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BACKGROUND/OBJECTIVES: Fatty acids are hypothesized to influence cardiovascular disease risk because of their effect on inflammation. The aim of this study is to assess the relationship between whole-blood fatty acids (WBFAs) and high- sensitivity C-reactive protein (hs-CRP) in European children. SUBJECTS/METHODS: A total of 1401 subjects (697 boys and 704 girls) aged between 2 and 9 years from the IDEFICS (/dentification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS) study were measured in this cross-sectional analysis. The sample was divided into three categories of hs-CRP. Associations between WBFA and hs-CRP were assessed by logistic regression models adjusting for body mass index (BMI), country, age, breastfeeding, mother's education and hours of physical activity. RESULTS: Linoleic acid (LA) (P = 0.013, 95% confidence interval (CI): 0.822-0.977) and sum of n-6 WBFA (P=0.029,95% CI: 0.866-0.992) concentrations were associated with lower concentrations of hs-CRP in boys. In girls, a high ratio of eicosapentaenoic acid (EPA)/arachidonic acid (AA) was associated (P=0.018, 95% CI: 0.892-0.989) with lower hs-CRP concentrations. In contrast, sum of blood n-6 highly unsaturated fatty acids (P = 0.012, 95% CI: 1.031-1.284), AA (P=0.007, 95% CI: 1.053-1.395) and AA/LA ratio (P = 0.005, 95% CI: 1.102-1.703) were associated (P < 0.05) with higher concentrations of hs-CRP in girls. CONCLUSIONS: The n-6 WBFAs (sum of n-6 FA and LA) were associated with lower hs-CRP in boys and with higher hs-CRP in girls (AA, sum of n-6 highly unsaturated and AA/LA ratio). More studies are needed to identify the optimal levels of WBFAs to avoid low-grade inflammation in children considering the differences by sex and BMI. European Journal of Clinical Nutrition (2016) 70, 819-823; doi: 10.1038/ejcn.2015.219; published online 13 January 2016, INTRODUCTION Low-grade chronic inflammation is related with obesity (1-3) and with the onset and development of atherosclerosis. (1,4) Athero-sclerosis development is characterized by an interaction between vascular endothelial cells and [...]

BACKGROUND/OBJECTIVES: The objective of the study is to describe the hydration status and to assess the main food- and/or fluid intake-associated factors in healthy adolescents. SUBJECTS/METHODS: A total of 194 adolescents from the city of Zaragoza aged 12.5-17.5 years (99 males) participating in the 'Healthy Lifestyle in Europe by Nutrition in Adolescence' (HELENA) cross-sectional study were included. First morning urine was collected, and osmolality was determined by freezing point depression osmometer. A self-reported computer-based 24-h dietary recall was applied the same day of the urine collection. Analysis of variance, Kruskal-Wallis procedure or Pearson's [chi square] analyses was used to examine the group associations. RESULTS: Seventy-one percent of adolescents did not meet the European Food Safety Agency (EFSA) recommendations for average total water intake (TWI), and 68% had high first morning urine osmolality values. TWI and the proportion of those meeting EFSA reference values significantly (P < 0.05) decreased with increased osmolality. Males who met the EFSA recommendations consumed significantly (P < 0.05) more plain water (1035.13 vs 582.68 ml) and dairy drinks (368.13 vs 226.68 ml) than those who did not. In females, the consumption of water (1359.41 vs 620.44 ml) and sugar-sweetened beverages (214.61 vs 127.42 ml) was significantly higher in those meeting the EFSA recommendations than in those who did not. First morning urine osmolality was associated with vegetables (unstandardized β -0.6;95% confidence interval (CI): - 1.02 and -0.18) and fruits intake (β -0.41;95% CI: -0.63 and -0.19) in males and with dairy drinks (β: -0.39;95% CI: - 0.76 and -0.02) and fruits (β: -0.41;95% CI: -0.73 and -0.10) in females. CONCLUSIONS: There was a high prevalence of inadequate TWI and high urine osmolality among these Spanish adolescents. Lower urine osmolality was associated with higher consumption of vegetables in males, dairy drinks in females and fruits in both males and females. European Journal of Clinical Nutrition (2016) 541-547; doi: 10.1038/ejcn.2015.203; published online 16 December 2015, INTRODUCTION Water is essential for all functions of the body. (1) Total body water, as a percentage of body mass, varies as a function of body composition (from 50 to [...]

