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The health-transitions humans have delivered during the 20th Century associated with the nutrition is that from undernutrition to obesity, which perseveres in the current years of the 21st Century. Energy intake (EI) is a contributing factor and therefore a fascination in nutritional sciences. However, energy expenditure (EE) has not been usually considered as a conjoint factor. Thus, this study aimed to review if studies on adults consider data on dietary intake, specifically EI, and included data on EE and physical activity (PA). A search of MEDLINE from 1975 to December 2015 was managed. Our scoping review consisted of keywords related to EI, dietary allowances, and nutritional requirements. From 2229 acknowledged articles, 698 articles were finally taken fulfilling inclusion and quality criteria. A total of 2,081,824 adults (53.7% females) were involved, and most studies had been conducted in EEUU (241), Canada (42), Australia (30), Japan (32), and Brazil (14). In Europe, apart from UK (64), the Netherlands (31) and France (26) led the classification, followed by Sweden (18), Denmark (17), and France (26). Mediterranean countries are represented with 27 studies. A total of 76.4% did not include EE and 93.1% did not include PA. Only 23.6% of the studies contained both EI and EE. A large methodological diversity was perceived, with more than 14 different methods regarding EI, and more than 10 for EE. PA was only analyzed in scarce articles, and scarcely considered for interpretation of data and conclusions. Moreover, PA was often measured by subjective questionnaires. Dietary surveys show a large diversity regarding methodology, which makes comparability of studies difficult. EE and PA are missing in around 80% of studies or are not included in the interpretation of results. Conclusions regarding EI or diet adequacy in adults should not be taken without analyzing EE and PA.

Introduction: Inflammation is related to insulin resistance in adults, especially on those individuals with high levels of body composition. Objectives: The aim of this study is to assess the relationship between a set of inflammatory biomarkers and insulin resistance by levels of body composition in a sample of European adolescents. Material and methods: Nine hundred and sixty-two adolescents (442 boys and 520 girls) from nine European countries met the inclusion criteria of having measurements for the homeostasis model assessment (HOMA) and a set of inflammation-related biomarkers: C-reactive protein (CRP), tumor necrosis factor alpha (TNF-a), interleukin (IL-6), complement factors C3 and C4 and selected cell adhesion molecules. Body mass index (BMI), fat mass index (FMI) and waist circumference (WC) were categorized using tertiles. To assess the associations stratifying by body composition indexes, ANOVA and linear regression models were performed. Results: Mean biomarkers’ concentrations differed across BMI, FMI and WC tertiles (p < 0.05) by sex. In both sexes, insulin, HOMA, CRP, C3 and C4 were significantly different between categories (p < 0.001), always showing the highest mean concentration in the upper category of BMI, FMI and WC. The most consistent finding was an association between insulin resistance and C3 concentrations (p < 0.05), in the adolescents in the highest tertile of BMI, FMI and WC, except in the case of FMI in girls. Conclusion: Inflammatory and glucose metabolism markers differed by tertiles of body composition, being usually higher in the highest tertile. C3 complement factor was associated with insulin resistance in adolescents, especially those with high total and abdominal adiposity. Introducción: la inflamación está relacionada con la resistencia a la insulina en adultos, especialmente en individuos con altos valores de composición corporal. Objetivos: valorar la relación entre diferentes marcadores inflamatorios y la resistencia a la insulina según valores de composición corporal en adolescentes europeos. Material y métodos: novecientos sesenta y dos adolescentes (442 chicos y 520 chicas) de nueve países europeos cumplían el criterio de inclusión de tener medidos la evaluación del modelo de homeostasis (HOMA) y diferentes marcadores inflamatorios: proteína C-reactiva (PCR), factor de necrosis tumoral alfa (TNF-a), interleukina (IL-6), factores de complemento C3 y C4 y moléculas de adhesión. El índice de masa corporal (IMC), el índice de masa grasa (IMG) y la circunferencia de cintura (CC) se categorizaron en tertiles. Para valorar las asociaciones por índices de composición corporal se realizó ANOVA y regresión. Resultados: las concentraciones de los marcadores diferían entre los tertiles de IMC, IMG y CC (p < 0,05), por sexo. En ambos sexos, insulina, HOMA, PCR, C3 y C4 fueron significativamente diferentes entre categorías (p < 0,001), presentando la mayor concentración en la categoría superior de IMC, IMG y CC. El resultado más consistente para los adolescentes del tertil superior de IMC, IMG y CC fue la asociación entre resistencia a la insulina y concentraciones de C3 (p < 0,05), excepto para IMG en chicas. Conclusión: los marcadores del metabolismo inflamatorio y de la glucosa diferían según tertiles de composición corporal, siendo mayores en el tertil superior. El C3 se asoció con resistencia a la insulina en adolescentes, especialmente en aquellos con adiposidad total y abdominal.

