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Chronic stress exposure is associated with diverse negative health outcomes. It has been hypothesised that stress may also negatively affect the body's mineral status. This study investigates the association between chronic stress and long-term mineral concentrations of calcium (Ca), copper (Cu), iron (Fe), magnesium (Mg), phosphorus (P) and zinc (Zn) in scalp hair among elementary school girls. Complete information on child-reported stress estimates (Coddington Life Events Scale (CLES)), hair cortisone and hair mineral concentrations, and predefined confounders in the stress-mineral relationship (i.e. age, body mass index, physical activity, diet, hair colour and parental education) was provided cross-sectionally for 140 girls (5-10 years old). The relationship between childhood stress measures (predictor) and hair minerals (outcome) was studied using linear regression analysis, adjusted for the abovementioned confounders. Hair cortisone concentrations were inversely associated with hair mineral concentrations of Ca, Mg, Zn and the Ca/P ratio. Children at risk by life events (CLES) presented an elevated Ca/Mg ratio. These findings were persistent after adjustment for confounders. This study demonstrated an independent association between chronic stress measures and hair mineral levels in young girls, indicating the importance of physiological stress-mineral pathways independently from individual or behavioural factors. Findings need to be confirmed in a more heterogeneous population and on longitudinal basis. The precise mechanisms by which stress alters hair mineral levels should be further elucidated.

BACKGROUND/OBJECTIVES: Longitudinal studies investigating dietary patterns (DPs) and their association with childhood overweight/obesity are lacking in Europe. We identified DPs and investigated their association with overweight/obesity and changes in body mass index (BMI) in a cohort of European children. SUBJECTS/METHODS: Children aged 2-10 from eight European countries were recruited in 2007-2008. Food frequency questionnaires were collected from 14 989 children. BMI and BMI z-scores were derived from height and weight and were used to identify overweight/obese children. After 2 years (mean), anthropometric measurements were repeated in 9427 children. Principal component analysis was used to identify DPs. Simplified DPs (SDPs) were derived from DPs. Adjusted odds ratios (ORs) for overweight/obesity with increasing DP intake were estimated using multilevel logistic regression. Associations of BMI change with DP and SDP were assessed by multilevel mixed regression. Models were adjusted for baseline BMI, age, sex, physical activity and family income. RESULTS: Four DPs were identified that explained 25% of food intake variance: snacking, sweet and fat, vegetables and wholemeal, and protein and water. After 2 years, 849(9%) children became overweight/obese. Children in the highest vegetables and wholemeal tertile had lower risk of becoming overweight/obese (OR: 0.69, 95% confidence intervals (CIs): 0.54-0.88). Children in the highest SDP tertile of vegetables and wholemeal had similarly lower risk of becoming overweight/obese (OR: 0.64, 95% CIs: 0.51-0.82), and their BMI increased by 0.7 kg/m2 over the study period--significantly less than the increase in the lowest tertile (0.84 kg/m2). CONCLUSIONS: Our findings suggest that promoting a diet rich in vegetables and wholemeal cereals may counteract overweight/ obesity in children.

AIMS/HYPOTHESIS: Consumption of sugar-sweetened beverages has been shown, largely in American populations, to increase type 2 diabetes incidence. We aimed to evaluate the association of consumption of sweet beverages (juices and nectars, sugar-sweetened soft drinks and artificially sweetened soft drinks) with type 2 diabetes incidence in European adults.METHODS: We established a case-cohort study including 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants selected from eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. After exclusions, the final sample size included 11,684 incident cases and a subcohort of 15,374 participants. Cox proportional hazards regression models (modified for the case-cohort design) and random-effects meta-analyses were used to estimate the association between sweet beverage consumption (obtained from validated dietary questionnaires) and type 2 diabetes incidence.RESULTS: In adjusted models, one 336 g (12 oz) daily increment in sugar-sweetened and artificially sweetened soft drink consumption was associated with HRs for type 2 diabetes of 1.22 (95% CI 1.09, 1.38) and 1.52 (95% CI 1.26, 1.83), respectively. After further adjustment for energy intake and BMI, the association of sugar-sweetened soft drinks with type 2 diabetes persisted (HR 1.18, 95% CI 1.06, 1.32), but the association of artificially sweetened soft drinks became statistically not significant (HR 1.11, 95% CI 0.95, 1.31). Juice and nectar consumption was not associated with type 2 diabetes incidence.CONCLUSIONS/INTERPRETATION: This study corroborates the association between increased incidence of type 2 diabetes and high consumption of sugar-sweetened soft drinks in European adults.

Journal Article; Research Support, Non-U.S. Gov't; BACKGROUND Observational studies implicate higher dietary energy density (DED) as a potential risk factor for weight gain and obesity. It has been hypothesized that DED may also be associated with risk of type 2 diabetes (T2D), but limited evidence exists. Therefore, we investigated the association between DED and risk of T2D in a large prospective study with heterogeneity of dietary intake. METHODOLOGY/PRINCIPAL FINDINGS A case-cohort study was nested within the European Prospective Investigation into Cancer (EPIC) study of 340,234 participants contributing 3.99 million person years of follow-up, identifying 12,403 incident diabetes cases and a random subcohort of 16,835 individuals from 8 European countries. DED was calculated as energy (kcal) from foods (except beverages) divided by the weight (gram) of foods estimated from dietary questionnaires. Prentice-weighted Cox proportional hazard regression models were fitted by country. Risk estimates were pooled by random effects meta-analysis and heterogeneity was evaluated. Estimated mean (sd) DED was 1.5 (0.3) kcal/g among cases and subcohort members, varying across countries (range 1.4-1.7 kcal/g). After adjustment for age, sex, smoking, physical activity, alcohol intake, energy intake from beverages and misreporting of dietary intake, no association was observed between DED and T2D (HR 1.02 (95% CI: 0.93-1.13), which was consistent across countries (I(2) = 2.9%). CONCLUSIONS/SIGNIFICANCE In this large European case-cohort study no association between DED of solid and semi-solid foods and risk of T2D was observed. However, despite the fact that there currently is no conclusive evidence for an association between DED and T2DM risk, choosing low energy dense foods should be promoted as they support current WHO recommendations to prevent chronic diseases. Yes

Background: Dietary pattern analysis, based on the concept that foods eaten together are as important as a reductive methodology characterized by a single food or nutrient analysis, has emerged as an alternative approach to study the relation between nutrition and disease. The aim of the present study was to compare nutritional intake and the results of dietary pattern analysis in properly matched vegetarian and omnivorous subjects. Methods: Vegetarians (n = 69) were recruited via purposeful sampling and matched non-vegetarians (n = 69) with same age, gender, health and lifestyle characteristics were searched for via convenience sampling. Two dietary pattern analysis methods, the Healthy Eating Index-2010 (HEI-2010) and the Mediterranean Diet Score (MDS) were calculated and analysed in function of the nutrient intake. Results: Mean total energy intake was comparable between vegetarians and omnivorous subjects (p > 0.05). Macronutrient analysis revealed significant differences between the mean values for vegetarians and omnivorous subjects (absolute and relative protein and total fat intake were significantly lower in vegetarians, while carbohydrate and fibre intakes were significantly higher in vegetarians than in omnivorous subjects). The HEI and MDS were significantly higher for the vegetarians (HEI = 53.8.1 +/- 11.2; MDS = 4.3 +/- 1.3) compared to the omnivorous subjects (HEI = 46.4 +/- 15.3; MDS = 3.8 +/- 1.4). Conclusions: Our results indicate a more nutrient dense pattern, closer to the current dietary recommendations for the vegetarians compared to the omnivorous subjects. Both indexing systems were able to discriminate between the vegetarians and the non-vegetarians with higher scores for the vegetarian subjects.

