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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.

Objective:To develop a scale to assess health motivation influencing food choices and to explore its performance in the associations with food intakes and nutritional biomarkers.Design:Psychometric study using cross-sectional self-report questionnaires and nutritional biomarkers.Setting:Multi-centre investigation conducted in ten European cities.Participants:2954 adolescents who were included in the HELENA study and completed the Food Choices and Preferences (FCP) questionnaire.Results:Nineteen out of 124 items of the FCP questionnaire were in the same dimension. Sixteen presented adequate parameters for the Scale of evaluatiOn of Food choIcEs (SOFIE). The scores were positively associated with the intakes of cereals, dairy products, meats and eggs, and fish, as well as with blood concentrations of vitamin C, β-carotene, n-3 fatty acids, cobalamin, holo-transcobalamin and folate; scores were negatively associated with the intake of alcohol.Conclusions:SOFIE can improve the assessment of motivation influencing food choices based on items with the best performance and is proposed as a new measure to health-related studies.

INTRODUCTION: This review aimed 1) to describe the most common tests used for assessing change of direction (COD) performance; 2) to detail the reliability of current COD tests; 3) to provide an overview of current intervention strategies used to improve COD performance in adolescent female soccer players.\ud \ud EVIDENCE ACQUISITION: A computerized search was conducted in the PubMed, Cochrane Plus and Web of Science (from 1995 to January 2020) for English and Spanish language and peer-reviewed investigations.\ud \ud EVIDENCE SYNTHESIS: A total of 221 studies were identified, with only 16 meeting the specific search criteria. The main findings were that eleven different tests have been used to assess COD performance with intraclass correlation coefficient and coefficient of variation values between 0.72-0.99 and 1-10.6%, respectively. The number of CODs performed during each test ranged from 1 to 9 within a range of 45º to 180º and with a duration 10 s.\ud \ud CONCLUSIONS: Findings indicate that the reliability of the COD tests seems to depend on: the equipment used, the surface tested on and the technical level of the soccer player. These results should be interpreted with caution as they may be influenced by the period of growth and maturation, the playing position of the player and the period of the soccer season. Finally, strength and power drills could be considered as appropriate to improve COD performance.

Accepted manuscript version, licensed CC BY-NC-ND 4.0. A standardised methodology was used to compile and validate a methyl-group carrier database (MGDB) including folate, choline, betaine and methionine, for use in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Compilation was performed by following structured guidelines to match the EPIC dietary intake data to food items from four food composition databases, according to their assigned priority of use. To assess relative validity, calculated dietary folate intakes were compared between the MGDB and the EPIC nutrient database (ENDB), used as the reference database. Folate intakes based on the MGDB and those generated using the ENDB showed good agreement (weighted κ = 0.63) and were strongly correlated (r = 0.81). This MGDB can be used for investigating potential associations between methyl-group carrier intakes and risk or prognosis of cancer and other diseases in the EPIC study population.

Background Swimming has no effect on bone mass or structure. Therefore, adolescent swimmers present similar bone strength values when compared to normo-active controls, and lower values when compared to weight-bearing athletes. It thus seems necessary to try to improve bone structure and strength of adolescent swimmers through a weight-bearing intervention in order to reduce the risk of suffering osteoporosis later in life. Objective To evaluate the effects of a 6-month whole body vibration (WBV) intervention on bone strength and structure of adolescent swimmers. Design Randomized controlled trial. Setting Research center. Participants A total of 51 swimmers (14.4 ± 2.0 years) participated in the study. Methods Swimmers were randomly allocated into 2 groups: 20 swimmers (9 females) who only performed their swimming training, and 31 swimmers (15 females) who performed their swimming training and received a WBV intervention (3.6-11.6 g) 3 times per week during 6 months (VIB). Outcome measurements Peripheral quantitative computed tomography was performed in the nondominant tibia of all swimmers at 4%, 38%, and 66% of the tibia length before and after the intervention. Results No differences between groups in any bone structure variable were found at pre- or postintervention. Both groups presented similar improvements in time, and no group by time interactions were found, suggesting that the WBV intervention was not intense enough to achieve positive changes in bone strength or structure. Conclusion WBV, at the chosen intensities and durations, had no effect on adolescent swimmers’ bone strength or structure. Future studies should test other weight-bearing interventions aiming to improve bone strength and structure of adolescent swimmers. Level of Evidence II

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).

[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).

La osteoporosis es un importante problema de salud pública en todo el mundo, causa más de 8,9 millones de fracturas al año, lo que resulta en una fractura osteoporótica cada 3 segundos. Múltiples factores influyen en el riesgo a padecer osteoporosis, como las caídas, el tabaquismo, la dieta, la actividad física o los niveles de vitamina D en sangre (25 (OH) D) y cada uno de estos factores desarrollan un papel diferente dependiendo de la etapa de la vida en la que nos encontremos.