© 2015, Springer-Verlag Berlin Heidelberg. Percentiles 10th, 25th, 50th, 75th and 90th are presented for circulating white blood cells (WBC), neutrophils, lymphocytes, monocytes, eosinophils and basophils in healthy European adolescents (12.5–17.5 years, n = 405, 48.9 % boys), considering age, sex, puberty and body mass index (BMI). CD3+ (mature T cells), CD4+ (T helper), CD8+ (T cytotoxic), CD16+56+ (natural killer), CD19+ (B cells), CD3+CD45RA+, CD4+CD45RA+, CD8+CD45RA+ (naïve), CD3+CD45RO+, CD4+CD45RO+ and CD8+CD45RO+ (memory) lymphocytes were also analysed by immunophenotyping. Girls presented higher WBC, neutrophil, CD3+CD45RO+ and CD4+CD45RO+ cell counts and CD3+/CD19+ ratio, and lower CD3+CD45RA+ and CD4+CD45RA+ counts than boys. Age was associated with higher neutrophil counts and CD3+/CD19+, and lower CD19+ counts; in boys, with lower CD3+CD45RA+, CD4+CD45RA+ and CD8+CD45RA+ counts as well; in girls, with higher WBC, CD3+CD45RO+ and CD4+CD45RO+ counts. Pubertal maturation in boys was associated with lower WBC and lymphocyte counts; in girls, with higher basophil, CD3+CD45RO+ and CD4+CD45RO+ values. BMI was associated with higher WBC counts; in boys, also with higher lymphocyte counts; in girls, with higher neutrophil, CD4+, CD3+CD45RO+ and CD4+CD45RO+ counts. Conclusion: Our study provides normative values for circulating immune cells in adolescents, highlighting the importance of considering sex, age, pubertal maturation and BMI when establishing reference ranges for WBC in paediatric populations., As well as the financial support of the European Community 6th RTD Framework Programme (contract FOOD-CT-2005-007034)

© 2014 The Authors. The present study aimed to investigate the relationships between macronutrient intake and serum lipid profile in adolescents from eight European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) cross-sectional study (2006-7), and to assess the role of body fat-related variables in these associations. Weight, height, waist circumference, skinfold thicknesses, total cholesterol, HDL-cholesterol (HDL-C), LDL-cholesterol, TAG, apoB and apoA1 were measured in 454 adolescents (44 % boys) aged 12·5-17·5 years. Macronutrient intake (g/4180 kJ per d (1000 kcal per d)) was assessed using two non-consecutive 24 h dietary recalls. Associations were evaluated by multi-level analysis and adjusted for sex, age, maternal education, centre, sum of four skinfolds, moderate-to-vigorous physical activity, sedentary behaviours and diet quality index for adolescents. Carbohydrate intake was inversely associated with HDL-C (β =-0·189, P< 0·001). An inverse association was found between fat intake and TAG (β =-0·319, P< 0·001). Associations between macronutrient intake and serum lipids varied according to adiposity levels, i.e. an inverse association between carbohydrate intake and HDL-C was only observed in those adolescents with a higher waist:height ratio. As serum lipids and excess body fat are the major markers of CVD, these findings should be considered when developing strategies to prevent the risk of CVD among adolescents., TheHELENA study was financially supported by the European Community Sixth RTD Framework Programme (contract FOOD-CT-2005-007034).

