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

This article belongs to the Special Issue Advances in Research on Nutrition and Childhood Obesity. On behalf of the HELENA study group., Obesity in children and adolescents is a public health problem and diet can play a major role in this condition. We aimed to identify sex-specific dietary patterns (DP) and to evaluate the association with overweight/obesity in European adolescents. We conducted a cross-sectional analysis with 2327 adolescents aged between 12.5 to 17.5 years from a multicenter study across Europe. The body mass index was categorized in “normal weight” and “overweight/obesity”. Two non-consecutive 24-h dietary recalls were collected with a computerized self-reported software. Principal component factor analysis was used to identify DP. Mixed-effect logistic regression models were used to evaluate the association between the sex-specific DP and overweight/obesity outcome. As a result, we found three DP in boys (snacking and bread, Mediterranean diet, and breakfast) and four DP in girls (convenience, plant-based and eggs, Western, and breakfast). The association between DP and overweight/obesity highlights that those adolescents with higher adherence to the breakfast DP had lower odds for overweight/obesity, even after the inclusion of covariables in the adjustments. In European adolescents, the breakfast DP positively characterized by breakfast cereals, fruit, milk, and dairy and negatively characterized by sugar-sweetened beverages in boys and negatively characterized by cereals (pasta, rice, and others) in girls, was inversely associated with overweight/obesity., The HELENA study received funding from the European Union’s Sixth RTD Framework Programme (contracts FOODCT-2007-036196-2 and FOODCT-2005-007034, respectively). Additional support was obtained from the Spanish Ministry of Education (AGL2007-29784-E/ALI). Leandro Teixeira Cacau received a research internship abroad scholarship (grant number 2020/12326-1) from the Sao Paulo Research Foundation (FAPESP).

ZusammenfassungDer Leitfaden Ernährungstherapie in Klinik und Praxis (LEKuP) stellt eine grundlegende Überarbeitung des zuletzt im Jahr 2004 von der Deutschen Akademie für Ernährungsmedizin e. V. (DAEM) herausgegebenen Rationalisierungsschemas dar. Dabei erfolgte die Erstellung des LEKuP in enger Zusammenarbeit der verschiedenen Fachgesellschaften: Deutsche Gesellschaft für Ernährung e. V. (DGE) und die Deutsche Akademie für Ernährungsmedizin e. V. (DAEM) mit der Deutschen Gesellschaft für Ernährungsmedizin e. V. (DGEM), dem Berufsverband Deutscher Ernährungsmediziner e. V. (BDEM), der Deutschen Adipositas-Gesellschaft e. V. (DAG), dem Verband der Diätassistenten – Deutscher Bundesverband e. V. (VDD) und dem Berufsverband Oecotrophologie e. V. (VDOE).Gemeinsames Ziel der beteiligten Fachgesellschaften und -verbände war es, auf Grundlage evidenzbasierter Leitlinien einen aktuellen und konsensbasierten Leitfaden für die praktische Ernährungstherapie in Klinik und Praxis zu verfassen. Ein weiteres Ziel der Überarbeitung war es, damit eine Vorlage zu schaffen, aus der ein Kostformenkatalog für stationäre und ambulante medizinische Einrichtungen nach den lokalen Bedürfnissen abgeleitet werden kann.Die dem LEKuP zugrunde liegenden Empfehlungen basieren auf den D-A-CH-Referenzwerten für die Nährstoffzufuhr der Deutschen Gesellschaft für Ernährung e. V. (DGE) für Erwachsene und entsprechen einer vollwertigen und gesundheitsförderlichen Ernährung. Mittelmeerkost und vegetarische Ernährung werden als gleichwertig betrachtet. Abhängig von krankheitsspezifischen Erfordernissen werden Abweichungen und Ergänzungen vorgenommen, sodass eine Ernährungstherapie umgesetzt werden kann, die alle ernährungsbezogenen Maßnahmen zur Wiederherstellung von Gesundheit und Wiedererlangung des Handlungsvermögens von Patienten darstellt. Der vorliegende Leitfaden beschränkt sich auf die Darstellung der Prinzipien der Ernährungstherapie und deren praktische Umsetzung.

Background/Objectives: To assess dietary patterns (DPs) in European adolescents and to examine their relationship with healthy eating determinants.Subject/Methods: A total of 2205 European adolesce...

[Background]: Dietary misreporting is the main limitation of dietary assessments and has been associated with BMI during youth. However there are no prior studies assessing misreporting and cardiometabolic risks (CMRs) in adolescence., [Objectives]: To examine the associations between dietary misreporting and CMR factors in adolescents and to assess the potential bias in the association between CMR and energy intake (EI) driven by dietary misreporting., [Methods]: Two 24-hour dietary recalls were obtained from 1512 European adolescents (54.8% girls) aged 12.5–17.5 years. Physical activity was measured by accelerometry. Cut-offs suggested by Huang were applied to identify misreporters. Height, waist circumference (WC), the sum of 4 skinfold thicknesses, diastolic blood pressure (DBP), systolic blood pressure (SBP), and cardiorespiratory fitness (CRF) measurements were taken and serum triglycerides and total-/high-density lipoprotein cholesterol ratio were analyzed. A sex- and age-specific clustered CMR score (n = 364) was computed. Associations were investigated by multilevel regression analyses adjusting for age, sex, center, socioeconomic status, and physical activity., [Results]: Underreporting (24.8% adolescents) was significantly (P < 0.05) associated with a higher WC, waist-to-height ratio (WHeR), and sum of skinfold thickness, whereas overreporting (23.4% adolescents) was significantly associated with a lower WC, WHeR, sum of skinfold thickness, and SBP. Associations between CMR factors and EI were significantly affected by misreporting, considering various approaches. Significant, positive associations became inverse after adjusting for misreporting for WC and WHeR. The opposite was true for the sum of skinfold thickness, SBP, and CMR score. The associations between EI and DBP and CRF did not remain significant after adjusting for misreporting., [Conclusions]: CMR factors differed among misreporting groups, and both abdominal and total fat mass indicators were more strongly associated with all forms of misreporting than was BMI. Moreover, misreporting seems to bias EI and CMR associations in adolescents. Therefore, energy misreporting should be taken into account when examining diet-CMR associations., The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study was carried out with the financial support of the European Community Sixth Framework Programme Research and Technological Development (RTD) Framework Programme (contract FOODCT-2005-007034).

Objective:To investigate whether adherence to the adapted Mediterranean Diet Score for Adolescents (MDS_A) and the adapted Mediterranean Diet Quality Index for Adolescents (KIDMED_A) is associated with better food/nutrient intakes and nutritional biomarkers.Design:The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study is a cross-sectional study aiming to obtain comparable data on a variety of nutritional and health-related parameters in European adolescents aged 12·5–17·5 years.Setting:Nine European countries.Participants:European adolescents (n 2330) recruited to the HELENA study. Dietary intake was obtained with 24 h dietary recalls, an FFQ and a Food Choices and Preferences questionnaire. MDS_A was calculated as a categorical variable using cut-offs (MDS_A), as a continuous variable (zMDS_A) and with energy adjustments (zEnMDS_A). The KIDMED_A score was also calculated.Results:Multilevel linear regression analysis showed positive associations for zMDS_A and KIDMED_A with serum levels of vitamin D, vitamin C, plasma folate, holo-transcobalamin, β-carotene and n-3 fatty acids, while negative associations were observed with trans-fatty acid serum levels. For categorical indices, blood biomarkers showed few significant results. zMDS_A and KIDMED_A showed positive associations with vegetables and fruits intake, and negative associations with energy-dense and low-nutritious foods. zMDS_A and KIDMED_A were positively associated with all macronutrients, vitamins and minerals (all P < 0·0001), except with monosaccharides and PUFA for KIDMED_A and cholesterol for both indices (P < 0·05).Conclusions:zMDS_A and KIDMED_A have shown the strongest associations with the dietary indicators and biomarkers that have been associated with the Mediterranean diet before, and are therefore considered the most appropriate and valid Mediterranean diet scores for European adolescents.