BACKGROUND: Dietary patterns, physical activity (PA) and sedentary behaviours are some of the main behavioural determinants of obesity; their combined influence in children has been addressed in a limited number of studies. SUBJECTS/METHODS: Children (16 228) aged 2-9 years old from eight European countries participated in the baseline survey of the IDEFICS study. A subsample of 11 674 children (50.8% males) were included in the present study. Children's food and beverage consumption (fruit and vegetables (F&V) and sugar-sweetened beverages (SSBs)), PA and sedentary behaviours were assessed via parental questionnaires. Sex-specific cluster analysis was applied to identify behavioural clusters. Analysis of covariance and logistic regression were applied to examine the association between behavioural clusters and body composition indicators (BCIs). RESULTS: Six behavioural clusters were identified (C1-C6) both in boys and girls. In both sexes, clusters characterised by high level of PA (C1 and C3) included a large proportion of older children, whereas clusters characterised by low SSB consumption (C5 and C6) included a large proportion of younger children. Significant associations between derived clusters and BCI were observed only in boys; those boys in the cluster with the highest time spent in sedentary activities and low PA had increased odds of having a body mass index z-score (odds ratio (OR) = 1.33;95% confidence interval (CI) = (1.01, 1.74)) and a waist circumference z- score (OR = 1.41; 95%CI = (1.06, 1.86)) greater than one. CONCLUSION: Clusters characterised by high sedentary behaviour, low F&V and SSB consumption and low PA turned out to be the most obesogenic factors in this sample of European children. European Journal of Clinical Nutrition (2015) 69, 811-816; doi:10.1038/ejcn.2015.76; published online 3 June 2015, INTRODUCTION Changes in multiple lifestyle behaviours contributing to energy imbalance are required in successful multi-factorial approaches of obesity prevention. (1) Dietary patterns, physical activity (PA) and sedentary behaviours are some [...]

BACKGROUND/OBJECTIVES: The objectives of this study were to investigate the relationship between inflammatory parameters (CRP, c-reactive protein; AGP, [alpha]1-acid glycoprotein), iron status indicators (SF, serum ferritin; sTfR, soluble transferrin receptor) and body mass index (BMI) z-score, fat-free mass (FFM) and fat mass (FM) in European adolescents. Differences in intake for some nutrients (total iron, haem and non-haem iron, vitamin C, calcium, proteins) were assessed according to BMI categories, and the association of nutrient intakes with BMI z-score, FM and FFM was evaluated. METHODS: A total of 876 adolescents participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence-Cross Sectional Study were included in the study sample. RESULTS: Mean CRP values (standard error; s.e.) were significantly higher in overweight/obese adolescents (1.7 [+ or - ] 0.3 and 1.4 [+ or -] 0.3 mg/l in boys and girls, respectively) than in thin/normal-weight adolescents (1.1 [+ or -] 0.2 and 1.0 [+ or -]0.1 mg/l in boys and girls, respectively) (P < 0.05). For boys, mean SF values (s.e.) were significantly higher in overweight/obese adolescents (46.9 [+ or -] 2.7 [micro]g/l) than in thin/normal-weight adolescents (35.7 [+ or -] 1.7 [micro]g/l) (P < 0.001), whereas median sTfR values did not differ among BMI categories for both boys and girls. Multilevel regression analyses showed that BMI z-score and FM were significantly related to CRP and AGP (P < 0.05). Dietary variables did not differ significantly among BMI categories, except for the intake of vegetable proteins, which, for boys, was higher in thin/normal-weight adolescents than in overweight/obese adolescents (P < 0.05). CONCLUSIONS: The adiposity of the European adolescents was sufficient to cause chronic inflammation but not sufficient to impair iron status and cause iron deficiency. European Journal of Clinical Nutrition (2015) 69, 247-255; doi:10.1038/ejcn.2014.154; published online 10 September 2014, INTRODUCTION There is growing evidence that obesity is characterised by a chronic, low-grade, systemic inflammation (1, 2) that may have a causal role in the development of several diseases such [...]