BACKGROUND: Sleep patterns face important changes during adolescence. This can have implications for the immune system, which is regulated by the sleep-wake cycle; however, most studies relating sleep and immune system have been conducted on adults. OBJECTIVE: To study the relationships between sleep duration, immune cell counts, and cytokines in European adolescents participating in the HELENA Cross-Sectional Study. METHODS: Adolescents (12.5-17.5¿years; n¿=¿933; 53.9% girls) were grouped according to self-reported sleep duration into

Objective: to examine if those adolescents who dislike physical education classes get better results on academic and cognitive performance than their peers. Methods: participants included 4 226 adolescents from the AVENA, AFINOS and UP&DOWN studies. Physical education enjoyment was assessed with a 7-point Likert scale. Cognitive performance in the AVENA study was assessed using the Spanish version of the SRA Test of Educational Ability. Academic performance in the AFI- NOS and UP&DOWN studies was assessed through Ma- thematics and Language grades and the average of both subjects. Results: in the AVENA study we found differences in verbal ability among girls who dislike physical education and their peers (P=0.033). In the AFINOS study, boys who dislike physical education had higher scores in Lan- guage than their peers (P=0.024). In the UP&DOWN study girls who disliked physical education had higher scores in Language and in the average of Language and Mathematics than their peers (P < 0.001). Conclusion: in the AVENA and AFINOS studies ado- lescents who disliked physical education had similar re- sults in cognitive and academic performance than their peers, but in the UP&DOWN study girls who disliked physical education showed higher results in academic performance than their peers.

Background: Dietary treatment for obese adolescents should aim to ensure adequate growth and development, by reducing excessive fat mass accumulation, avoiding loss of lean body mass, improving well-being and self-esteem and preventing cyclical weight regain. The aim of this article is to describe the dietary intervention design and the methods used to evaluate nutritional knowledge and behavior in the EVASYON study (Development, implementation and evaluation of the efficacy of a therapeutic programme for overweight/obese adolescents). Methods/design: EVASYON is a multi-centre study conducted in 5 Spanish hospital settings (Granada, Madrid, Pamplona, Santander and Zaragoza), where 204 overweight/obese Spanish adolescents were treated in groups of 9 to 11 subjects over 20 visits. The study was implemented in two stages: an intensive, calorie-restricted period for the first 9 weeks, and an extensive body-weight follow-up period for the last 11 months. A moderate energy intake restriction was applied in the intensive period according to the degree of obesity, on the basis of a balanced diet supplying 50-55% of daily energy as carbohydrates; 30-35% as fats and 10-15% as proteins. In the intensive period, adolescents were prescribed both a fixed full-day meal plan for the first three weeks and a full day meal plan with different food-choices for 6 weeks. Later, adolescents received a flexible meal plan based on food exchanges for the follow-up period until the end of the trial. Data on food intake, dietary and meal-related habits and behavior were collected by means of dietary questionnaires. To analyse nutritional knowledge, adolescents were examined regarding nutrient concepts and food adoitems for a healthy diet with the appropriate tools. Participants were given nutritional information with complementary teaching material, which was available on the EVASYON website (www.estudioevasyon.com). Discussion: The dietary intervention of the EVASYON programme with a moderate calorie restriction for a limited period of time could be a good strategy in treating overweight and obese adolescents and that will be tested further. Moreover, combining fixed plan with free-choice menus may help adolescents and their families to make right decisions for every day meals. Antecedentes: El tratamiento dietético para los adolescentes obesos debería asegurar el crecimiento y desarrollo adecuados al reducir la acumulación excesiva de masa grasa, evitar la pérdida de masa magra corporal, mejorar el bienestar y la autoestima y prevenir la ganancia cíclica de peso. El objetivo de este artículo es el de describir el diseño de la intervención dietética y los métodos empleados para evaluar el conocimiento y la conducta nutricionales del estudio