The gaps in human diets have mainly been discussed by comparing nutrient intakes with age- and gender-specific recommended dietary allowances (RDA) for nutrients [1] or by comparing food intakes with Food Based Dietary Guidelines (FBDG). A complementary approach to assessing compliance with nutrition and food guidelines consists of obtaining an overall dietary index, which has the added value of considering the complexity of food consumption patterns and their multidimensional nature [2–5]. In this respect, indices based on nutrients, foods and a combination of both have been proposed [3, 5–9]. Some of these indices have shown an association with mortality risk, cardiovascular diseases (CVD) and some types of cancer, of greater magnitude than that observed for any nutrient or food at an individual level [10, 11].

The competitiveness of two transgenic oilseed rape (Brassica napus ssp.napus) lines and their fertile transgenic hybrid was tested in field trials in Belgium and Denmark. The lines contained genes for male sterility, restoration of fertility and herbicide resistance. The competitiveness of the three transgenic lines was related to three non-transformed commercially-grown oilseed rape varieties: Drakkar, Topas and Line. As a reference of a more aggressive crucifer, white mustard (Sinapis alba) was also included in the experiment. The experimental design was a complete block design with two locations, monocultures and mixtures with barley (Hordeum vulgare), three plant densities, four harvest times and four blocks. The yield density relationship of the transgenic oilseed rape lines was not different from that of the non-transgenic varieties in either location. The first harvest times showed a vigorous biomass production of white mustard, which in turn produced a significant difference in the competitive ability between oilseed rape and white mustard. Later, this difference decreased, and in Belgium there was no difference at the last harvest time. Variations within populations may blur actual differences between lines and varieties, and it is argued that unless the experimental design covers a range of competitiveness for which it is possible to detect significant differences, test results reporting a lack of difference between transgenic and non-transgenic plants are of little value.

Stress is a complex phenomenon coordinated by two main neural systems: the hypothalamic–pituitary–adrenal system with cortisol as classical stress biomarker and the autonomic nervous system with heart rate variability (HRV) as recently suggested stress marker. To test low HRV (5 minute measurements) as stress indicator in young children (5-10y), associations with self-reported chronic stress aspects (events, emotions and problems) (N = 334) and salivary cortisol (N = 293) were performed. Peer problems, anger, anxiety and sadness were associated with lower root mean square of successive differences (RMSSD) and high frequency power (i.e. lower parasympathetic activity). Anxiety and anger were also related to a higher low frequency to high frequency ratio. Using multilevel modelling, higher cortisol levels, a larger cortisol awakening response and steeper diurnal decline were also associated with these HRV patterns of lower parasympathetic activity. Conclusion: Low HRV (lower parasympathetic activity) might serve as stress indicator in children.

The present paper will use fat mass percentage (FM%) obtained via BOD POD® air-displacement plethysmography (FMADP%) to examine the relative validity of (1) anthropometric measurements/indices and (2) of FM% assessed with equations (FMeq%) based on skinfold thickness and bioelectrical impedance (BIA). In 480 Belgian children (aged 5–11 years) weight, height, skinfold thickness (triceps and subscapular), body circumferences (mid-upper arm, waist and hip), foot-to-foot BIA (Tanita®) and FMADP% were measured. Anthropometric measurements and calculated indices were compared with FMADP%. Next, published equations were used to calculate FMeq% using impedance (equations of Tanita®, Tyrrell, Shaefer and Deurenberg) or skinfold thickness (equations of Slaughter, Goran, Dezenberg and Deurenberg). Both indices and equations performed better in girls than in boys. For both sexes, the sum of skinfold thicknesses resulted in the highest correlation with FMADP%, followed by triceps skinfold, arm fat area and subscapular skinfold. In general, comparing FMeq% with FMADP% indicated mostly an age and sex effect, and an increasing underestimation but less dispersion with increasing FM%. The Tanita® impedance equation and the Deurenberg skinfold equation performed the best, although none of the used equations were interchangeable with FMADP%. In conclusion, the sum of triceps and subscapular skinfold thickness is recommended as marker of FM% in the absence of specialised technologies. Nevertheless, the higher workload, cost and survey management of an immobile device like the BOD POD® remains justified.

ObjectiveMeasurement errors in dietary data lead to attenuated estimates of associations between dietary exposures and health outcomes. The present study aimed to compare and evaluate different approaches of handling implausible reports by exemplary analysis of the association between dietary intakes (total energy, soft drinks, fruits/vegetables) and overweight/obesity in children.DesignCross-sectional multicentre study.SettingKindergartens/schools from eight European countries participating in the IDEFICS Study.SubjectsChildren (n 5357) aged 2–9 years who provided one 24 h dietary recall and complete covariate information.ResultsThe 24 h recalls were classified into three reporting groups according to adapted Goldberg cut-offs: under-report, plausible report or over-report. In the basic logistic multilevel model (adjusted for age and sex, including study centre as random effect), the dietary exposures showed no significant association with overweight/obesity (energy intake: OR=0·996 (95 % CI 0·983, 1·010); soft drinks: OR = 0·999 (95 % CI 0·986, 1·013)) and revealed even a positive association for fruits/vegetables (OR = 1·009 (95 % CI 1·001, 1·018)). When adding the reporting group (dummy variables) and a propensity score for misreporting as adjustment terms, associations became significant for energy intake as well as soft drinks (energy: OR = 1·074 (95 % CI 1·053, 1·096); soft drinks: OR = 1·015 (95 % CI 1·000, 1·031)) and the association between fruits/vegetables and overweight/obesity pointed to the reverse direction compared with the basic model (OR = 0·993 (95 % CI 0·984, 1·002)).ConclusionsAssociations between dietary exposures and health outcomes are strongly affected or even masked by measurement errors. In the present analysis consideration of the reporting group and inclusion of a propensity score for misreporting turned out to be useful tools to counteract attenuation of effect estimates.

One of the aims of Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants (IDEFICS) validation study is to validate field measures of physical activity (PA) and energy expenditure (EE) in young children. This study compared the validity of uniaxial accelerometry with heart-rate (HR) monitoring vs. triaxial accelerometry against doubly labeled water (DLW) criterion method for assessment of free-living EE in young children. Forty-nine European children (25 female, 24 male) aged 4–10 yr (mean age: 6.9 ± 1.5 yr) were assessed by uniaxial ActiTrainer with HR, uniaxial 3DNX, and triaxial 3DNX accelerometry. Total energy expenditure (TEE) was estimated using DLW over a 1-wk period. The longitudinal axis of both devices and triaxial 3DNX counts per minute (CPM) were significantly ( P < 0.05) associated with physical activity level (PAL; r = 0.51 ActiTrainer, r = 0.49 uniaxial-3DNX, and r = 0.42 triaxial Σ3DNX). Eight-six percent of the variance in TEE could be predicted by a model combining body mass (partial r2 = 71%; P < 0.05), CPM-ActiTrainer (partial r2 = 11%; P < 0.05), and difference between HR at moderate and sedentary activities (ModHR − SedHR) (partial r2 = 4%; P < 0.05). The SE of TEE estimate for ActiTrainer and 3DNX models ranged from 0.44 to 0.74 MJ/days or ∼7–11% of the average TEE. The SE of activity-induced energy expenditure (AEE) model estimates ranged from 0.38 to 0.57 MJ/day or 24–26% of the average AEE. It is concluded that the comparative validity of hip-mounted uniaxial and triaxial accelerometers for assessing PA and EE is similar.