BACKGROUND/OBJECTIVES: Limited data exist regarding breakfast consumption and its association with cardiovascular disease (CVD) risk factors. This study investigates the relationship between breakfast routine and CVD risk factors in a multinational sample. SUBJECTS/METHODS: Cross-sectional data from eight European countries participating in the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) survey (2007-2008) were used. The sample included children 2 to RESULTS: Male school-aged NBrH consumers, compared with DBrH consumers, were more likely to be overweight/obese (odds ratio (OR): 1.37, 95% confidence interval (CI) = 1.05-1.79), to have higher risk for high-density lipoprotein (HDL) cholesterol levels lower than 40 mg/dl (OR: 1.69, 95% CI = 1.24-2.30), triglycerides (TG) above 75 mg/dl (OR: 1.65, 95% CI = 1.24-2.19) and sum of skinfolds greater than the 90th percentile (OR: 1.32, 95% CI = 1.0-1.76). Female school-aged NBrH consumers compared with DBrH consumers had a higher risk for waist circumference greater than the 90th percentile (OR: 1.70, 95% CI = 1.14-2.51), HDL cholesterol levels lower than 40 mg/dl (OR: 1.65, 95% CI = 1.23-2.21), TG above 75 mg/dl (OR: 1.65, 95% CI = 1.26-2.17) and total cholesterol/ HDL cholesterol ratio >3.5 (OR: 1.39, 95% CI = 1.09-1.77). Results remained significant after adjusting for daily physical activity in moderate-to-vigorous physical activity (MVPA) periods (in min/day). Male DBrH consumers, 6 to < 10 years of age, had longer daily periods of MVPA compared with NBrH consumers (32.0 [+ or -] 21.4 vs 27.5 [+ or -] 18.8, P CONCLUSIONS: Daily breakfast consumption contributes to controlling school-aged children's weight and lipid profile and promotes higher PA. 10.1038/ejcn.2014.88; published online 21 May 2014, INTRODUCTION Risk factors that accelerate the development of atherosclerotic cardiovascular disease (CVD) begin in childhood. Among others, obesity, lipid levels, blood pressure levels, physical avtivity (PA), age and gender are [...]

BACKGROUND/OBJECTIVES: Children from lower socioeconomic status (SES) may be at higher risk of unhealthy eating. We described country-specific dietary patterns among children aged 2-9 years from eight European countries participating in the IDEFICS study and assessed the association of dietary patterns with an additive SES indicator. SUBJECTS/METHODS: Children aged 2-9 years from eight European countries were recruited in 2007-2008. Principal component analysis was applied to identify dietary country-specific patterns. Linear regression analyses were applied to assess their association with SES. RESULTS: Two to four dietary patterns were identified in the participating regions. The existence of a 'processed' pattern was found in the eight regions. Also, a 'healthy' pattern was identified in seven of the eight regions. In addition, region-specific patterns were identified, reflecting the existing gastronomic and cultural differences in Europe. The 'processed' pattern was significantly inversely associated with the SES additive indicator in all countries except Sweden, whereas the 'healthy' pattern was positively associated with SES in the Belgian, Estonian, German and Hungarian regions, but was not significant in the Italian, Spanish and Swedish regions. CONCLUSIONS: A 'processed' pattern and a 'healthy' pattern were found in most of the participating countries in the IDEFICS study, with comparable food item profiles. The results showed a strong inverse association of SES with the 'processed' pattern, suggesting that children of parents with lower SES may be at higher risk of unhealthy eating. Therefore, special focus should be given to parents and their children from lower SES levels when developing healthy eating promotion strategies. European Journal of Clinical Nutrition (2014) 68, 811-821;doi:10.1038/ejcn.2014.78; published online 14 May 2014, INTRODUCTION Social inequalities in health are present from childhood until adult life; socioeconomic status (SES) differences in the risk of morbidity and mortality have been well documented. (1) The burden [...]