The present paper was presented as a poster in the 13th European Nutrition Conference in Dublin (Ireland)., [Purpose]: Psychosocial stressors derived from socioeconomic disadvantages in adolescents can result in higher risk of metabolic syndrome (MetS). We aimed to examine whether socioeconomic disadvantages were associated with MetS independent of lifestyle and whether there was a dose-response relationship between the number of cumulated socioeconomic disadvantages and risk of MetS., [Methods]: This study included 1,037 European adolescents (aged 12.5–17.5 years). Sociodemographic variables and lifestyle were assessed by self-reported questionnaires. Disadvantaged groups included adolescents with low-educated parents, low family affluence, migrant origin, unemployed parents, and nontraditional families. MetS risk score was calculated as the sum of sex- and age-specific z-scores of waist circumference, blood pressure, lipids, and insulin resistance. Linear mixed-effects models adjusted for sex, age, pubertal status, and lifestyle were used to study the association between social disadvantages and MetS risk score., [Results]: Adolescents with low-educated mothers showed a higher MetS score (.54 [.09–.98]; β estimate and 99% confidence interval) compared to those with high-educated mothers. Adolescents who accumulated more than three disadvantages (.69 [.08–1.31]) or with missing information on disadvantages (.72 [.04–1.40]) had a higher MetS risk score compared to nonsocioeconomically disadvantaged groups. Stronger associations between socioeconomic disadvantages and MetS were found in male than in female adolescents., [Conclusions]: Adolescents with low-educated mothers or with more than three socioeconomic disadvantages had a higher MetS risk, independent of lifestyle, potentially due to higher psychosocial stress exposure. Policy makers should focus on improving low-educated familiesa and more disadvantaged families' knowledge on nutrition and physical activity to help them cope better with stress., The HELENA Study was conducted with the financial support of the European Community sixth RTD Framework Programme (Contract FOOD-CT-2005-007034).

Zusammenfassung Hintergrund Die Gesundheitsförderung an Schulen ist ein fester Bestandteil des Bildungsauftrags in Deutschland. Mit dem Hintergrund, dass in Familien immer weniger Ernährungswissen vermittelt wird, ist eine Förderung auf die Ernährungsbildung (EB) von Schulkindern eine seit Jahren diskutierte Forderung. Ob und in welcher Form die Inhalte einer gesundheitsfördernden Ernährung in den Lehrplänen (LP) der Grundschulen (GS) und welche Unterrichtsmaterialien (Quantität, Qualität) zur Verfügung stehen, ist aktuell nicht zusammenhängend erfasst. Ziel dieser Erhebung ist daher eine Bestandsaufnahme in den 16 Bundesländern (BL). Methoden Die elektronische Version der BL-spezifischen LP wurde unter Verwendung von definierten Schlüsselbegriffen (z. B. Ernährung) durchsucht, um relevante Inhalte für die EB zu erfassen. Die bundesweit verfügbaren Materialien, Programme und Projekte für GS wurden mittels Internetrecherche ermittelt, unter vorgegebenen Kriterien in einer Materialsammlung zusammengetragen und mithilfe des Materialkompasses bewertet. Ergebnisse In den einzelnen BL steht die EB mit stark variierendem Umfang, Aktualität und Themen in den LP der GS. Es ergaben sich 15 Themenfelder mit weiteren Unterthemen. Die erstellte Materialsammlung umfasste 246 verschiedene Materialien von Verbänden, Verlagen und Wirtschaft, die sich in ihrer Qualität stark unterschieden. Neben den meisten empfehlenswerten Materialien wurden auch 13 % wegen inhaltlicher und didaktischer Defizite als unzureichend eingestuft. Schlussfolgerungen Die länderspezifischen LP für das Fach EB unterscheiden sich sowohl in Qualität als auch in Quantität deutlich. Zur bestmöglichen Erreichung der Ziele (Umfang, Wissenschaftlichkeit, Praktikabilität) in der EB wäre eine Regulierung auf Bundesebene erstrebenswert, um eine bundesweit einheitliche EB an GS durchzusetzen. Zur Aufrechterhaltung von Standards scheint eine Kontrolle mit einheitlichen Kriterien der Lehrmaterialien unabdingbar.

ObjectiveThe present study aimed to examine the association between different breakfast consumption patterns and vitamin intakes and blood vitamin concentrations in European adolescents.DesignBreakfast consumption was assessed by a questionnaire. Vitamin intake was calculated from two 24 h recalls. Blood vitamin and total homocysteine (tHcy) concentrations were analysed from fasting blood samples.SettingThe European Commission-funded HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.SubjectsParticipants were 1058 (52·8 % females) European adolescents (aged 12·5–17·5 years) from ten cities.ResultsLower vitamin D and vitamin C concentrations were observed in male and female breakfast skippers than in consumers (PPPP6and vitamin E than occasional consumers (PConclusionsRegular breakfast consumption is associated with higher blood vitamin D and cobalamin concentrations in males and with higher vitamin D and holo-transcobalamin and lower tHcy concentrations in females. Moreover, breakfast consumption is associated with high intakes of vitamin D and total folate in both sexes, and with high intakes of vitamin B6and vitamin E in females.

There is an increasing interest for the role of liver enzymes as predictors of non-liver-related morbidity and mortality. The American Heart Association (AHA) described the ideal cardiovascular health concept as a score of seven cardiovascular health behaviors and factors that can be used to monitor and predict ideal cardiovascular health over time. This study aimed to examine the association of the ideal cardiovascular health (ICH), as defined by the AHA, with liver enzyme levels in European adolescents. A total of 637 adolescents (54.6% females), aged 14.6 ± 1.2 years from nine European countries participated in this cross-sectional study. Blood levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase were measured and the AST/ALT ratio calculated. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviors (smoking, body mass index, physical activity, and diet) and three factors (total cholesterol, blood pressure, and glucose). A higher number of ideal cardiovascular health behaviors, factors, and ideal cardiovascular health index were associated with lower ALT (P

[Purpose]: To examine the adherence to the Mediterranean dietary pattern (MDP) in metabolically healthy overweight or obese (MHO) and metabolically unhealthy obese (MUO) European adolescents., [Methods]: In this cross-sectional study, 137 overweight/obese adolescents aged 12–17 years old from the HELENA study were included. Height, weight, waist circumference and skinfold thickness were measured and body mass index and body fat percent were calculated. Systolic and diastolic blood pressure, glucose, HDL cholesterol, triglycerides and cardiorespiratory fitness (20 m shuttle run test) were measured. MHO and MUO phenotypes were categorized following the Jolliffe and Janssen criteria. Two non-consecutive 24 h recalls were used for dietary intake assessment and the adherence to the MDP was calculated using the Mediterranean dietary pattern score (MDP score) (range 0–9)., [Results]: A total of 45 (22 girls) adolescents (32.8%) were categorized as MHO. The adherence to the MDP was significantly higher in MHO than in MUO adolescents regardless of age, sex, body fat percentage, energy intake and center (MDP score: 4.6 ± 1.6 vs. 3.9 ± 1.5, p = 0.036), but this difference became non-significant after further adjustment for cardiorespiratory fitness. Participants who had a low adherence to the MDP (MDP score ≤ 4) had a higher likelihood of having MUO phenotype regardless of sex, age, energy intake, center and body fat percentage (OR 2.2; 95% CI 1.01–4.81, p = 0.048)., [Conclusions]: Adherence to the MDP might be beneficial to maintain metabolic health in overweight/obese adolescents, yet cardiorespiratory fitness seems to play a key role on the metabolic phenotype., The HELENA project was supported by the European Community Sixth RTD Framework Programme (contract FOODCT-2005-007034), by the Education Department of the Government of the Basque Country (PRE_2016_1_0057, PRE_2017_2_0224), by the Spanish Ministry of Science and Innovation (RYC-2011-09011), by the University of the Basque Country (GIU14/21), and by the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES). Furthermore, the current study was supported by the Spanish Ministry of Health (CIBERobn CB12/03/30038).