[Summary]: Dietary scores, rather than individual nutrients, allow exploring associations between overall diet and bone health. The aim of the present study was to assess the associations between the Mediterranean Diet Score for Adolescents (MDS-A) and the Diet Quality Index for Adolescents (DQI-A) and bone mineral content (BMC) among Spanish adolescents. Our results do not support an association between dietary scores or indices and BMC in adolescents., [Introduction]: To assess the associations between the MDS-A and a DQI-A with the BMC measured with dual-energy X-ray absorptiometry., [Methods]: The MDS-A and the DQI-A were calculated in 179 Spanish adolescents, based on two 24-h dietary recalls from the HELENA cross-sectional study. The associations between the diet scores and the BMC outcomes [total body less head (TBLH), femoral neck (FN), lumbar spine (LS), and hip] were analyzed using logistic regression models adjusting for several confounders., [Results]: Four hundred ninety-two models were included and only fruits and nuts and cereal and roots were found to provide significant ORs with regard to BMC. The risk of having low BMC reduced by 32% (OR 0.684; CI 0.473–0.988) for FN when following the ideal MDS-A, but this association lost significance when adjusting for lean mass and physical activity. For every 1-point increase in the cereal and root and the fruit and nut components, the risk of having low FN diminished by 56% (OR 0.442; CI 0.216–0.901) and by 67% (OR 0.332; CI 0.146–0.755), respectively., [Conclusion]: An overall dietary score or index is not associated with BMC in our adolescent Spanish sample., This work was performed as part of the HELENA study. We gratefully acknowledge the financial support of the European Community sixth RTD Framework Programme (contact FOOD-CT-2005-007034). CJ received a Grant FPU13/00421 from the “Ministerio de Educación, Cultura y Deporte.”

Context The numbers of vegans and vegetarians have increased in the last decades. However, the impact of these diets on bone health is still under debate. Objective This systematic review and meta-analysis sought to study the impact of vegetarian and vegan diets on bone mineral density (BMD) and fracture risk. Data sources A systematic search was conducted of PubMed, Scopus, and Science Direct, covering the period from the respective start date of each database to November 2017. Data extraction Two investigators evaluated 275 studies against the inclusion criteria (original studies in humans, written in English or Spanish and including vegetarian or vegan diets and omnivorous diets as factors with BMD values for the whole body, lumbar spine, or femoral neck and/or the number of fractures as the outcome) and exclusion criteria (articles that did not include imaging or studies that included participants who had suffered a fracture before starting the vegetarian or vegan diet). The quality assessment tool for observational cohort and cross-sectional studies was used to assess the quality of the studies. Results Twenty studies including 37 134 participants met the inclusion criteria. Compared with omnivores, vegetarians and vegans had lower BMD at the femoral neck and lumbar spine and vegans also had higher fracture rates. Conclusions Vegetarian and vegan diets should be planned to avoid negative consequences on bone health. Systematic review registration PROSPERO registration no. CRD42017055508.

Introduction: There are increasing concerns about the types of foods and beverages consumed by children during mid-afternoon snack in Spain. Aim: To describe the frequency and quality of the mid-afternoon snack in a representative sample of Spanish children. Methods: A total of 1,233 younger (three to six years) and 1,618 older (seven to twelve years) children participated in the study. The report of food and beverages consumed per week during the mid-afternoon snack meal (merienda)was obtained by an online platform. Results: An 84.4% of younger and 78.3% of older children were mid-afternoon snack consumers. Regular consumers were more likely to be from the South and the Centre regions. Sandwich was the most consumed food item among younger (49.5%) and older (59.7%) consumers; 46.5% of mid-afternoon snacks contained two food items among younger children, and 50.1% of mid-afternoon snacks contained one food item among older children. “Fruit”, “milk and biscuits”, and “fruit, biscuits and juices” were the most consumed combinations when considering one, two and three or more food items during one-time mid-afternoon occasion, respectively. Conclusions: The frequency of mid-afternoon snack occasions and the number and quality of food items consumed during one-time mid-afternoon snack occasion decrease with age. Spanish children should increase the frequency of mid-afternoon snack consumption and include healthy options in their menus. Longitudinal and intervention studies are needed to address the health impact of snacking and how to use this meal occasion to balance children’s diets.

Swimming has little effect on bone mass. Therefore, adolescent swimmers should complement their water training with a short and intense weight-bearing training, aiming to increase their bone acquisition. Forty swimmers performed a six-month whole-body vibration (WBV) training. WBV had no effect on adolescent swimmers’ bone mass or lean mass. The aims of the present study were to evaluate the effects of a whole-body vibration (WBV) intervention on bone mineral density (BMD), bone mineral content (BMC) and lean mass (LM) in adolescent swimmers. Forty male and female adolescent swimmers (VIB; mean age 14.2 ± 1.9 years) completed the WBV protocol that consisted of 15 min of training 3 days per week during a 6-month period (ranging from 3.6 to 11.6 g), while 23 swimmers (SWI; mean age 15.0 ± 2.2 years) continued with their regular swimming training alone. VIB were divided into tertiles according to training compliance in order to evaluate if any dose-effect relation existed. BMD, BMC and LM were measured longitudinally by dual energy X-ray at the whole body, lumbar-spine and hip. No group by time interactions and no differences in change percentage were found for BMD, BMC or LM in any of the measured variables. The mean change percentage of the subtotal body (whole body minus the head) for VIB and SWI, respectively, was 2.3 vs. 2.4% for BMD, 5.7 vs 5.7% for BMC and 7.3 vs. 8.0% for lean mass. Moreover, no indication for dose-response was observed. The proposed WBV protocol had no effect on BMD, BMC and LM in adolescent swimmers. Other types of training should be used in this population to improve both bone and lean mass.