To evaluate the impact of stress on children's well-being, it is important to have valid and reliable stress assessment methods. Nevertheless, selection of an appropriate method for a particular research question may not be straightforward, as there is currently no consensus on a reference method to measure stress in children. This paper examined to what extent childhood stress can be estimated accurately by commonly applied stress measures.Two hundred and seventy-two girls between 5 and 11 years old participated in this study as part of the ChiBS project. Child-reported estimates of stress were collected through the Coddington Life Events Scale (CLES). Serum, saliva and hair samples were collected for cortisol analyses. The intercorrelations of cortisol in the different biological samples were investigated by Spearman rank correlations and Bland-Altman plots. Next, CLES-scores, salivary and hair cortisol concentrations were compared triangularly with the true, but unknown childhood stress using the Triads method, based on pair-wise Spearman's correlation coefficients and the calculation of validity coefficients.Serum cortisol (free and total) was positively correlated with salivary morning and AUC cortisol. Hair cortisol correlated with salivary morning and AUC cortisol, but not with serum cortisol. In relation to recent childhood stress (0–3 months ago), the highest validity coefficients were observed for salivary cortisol measurements, while for periods more distant in the past hair cortisol measurements displayed the highest validity coefficients.This paper investigated the relationship between cortisol measurements in different biological samples, showing a lack of association and disagreement between measures of single-point, short-term cortisol versus long(er)-term cortisol. In addition, this paper examined to what extent childhood stress can be accurately estimated by stressor questionnaires and biological markers in girls. Salivary cortisol was shown to most accurately indicate true childhood stress for short periods in the past (i.e. last three months), whereas hair cortisol may be preferred above salivary measurements for periods more distant and thus for chronic stress assessment.

Summary Purpose Psychological stress has been suggested to result in hormonal effects (e.g. changes in cortisol pattern) that may change food selection in unhealthy ways. This study examines whether children's dietary pattern is indeed related to salivary cortisol levels. Methods In 323 children (5–10 years old) participating in the Belgian ChiBS study, salivary cortisol samples, a biomarker for stress, was sampled when waking up, 30 and 60 min after wake up and in the evening on two consecutive weekdays. Data on the children's dietary pattern (frequency of sweet foods, fatty foods, snacks, fruit and vegetables) was collected with a food frequency questionnaire. Multilevel time modelling was used with adjustments for sex, age, body mass index, parental education and wake up time. Results Higher overall cortisol levels and a large cortisol awakening response (CAR) were associated with more frequent consumption of sweet foods. A steeper diurnal cortisol decline was associated with a higher sweet, fatty and snack food consumption frequency. No associations with fruit and vegetables consumption were found. Conclusions High cortisol levels were linked to an unhealthier dietary pattern (more fatty food, snacks and especially sweet food). This supports the theory of cortisol-induced comfort food preference and strengthens the stress–diet relation.

International audience; Background:REV-ERBα has been shown to regulate adipogenesis and lipid metabolism as well as to link the circadian timing system to whole body metabolic homeostasis. We thus tested whether polymorphisms in REV-ERBα could be associated with metabolic phenotypes in human population samples.Methods:We analyzed the associations between 5 REV-ERBα polymorphisms and anthropometric (body weight, body mass index (BMI), waist and hip circumferences), biochemical (plasma lipid, glucose and insulin levels) and clinical (systolic and diastolic blood pressure) variables in three population-based studies (MONICA Lille n=1155 adults, MONA LISA Lille n=1170 adults and HELENA n=1155 adolescents). We assessed in vitro, the potential influence of one REV-ERBα polymorphism in transient transfection assays using two different cell lines.Results:We observed significant and consistent associations between the T minor allele of the REV-ERBα rs2071427 polymorphism (located in intron 1) and higher BMI (mean allele effect=+0.33 kg m(-2)) in the MONICA Lille (P=0.02), MONA LISA (P=0.02) and HELENA (P=0.03) studies. The odds ratios for obesity associated with this allele were 1.67 (1.00-2.79) (P=0.05) in MONICA Lille, 1.29 (1.01-1.65) (P=0.04) in MONA LISA Lille and the odds ratio for overweight was 1.48 (1.08-2.03) (P=0.01) in HELENA. In transfection experiments in human hepatocyte-derived cell lines, the REV-ERBα intron 1 directed the transcription of a luciferase reporter gene independently of the rs2071427 polymorphism.Conclusion:Our results suggest that the REV-ERBα rs2071427 polymorphism modulates body fat mass in both adult and young people.International Journal of Obesity advance online publication, 17 July 2012; doi:10.1038/ijo.2012.117.

This paper provides age- and sex-specific reference values for short-term heart rate variability (HRV) data in children by time domain and frequency domain methods. Furthermore, HRV determinants will be determined. In 460 children (5-10 years), 5-minute HRV measurements in supine position were undertaken with Polar chest belts. The data were manually edited and processed with time and frequency domain methods. Age, time point, physical activity (accelerometry), physical fitness (cardiopulmonary fitness, upper and lower limb muscular fitness) and body composition (body mass index, fat%, fat and fat-free mass) were analysed as determinants using multiple regression analysis stratified by sex. Sex- and age-specific reference values were produced. Overall, girls had lower HRV. Age-related parasympathetic increases and sympathetic decreases were seen with sometimes age-related year-to-year wave-like changes in boys. The time point of recording had limited influence on HRV. Of the lifestyle related factors, fatness (only 7 % overweight) was not associated with HRV but fat-free mass, physical activity and in particular physical fitness (over and above activity) had a favourable association by increased parasympathetic activity. Future HRV studies in children should consider age, sex and physical fitness.

To evaluate the impact of stress on children's well-being, it is important to have valid and reliable stress assessment methods. Nevertheless, selection of an appropriate method for a particular research question may not be straightforward, as there is currently no consensus on a reference method to measure stress in children. This article examined to what extent childhood stress can be estimated accurately by stressor questionnaires (i.e., Coddington life events scale) and biological markers (serum, salivary, and hair cortisol) using the Triads (a triangulation) method in 272 elementary school girls. Salivary cortisol was shown to most accurately indicate true childhood stress for short periods in the past (i.e., last 3 months), whereas hair cortisol may be preferred above salivary measurements for periods more distant and thus for chronic stress assessment. However, applicability should be confirmed in larger and more heterogeneous populations.

ObjectiveTo assess the relationship between parental education level and the consumption frequency of obesity-related foods in European children.DesignThe analysis was based on data from the cross-sectional baseline survey of a prospective cohort study. The effects of parental education on food consumption were explored using analysis of covariance and logistic regression.SettingPrimary schools and pre-schools of selected regions in Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain.SubjectsParticipants (n 14 426) of the IDEFICS baseline cohort study aged 2 to 9 years.ResultsParental education level affected the intake of obesity-related foods in children. Children in the low and medium parental education level groups had lower odds of more frequently eating low-sugar and low-fat foods (vegetables, fruits, pasta/noodles/rice and wholemeal bread) and higher odds of more frequently eating high-sugar and high-fat foods (fried potatoes, fruits with sugar and nuts, snacks/desserts and sugared beverages; P < 0·001). The largest odds ratio differences were found in the low category (reference category: high) for vegetables (OR = 0·56; 95 % CI 0·47, 0·65), fruits (OR = 0·56; 95 % CI 0·48, 0·65), fruits with sugar and nuts (OR = 2·23; 95 % CI 1·92, 2·59) and sugared beverages (OR = 2·01; 95 % CI 1·77, 2·37).ConclusionsLow parental education level was associated with intakes of sugar-rich and fatty foods among children, while high parental education level was associated with intakes of low-sugar and low-fat foods. These findings should be taken into account in public health interventions, with more targeted policies aiming at an improvement of children's diet.