OBJECTIVES: Development of a diet optimization methodology, forming the next generation of food-based dietary guidelines (FBDG) in Germany, to identify dietary changes accounting for various dimensions: diet-health relations, environmental impact, and nutrient needs while staying culturally acceptable. METHODS: Three parameters define the German Nutrition Optimization Model (GNOM): The decision variables, which are observed food intakes (FoodEx2 food grouping); acceptability constraints (acceptability upper limits (AL) are set for foods based on P95), and the linear objective function. The latter consists of three components that are weighted between each other and minimizes environmental impact (greenhouse-gas emissions and land use), diet-related health burden (disability adjusted life years), and relative deviation from the observed dietary intake (cultural acceptability). Also, deviations from nutritional needs for 39 nutrients are minimized. Five models were run on the adult population by increasing weight on diet-health and decreasing weight on cultural acceptability progressively (by steps of 20%, from 0% in model 1 (M1) to 80% in model 5 (M5)), with a fixed environmental weight at 20%. Dietary changes are exemplary described for fruits, vegetables, whole grains and red meat. RESULTS: All models satisfied nutrient needs and, compared to the observed diet, increased in fruits, vegetables, and whole grains and decreased in red meat; dietary changes were higher with increasing weight on diet-health. Compared to the observed intake (174,4g/d), fruits increased moderately in M1–3 (205,7g/d - 338,8g/d) and reached the AL of 552g/d in M4 and M5. Vegetables reached the AL of 267g/d in every model (observed intake: 96,3g/d) except M1 (261,5g/d). Whole grains increased progressively from 13g/d in observed intake to 16,3g/d and 16,7g/d in M1 and M2, 61,9g and 67,9g in M3 and M4 and increased strongly to 250,7g/d in M5. The observed amount of red meat was 34,4g/d, which dropped from 2,5g/d in M1 to 0g/d in M5. CONCLUSIONS: This methodology accounts for multidimensional requirements in FBDGs and is flexible regarding the importance given to each dimension. Preliminary results suggest that using this innovative approach to operationalize diet-health relations, GNOM is able to help derive German FBDG. FUNDING SOURCES: German Federal Ministry of Food and Agriculture.

On behalf of the HELENA study group: et al., [Objectives]: To determine dietary patterns (DPs) and explain the highest variance of vitamin B6, folate, and B12 intake and related concentrations among European adolescents., [Methods]: A total of 2173 adolescents who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence study met the eligibility criteria for the vitamin B intake analysis (46% boys) and 586 adolescents for the biomarkers analysis (47% boys). Two non-consecutive, 24-h, dietary recalls were used to assess the mean intakes. Concentrations were measured by chromatography and immunoassay testing. A reduced rank regression was applied to elucidate the combined effect of food intake of vitamin B and related concentrations., [Results]: The identified DPs (one per vitamin B intake and biomarker and by sex) explained a variability between 34.2% and 23.7% of the vitamin B intake and between 17.2% and 7% of the biomarkers. In the reduced rank regression models, fish, eggs, cheese, whole milk and buttermilk intakes were loaded positively for vitamin B intake in both sexes; however, soft drinks and chocolate were loaded negatively. For the biomarkers, a higher variability was observed in the patterns in terms of food loads such as alcoholic drinks, sugars, and soft drinks. Some food items were loaded differently between intakes and biomarkers such as fish products, which was loaded positively for intakes but negatively for plasma folate in girls., [Conclusions]: The identified DPs explained up to 34.2% and 17.2% of the variability of the vitamin B intake and plasma concentrations, respectively, in European adolescents. Further studies are needed to elucidate the factors that determine such patterns., HELENA study received funding from the European Union’s Sixth RTD Framework Programme (Contract FOODCT-2005-007034). Additional support from the Spanish Ministry of Education (AGL2007-29784-E/ALI), Axis-Shield Diagnostics Ltd (Oslo, Norway), Abbot Científica S.A. (Spain). This analysis was also supported by the Spanish Ministry of Science and Innovation (JCI-2010-07055) with the contribution of the European Regional Development Fund (FEDER). The first author is supported by a grant from the Spanish Carlos III Health Institute: RD08/0072/0025 (Red SAMID: Maternal, Child Health and Development Research Network).

Copyright © 2015 by the American Society for Biochemistry and Molecular Biology, Inc. Dietary n-3 long-chain PUFAs (LC-PUFAs) are associated with improvement in the parameters of the metabolic syndrome (MetS). Glucokinase regulatory protein (GCKR) is a key protein regulating intracellular glucose disposal. Our aim was to investigate: i ) the relationship between the GCKR rs1260326 (Pro446Leu) polymorphism and parameters of the MetS; and ii ) a potential influence of n-3 and n-6 LC-PUFA levels on this relationship in the HELENA study (1,155 European adolescents). Linear regression analyses were performed to study the association between rs1260326 and the outcomes of interest. Interactions between rs1260326 and LC-PUFA levels on outcomes were explored. The T allele of rs1260326 was associated with higher serum TG concentrations compared with the C allele. In contrast to n-6 LC-PUFA levels, a significant interaction ( P = 0.01) between rs1260326 and total n-3 LC-PUFA levels on serum TG concentrations was observed. After stratification on the n-3 LC-PUFA median values, the association between rs1260326 and TG concentration was significant only in the group with high n-3 LC-PUFA levels. In conclusion, this is the first evidence that n-3 LC-PUFAs may modulate the impact of the GCKR rs1260326 polymorphism on TG concentrations in adolescents. Several molecular mechanisms, in link with glucose uptake, could explain these findings.

Zusammenfassung: Eine pflanzenbasierte Ernährung ist meist mit einer höheren Zufuhr verschiedener Vitamine, Mineralstoffe, Ballaststoffe sowie sekundärer Pflanzenstoffe verbunden sowie mit einer verminderten Zufuhr von gesättigten Fettsäuren und Cholesterol. Allerdings ist die Versorgung mit einigen Nährstoffen, insbesondere Vitamin B12, bei einer rein veganen Ernährung kritisch. Für eine evidenzbasierte Bewertung möglicher gesundheitlicher Vorteile und Risiken einer veganen Ernährung sind jedoch mehr aussagekräftige Daten notwendig.