ObjectiveTo investigate dietary sources of Ca and vitamin D (VitD) intakes, and the associated sociodemographic and lifestyle factors, among European adolescents.DesignLinear regression mixed models were used to examine sex-specific associations of Ca and VitD intakes with parental education, family affluence (FAS), physical activity and television (TV) watching while controlling for age, Tanner stage, energy intake and diet quality.SettingThe Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA)Cross-Sectional Study.SubjectsAdolescents aged 12·5–17·5 years (n 1804).ResultsMilk and cheese were the main sources of Ca (23 and 19 % contribution to overall Ca intake, respectively). Fish products were the main VitD source (30 % contribution to overall VitD intake). Ca intake was positively associated with maternal education (β=56·41; 95 % CI 1·98, 110·82) and negatively associated with TV viewing in boys (β=–0·43; 95 % CI −0·79, −0·07); however, the significance of these associations disappeared when adjusting for diet quality. In girls, Ca intake was positively associated with mother’s (β=73·08; 95 % CI 34·41, 111·74) and father’s education (β=43·29; 95 % CI 5·44, 81·14) and FAS (β=37·45; 95 % CI 2·25, 72·65). This association between Ca intake and mother’s education remained significant after further adjustment for diet quality (β=41·66; 95 % CI 0·94, 82·38). Girls with high-educated mothers had higher Ca intake.ConclusionsLow-educated families with poor diet quality may be targeted when strategizing health promotion programmes to enhance dietary Ca.

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.

accurate estimates of the intake of specific nutrients such as calcium (Ca) are crucial to correctly rank or classify subjects in the distribution of intakes. Therefore, we aimed to estimate the relative validity of a food frequency questionnaire (FFQ) for measuring Ca intake in two different groups of healthy adolescents, a normoactive control group and a physically active group of swimmers with 2 non-consecutive 24h recalls (2 x 24HR) collected as the reference method.Pearson correlations, agreement between the 24HR and the FFQ at an individual level and questionnaire's ability to assign individuals to the same quartile of intake as the 24HR were calculated.mean daily Ca intakes were 564.6 mg (SD 232.0) and 895.9 mg (SD 343.1) for the 2 x 24HR and FFQ respectively in controls (P0.001); and 731.9 mg (SD 299.8) and 979.8 mg (SD 408.5) for the 2 x 24HR and FFQ respectively in swimmers (P0.001). Pearson correlations were 0.52 for controls and 0.47 for swimmers after correcting for intra-variability. Cross-classification analysis indicated that 73.7% of controls and 63.1% of swimmers were classified correctly or in the adjacent category. Also, the 89% of the control group and 79% of swimmers were classified correctly with the FFQ according to the dietary reference intake (DRI) of 1300 mg/d.for both groups, the FFQ tended to overestimate Ca intake, however it demonstrated fairly good ability to classify subjects into extremes of Ca intake and identified adolescents having Ca intakes lower than the dietary reference intake.Introducción: estimar correctamente la ingesta de calcio es crucial para conocer cómo se distribuye nutricionalmente la ingesta calórica a lo largo del día. Por lo tanto, el objetivo del presente trabajo fue validar un cuestionario de frecuencia de consumo para calcular la ingesta de calcio, mediante dos recordatorios de 24 horas, usado como método de referencia en un grupo control de adolescentes normo-activos y un grupo de adolescentes nadadores de alta competición. Metodología: la congruencia de los cuestionarios se estudio mediante correlación de Pearson y el estudio del acuerdo entre los dos métodos a nivel individual, así como la habilidad del cuestionario para clasificar a los sujetos en el mismo cuartil que los recordatorios de 24 horas. Resultados: la ingesta media diaria de calcio del grupo control fue 564,6 mg (DE 232,0) y 895,9 mg (DE 343,1) calculada mediante el recordatorio de 24 horas y el cuestionario, respectivamente (P0.001); y 731,9 mg (DE 299,8) y 979,8 mg (DE 408,5) en los nadadores mediante el recordatorio de 24 horas y el cuestionario, respectivamente (P0.001). Las correlaciones de Pearson fueron 0,52 para el grupo control y 0,47 para los nadadores después de corregir por intravariablidad. Los análisis de clasificación indicaron que el 73,7% de los controles y el 63,1% de los nadadores fueron clasificados correctamente o en la categoría contigua. El 89% de los controles y el 79% de los nadadores fueron clasificados correctamente según estuvieran por encima o por debajo de las recomendaciones de ingesta de calcio diarias (1.300 mg). Conclusiones: para ambos grupos, el cuestionario de frecuencia de consumo tiende a sobreestimar la ingesta de calcio, sin embargo demuestra ser un buen método para clasificar tanto a los sujetos de ingestas de calcio extremas, como a los sujetos que no cumplen las recomendaciones de calcio.