12 páginas, 6 tablas.- Vandevijver, S.,Díaz, L.E.,Huybrecht, I. et al, Accurate food and nutrient intake assessment is essential for investigating diet–disease relationships. In the present study, food and nutrient intake assessment among European adolescents using 24 h recalls (mean of two recalls) and a FFQ (separately and the combination of both) were evaluated using concentration biomarkers. Biomarkers included were vitamin C, b-carotene, DHA þ EPA, vitamin B12 (cobalamin and holo-transcobalamin) and folate (erythrocyte folate and plasma folate). For the evaluation of the food intake assessment 390 adolescents were included, while 697 were included for the nutrient intake assessment evaluation. Spearman rank and Pearson correlations, and validity coefficients, which are correlations between intake estimated and habitual true intake, were calculated. Correlations were higher between frequency of food consumption (from the FFQ) and concentration biomarkers than between mean food intake (from the recalls) and concentration biomarkers, especially for DHA þ EPA (r 0·35 v. r 0·27). Most correlations were higher among girls than boys. For boys, the highest validity coefficients were found for frequency of fruit consumption (0·88) and for DHA þ EPA biomarker (0·71). In girls, the highest validity coefficients were found for fruit consumption frequency (0·76), vegetable consumption frequency (0·74), mean fruit intake (0·90) and DHA þ EPA biomarker (0·69). After exclusion of underreporters, correlations slightly improved. Correlations between usual food intakes, adjusted for food consumption frequency, and concentration biomarkers were higher than correlations between mean food intakes and concentration biomarkers. In conclusion, two non-consecutive 24 h recalls in combination with a FFQ seem to be appropriate to rank subjects according to their usual food intake., The HELENA Study has taken place with the financial support of the European Community Sixth RTD Framework Programme (contract FOOD-CT-2005-007034).Additional support from the Spanish Ministry of Education (AGL2007- 29784-E/ALI)

ObjectiveTo examine the association between breakfast consumption and CVD risk factors in European adolescents.DesignCross-sectional. Breakfast consumption was assessed by the statement ‘I often skip breakfast’ and categorized into ‘consumer’, ‘occasional consumer’ and ‘skipper’. Blood pressure, weight, height, waist circumference, skinfold thickness, total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), TAG, insulin and glucose were measured and BMI, TC:HDL-C, LDL-C:HDL-C and homeostasis model assessment–insulin resistance index (HOMA-IR) were calculated.SettingThe European Union-funded HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.SubjectsEuropean adolescents, aged 12·50–17·49 years, from ten cities within the HELENA study (n2929,n925 with blood sample, 53 % females).ResultsIn males, significant differences across breakfast consumption category (‘consumer’, ‘occasional consumer’ and ‘skipper’) were seen for age, BMI, skinfold thickness, waist circumference, cardiorespiratory fitness, systolic and diastolic blood pressures, TC:HDL-C, LDL-C:HDL-C, glucose, insulin, HOMA-IR and LDL-C; in females, for cardiorespiratory fitness, skinfold thickness, BMI, insulin and HOMA-IR. In overweight/obese males significant differences were also seen for TC and LDL-C, whereas no differences were observed in non-overweight males or in females regardless of weight status.ConclusionsOur findings among European adolescents confirm previous data indicating that adolescents who regularly consume breakfast have lower body fat content. The results also show that regular breakfast consumption is associated with higher cardiorespiratory fitness in adolescents, and with a healthier cardiovascular profile, especially in males. Eating breakfast regularly may also negate somewhat the effect of excess adiposity on TC and LDL-C, especially in male adolescents.

ObjectiveTo evaluate the impact of different modes of administration (face-to-facev. telephone), recall days (firstv. second), days of the week (weekdayv. weekend) and interview days (1 d laterv. 2 d later) on bias in protein and K intakes collected with 24 h dietary recalls (24-HDR).DesignTwo non-consecutive 24-HDR (collected with standardised EPIC-Soft software) were used to estimate protein and K intakes by a face-to-face interview at the research centres and a telephone interview, and included all days of the week. Two 24 h urine collections were used to determine biomarkers of protein and K intake. The bias in intake was defined as the ratio between the 24-HDR estimate and the biomarker.SettingFive centres in Belgium, Czech Republic, France, the Netherlands and Norway in the European Food Consumption Validation (EFCOVAL) study.SubjectsAbout 120 adults (aged 45–65 years) per centre.ResultsThe bias in protein intake in the Czech Republic and Norway was smaller for telephone than face-to-face interviews (P= 0·01). The second 24-HDR estimates of protein intake in France and K intake in Belgium had a larger bias than the first 24-HDR (P= 0·01 and 0·04, respectively). In the Czech Republic, protein intake estimated during weekends and K intake estimated during weekdays had a larger bias than during other days of the week (P= 0·01). In addition, K intake collected 2 d later in the Czech Republic was likely to be overestimated.ConclusionsThe biases in protein and K intakes were comparable between modes of administration, recall days, days of the week and interview days in some, but not all, study centres.

Background: Children are not always recognized as being susceptible to stress, although childhood stressors may originate from multiple events in their everyday surroundings with negative effects on children’s health.Methods: As there is a lack of large-scale, European prevalence data on childhood adversities, this study presents the prevalence of (1) negative life events and (2) familial and social adversities in 4637 European pre- and primary-school children (4–11 years old), using a parentally-reported questionnaire embedded in the IDEFICS project (‘Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS’).Results: The following findings were observed: (1) Certain adversities occur only rarely, while others are very regular (i.e. parental divorce); (2) A large percentage of children is shielded from stressors, while a small group of children is exposed to multiple, accumulating adversities; (3) The prevalence of childhood adversity is influenced by geographical location (e.g. north versus south), age group and sex; (4) Childhood adversities are associated and co-occur, resulting in potential cumulative childhood stress.Conclusions: This study demonstrated the importance of not only studying traumatic events but also of focusing on the early familial and social environment in childhood stress research and indicated the importance of recording or monitoring childhood adversities.

BACKGROUND/OBJECTIVES:In the absence of biochemical data on iron status in preschoolers, data on the adequacy of iron intake may be used to assess the possible risk of iron deficiency in this population group. Therefore, this study aims to investigate iron intake and its food sources in Flemish preschoolers.SUBJECTS/METHODS:A total of 661 Flemish preschoolers 2.5-6.5 years old were recruited via a random cluster sampling design, using schools as primary sampling units. Three-day estimated diet records were used to assess dietary intakes. The contribution to iron intake (haem and non-haem) of 57 food groups was computed by summing the amount provided by the food group for all individuals divided by the total intake for all individuals.RESULTS:Mean total iron intake (s.d.) was 7.4 (2.3) and 6.7 (2.8) mg/day for boys and girls, respectively. In all 65% of the children 4 years old and 45% of those 4-6.5 years old presented adequate iron intakes. The food groups with the highest mean proportional contribution to total iron intake were bread, meat and meat products, breakfast cereals and sweet snacks (in that order). Children from small families whose mother had a low educational level had higher iron intakes.CONCLUSION:Iron intakes were similar for boys and girls and almost half of the Flemish preschoolers do not comply with the dietary iron recommendations. © 2012 Macmillan Publishers Limited.

ObjectivesWe investigated cross-sectionally and longitudinally the relationship between FTO rs9939609 and obesity-related characteristics in the European children of the IDEFICS project and the interaction of this variant with a lifestyle intervention.Population and methodsA cohort of 16224 children (2-9 years) was recruited into a population-based survey (T0) from eight European countries. A second survey (T1) reassessed the children two years later. A random sample of 4405 children was extracted for genetic studies. 3168 children were re-examined two years later. Half of them underwent a lifestyle intervention program. The FTO rs9939609 was genotyped. Weight, height, waist circumference, triceps and subscapular skinfolds were measured at T0 and T1.ResultsAt T0, the risk A allele of rs9939609 was significantly associated with higher values of body mass index (BMI), waist circumference and skinfolds (age, sex, and country-adjusted p-values: all pConclusionsWe confirmed the association between the FTO rs9939609 and body mass and overweight/obesity risk in European children. The main finding of the study is that the A allele carriers present higher increase of body mass and central adiposity over time and higher risk of developing overweight/obesity during growth, independently from intervention measures.