BACKGROUND/OBJECTIVES: The objective of this study was to examine the relationship between amino acid (AA) intake and serum lipid profile in European adolescents from eight European cities participating in the cross-sectional (2006-2007) HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study, and to assess whether this association was independent of total fat intake. SUBJECTS/METHODS: Diet, skinfold thickness, triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), TC/HDL-c ratio, low-density lipoprotein cholesterol (LDL-c), apolipoprotein B (Apo B), apolipoprotein A1 (Apo A1) and Apo B/Apo A1 ratio were measured in 454 12.5- to 17.5-year-old adolescents (44% boys). Intake was assessed via two non-consecutive 24-h dietary recalls. Data on maternal education and sedentary behaviors were obtained via questionnaires. Physical activity was objectively measured by accelerometry. RESULTS: Alanine, arginine, asparaginic acid, glycine, histidine, lysine and serine intakes were inversely associated with serum TG concentrations in both boys and girls. Intake of other AA like alanine and/or arginine was also inversely associated with serum TC, LDL-c and Apo B/Apo A1 ratio only in girls. An inverse association was observed between intakes of alanine, isoleucine, leucine, methionine, serine, tryptophan, tyrosine and valine and TC/HDL-c ratio among female adolescents. Similar results were found in males for serine and tryptophan intakes. It is noteworthy, however, that associations were no longer significant in both genders when total fat intake was considered as a confounding factor. CONCLUSIONS: In this sample of adolescents, the association between AA intakes and serum lipid profile did not persist when dietary fat was considered. Therefore, dietary interventions and health promotion activities should focus on fat intake to improve lipid profile and potentially prevent cardiovascular disease. European Journal of Clinical Nutrition (2014) 68, 464-473; doi: 10.1038/ejcn.2013.284; published online 5 February 2014 Keywords: amino acids; lipoproteins; dietary fat; adolescence, INTRODUCTION Cardiovascular diseases (CVD) are the number one cause of death worldwide, equally affecting men and women, not only in high-income countries, but also across those of low and middle [...]

BACKGROUND/OBJECTIVES: To assess dietary patterns (DPs) in European adolescents and to examine their relationship with several indicators of sedentary behaviour. SUBJECTS/METHODS: A multinational cross-sectional study was carried out in 2202 adolescents (45.4% boys) aged 12.5-17.5 years. A self-reported questionnaire with information on sedentary behaviours, separately for weekdays and weekend days, and two non-consecutive 24 h-recalls were used. Principal component analysis was used to obtain DPs, and linear regression examined the association between DPs scores and sedentary behaviour. RESULTS: Four DPs for boys ('plant based', 'snacking', 'breakfast' and 'health conscious') and five DPs for girls ('confectionary and snacking', 'plant based', 'breakfast', 'animal protein' and 'health conscious') were obtained. Boys who spent >4h/day watching television (TV) had lower adherence to the 'plant based', 'breakfast' and 'health conscious' DPs, and higher adherence to the 'snacking' DP. Higher computer use and internet use for recreational reason were associated with higher adherence to the 'snacking' DP. In girls, TV viewing and using internet for recreational reasons for >4h/day was associated with higher adherence to the 'confectionary and snacking' and lower adherence with 'health conscious' DP. Also, studying between 2 and 4h during weekend days was associated with lower adherence to the 'snacking' and with higher adherence to the 'plant based' and 'breakfast' DPs. CONCLUSION: Adolescents' DPs are related with the time spent in several sedentary behaviours. Such findings may help to generate interventions focusing on decreasing unhealthy dietary habits and specific sedentary behaviours. European Journal of Clinical Nutrition (2014) 68, 300-308;doi:10.1038/ejcn.2013.170; published online 18 September 2013 Keywords: sedentary behaviours; dietary patterns; television; adolescents, INTRODUCTION Dietary pattern (DP) analysis has emerged as an alternative and complementary approach to addressing diet-diseases associations. (1) Traditional analysis in nutritional epidemiology typically reflects diet in relation to a [...]

BACKGROUND/OBJECTIVES: This longitudinal study describes the relationship between young children's screen time, dietary habits and anthropometric measures. The hypothesis was that television viewing and other screen activities at baseline result in increased consumption of sugar-sweetened beverages (SSB) and increased BMI, BMI z-score and waist to height ratio (WHtR) two years later. A second hypothesis was that SSB consumption mediates the association between the screen activities and changes in the anthropometric measures. SUBJECTS/METHODS: The study is a part of the prospective cohort study IDEFICS ('Identification and prevention of dietary and lifestyle-induced health effects in children and infants'), investigating diet, lifestyle and social determinants of obesity in 2 to 9-year-olds in eight European countries (baseline n = 16 225, two-year follow- up; n = 11 038). Anthropometry was objectively measured, and behaviours were parent-reported. RESULTS: The main hypothesis was supported, but the second hypothesis was not confirmed. The odds ratio of being in the highest quintile of % change in WHtR was 1.26 (95% CI: 1.17-1.36) and in BMI 1.22 (95% CI: 1.13-1.31), for each hour per day watching television. The odds ratio of having increased SSB consumption was 1.19 (95% CI: 1.09-1.29) for each hour per day watching TV. The associations for total screen time were slightly weaker. CONCLUSIONS: The results indicate substantial effects of TV viewing and other screen activities for young children, both on their consumption of sugary drinks and on an increase in BMI and central obesity. Our findings suggest that television viewing seems to have a stronger effect on food habits and anthropometry than other screen activities in this age group. European Journal of Clinical Nutrition (2014) 68, 223-228; doi: 10.1038/ejcn.2013.234; published online 20 November 2013 Keywords: Children; screen time; television; soft drinks; overweight, INTRODUCTION Childhood obesity has a complex etiology and, according to a recent review, has long-term effects into adulthood, including premature mortality and morbidity. (1) Systematic reviews (2,3) and pooled analysis [...]