Childhood obesity is one of the major concerns in the last years due to the association with future health problems and all-cause mortality. However, there is a subset of adolescents with overweight/obesity who present a metabolic healthy profile. Therefore, the aim of this study was to examine the prevalence of metabolically healthy but overweight/obese adolescents and whether sedentary time, physical activity, and fitness differ between metabolically healthy and nonmetabolically healthy phenotypes.A subsample of 237 European adolescents from the HEalthy Lifestyle in Europe by Nutrition in Adolescence study (n = 3,528, participation rate: 61.3%) with overweight/obesity were included. The study sample was not fully representative for the European adolescent population. Based on sex- and age-specific metabolic syndrome cutoff points for triglycerides, glucose, blood pressure, and high-density cholesterol participants were classified as metabolically healthy or nonmetabolically healthy. Sedentary time, physical activity, and fitness were assessed by accelerometry and the Alpha battery, respectively.The prevalence of metabolically healthy status in adolescents with overweight and obesity was higher in girls (87%) than in boys (74%, p = .019), being similar when only obesity was considered. Sedentary time was lower in metabolically healthy overweight/obese than in nonmetabolically healthy participants (mean difference = 48.0 minutes, p = .012). Moderate and moderate-to-vigorous physical activity were higher (p's.05) in metabolically healthy than in nonmetabolically healthy adolescents with overweight/obesity (mean difference = 7.9 min/day and 10.9 min/day, respectively). No significant differences were found in fitness. Overall, these results persisted when only adolescents with obesity were included in the analyses.Metabolically healthy adolescents with overweight/obesity are less sedentary and more active than their nonmetabolically healthy peers with overweight/obesity, yet consistent differences in fitness were not observed.

Despite an acknowledged dearth of data on serum 25-hydroxyvitamin D (25(OH)D) concentrations from Southern European countries, inter-country comparison is hampered by inconsistent data reporting. The purpose of the current study was to conduct a systematic literature review of available data on serum 25(OH)D concentrations and estimate vitamin D status in Southern European and Eastern Mediterranean countries, both at a population level and within key population subgroups, stratified by age, sex, season and country. A systematic review of the literature was conducted to identify and retrieve scientific articles reporting data on serum 25(OH)D concentration and/or vitamin D status following standard procedures. Data were extracted from 107 studies, stratified by sex and age group, representing 630,093 individuals. More than one-third of the studies reported mean 25(OH)D concentrations below 50 nmol/L and ~ 10% reported mean serum 25(OH)D concentrations below 25 nmol/L. Overall, females, neonates/ infants and adolescents had the higher prevalence of poor vitamin D status. As expected, there was considerable variability between studies. Specifically, mean 25(OH)D ranged from 6.0 (in Italian centenarians) to 158 nmol/L (in elderly Turkish men); the prevalence of serum 25(OH)D

HELENA Study Group: et al., [Purpose]: To examine the association between food groups consumption and vitamin B6, folate and B12 intakes and biomarkers in adolescents., [Methods]: In total 2189 individuals participating in the cross-sectional Healthy Lifestyle in Europe by Nutrition in Adolescence study met the eligibility criteria for analysis of dietary intakes (46 % males) and 632 for biomarker analysis (47 % males). Food intakes were assessed by two non-consecutive 24-h recalls. Biomarkers were measured by chromatography and immunoassay. Food groups which best discriminated participants in the extreme tertiles of the distribution of vitamins were identified by discriminant analyses. Food groups with standardised canonical coefficients higher or equal to 0.3 were selected as valid discriminators of vitamins intake and biomarkers extreme tertiles. Linear mixed model elucidated the association between food groups and vitamins intakes and biomarkers., [Results]: Vitamin B6 intakes and biomarkers were best discriminated by meat (males and females), margarine and mixed origin lipids only in males and breakfast cereals (females). Breakfast cereals (males), and fruits, margarine and mixed origin lipids, vegetables excluding potatoes, breakfast cereals, and soups/bouillon (females) determined the most folate intakes and biomarkers. Considering vitamin B12 intakes and biomarkers, meat, and white and butter milk (males and females), snacks (males), and dairy products (females) best discriminated individual in the extremes of the distribution. Fewer associations were obtained with mixed model for biomarkers than for vitamins intakes with food groups., [Conclusions]: Whereas B-vitamin intakes were associated with their food sources, biomarkers did with overall food consumption. Low-nutrient-density foods may compromise adolescents’ vitamin status., HELENA study received funding from the European Union’s Sixth RTD Framework Programme (Contract FOODCT-2005-007034). Additional support from the Spanish Ministry of Education (AGL2007-29784-E/ALI), Axis-Shield Diagnostics Ltd (Oslo, Norway), Abbot Científica S.A. (Spain). The first author was financially supported by EURRECA-Network of Excellence-. This analysis was also supported by the Spanish Ministry of Science and Innovation (JCI-2010-07055) with the contribution of the European Regional Development Fund (FEDER).

On behalf of the HELENA study group., [Background & aims]: Chronobiology studies periodic changes in living organisms and it has been proposed as a promising approach to investigate obesity. We analyze the association of the characteristics of the rest-activity rhythms with obesity, cardiorespiratory fitness and metabolic risk in adolescents from nine European countries. [Methods]: 1044 adolescents (12.5–17.5 y) were studied. Circadian health was evaluated by actigraphy with accelerometers (Actigraph GT1M). Characteristics of the daytime activity such as fragmentation (intradaily variability), estimated acrophase, and 10 h mean daytime activity index were obtained. Body composition was assessed using Bioelectrical-Impedance-Analysis, skinfold thickness, air-displacement-plethysmography and Dual-energy-X-ray-Absorptiometry. Cardiorespiratory fitness (VO) and metabolic risk were studied. [Results]: Highly fragmented activity rhythms were associated with obesity and central adiposity (P < 0.05). Obese adolescents had ∼3 times higher odds of having a high fragmentation of daytime activity compared to normal weight adolescents OR (95% CI) = 2.8 (1.170, 6.443). A highly fragmented rhythm was also related to lower cardiorespiratory fitness and higher metabolic risk (P < 0.05) so those adolescents classified as low fitness showed a significantly higher fragmentation of daytime activity than those included in the high fitness group (P < 0.0001). Other characteristics of the rhythms such as smaller 10 h daytime mean activity index and delayed estimated acrophase were also related to obesity and metabolic risk (P < 0.05). [Conclusions]: Our results indicate that the daily organization of the rest-activity cycle is more fragmented in obese and less fit adolescents and correlates with higher metabolic risk. This fact reinforces our hypothesis that disturbances in daily rhythms can be considered as sensitive markers of poorer adolescent's health., The HELENA project was supported by of the European Community Sixth RTD Framework Programme (Contract FOOD-CT-2005-007034). The data for this study were gathered under the aegis of the HELENA project and their further analysis was additionally supported by grants from the Spanish Ministry of Economy and Competitiveness (RYC-2010-05957; RYC-2011-09011), the Spanish Ministry of Health: Maternal, Child Health and Development Network (number RD08/0072) and the “Fondo Europeo de Desarrollo Regional (MICINN-FEDER)”. The analyses were additionally funded by the Spanish Ministry of Economy and Competitiveness (SAF2014-52480); by the Ministry of Economy and Competitiveness and the Instituto de Salud Carlos III – RETICEF (The Ageing and Frailty Cooperative Research Network, RD12/0043/0011) and the Ministry of Education and Science (SAF2013-49132-C2-1-R) and the Ministry of Economy and Competitiveness (IPT-2011-0833-900000), including FEDER co-funding.