EVASYON (Desarrollo, implantación y evaluación de la eficacia de un programa terapéutico para adolescentes con sobrepeso/obesidad). Métodos/diseño: EVASYON es un estudio multicéntrico realizado en 5 hospitales españoles (Granada, Madrid, Pamplona, Santander y Zaragoza), en el que se trató a 204 adolescentes españoles con sobrepeso/obesidad en grupos de 9 a 11 individuos a lo largo de 20 visitas. El estudio se implantó en dos etapas: un período intensivo de restricción calórica durante las 9 primeras visitas y un período extensivo de seguimiento del peso corporal durante los últimos 11 meses. Se aplicó una restricción moderada de consumo de energía durante el período intensivo en función del grado de obesidad, sobre la base de una dieta equilibrada que aporta el 50-55% de la energía diaria en forma de carbohidratos; 30-35% como grasas y 10-15% como proteínas. En el período intensivo, se prescribió a los adolescentes un régimen de comidas fijo para todo el día durante las 3 primeras semanas y un plan de comidas para todo el día con diferentes opciones durante 6 semanas. Posteriormente, los adolescentes recibieron un régimen de comidas flexible sobre la base de los intercambios de alimentos durante el período de seguimiento hasta el final del ensayo. Se recogieron los datos de consumo de alimentos, dietéticos y hábitos relacionados con las comidas mediante cuestionarios de dieta. Para analizar el conocimiento nutricional, se examinó a los adolescentes con respecto a conceptos de nutrición y alimentos concretos para una dieta sana con las herramientas adecuadas. Se proporcionó a los participantes información nutricional con material educativo complementario que estaba disponible en la página web del estudio (www.estudioevasyon.com). Discusión: La intervención dietética del programa EVASYON con una restricción calórica moderada durante un período de tiempo limitado podría ser una buena estrategia para el tratamiento de los adolescentes con sobrepeso y obesidad y se probará más adelante. Además, el combinar el plan fijo con menús de elección libre podría ayudar a los adolescentes y sus familias a tomar las decisiones correctas para las comidas de todos los días.

Introduction: Low-grade inflammation and increased immunity related to cardiovascular diseases have been described in children and adults, however, studies in Mexican adolescents are being done at present. Objective: To evaluate inflammatory proteins and indicators of immunity in adolescents by gender and body mass index. Material and methods: 115 Mexican adolescents, 15-18 years old (36 men), were divided into non-overweight, risk of overweight and overweight by CDC pediatric criteria by body mass index. Serum concentrations of ceruloplasmin, C3 and C4 were quantified by nephelometry; IL-6 and TNF-α from stimulated supernatant were analyzed with Human Th1-Th2 cytokine CBA II kit (BD Biosciences Pharmigen, San Diego, CA), and detected by flow cytometry. Data were analysed by Mann-Whitney U. Results: Gender differences were found in C3 (men: median 118.8, mean rank: 41.0; women: median: 143.9, mean rank: 65.7, p = 0.001) and ceruloplasmin (men: median: 31.01, mean rank: 47.06; women: median: 31.0, mean rank: 62.9, p = 0.015). Differences by BMI were found in C3 (women non-overweight: median: 137.00 mena rank: 36.52; women with risk of overweight/overweight: median: 175.80, mean rank: 57.69, p = 0.002) and C4 (men non-overweight: median: 23.40, mean rank: 16.60; men with risk of overweight/overweight: median: 26.40, mean rank: 26.36, p = 0.028; women non-overweight: median: 24.25, mean rank: 37.16 and women with risk of overweight/overweight: median: 32.80, mean rank: 54.42, p = 0.013). Conclusion: Inflammatory proteins are increased in adolescents with risk of overweight and overweight, particularly in women. Introducción: La inflamación de bajo grado y el aumento en la inmunidad relaciondas con las enfermedades cardiovasculares se han descrito en niños y adultos, sin embargo, estudios en adolescentes mexicanos se están haciendo en la actualidad. Objetivo: Evaluar las proteínas inflamatorias e indicadores de la inmunidad en los adolescentes por género e índice de masa corporal. Material y métodos: 115 adolescentes mexicanos, 15-18 años (36 niños), fueron clasificados como sin sobrepeso, riesgo de sobrepeso y sobrepeso según los criterios pediátricos de la CDC para índice de masa corporal. Las concentraciones séricas de ceruloplasmina, C3 y C4 se cuantificaron por nefelometría, IL-6 y TNF-α a partir de sobrenadante de cultivo de linfocitos estimulados con mitógeno, se