Background and Aims: This study aims to examine the associations of food portion size (PS) with markers of insulin resistance (IR) and clustered of metabolic risk score in European adolescents.Methods: A total of 495 adolescents (53.5% females) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study were included. The association between PS from food groups and homeostasis model assessment of insulin resistance (HOMA-IR) index, VO2 max, and metabolic risk score was assessed by multilinear regression analysis adjusting for several confounders. Analysis of covariance (ANCOVA) was used to determine the mean differences of food PS from food groups by HOMA-IR cutoff categories by using maternal education as a covariable.Results: Larger PS from vegetables in both gender and milk, yoghurt, and milk beverages in males were associated with higher VO2 max, while larger PS from margarines and vegetable oils were associated with lower VO2 max (p < 0.05). Males who consumed larger PS from fish and fish products; meat substitutes, nuts, and pulses; cakes, pies, and biscuits; and sugar, honey, jams, and chocolate have a higher metabolic risk score (p < 0.05). Males with lower HOMA-IR cutoff values consumed larger PS from vegetables, milk, yoghurt, and milk beverages (p < 0.05). Females with lower HOMA-IR cutoff values consumed larger PS from breakfast cereals, while those with higher HOMA-IR cutoff values consumed larger PS from butter and animal fats (p = 0.018).Conclusion: The results show that larger PS from dairy products, cereals, and high energy dense foods are a significant determinant of IR and VO2 max, and larger PS from food with higher content of sugar were associated with higher metabolic risk score. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: Individual lifestyle behaviours have independently been associated with cardiovascular diseases (CVD) risk factors in children. This study aimed to identify clustered lifestyle behaviours (dietary, physical activity (PA) and sedentary indicators) and to examine their association with CVD risk factors in children aged 2-9 years. SUBJECTS/METHODS: Participants included 4619 children (51.6% boys) from eight European countries participating in the IDEFICS cross-sectional baseline survey (2007-2008). Insulin resistance, total cholesterol/high-density lipoprotein cholesterol ratio, triglycerides, sum of two skinfolds and systolic blood pressure (SBP) z-scores were summed to compute a CVD risk score. Cluster analyses stratified by sex and age groups (2 to < 6 years; 6-9 years) were performed using parental-reported data on fruit, vegetables and sugar-sweetened beverages (SSB) consumption, PA performance and television video/DVD viewing. RESULTS: Five clusters were identified. Associations between CVD risk factors and score, and clusters were obtained by multiple linear regression using cluster 5 ('low beverages consumption and low sedentary') as the reference cluster. SBP was positively associated with clusters 1 ('physically active'; β = 1.34;95% confidence interval (CI): 0.02, 2.67), 2 ('sedentary'; β = 1.84; 95% CI: 0.57, 3.11), 3 ('physically active and sedentary'; β = 1.45;95% CI: 0.15, 2.75) and 4 ('healthy diet'; β = 1.83;95% CI: 0.50, 3.17) in older boys. A positive association was observed between CVD risk score and clusters 2 (b = 0.60;95% CI: 0.20, 1.01), 3 (b = 0.55;95% CI: 0.14, 0.97) and 4 (β = 0.60, 95% CI: 0.18, 1.02) in older boys. CONCLUSIONS: Low television/video/DVD viewing levels and low SSB consumption may result in a healthier CVD profile rather than having a diet rich in fruits and vegetables or being physically active in (pre-)school children. European Journal of Clinical Nutrition (2013) 67, 848-854; doi:10.1038/ejcn.2013.84; published online 1 May 2013 Keywords: cardiovascular diseases; lifestyle; diet; exercise; sedentary lifestyle; child, INTRODUCTION Increased risk of CVD is characterized by a cluster of metabolic abnormalities, such as abdominal obesity, atherogenic dyslipemia, hypertension, insulin resistance and glucose intolerance. (1) CVD remains the leading [...]