Psychological stress has been suggested to change dietary pattern towards more unhealthy choices and as such to contribute to overweight. Emotional eating behaviour could be an underlying mediating mechanism. The interrelationship between stress, emotional eating behaviour and dietary patterns has only rarely been examined in young children. Nevertheless, research in children is pivotal as the foundations of dietary habits are established starting from childhood and may track into adulthood. In 437 children (5-12years) of the ChiBS study, stress was measured by questionnaires on stressful events, emotions (happy, angry, sad, anxious) and problems (emotional, peer, conduct and hyperactivity). Data were collected on children's emotional eating behaviour and also on dietary patterns: frequency of fatty foods, sweet foods, snacks (fat and sweet), fruit and vegetables. Stressful events, negative emotions and problems were positively associated with emotional eating. Positive associations were observed between problems and both sweet and fatty foods consumption. Negative associations were observed between events and fruit and vegetables consumption. Overall, stress was associated with emotional eating and a more unhealthy dietary pattern and could thus contribute to the development of overweight, also in children. Nevertheless, emotional eating behaviour was not observed to mediate the stress-diet relation.

Studies using 24 h urine collections need to incorporate ways to validate the completeness of the urine samples. Models to predict urinary creatinine excretion (UCE) have been developed for this purpose; however, information on their usefulness to identify incomplete urine collections is limited. We aimed to develop a model for predicting UCE and to assess the performance of a creatinine index usingpara-aminobenzoic acid (PABA) as a reference. Data were taken from the European Food Consumption Validation study comprising two non-consecutive 24 h urine collections from 600 subjects in five European countries. Data from one collection were used to build a multiple linear regression model to predict UCE, and data from the other collection were used for performance testing of a creatinine index-based strategy to identify incomplete collections. Multiple linear regression (n458) of UCE showed a significant positive association for body weight (β = 0·07), the interaction term sex × weight (β = 0·09, reference women) and protein intake (β = 0·02). A significant negative association was found for age (β = − 0·09) and sex (β = − 3·14, reference women). An index of observed-to-predicted creatinine resulted in a sensitivity to identify incomplete collections of 0·06 (95 % CI 0·01, 0·20) and 0·11 (95 % CI 0·03, 0·22) in men and women, respectively. Specificity was 0·97 (95 % CI 0·97, 0·98) in men and 0·98 (95 % CI 0·98, 0·99) in women. The present study shows that UCE can be predicted from weight, age and sex. However, the results revealed that a creatinine index based on these predictions is not sufficiently sensitive to exclude incomplete 24 h urine collections.

It is important to be able to evaluate vitamin status correctly at any age, but this is especially vital during adolescence since there are higher requirements for healthy growth and development. However, there are no currently available B-vitamin reference values for healthy adolescents. The aim of the present study is to assess the vitamin B status in European adolescents in order to contribute to the development of reference values for selected B-vitamins and total homocysteine (tHcy). Within the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) cross-sectional study, a sub sample of 1051 (499 males, 552 females) adolescents from ten European cities aged 12.5 to 17.49 were analyzed for fasting plasma folate (PF), red blood cell (RBC) folate, serum cobalamin (Cbl), holo-transcobalamin (Holo-TC), Vitamin B(6) (PLP), and tHcy. The level of significance was set at P < .05. Following the current cut-off for adults, 2% had low Cbl and 5% had low holo-TC concentrations. Low concentrations of both PF and RBC folate were identified in 10%. Five percent had PLP concentrations

This study aims to identify major food sources of energy and macronutrients among Flemish preschoolers as a basis for evaluating dietary guidelines. Three-day estimated diet records were collected from a representative sample of 696 Flemish preschoolers (2.5-6.5 years old; participation response rate: 50%). For 11 dietary constituents, the contribution of 57 food groups was computed by summing the amount provided by the food group for all individuals divided by the total intake of the respective nutrient for all individuals. Bread (12%), sweet snacks (12%), milk (6%), flavoured milk drinks (9%), and meat products (6%) were the top five energy contributors. Sweet snacks were among the top contributors to energy, total fat, all fatty acids, cholesterol, and complex and simple carbohydrates. Fruit juices and flavoured milk drinks are the main contributors to simple carbohydrates (respectively 14% and 18%). All principal food groups like water, bread and cereals, vegetables, fruit, milk and spreadable fats were under-consumed by more than 30% of the population, while the food groups that were over-consumed consisted only of low nutritious and high energy dense foods (sweet snacks, sugared drinks, fried potatoes, sauces and sweet spreads). From the major food sources and gaps in nutrient and food intakes, some recommendations to pursue the nutritional goals could be drawn: the intake of sweet snacks and sugar-rich drinks (incl. fruit juices) should be discouraged, while consumption of fruits, vegetables, water, bread and margarine on bread should be encouraged.

Background/purpose The number of dietary exposure assessment studies focussing on children is very limited. Children are however a vulnerable group due to their higher food consumption level per kg body weight. Therefore, the EXPOCHI project aims [1] to create a relational network of individual food consumption databases in children, covering different geographical areas within Europe, and [2] to use these data to assess the usual intake of lead, chromium, selenium and food colours. Methods EXPOCHI includes 14 food consumption databases focussed on children (1-14 y old). The data are considered representative at national/regional level: 14 regions covering 13 countries. Since the aim of the study is to perform long-term exposure assessments, only data derived from 24 hr dietary recalls and dietary records recorded on at least two non-consecutive days per individual were included in the dietary exposure assessments. To link consumption data and concentration data of lead, chromium and selenium in a standardised way, categorisation of the food consumption data was based on the food categorisation system described within the SCOOP Task report 3.2.11. For food colours, the food categorisation system specified in the Council Directive 94/36/EC was used. Conclusion The EXPOCHI project includes a pan-European long-term exposure assessment of lead, chromium, selenium and food colours among children living in 13 different EU countries. However, the different study methods and designs used to collect the data in the different countries necessitate an in-depth description of these different methods and a discussion about the resulting limitations.

Background Participation rate and response rate are key issues in a cross sectional large-scale epidemiological study. The objective of this paper is to describe the study population and to evaluate participation and response rate as well as the key nutritional status variables in male and female adolescents involved in the HELENA study. Methods A multi-stage random cluster sampling with a target sample of 3000 adolescents aged [12.5 to 17.5] years, stratified for geographical location and age, was carried out. Information for participants and non-participants (NP) was compared, and participation and response rates to specific questionnaires were discussed. Results 3,865 adolescents aged [12.5 to 17.5] years (1,845 females) participated in the HELENA study, of whom 1,076 (568 females) participated in the blood sampling. 3,528 (1,845 females) adolescents were finally kept for statistical analysis. Participation rates for the schools and classes differed importantly between countries. The participation rate of pupils within the participating classes also differed importantly between countries. Sex ratio, mean age and BMI were similar between NP and participating adolescents within each centre, and in the overall sample. For all the questionnaires included in the database, the response rate of questionnaires was high (more than 80% of questions were completed). Conclusion From this study it could be concluded that participation rate differed importantly between countries, though no bias could be identified when comparing the key study variables between participants and non-participants. Response rate for questionnaires was very high. Future studies investigating lifestyle and health in adolescents can optimize their methods when considering the opportunities and barriers observed in the HELENA study.