On behalf of the HELENA project group., Various definitions are used to define metabolic syndrome in adolescents. This study aimed to compare, in terms of prevalence and differences, five frequently used definitions for this population: International Diabetes Federation, National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP) modified by Cook, pediatric American Heart Association (AHA), World Health Organization, and Jolliffe and Janssen. A sample of 1004 adolescents (12.5–17.0 years) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study was considered. The components of the definitions (waist circumference/BMI, plasma lipids, glycemia, and blood pressure) were applied, and definitions were compared by using crosstabs, sensitivity, specificity, and kappa coefficient. The prevalence of metabolic syndrome varied from 1.6 to 3.8% depending on the used definitions. Crosstabs comparing the definitions showed the fewest cases being misclassified (having metabolic syndrome or not) between NCEP-ATP and AHA. Analyses for kappa coefficient, sensitivity, and specificity confirmed this finding. [Conclusion]: The different definitions do not classify the same adolescents as having MS and prevalence varied between diagnostic methods. The modified NCEP-ATP and the AHA definitions were most analogous in defining subjects as having metabolic syndrome or not., The HELENA study took place with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT-2005-007034). KV is financially supported by the Research Foundation Flanders (FWO). CCS is supported by a grant from the Spanish Ministry of Economy and Competitiveness (BES-2014-068829). FBO is supported by a grant from the Spanish Ministry of Science and Innovation (RYC-2011-09011).

Summary Objectives This study aimed to explore the associations of liver biomarkers with cardiometabolic risk factors and their clustering, and to provide reference values (percentiles) and cut-off points for liver biomarkers associated with high cardiometabolic risk in European adolescents. Methods Alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), aspartate aminotransferase to ALT ratio (AST/ALT), waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol and insulin were measured in 1084 adolescents. We computed a continuous cardiometabolic risk score and defined the high cardiometabolic risk. Results Higher ALT and GGT and lower AST/ALT were associated with adiposity and with the number of adverse cardiometabolic risk factors (Ps

[Objectives]: Previous research showed that low concentration of biomarkers in the blood during adolescence (i.e., iron status; retinol; and vitamins B6, B12, C, and D) may be involved in the early stages of development of many chronic diseases, such as hypertension. The aim was to evaluate if iron biomarkers and vitamins in the blood are associated with blood pressure in European adolescents., [Methods]: Participants from the Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional study (N = 1089; 12.5–17.5 y; 580 girls) were selected by complex sampling. Multilevel linear regression models examined the associations between iron biomarkers and vitamins in the blood and blood pressure; the analyses were stratified by sex and adjusted for contextual and individual potential confounders., [Results]: A positive association was found in girls between RBC folate concentration and systolic blood pressure (SBP) (β = 3.19; 95% confidence interval [CI], 0.61–5.77), although no association between the vitamin serum biomarkers concentrations and diastolic blood pressure (DBP) was found. In boys, retinol was positively associated with DBP (β = 3.84; 95% CI, 0.51–7.17) and vitamin B6 was positively associated with SBP (β = 3.82; 95% CI, 1.46–6.18). In contrast, holotranscobalamin was inversely associated with SBP (β = −3.74; 95% CI, −7.28 to −0.21)., [Conclusions]: Levels of RBC folate and vitamin B6 in blood may affect BP in adolescents. In this context, programs aimed at avoiding high BP levels should promote healthy eating behavior by focusing on the promotion of vegetable proteins and foods rich in vitamin B12 (i.e., white meat and eggs), which may help to achieve BP blood control in adolescents., The HELENA Study was financially support by the European Community SixthRTD Framework Programme (contract FOOD-CT-2005-007034). The writing group takes sole responsibility for the content of this article. This study was also supported by a grant from the Spanish Ministry of Health: Maternal, Child Health and Development Network (number RD08/0072), grant from the Spanish Ministry of Education (EX-2008-0641; AP-2008-03806) and the Swedish Heart-Lung Foundation (20090635). ACdeM received scholarship from S~ao PauloResearch FoundationdFAPESP (proc. 2011/11137-1 and 2011/20662-2). LAM received scholarship of visiting professor from the Brazilian government by Science without Borders Program by CNPq (National Counsel of Technological and Scientific Development) and CAPES (Coordination of Improvement of Higher Education Personnel) (proc. 007/2012). The GENUD Research Group cofinancedby the European Regional Development Fund (MICINN-FEDER)

To examine the association between physical activity (PA) and liver enzyme levels in adolescents from nine European countries. The study comprised 718 adolescents (397 girls). PA was measured by accelerometry and expressed as total PA (counts/min), and time (min/d) engaged in moderate to vigorous intensity PA (MVPA). Time spent sedentary was also objectively measured. We measured serum levels of alanine aspartate aminostrasferase (AST), alanine aminostransferase (ALT), and γ-glutamyltrasnferase (GGT), and the AST/ALT ratio was computed. There was an association between MVPA and AST and AST/ALT (age, sex, and center-adjusted β = 0.096, 95% confidence interval (CI): 0.016 to 0.118; and β = 0.090, 95% CI: 0.006 to 0.112, respectively). Meeting the PA recommendations (60 min/d of MVPA) was significantly associated with higher AST and AST/ALT, which persisted after further adjusting for sedentary time and waist circumference. Sedentary time was not associated with any of the studied liver enzyme levels. Meeting the current PA recommendations of 60 min/d of MVPA is associated with higher levels of AST and AST/ALT regardless of time spent sedentary as well as total and central body fat in European adolescents.

11 páginas, 2 figuras, 3 tablas..-Valtueña, J.,Moreno, L.A, et al., Evidence indicates low 25-hydroxyvitamin D [(25(OH)D] concentrations in European adolescents. Identification of potential determinants is therefore essential to guide public health initiatives aiming at optimizing vitamin D status across Europe. The aim of the study was to identify potential influencing factors of 25(OH)D concentrations in European adolescents aged 12.5 to 17.5 y, participating in the multi-centre cross-sectional Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. A subset of 1,006 participants (46.8% males) was drawn from the main study. Measures of body composition, biochemical markers, socioeconomic status, dietary intake, physical activity, fitness, sleep time and vitamin D genetic polymorphism (rs1544410) were assessed. Stepwise multivariate linear regression analysis was conducted stratified by gender. In males, linear regression of 25(OH)D, suggested that (1) winter season (β= -0.364; p

Objectives (1) To examine whether cardiorespiratory fitness (CRF) is related to liver enzyme levels independent of waist circumference (WC), and (2) To test whether having a high CRF is associated with an improved liver enzyme profile with a high WC. Design Cross-sectional. Methods CRF (20 m-shuttle-run test) and WC were assessed in 811 European adolescents (48.5% males) aged 12.5–17.5 years. Fatty liver biomarkers included fasting serum alanine-aminotransferase (ALT), gamma-glutamyl-transpeptidase (GGT) and the aspartate-aminotransferase to ALT (AST/ALT) ratio. Participants were categorized as fit or unfit (CRF below or above 43.8 mL/kg/min and 34.6 mL/kg/min, for boys and girls, respectively) and as high or non-high WC (sex and age-specific cut-offs). Results CRF was associated with ALT ( β = −0.106; p = 0.049) and GGT levels ( β = −0.225; p β = 0.234; p 0.1). High WC and fit adolescents had lower ALT levels (28 ± 1 U/L vs. 23 ± 2 U/L, unfit and fit respectively, p = 0.018) and higher AST/ALT ratio (0.94 ± 0.04 vs. 1.10 ± 0.06, unfit and fit respectively, p = 0.010) than those who were high WC but unfit. Conclusions The results showed that CRF is not independently associated with liver enzymes, and that WC is a stronger predictor in adolescents. These findings also suggest that high CRF may have specific protective effects on liver enzyme levels in adolescents with high WC. Exercise programs focused on increasing CRF and decreasing abdominal adiposity could be a good alternative in the treatment and prevention of obesity related fatty liver disease in adolescents.