analizaron con Human cytokines Th1-Th2 CBA kit II (BD Biosciences Pharmigen, San Diego, CA), y se detectaron por citometría de flujo. Los datos fueron analizados estadísticamente por la prueba de U Mann-Whitney. Resultados: Las diferencias de género se encontraron en C3 (Hombres: mediana de 118,8 rango promedio: 41,0; Hombres: mediana: 143,9, rango promedio: 65,7, p = 0,001) y ceruloplasmina (Hombres: media: 31,01, rango promedio: 47,06; Hombres: mediana: 31,0, rango promedio: 62,9, p = 0,015). Las diferencias por IMC se encontraron en C3 (Mujeres sin sobrepeso: mediana: 137,00 rango promedio: 36,52; Hombres con riesgo de sobrepeso y sobrepeso: mediana: 175,80, rango promedio: 57,69, p = 0,002) y C4 (Hombres sin sobrepeso: mediana: 23,40, rango promedio: 16,60; Hombres con riesgo de sobrepeso y sobrepeso: media: 26,40, rango promedio: 26,36, p = 0,028; Hombres sin sobrepeso: media: 24,25, rango promedio: 37,16 y Mujeres con riesgo de sobrepeso/sobrepeso: media: 32,80, rango promedio: 54,42, p = 0,013). Conclusiones: Las proteínas inflamatorias aumentan en los adolescentes con riesgo de sobrepeso y sobrepeso, particularmente en mujeres.

Chronic diseases associated to modern lifestyle habits are usually related to immune system malfunction. In this context, since diet is very well-known to modulate host resistance to infectious and inflammatory processes, the consumption of fibre and probiotics seems to be a promising nutritional tool for immune system modulation in different populations. Health effects of dietary fibres and probiotics have been extensively documented in numerous epidemiological and intervention studies, especially their beneficial effect on intestinal microbiota with important clinical implications in the prevention and/or treatment of infectious and inflammatory diseases. Mechanisms may include modulation of the functional properties of the microbiota, epithelial cells, dendritic cells and immune cell types. Prebiotics have been extensively reported to affect the composition of the gut microbiota, stimulating directly or indirectly putative beneficial gut commensals other than lactic acid bacteria, opening promising areas of research for the discovery of new probiotic strains and synbiotic combinations. Age-related changes in gut physiology, microbiota and mucosal immune response are well established. Moreover, exposure to different challenges during life such as early encounter of environmental insults in the newborn, infant formula feeding, antibiotic treatment, gastrointestinal diseases and stress, also interferes with the normal development and balance of the healthy gut microbiota. Therefore, the current short review gives an overview of today's main aspects of the effect of fibres, probiotics and synbiotics on the immune system in different life-stages. Las enfermedades crónicas relacionadas con el estilo de vida frecuentemente están asociadas con una alteración del sistema inmunológico. En este sentido, ya que la dieta es capaz de modular la resistencia a infecciones y procesos inflamatorios, el consumo de fibra y probióticos parece ser una herramienta prometedora en la modulación del sistema inmune en diferentes poblaciones. Los efectos saludables de la fibra dietética y los probióticos han sido documentados en numerosos estudios epidemiológicos y de intervención, especialmente sus efectos beneficiosos sobre la microbiota del intestino con implicaciones clínicas importantes en la prevención y/o tratamiento de enfermedades infecciosas e inflamatorias. Los mecanismos incluyen la modulación de las propiedades funcionales de la microbiota, células epiteliales, dendríticas e inmunológicas. Se han estudiado en profundidad cómo los prebióticos afectan a la composición de la microbiota del intestino, estimulando beneficiosamente a otros comensales además de las bacterias acido lácticas, abriendo así una futura línea de investigación con nuevas cepas de probióticos y combinaciones de sinbióticos. Por otro lado, están bien establecidos los cambios en la fisiología del intestino, microbiota y respuesta inmune atribuidos al envejecimiento están bien establecidos. Además, las agresiones externas en los primeros días de vida, la alimentación con formulas infantiles, el tratamiento con probióticos, las enfermedades gastrointestinales y el estrés, también alteran el desarrollo y equilibrio de la microbiota intestinal. Por todo ello, esta revisión ofrece una visión actual sobre los aspectos mas relevantes del efecto de la fibra, probióticos y simbióticos sobre el sistema inmune en las diferentes etapas de la vida.