This paper describes whether children's life events, emotions and psychological difficulties are related to their salivary cortisol patterns and whether this is different between sexes.In 385 children (5-10 years old) participating in the ChiBS study, salivary cortisol samples were collected when waking up, 30 min and 60 min after wake up and in the evening on two consecutive weekdays. Moreover, data on children's life events, emotions and difficulties were collected. Statistical analysis was done separately for boys and girls by multilevel growth curve modelling with adjustments for age, body mass index, socio-economic status and wake up time.In boys and girls with more negative life events during the last three months, the diurnal cortisol slope was steeper (more decline). Boys with higher self-reported happiness showed lower overall, morning and evening cortisol levels. In contrast, the diurnal slope was steeper (more decline) in boys with emotional problems due to higher morning values. In girls, peer problems were associated with lower overall and morning cortisol levels.Children's salivary cortisol patterns were related to some negative life events, emotions and difficulties, although differently in boys and girls. As such, sex-differences in HPA functioning are already present in young children. Most findings support the upregulation of the cortisol response to stress, although lower morning values were found in the presence of peer problems in girls. Future studies should focus on sex differences, positive emotions and the diurnal cortisol slope.

Background The aims of this study were to assess the intake of animal, plant and food group-specific protein, and to investigate their associations with socio-economic and lifestyle-related factors in Flemish preschoolers. Methods Three-day estimated dietary records were collected from 661 preschoolers aged 2.5-6.5 y (338 boys and 323 girls). Multiple linear regression analysis was used to investigate the association between animal, plant, and food group-specific protein intake and socio-economic and lifestyle factors. Results Animal proteins (mean 38 g/d) were the main source of total protein (mean 56 g/d), while mean plant protein intake amounted to 18 g/d. The group of meat, poultry, fish and eggs was the main contributor (51%) to animal protein intake, followed by milk and milk products (35%). Bread and cereals (41%) contributed most to the plant protein intake, followed by low-nutritious, energy-dense foods (21%). With higher educated fathers and mothers as reference, respectively, preschoolers with lower secondary and secondary paternal education had lower animal, dairy-, and meat-derived protein intakes, and those with lower secondary and secondary maternal education consumed less plant, and bread and cereal-derived proteins. Compared to children with high physical activity levels, preschoolers with low and moderate physical activity had lower animal and plant protein intakes. Significantly higher potatoes and grains-, and fish- derived proteins were reported for children of smoking mothers and fathers, respectively, compared to those of non-smoking mothers and fathers. Conclusions The total protein intake of Flemish preschoolers was sufficient according to the recommendations of the Belgian Superior Health Council. Parental level of education and smoking status might play a role in the sources of children's dietary proteins.

Background/Aims: Salivary cortisol has been widely used to assess childhood stress. Yet, there is no consensus on reference concentrations, awakening response, guideline compliance and contribution of sampling factors to the variation in children's salivary cortisol levels. Methods: Samples were collected from 444 Belgian children participating in the ChiBS study (5-11 years old) on two consecutive weekdays at four moments: awakening, 30 min later, 60 min later and in the evening. A checklist requested awakening time, collection hours and guideline compliance. Results: Reference values were determined. Mixed model analyses revealed that age, time compliance and awakening time contributed significantly to the variance in cortisol levels. In only 52.5% of the children a cortisol morning increase was observed. Participants with no morning increase showed higher awakening but lower post-awakening concentrations on that day, and the morning response showed a small negative correlation with the time lag between first and second sampling. Conclusion: This study emphasizes the importance of excluding extreme time deviation and correcting for age and awakening time. Appearance of a cortisol morning increase was only found in approximately half of the children, suggesting the absence of the cortisol awakening response as a general characteristic. Also, this could partially be explained by poor time compliance.

The objectives were to assess total dietary fiber intake, identify the major sources of dietary fiber, and examine its association with socio-economic factors among Flemish preschoolers. Three-day estimated dietary records were collected from a representative sample of preschoolers 2.5–6.5 years old (n = 661, 338 boys, 323 girls). The mean dietary fiber intake (13.4 g/d) was lower than the intake level recommended by the Belgian Superior Health Council (70% boys and 81% girls below the guidelines). The most important contributor was the group of bread and cereals (29.5%), followed by fruits (17.8%), potatoes and grains (16.0%), energy-dense, low-nutritious foods (12.4%), and vegetables (11.8%). Multiple linear regression analyses showed that total fiber intake was associated with maternal education and parents’ employment. Overall, fiber intakes from high-nutritious foods (vegetables and fruits) were higher in preschoolers of higher educated mothers and those with one or both parents being employed. In conclusion, the majority of the preschoolers had dietary fiber intakes below the recommended level. Hence, dietary fiber should be promoted among parents of preschoolers and low socio-economic status families should be addressed in particular.

ObjectiveTo compare food consumption during television (TV) viewing among adolescents who watched >2 h/d v. ≤2 h/d; and to examine the association between sociodemographic variables (age, gender and socio-economic status (SES)) and the consumption of energy-dense foods and drinks during TV viewing.DesignThe data are part of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional survey. Data on time watching TV, types of foods and drinks consuming during TV viewing and parental SES (parental education, parental occupation and family affluence) were measured by questionnaires completed by adolescents. Binary logistic regression tested the association between energy-dense foods and drinks and (i) sociodemographic variables and (ii) TV time.SettingGhent (Belgium), Heraklion (Greece), Pecs (Hungary) and Zaragoza (Spain).SubjectsGirls (n 699) and boys (n 637) aged 12·5–17·5 years.ResultsBoys reported more frequent consumption of beer and soft drinks whereas girls selected more fruit juice, water, herbal infusions and sweets (all P ≤ 0·05). Watching TV for >2 h/d was associated with the consumption of energy-dense foods and drinks. Girls whose mothers achieved the lowest education level had an adjusted OR of 3·22 (95 % CI 1·81, 5·72) for the consumption of energy-dense drinks during TV viewing v. those whose mothers had the highest educational level.ConclusionsExcessive TV watching may favour concurrent consumption of energy-dense snacks and beverages. Adolescents from low-SES families are more likely to consume unhealthy drinks while watching TV.

The present study describes the consumption of foods enriched with plant sterols (PS) and supplements containing PS, and evaluates PS intakes via the current consumption and for specific consumption scenarios. A market inventory was performed to collate different PS-enriched food items and supplements available in Belgium. An FFQ was developed to investigate the consumption of PS-enriched foods and supplements. A total of 139 pre-school children (2·5–7 years old) and 569 adults (308 women and 261 men) living in Flanders (the northern, Dutch-speaking part of Belgium) participated in the study. Of these, 21 % (Flemish pre-school children) and 28·5 % (Flemish adults) consume PS-enriched food products, leading to a mean PS intake in the consumer group of 0·70 (sd 0·61) g/d for pre-school children and 1·51 (sd 1·42) g/d for adults. Of the adult PS consumers, 23·2 % did not suffer from elevated blood cholesterol levels; 50 % of them had a PS intake less than or equal to 1 g/d and 16·4 % had a PS intake above 3 g/d and 7·8 % even had an intake above 4 g/d. Scenario studies assessed the intake when all Belgian adults would consume PS-enriched margarines without (scenario 1) or with (scenario 2) a daily consumption of a PS-enriched yoghurt drink. This resulted in an intake above 3 g/d in 17 % (women) and 29 % (men) for scenario 1 and 40 % (women) and 53 % (men) for scenario 2. The results indicate that PS-enriched food products are also consumed by the non-target group. Efficient communication tools are needed to inform consumers better about the target group of PS-enriched products, the advised dose per day and alternative dietary strategies to lower the blood cholesterol level.