Objectives Adolescents in the European Union (EU) exhibit a higher prevalence of vitamin D (VitD) deficiency than other age groups. The degree to which sunlight exposure 25-hydroxyvitamin D [25(OH)D] concentrations depends on a variety of factors, including diet. Nevertheless, the relationship between calcium and VitD intake and 25(OH)D concentrations has not been previously studied among adolescents living in different EU countries and consequently in different latitudes. Therefore, the aim of this study was to examine whether calcium and VitD intakes are differentially associated with 25(OH)D in adolescents from northern, central and southern EU countries. Methods The present analysis included 178 adolescents from northern EU countries, 251 from central EU countries, and 212 from southern EU countries (ages 12.5–17.5 y). Mixed model linear regression analyses stratified by geographic location were used to verify associations between calcium and VitD intake and 25(OH)D concentrations. Age, Tanner stage, seasonality, energy intake, and supplement use were entered as covariates. Results Only the calcium intake of central EU adolescents was positively associated with 25(OH)D (α = 0.005; 95% confidence interval, 0.007–0.028). Conclusions Further longitudinal studies should confirm these observations, as this could be important for future public health interventions aiming to increase 25(OH)D concentrations in adolescents.

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.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.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 (P0.05). 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 (P0.05). 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 (P0.05).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.

To investigate the combined influence of diet quality and physical activity on cardiovascular disease (CVD) risk factors in adolescents, adolescents (n = 1513; 12.5-17.5 years) participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence study were studied. Dietary intake was registered using a 24-h recall and a diet quality index was calculated. Physical activity was assessed by accelerometry. Lifestyle groups were computed as: healthy diet and active, unhealthy diet but active, healthy diet but inactive, and unhealthy diet and inactive. CVD risk factor measurements included cardiorespiratory fitness, adiposity indicators, blood lipid profile, blood pressure, and insulin resistance. A CVD risk score was computed. The healthy diet and active group had a healthier cardiorespiratory profile, fat mass index (FMI), triglycerides, and high-density lipoprotein cholesterol (HDL-C) levels and total cholesterol (TC)/HDL-C ratio (all P ≤ 0.05). Overall, active adolescents showed higher cardiorespiratory fitness, lower FMI, TC/HDL-C ratio, and homeostasis model assessment index and healthier blood pressure than their inactive peers with either healthy or unhealthy diet (all P ≤ 0.05). Healthy diet and active group had healthier CVD risk score compared with the inactive groups (all P ≤ 0.02). Thus, a combination of healthy diet and active lifestyle is associated with decreased CVD risk in adolescents. Moreover, an active lifestyle may reduce the adverse consequences of an unhealthy diet.

Food-based dietary guidelines (FBDG) aim to address the nutritional requirements at population level in order to prevent diseases and promote a healthy lifestyle. Diet quality indices can be used to assess the compliance with these FBDG. The present study aimed to investigate whether the newly developed Diet Quality Index for Adolescents (DQI-A) is a good surrogate measure for adherence to FBDG, and whether adherence to these FBDG effectively leads to better nutrient intakes and nutritional biomarkers in adolescents. Participants included 1804 European adolescents who were recruited in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study. Dietary intake was assessed by two, non-consecutive 24 h recalls. A DQI-A score, considering the components' dietary quality, diversity and equilibrium, was calculated. Associations between the DQI-A and food and nutrient intakes and blood concentration biomarkers were investigated using multilevel regression analysis corrected for centre, age and sex. DQI-A scores were associated with food intake in the expected direction: positive associations with nutrient-dense food items, such as fruits and vegetables, and inverse associations with energy-dense and low-nutritious foods. On the nutrient level, the DQI-A was positively related to the intake of water, fibre and most minerals and vitamins. No association was found between the DQI-A and total fat intake. Furthermore, a positive association was observed with 25-hydroxyvitamin D, holo-transcobalamin and n-3 fatty acid serum levels. The present study has shown good validity of the DQI-A by confirming the expected associations with food and nutrient intakes and some biomarkers in blood. Copyright © 2012 The Authors.

There is a lack of studies that analyze the association between micronutrient-related biomarker status and physical fitness in adolescents. In the present study, biochemical parameters for iron and vitamin status were studied, along with objective measures of physical fitness in healthy male and female European adolescents. One thousand eighty-nine adolescents (580 girls, 12.5-17.5 yr) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study were included. Hierarchical linear models were performed to determine the associations between micronutrient biomarkers and physical fitness. Age, seasonality, latitude, body mass index, menarche (in girls), and physical activity were used as covariates. For cardiorespiratory fitness, concentrations of hemoglobin, retinol, and vitamin C in male adolescents and β-carotene and 25(OH)D in female adolescents were associated with maximal oxygen consumption. For muscular fitness, concentrations of hemoglobin, β-carotene, retinol, and α-tocopherol in male adolescents and β-carotene and 25(OH)D in female adolescents were associated with better performance of the standing long jump test. In summary, concentrations of hemoglobin and most antioxidant vitamins in male adolescents and β-carotene and 25(OH)D in female adolescents were positively associated with cardiorespiratory and muscular fitness, after controlling for relevant confounders. The associations between physical fitness and iron or vitamin status observed in this cross-sectional study in adolescents should be followed up by a study specifically designed to evaluate causal relationships. Copyright © 2012 the American Physiological Society.

While it has been indicated that exposure to second-hand smoke (SHS) can cause a local in vivo response, limited evidence exists on its possible systemic effects from population-based levels of exposure. We investigated into a possible systemic response in the immune parameters and lymphocyte subsets, i.e. B cell (CD19+), T cell (CD4+CD45RO+, CD4+CD45RA+, CD3+CD45RO+, CD3+CD45RA+) and natural killer (CD3+CD16CD56+) lymphocyte subsets relative to exposure to SHS. Blood was drawn from healthy, verified non-smoker, adolescent subjects (n = 68, mean age 14.2) and analysed for cotinine, antioxidants and lymphocyte immunophenotyping. SHS exposure was assessed using serum cotinine. Biomarker quantified exposure to SHS was correlated with a linear dose-response reduction in the percentages of memory CD4+CD45RO+ (p = 0.005) and CD3+CD45RO+ T-cell subsets (p = 0.005 and p = 0.003, respectively) and a linear increase in the percentage of naive CD4+CD45RA+ and CD3+CD45RA+ T-cell subsets (p = 0.006 and p = 0.003, respectively). Additionally, higher exposure to SHS was associated with a higher CD4+CD45RA+ count (532 vs. 409 cells/ml, p = 0.017). Moreover, after controlling for age, gender, body mass index and plasma antioxidants, SHS exposure was found to be associated with the percentage of circulating naive and memory CD4+ and CD3+ T-cell subpopulations, as revealed through a linear regression analysis. These findings indicate a systemic immunological response in healthy adolescents exposed to population-based levels of SHS exposure and imply an additional biological pathway for the interaction between exposure to SHS and its adverse effects on human health.