Chronic diseases associated to modern lifestyle habits are usually related to immune system malfunction. In this context, since diet is very well-known to modulate host resistance to infectious and inflammatory processes, the consumption of fibre and probiotics seems to be a promising nutritional tool for immune system modulation in different populations. Health effects of dietary fibres and probiotics have been extensively documented in numerous epidemiological and intervention studies, especially their beneficial effect on intestinal microbiota with important clinical implications in the prevention and/or treatment of infectious and inflammatory diseases. Mechanisms may include modulation of the functional properties of the microbiota, epithelial cells, dendritic cells and immune cell types. Prebiotics have been extensively reported to affect the composition of the gut microbiota, stimulating directly or indirectly putative beneficial gut commensals other than lactic acid bacteria, opening promising areas of research for the discovery of new probiotic strains and synbiotic combinations. Age-related changes in gut physiology, microbiota and mucosal immune response are well established. Moreover, exposure to different challenges during life such as early encounter of environmental insults in the newborn, infant formula feeding, antibiotic treatment, gastrointestinal diseases and stress, also interferes with the normal development and balance of the healthy gut microbiota. Therefore, the current short review gives an overview of today's main aspects of the effect of fibres, probiotics and synbiotics on the immune system in different life-stages.

Introduction: The influence of socioeconomic status on health-related fitness is not clear. Aim: To examine the influence of socioeconomic status on health-related fitness in adolescents. Methods: A total of 3,259 adolescents (15.0 ± 1.3 y) from the Healthy Lifestyle in Europe by Nutrition in Ado- lescence Cross-Sectional Study (HELENA-CSS) partici- pated in the study. Socioeconomic status was assessed by the family affluence scale (FAS). Speed-agility, muscular strength and cardiorespiratory fitness were assessed. Covariates included total body fat, physical activity and pubertal status. Results: Adolescents with high FAS had significantly higher fitness levels than their peers of lower FAS cate- gories except for speed-agility and handgrip in boys. Overall, the associations observed presented a medium to large effect size. Conclusion: These results suggest that socioeconomic status is positively associated with physical fitness in European adolescents independently of total body fat and habitual physical activity Introducción: La influencia del estatus socioeconómico sobre la condición física en relación con la salud no está clara. Objetivo: Examinar la influencia del estatus socioeconómico sobre la condición física en relación con la salud en adolescentes. Metodología: Un total de 3259 adolescentes (15,0 ± 1,3 años) del “Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study” (HELENA-CSS) participaron en el estudio. El estatus socioeconómico fue medido con una escala de riqueza familiar “family affluence scale (FAS)”. Se midieron velocidad-agilidad, fuerza muscular y capacidad aeróbica. Las covariables incluidas fueron grasa corporal total, actividad física y estadio madurativo. Resultados: Los adolescentes con alto FAS tuvieron significativamente mayores niveles de condición física que aquellos con bajo FAS exceptuando los tests de velocidad-agilidad y fuerza de prensión manual en chicos. En general, las asociaciones observadas presentaron un efecto del tamaño de la muestra (effect size) entre medio y largo. Conclusión: Estos resultados sugieren que el estatus socioeconómico esta positivamente asociado con la condición física en adolescentes Europeos independientemente de la grasa corporal total y el nivel de actividad física.