The EPIC-Soft 24-h recall (the software developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) has been used in several regional/national dietary monitoring surveys. The main objective of the study was to present and discuss design, settings, logistics, data management and quality controls of dietary monitoring surveys that used EPIC-Soft for the collection of food consumption data. Within European Food Consumption Validation (EFCOVAL), a questionnaire including questions on current/past EPIC-Soft experiences and requirements for the future was developed and sent to all institutes that used EPIC-Soft in their food consumption survey(s) (five surveys in four different countries). EPIC-Soft was used in the national food consumption survey in Belgium (⩾15–97 years), Germany (14–80 years), the Netherlands (19–30 years and 2–6 years) and Spain (regional only; 4–18 years). Participation rates in these surveys were 46% (Belgium), 42% (Germany), 42% (Dutch survey in adults), 79% (Dutch survey in children) and 77% (Basque survey). Two 24-HDRs were collected by conducting face-to-face interviews in Belgium and Spain, and through telephone interviews in Germany and the Netherlands. Except the Netherlands (19–30 years), where the study was conducted only in autumn, in all other countries the study was conducted throughout the four seasons, including all days of the week. Interviews were conducted by dietitians, except in Germany and Spain. Mean EPIC-Soft interview time was 20–34 min. The dropout rate between the first and second interviews was low (

Background/Objectives: A standardized methodology is important to enable consistent monitoring of dietary intake across European countries. For this reason, we evaluated the comparability of the assessment of usual food intake collected with two non-consecutive computerized 24-h dietary recalls (24-HDRs) and a food propensity questionnaire (FPQ) among five European centers. Subjects/Methods: Two 24-HDRs using EPIC-Soft (the software developed to conduct 24-HDRs in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) were performed to determine fish, fruit and vegetable (FV) consumed by 600 adults in Belgium (BE), the Czech Republic (CZ), France (FR), the Netherlands (NL) and Norway (NO) in a validation study. An FPQ was used to identify non-consumers. Information from the 24-HDRs and FPQ were used to estimate individual usual food intake by the Multiple Source Method (MSM). Blood samples were drawn to determine fatty acids in phospholipids and serum carotenoids as biomarkers of fish, and FV intake, respectively. Results: The pooled correlation between usual fish intake and eicosapentaenoic acid plus docosahexaenoic acid in phospholipids was 0.19 in men and 0.31 in women (P for heterogeneity >0.50) and center-specific correlations ranged between 0.08 (CZ) and 0.28 (BE and NO) in men, and between 0.19 (BE) and 0.55 (FR) in women. For usual FV intake, the pooled correlation with serum carotenoids was 0.31 in men and 0.40 in women (P for heterogeneity >0.10); the center-specific correlations varied between 0.07 (NO) and 0.52 (FR) in men, and between 0.25 (NL) and 0.45 (NO) in women. Conclusion: Two standardized 24-HDRs using EPIC-Soft and an FPQ appeared to be appropriate to rank individuals according to their fish and FV intake in a comparable way among five European centers.

The objectives of the present study were to assess total dietary fibre intake and the main contributors to fibre intake in the Belgian population by sex–age and sex–education groups and to investigate its relationship with BMI and waist circumference (WC). The participants of the Belgian food consumption survey (2004) were randomly selected. Information about food intake was collected using two repeated, non-consecutive 24 h recall interviews. A total of 3083 individuals ( ≥ 15 years; 1546 men and 1537 women) completed both interviews. The main contributors to total fibre intake (17·8 g/d) were cereals and cereal products (34 %; 5·9 g/d), potatoes and other tubers (18·6 %; 3·3 g/d), fruits (14·7 %; 2·8 g/d) and vegetables (14·4 %; 2·6 g/d). Legume fibre intake was extremely low (0·672 %; 0·139 g/d). In all sex–age and sex–education groups, total fibre intake was below the recommendations of the Belgian Superior Health Council. Men (21 g/d) consumed significantly more fibre than women (17·3 g/d) (P P P = 0·001). In summary, total fibre intake was inversely associated with WC, whereas fruit-derived fibre intake was positively associated with WC in the Belgian population.

Background/Objectives: The EPIC-Soft program (the software initially developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) was recommended as the best way to standardize 24-HDRs for future pan-European dietary monitoring. Within European Food Consumption Validation (EFCOVAL), EPIC-Soft was adapted and further developed on various aspects that were required to optimize its use. In this paper, we present the structure and main interview steps of the EPIC-Soft program, after implementation of a series of new specifications deemed to satisfy specific requirements of pan-European monitoring surveys and other international studies. Subjects/Methods: Updates to optimize the EPIC-Soft program were ascertained according to the following stepwise approach: (1) identification of requested specifications to be potentially implemented through an ad hoc ‘EPIC-Soft specifications questionnaire’ sent to past, current and possible future users of the software; (2) evaluation of the specifications in collaboration with two ad hoc task force groups and through a workshop; (3) development of a technical solution for each retained specification; (4) implementation of the specifications by software developers; (5) testing and amendment of bugs. Results: A number of new specifications and facilities were implemented to EPIC-Soft program. In addition, the software underwent a full reprogramming and migration to a modern Windows environment, including changes in its internal architecture and user interface. Although the overall concept and structure of the initial software were not changed substantially, these improvements ease the current and future use of EPIC-Soft and increase further its adaptation to other countries and study contexts. Conclusions: EPIC-Soft is enriched with further functions and facilities expected to fulfil specific needs of pan-European dietary monitoring and risk assessment purposes. The validity, feasibility and relevance of this software for different national and international study designs, and the logistical aspects related to its implementation are reported elsewhere.

Aim: The aim of this study was to test the hypothesis that a lower birth weight, as an indicator of adverse intrauterine environment, is associated with higher serum leptin levels in European adolescents. We also examined the possible sexual dimorphism in this relationship. Methods: Fasting serum leptin was measured in 757 European born at term adolescents (429 females) aged 14.6 ± 1.2 yr. We measured weight and height, and body mass index was calculated. Birth weight, duration of pregnancy, and duration of breast-feeding were obtained from parental records. Duration of pregnancy and breast-feeding, pubertal status, center, body mass index, and physical activity were entered as confounders in the analyses. Results: There was a significant interaction effect between sex and birth weight on serum leptin levels (P = 0.044). We observed that body weight at birth was negatively and significantly associated with serum leptin levels only in female adolescents (β = -0.109; adjusted P = 0.008). The association persisted after further controlling for physical activity (β = -0.115; adjusted P = 0.016). Conclusions: These findings provide further evidence for a sex-specific programming effect of birth weight on serum leptin levels. Our results also contribute to explain the detrimental health effects associated with lower birth weight, such as long-term increased risk of developing obesity and type 2 diabetes. Copyright © 2011 by The Endocrine Society.

The objective of the present study was to assess animal and plant protein intakes in the Belgian population and to examine their relationship with overweight and obesity (OB). The subjects participated in the Belgian National Food Consumption Survey conducted in 2004. Food consumption was assessed by using two non-consecutive 24 h dietary recalls. About 3083 participants ( ≥ 15 years of age; 1546 males, 1537 females) provided completed dietary information. Animal protein intake (47 g/d) contributed more to total protein intakes of 72 g/d than plant protein intake, which accounted for 25 g/d. Meat and meat products were the main contributors to total animal protein intakes (53 %), whereas cereals and cereal products contributed most to plant protein intake (54 %). Males had higher animal and plant protein intakes than females (P P = 0·001) and waist circumference (WC; β = 0·041; P = 0·002). Both in males and females, plant protein intake was inversely associated with BMI (males: β = − 0·036; P P = 0·001) and WC (male: β = − 0·137; P P = 0·024). In conclusion, plant protein intakes were lower than animal protein intakes among a representative sample of the Belgian population and decreased with age. Associations with anthropometric data indicated that plant proteins could offer a protective effect in the prevention of overweight and OB in the Belgian population.

