immune response, further research is needed; and special efforts should be made to establish the most adequate dose in nutritional supplements to reach beneficial effects on health.

Background: In the last decade, research in the field of nutrition has grown both in width and depth, and has incorporated the advances of other scientific fields, like artificial intelligence theories. Specifically in the case of recommended nutrient intakes, the fuzzy theory is an interesting contribution to the development of a new concept for the recommendations. The recommended intakes have passed from avoiding deficiency status to preventing several pathological aspects and reducing risk factors., Objective: To establish whether the recommended dietary intakes for Spain (IREs) must be reviewed, taking into account the current scientific state of the art., Methods: We have compared IREs, published in 1994, with the recently published 'Dietary Reference Intakes' (DRIs) for the American and Canadian population, the 'Referenzwerte für die Nährstoffzufuhr' (DACH) for the German, Swiss and Austrian population. In addition, the main guidelines of the EURODIET criteria (Nutrition and Diet for Healthy Lifestyles), which was developed for the population of the European Union Member States, were taken into account. As an example, comparisons were made for the elderly population group, establishing differences and similarities between the different scientific communities and the adequacy of Spanish recommended intakes for energy and nutrients., Results: Recommended intakes for folate, calcium and vitamins C, D and E are lower in the IREs and probably should be increased. Recommended intakes for nutrients which have not previously been included in the IREs, such as vitamin K, selenium, copper, chromium, molybdenum, manganese, phosphorus, sodium, potassium, and water need to be developed., Conclusions: The current recommended intakes for the Spanish population need to be reviewed in order to encompass current scientific knowledge. Moreover, the opportunity to include non-nutrients (bioactive compounds) should be considered.

In the last decade, preventive medicine has undergone a great advance, especially in developed countries. Research has demonstrated that nutrition plays a crucial role in the prevention of chronic diseases, as most of them can be related to diet. Functional food enters the concept of considering food not only necessary for living but also as a source of mental and physical well-being, contributing to the prevention and reduction of risk factors for several diseases or enhancing certain physiological functions. In reference to the immune system, many studies have pointed out that not only pre- and probiotics, but also single micronutrients incorporated into functional foods contribute to an enhancement of immunocompetence. In fact, one of the authorized claims consists of pointing out the immunomodulator properties of functional foods. In this article, the effect of some functional foods and ingredients such as probiotics, selenium and dietary antioxidants (vitamins A, E and C) on the immune function are reviewed. However, the optimum intake level and recommended amounts of functional foods have not yet been established. Thus, in order to remove the controversy surrounding functional food, further research studies are necessary, both in experimental animals and in humans. Finally: efforts should be directed towards the ultimate goal, that is, a 'functional diet'.

The aim of this review is to present and discuss the effect of different levels of alcohol consumption on the immune system. Not only the amount consumed but also the type of alcoholic beverage have to be taken into account in order to determine the consequences on activity, number, distribution, balance, interaction and response of immunocompetent cells. The association between alcohol exposure and the risk of developing an alcohol-related disease is multifactorial. In fact, age, gender, smoking habits, dietary intake and exercise are involved among other factors. The evaluation of the host cellular and humoral immune responses has shown that alcohol may induce some benefits when consumption is moderate. Moreover, those alcoholic beverages that contain antioxidants, such as red wine, could be protectors against immune cell damage. According to the literature consulted, the daily consumption of 10-12 g and 20-24 g of alcohol for women and men, respectively, is considered to be a moderate intake; the type of beverage has been established not to be important when defining moderation. Particular attention is often focused on the U- or J-shaped curve which also suggests that light to moderate drinking produces a protective effect. Such an inverse relationship indicates a reduction of risk for both light and moderate consumers and a higher risk not only for hard drinkers, but also for non-consumers.