OBJECTIVE The peroxisome proliferator–activated receptor-γ2 (PPARG2) Pro12Ala polymorphism has been associated with a higher BMI and a lower risk of type 2 diabetes in adulthood. The association between adiposity and PPARG variants can be influenced by environmental factors such as early growth, dietary fat, and (as recently shown) breast-feeding. The objectives of this study were to assess 1) the influence of the PPARG2 Pro12Ala polymorphism on adiposity markers in adolescents and 2) a possible modulating effect of breast-feeding on these associations. RESEARCH DESIGN AND METHODS Data on breast-feeding duration, BMI, and genotypes for the Pro12Ala polymorphism were available for 945 adolescents (mean age 14.7 years). The breast-feeding duration was obtained from parental records. We measured weight, height, waist circumference, and six skinfold thicknesses. RESULTS No significant associations between the Pro12Ala polymorphism and any of the above-mentioned anthropometric parameters were found. There were significant interactions between the PPARG2 Pro12Ala polymorphism and breast-feeding with regard to adiposity measurements (all adjusted P < 0.05). Indeed, in children who had not been breast-fed, Ala12 allele carriers had higher adiposity parameters (e.g., Δ BMI +1.88 kg/m2, adjusted for age, sex, and center, P = 0.007) than Pro12Pro adolescents. In contrast, in breast-fed subjects, there was no significant difference between Ala12 allele carriers and Pro12Pro children in terms of adiposity measurements, whatever the duration of breast-feeding. CONCLUSIONS Breast-feeding appears to counter the deleterious effect of the PPARG2 Pro12Ala polymorphism on anthropometric parameters in adolescents.

Background: Folate and cobalamin are responsible for healthy growth. However, the B-vitamin and homocysteine status of adolescents is not well known. The aim was to assess the status of folate, cobalamin, and homocysteine in healthy Spanish adolescents. Methods: Serum cobalamin, serum folate, homocysteine, methylenetetrahydrofolate reductase 677C>T variant, BMI, smoking habits, and Tanner stage were determined according to gender in 165 adolescents (84 females, 81 males; 13–18.5 years) using the Student’s t test, Mann-Whitney U test and χ2 test, respectively. Interactions between socioeconomic status, age group, methylenetetrahydrofolate reductase polymorphism, BMI, smoking habits, Tanner stage, and vitamin status, respectively, were examined by ANOVA or Kruskal-Wallis H test (p < 0.05). Results: Boys had markedly higher homocysteine (males 8.92 (5.51–22.94) µmol/l; females 7.91 (5.09–13.86) µmol/l), whereas girls showed higher serum cobalamin concentrations (males 540.00 (268.00–946.47) pmol/l; females 594.82 (280.63–1,559.64) pmol/l). Data are shown as medians and the 2.5th to 97.5th percentiles in parentheses. Adolescents with the homozygous variant of methylenetetrahydrofolate reductase displayed significantly higher homocysteine and lower serum folate: normal 5.73 (3.09–10.73) ng/ml serum folate, 7.57 (4.94–12.94) µmol/l homocysteine; homozygous 4.10 (2.75–7.88) ng/ml serum folate, 10.83 (7.00–22.82) µmol/l homocysteine. Conclusion: The present study provides data on the folate, cobalamin, and homocysteine status of Spanish adolescents. To assure a better assessment, revision of references for adolescents is still needed.

The HELENA Project—Healthy Lifestyle in Europe by Nutrition in Adolescence—is a European, collaborative research project financed by the EU Sixth Framework Programme in the area of nutrition-related adolescent health. The basic objective of the HELENA project is to obtain reliable and comparable data from a random sample of European adolescents (boys and girls aged 13–16 years) on a broad battery of relevant nutrition and health-related parameters: dietary intake, food choices and preferences, anthropometry, serum indicators of lipid metabolism and glucose metabolism, vitamin and mineral status, immunological markers, physical activity, fitness and genetic markers. The HELENA project is conceived as a scientific construction with four complementary sub-studies that are elaborated through 14 well-defined work packages. Sub-studies are focused, respectively, on “a cross-sectional description of lifestyles and indicators of nutritional status (HELENA-CSS)”, “a lifestyle education intervention programme (HELENA-LSEI), “a metabolic study with cross-over design (HELENA-COMS)” and a “study on behaviour, food preferences and food development” (HELENA-BEFO). The project unites 20 research centres from 10 European countries. In addition, the consortium comprises five SMEs (small and medium-sized enterprises) that are actively involved in the research activities. The core of the HELENA project study material is an overall European cohort of 3,000 adolescents, equally recruited in ten cities from nine countries. Standardization of methods among partners is a key issue in the project and is obtained through the development of standard protocols, training sessions, validation sub-studies and pilot projects. Health-related problems have a tendency to evolve in cycles, with ever new problems emerging in ever new contexts that call for appropriate and tailored actions. The HELENA project is expected to offer essential elements for use in the overall machinery of required public health nutrition cycles. It is of the greatest importance for its results to prove useful that it can communicate with other initiatives on the level of science and society.

To examine the association between food groups consumption and vitamin BIn total 2189 individuals participating in the cross-sectional Healthy Lifestyle in Europe by Nutrition in Adolescence study met the eligibility criteria for analysis of dietary intakes (46 % males) and 632 for biomarker analysis (47 % males). Food intakes were assessed by two non-consecutive 24-h recalls. Biomarkers were measured by chromatography and immunoassay. Food groups which best discriminated participants in the extreme tertiles of the distribution of vitamins were identified by discriminant analyses. Food groups with standardised canonical coefficients higher or equal to 0.3 were selected as valid discriminators of vitamins intake and biomarkers extreme tertiles. Linear mixed model elucidated the association between food groups and vitamins intakes and biomarkers.Vitamin BWhereas B-vitamin intakes were associated with their food sources, biomarkers did with overall food consumption. Low-nutrient-density foods may compromise adolescents' vitamin status.

International audience; Objective: To assess the relationships among physical activity, measured objectively, and attention capacity in European adolescents.Study design: The study included 273 adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Participants wore a uniaxial accelerometer for 7 days to measure physical activity. The d2 Test of Attention was administered to assess attention capacity. Multivariate analyses were used to study the association of attention capacity with each measure of physical activity. Receiver operating characteristic analysis was performed to determine thresholds that best discriminate between low and good attention capacity.Results: After controlling for potential confounding variables (age, sex, body mass index, parental educational level, fat mass, aerobic fitness, and center), adolescents' attention capacity test performances were significantly and positively associated with longer time spent in moderate or moderate-to-vigorous physical activity (MVPA) in free-living conditions (P < .05). Receiver operating characteristic curve analyses revealed that the physical activity thresholds that best discriminated between low/good attention capacities were ≥41 min·day−1 for moderate, ≥12 min·day−1 for vigorous, and ≥58 min·day−1 for MVPA.Conclusion:These findings suggest that promoting MVPA may be have a beneficial effect on attention capacity, an important component of cognition, in adolescents.

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

12 páginas.- Ortega, Francisco B.; Marcos, Ascensión; Castillo, Manuel J.; et al., OBJECTIVE: Coordinated European projects relying on standardized methods are needed to identify health inequalities across Europe. This study aimed to compare fitness, fatness, and cardiometabolic risk between urban adolescents from the south and center-north of Europe and to explore whether physical activity (PA) and other factors might explain these differences., METHODS: The Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional project comprised 3528 adolescents from the south (4 cities) and central-north (6 cities) of Europe, 1089 of whom provided blood samples for analysis. Fitness (strength, speed-agility, and cardiorespiratory fitness), total and abdominal fatness (anthropometry and bioelectrical impedance), and cardiometabolic risk (z scores including fitness, fatness, blood lipids, insulin resistance, and blood pressure) were assessed. The analyses were adjusted for socioeconomic factors, objectively measured PA (accelerometry), total energy intake and diet quality, and genetic variants of the FTO rs9939609 polymorphism., RESULTS: Adolescents from southern Europe were less fit and fatter according to all markers (P < .001). Differences in cardiometabolic risk scores were not consistent. Adolescents from the south were less active and this would largely explain the differences observed in speed-agility and cardiorespiratory fitness. Differences in total and abdominal fatness could not be explained by PA, energy intake, diet quality, or FTO rs9939609 polymorphism., CONCLUSIONS: Fitness and fatness levels indicate that urban adolescents from the south are less healthy than those from central-northern Europe. Our data suggest that differences in PA might explain differences in important health-related fitness components, yet factors explaining the differences in fatness encountered remain unknown.