BACKGROUND: Parental reports are often used in large-scale surveys to assess children's body mass index (BMI). Therefore, it is important to know to what extent these parental reports are valid and whether it makes a difference if the parents measured their children's weight and height at home or whether they simply estimated these values. The aim of this study is to compare the validity of parent-reported height, weight and BMI values of preschool children (3-7 y-old), when measured at home or estimated by parents without actual measurement. METHODS: The subjects were 297 Belgian preschool children (52.9% male). Participation rate was 73%. A questionnaire including questions about height and weight of the children was completed by the parents. Nurses measured height and weight following standardised procedures. International age- and sex-specific BMI cut-off values were employed to determine categories of weight status and obesity. RESULTS: On the group level, no important differences in accuracy of reported height, weight and BMI were identified between parent-measured or estimated values. However, for all 3 parameters, the correlations between parental reports and nurse measurements were higher in the group of children whose body dimensions were measured by the parents. Sensitivity for underweight and overweight/obesity were respectively 73% and 47% when parents measured their child's height and weight, and 55% and 47% when parents estimated values without measurement. Specificity for underweight and overweight/obesity were respectively 82% and 97% when parents measured the children, and 75% and 93% with parent estimations. CONCLUSIONS: Diagnostic measures were more accurate when parents measured their child's weight and height at home than when those dimensions were based on parental judgements. When parent-reported data on an individual level is used, the accuracy could be improved by encouraging the parents to measure weight and height of their children at home. ispartof: BMC PEDIATRICS vol:11 issue:1 ispartof: location:England status: published

While genetic factors play a role in the development of obesity, the dramatic increase of its ­prevalence in the past 20 years strongly suggests that environmental factors are largely responsible. The history of human race during the past 20 years has seen a drastic and extremely rapid evolution of the environment (British Medical Association (BMA) 2005). While more than 100 years ago, “saving steps” documents were published (Fig. 22.1) (Van Rensselaer 1901), nowadays we are recommended to strive for 10,000 steps per day (Lindberg 2000; Mummery et al. 2006; US Department of Health and Human Services 1996).

Food photographs are widely used as instruments to estimate portion sizes of consumed foods. Several food atlases are available, all developed to be used in a specific context and for a given study population. Frequently, food photographs are adopted for use in other studies with a different context or another study population. In the present study, errors in portion size estimation of bread, margarine on bread and beverages by two-dimensional models used in the context of a Belgian food consumption survey are investigated. A sample of 111 men and women (age 45–65 years) were invited for breakfast; two test groups were created. One group was asked to estimate portion sizes of consumed foods using photographs 1–2 d after consumption, and a second group was asked the same after 4 d. Also, real-time assessment of portion sizes using photographs was performed. At the group level, large overestimation of margarine, acceptable underestimation of bread and only small estimation errors for beverages were found. Women tended to have smaller estimation errors for bread and margarine compared with men, while the opposite was found for beverages. Surprisingly, no major difference in estimation error was found after 4 d compared with 1–2 d. Individual estimation errors were large for all foods. The results from the present study suggest that the use of food photographs for portion size estimation of bread and beverages is acceptable for use in nutrition surveys. For photographs of margarine on bread, further validation using smaller amounts corresponding to actual consumption is recommended.

Department of Public Health, Ghent University, Ghent, BelgiumSubmitted 17 July 2009: Accepted 22 April 2010: First published online 8 June 2010AbstractObjective: To assess the relationship(s) between overall and within-food groupdiversity and several indices of dietary quality, such as dietary adequacy, mod-eration and balance, in Belgian adults. Dietary quality indices were derived fromthe food-based dietary guidelines (FBDG).Design: Information on food intake was collected with two 24h recalls.Setting: Average overall and within-food group diversity scores and dietaryadequacy, moderation and balance scores were calculated.Subjects: A representative sample (n 3245) of the Belgian population at the ageof 15 years and older was randomly selected from the National Register using amultistage stratified procedure.Results: For both men and women, total dietary diversity score increased with ageand smokers had a significantly lower overall diversity score than non- or formersmokers. A positive association was found between overall dietary diversity andboth dietary adequacy and balance. For most food groups, especially bread andcereals, vegetables, dairy products and spreadable fats, within-food group dietarydiversity was positively associated with the fulfilment of the specific recom-mendation for the intake of that food group. An inverse association was foundbetween dietary diversity within the meat and the energy-dense, nutrient-poorfood groups and dietary balance. Diversity within the dairy and spreadable fatgroup was responsible for the strongest increase in overall dietary adequacyand balance.Conclusions: Overall dietary diversity is a useful indicator of dietary quality inBelgium. For some food groups, within-food group dietary diversity is a usefulindicator of compliance with the specific FBDG for intake of that food group.KeywordsDietary diversityDietary qualityFood consumption surveyFood-based dietary guidelines (FBDG) have been devel-oped

The purpose was to compare data obtained from a modified, long, self-administered version of the International Physical Activity Questionnaire (IPAQ-A) with objective data obtained in parallel from Actigraph accelerometers, and VO2max in adolescents. The study comprised a total of 2018 adolescents (46% male) from ten European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Physical activity was assessed over seven consecutive days by accelerometry and expressed as min/day of moderate, vigorous, and moderate to vigorous (MVPA) physical activity (PA). PA was also assessed with the IPAQ-A. VO2max was estimated from a 20-m shuttle run test. Poor to fair correlations between the two methodologies were found for the whole study sample and when stratified by age and gender (rs=0.08-0.26, p

Previous EFSA exposure assessments of selenium have been based on limited data and a more detailed assessment was considered important. As part of the EXPOCHI project, long-term dietary exposure to selenium in young children living in 12 different European countries was assessed. National or regional individual food consumption data from 14 different food consumption databases were used together with selenium concentration data in food collected in eight Member States. Food consumption data were all categorised according to a harmonised system to allow for linkage with selenium concentration data in a standardised way. Two approaches were used to calculate long-term exposure to selenium: the observed individual means (OIM) and the beta-binomial normal (BBN) approach. The results showed differences in exposure between countries based on food consumption patterns and decreased exposure with increased age. Young children in the upper bound scenario commonly exceeded the tolerable upper intake level of 5 μg/kg bw per day. However, current results should be interpreted with caution since they do not necessarily represent the actual selenium exposure in the respective country. To improve reliability, consumption and occurrence results should be linked at more detailed levels, local variations in selenium concentrations explored and handling of long-term exposure calculations refined for all types of data distributions. 1 EFSA-Q-2010-00786. Accepted for Publication on 12 May 2010. 2 Current affiliation is „National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands‟ Long-term dietary exposure to selenium in children living in Europe

In this document, we report on the long-term dietary exposure to 40 different food colours in young children living in 11 European countries. Food consumption data of children aged 1 up to 10 years (in Cyprus 11 up to 14 years) were combined with food colour concentrations as supplied by EFSA using statistical models to calculate exposure. Food consumption data were all categorised according to a harmonised system to allow for linkage with food colour concentration data in a standardised way. Two different exposure scenarios were calculated for each food colour: the maximum permitted usage levels in the relevant Community legislation (here called the „MPL scenario‟) and the actual maximum reported usage patterns (here called the „maximum usage level scenario‟). For some food colours extra scenarios were considered depending on the percentage of coating (5 or 20%), e.g. food colours permitted in the coating of chocolate products. For lycopene, five different scenarios were considered. Although the results showed differences in exposure between countries, such differences should be interpreted with caution, as different methodological limitations rather than true exposure differences might be partly responsible for such findings. It is clear from this exercise that food consumption data in different countries can be categorised in a standard way to allow for harmonised exposure modelling. Methodological issues related to exposure 1 EFSA-Q-2010-00787. Accepted for Publication on 5 May 2010. 2 Current affiliation is „National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands‟ Long-term dietary exposure to food colours in European children