Because socioeconomic factors (SEFs) may influence dietary quality and vitamin intakes, this study aimed to examine associations between socioeconomic factors and folate and vitamin B12 intakes as well as their related biomarkers in the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Vitamin intakes were obtained from two 24-hour recalls in 2253 participants (47% males). Vitamin B biomarkers were assessed in a subsample of 977 participants (46% males). Socioeconomic factors were assessed by questionnaire, and 1-way analysis of covariance and linear regression analysis were applied. For males and females, mean intakes of folate were 211.19 and 177.18μg/d, and for vitamin B12, 5.98 and 4.54μg/d, respectively. Levels of plasma folate, red blood cell folate, serum B12, and holotranscobalamin were 18.74, 807.19, 330.64, and 63.04nmol/L in males, respectively, and 19.13, 770.16, 377.9, and 65.63nmol/L in females, respectively. Lower folate intakes were associated with several SEFs, including maternal and paternal education in both sexes. Regarding folate biomarkers, lower plasma folate intakes were associated with single/shared care in males and with lower paternal occupation in females. Lower vitamin B12 intakes were associated with almost all the studied SEFs, except paternal occupation in both sexes. In females, when considering vitamin B12 biomarkers, lower plasma vitamin B12 was associated with lower maternal education and occupation, and lower holotranscobalamin was associated with lower maternal education and lower paternal occupation. In conclusion, from the set of socioeconomic determinants studied in a sample of European adolescents, maternal education and paternal occupation were more consistently associated with folate and vitamin B12 intakes and biomarkers concentrations. © 2014 Elsevier Inc.

The programming effect of birth weight on later body composition has become of increasing interest in recent years. This programming effect is affected by factors such as gender. Physical fitness could be another factor of influence. This study aimed to examine whether handgrip strength (HG) or cardiovascular fitness (CVF) modify the associations between birth weight and body composition in adolescents. A sample of 1,740 (942 females) adolescents aged 13 to 18.5 years, born at more than 35 weeks of gestation, from the AVENA study was studied. Waist circumference was measured, percentage body fat was calculated from skinfold thicknesses and fat free mass was derived by subtracting fat mass from total body weight. HG and CVF were assessed using the HG test and the 20 m shuttle run test, respectively. Birth weight was positively associated with fat free mass in females with high (above the median) CVF (P < 0.001), but not in those with low (below the median) CVF. In contrast, birth weight was positively associated with total and central adiposity in males with low HG (both P = 0.002), but not in those with high HG. These results suggest that the programming effect of birth weight on later body composition is dependent on gender and fitness level. A high birth weight may have a healthy programming effect on body composition in those adolescents with a high fitness level, being associated with increased fat free mass levels in females and not showing the increased adiposity levels observed in unfit males.

Emerging data indicate that higher levels of insulin resistance (IR) are common among children and adolescents and are related to cardiometabolic risk; therefore, IR requires consideration early in life. In addition, there is a lack of conclusive evidence regarding the role of dietary nutrients on IR. The Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS) was conducted in European adolescents aged 12·5–17·5 years. A total of 637 participants with valid homeostasis model assessment (HOMA) index data and who completed at least a 2 d 24 h dietary recall were included in the study (60 % of the total HELENA-CSS sample). There were two dietary indices calculated, with the only difference between them being the inclusion or not of physical activity (PA). Markers of IR such as HOMA and the quantitative insulin sensitivity check index (QUICKI) were calculated. Pubertal status, BMI and cardiorespiratory fitness (CRF) were measured as potential confounders. The dietary index including PA was inversely associated with HOMA and directly with the QUICKI in females, but not in males, after adjusting for pubertal status, centre, BMI and CRF. In conclusion, the present study indicates that considering PA as part of the dietary index is of relevance as the resulted index is inversely related to IR independently of potential confounders including CRF. Overall, these findings suggest that intervention studies aimed at preventing IR in young people should focus on increasing the quality of the diet and also on including an optimal PA level in healthy adolescents.

International audience; Scavenger receptor class B type I (SR-BI) and cluster determinant 36 (CD36) have been involved in cellular uptake of some provitamin A carotenoids. However, data are incomplete (e.g., there are no data on a-carotene), and it is not known whether genetic variants in their encoding genes can affect provitamin A carotenoid status. The objectives were 1) to assess the involvement of these scavenger receptors in cellular uptake of the main provitamin A carotenoids (i.e., beta-carotene, alpha-carotene, and beta-cryptoxanthin) as well as that of preformed vitamin A (i.e., retinol) and 2) to investigate the contribution of genetic variations in genes encoding these proteins to interindividual variations in plasma concentrations of provitamin A carotenoids. The involvement of SR-BI and CD36 in carotenoids and retinol cellular uptake was investigated in Caco-2 and human embryonic kidney (HEK) cell lines. The involvement of scavenger receptor class B type I (SCARB1) and CD36 genetic variants on plasma concentrations of provitamin A carotenoids was assessed by association studies in 3 independent populations. Cell experiments suggested the involvement of both proteins in cellular uptake of provitamin A carotenoids but not in that of retinol. Association studies showed that several plasma provitamin A carotenoid concentrations were significantly different (P < 0.0083) between participants who bore different genotypes at single nucleotide polymorphisms and haplotypes in CD36 and SCARB1. In conclusion, SR-BI and CD36 are involved in cellular uptake of provitamin A carotenoids, and genetic variations in their encoding genes may modulate plasma concentrations of provitamin A carotenoids at a population level. J. Nutr. 143: 448-456, 2013.

Insufficient sleep is associated with higher incidence of infections and worse recovery, and more recently with increased risk for noninfectious diseases and low-grade inflammation (1) . The immune system seems to be strongly influenced by the sleep/wake cycle and has its own circadian rhythm, in both its functions and circulating cell numbers (2) . During adolescence sleep patterns experience significant changes, such as delay of sleep initiation and/or reduction of the sleep duration; therefore, sleeping habits at this period may have an impact on the immune system. In the present work, absolute and relative counts of leukocyte types and lymphocyte subsets were compared between adolescents reporting to sleep less than 8 hours per night (short-sleep group) and those reporting 8 hours or more (sufficient sleep). Blood samples were collected after an overnight fast from 1,089 boys and girls (12.5‐17.5 years old; 53.3% females) participating in the HELENA-CSS (Healthy Lifestyle in Europe by Nutrition in Adolescence-Cross-Sectional Study). Leukocyte and lymphocyte subset counts were compared by means of analysis of covariance (ANCOVA), adjusting for country, gender, Tanner stage and body mass index (BMI). Non-normally distributed variables were previously log-transformed. Adolescents in the short-sleep group ( < 8h/night) presented higher counts and percentages of total T (CD3 + ; P < 0.05) and helper T (CD4 + ; P < 0.01) lymphocytes, higher counts of total memory T cells (CD3 + RO + ; P < 0.05) and memory helper T cells (CD4 + RO + ; P < 0.001), and lower percentages of natural killer cells (CD3 - CD16 + 56 + ; P < 0.05), independently of gender and BMI. Our results show a significant relationship between sleep duration and immune parameters in European adolescents, suggesting that sleep-related immune alterations can start at early life stages.