Food intake of European adolescents in the light of different food-based dietary guidelines : results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study

Objective: Since inadequate food consumption patterns during adolescence are not only linked with the occurrence of obesity in youth but also with the subsequent risk of developing diseases in adulthood, the establishment and maintenance of a healthy diet early in life is of great public health importance. Therefore, the aim of the present study was to describe and evaluate the food consumption of a well-characterized sample of European adolescents against food-based dietary guidelines for the first time. Design: The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study is a cross-sectional study, whose main objective was to obtain comparable data on a variety of nutritional and health-related parameters in adolescents aged 12.5-17.5 years. Setting: Ten cities in Europe. Subjects: The initial sample consisted of more than 3000 European adolescents. Among these, 1593 adolescents (54% female) had sufficient and plausible dietary data on energy and food intakes from two 24 h recalls using the HELENA-DIAT software. Results: Food intake of adolescents in Europe is not optimal compared with the two food-based dietary guidelines, Optimized Mixed Diet and Food Guide Pyramid, examined in this study. Adolescents eat half of the recommended amount of fruit and vegetables and less than two-thirds of the recommended amount of milk (and milk products), but consume much more meat (and meat products), fats and sweets than recommended. However, median total energy intake may be estimated to be nearly in line with the recommendations. Conclusion: The results urge the need to improve the dietary habits of adolescents in order to maintain health in later life

Association between dietary inflammatory index and inflammatory markers in the HELENA study

Background: Previous research has shown that diet is associated with low-grade systemic inflammation among adults. However, no study has yet been conducted to explore the association between inflammatory potential of diet and low-grade systemic inflammation among adolescents whose dietary behavior may be different from adults. Methods and Results: We examine the predictive ability of 24-h recall-derived dietary inflammatory index (DII) scores on inflammation among 532 European adolescents in the HELENA cross-sectional study. The DII is a literature-derived dietary index developed to predict inflammation. The DII was calculated per 1000 calories and was tested against C-reactive protein, ILs-1,2,4,10, TNF-alpha, ICAM, vascular cell adhesion molecule (VCAM), and IFN-gamma. All inflammatory markers had nonnormal distributions and therefore were log transformed. Analyses were performed using multivariable linear regression, adjusting for age, sex, city, BMI, smoking, and physical activity. Pro-inflammatory diet (higher DII scores) was associated with increased levels of various inflammatory markers: TNF-alpha, IL-1, 2, IFN-gamma, and vascular cell adhesion molecule (b(DIIt3vs1) = 0.13, 95% CI: 0.001, 0.25; 0.13, 95% CI 0.001, 0.25; 0.40, 95% CI: 0.03, 0.77; 0.53, 95% CI: 0.05, 1.01; 0.07, 95% CI: 0.01, 0.13, respectively). Conclusion: These results reinforce the fact that diet, as a whole, plays an important role in modifying inflammation in adolescents

Clustering patterns of physical activity, sedentary and dietary behavior among European adolescents: The HELENA study.

Evidence suggests possible synergetic effects of multiple lifestyle behaviors on health risks like obesity and other health outcomes. A better insight in the clustering of those behaviors, could help to identify groups who are at risk in developing chronic diseases. This study examines the prevalence and clustering of physical activity, sedentary and dietary patterns among European adolescents and investigates if the identified clusters could be characterized by socio-demographic factors. METHODS: The study comprised a total of 2084 adolescents (45.6% male), from eight European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Physical activity and sedentary behavior were measured using self-reported questionnaires and diet quality was assessed based on dietary recall. Based on the results of those three indices, cluster analyses were performed. To identify gender differences and associations with socio-demographic variables, chi-square tests were executed. RESULTS: Five stable and meaningful clusters were found. Only 18% of the adolescents showed healthy and 21% unhealthy scores on all three included indices. Males were highly presented in the cluster with high levels of moderate to vigorous physical activity (MVPA) and low quality diets. The clusters with low levels of MVPA and high quality diets comprised more female adolescents. Adolescents with low educated parents had diets of lower quality and spent more time in sedentary activities. In addition, the clusters with high levels of MVPA comprised more adolescents of the younger age category. CONCLUSION: In order to develop effective primary prevention strategies, it would be important to consider multiple health indices when identifying high risk groups.Peer Reviewe

Correlates of dietary energy misreporting among European adolescents : the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

This study examined the correlates of dietary energy under-reporting (UR) and over-reporting (OV) in European adolescents. Two selfadministered computerised 24-h dietary recalls and physical activity data using accelerometry were collected from 1512 adolescents aged 12.5-17.5 years from eight European countries. Objective measurements of height and weight were obtained. BMI was categorised according to Cole/International Obesity Task Force (IOTF) cut-off points. Diet-related attitudes were assessed via self-administered questionnaires.Reported energy intake (EI) was compared with predicted total energy expenditure to identify UR and OV using individual physical activity objective measures. Associations between misreporting and covariates were examined by multilevel logistic regression analyses. Among all, 33.3% of the adolescents were UR and 15.6% were OV when considering mean EI. Overweight (OR 3.25; 95% CI 2.01, 5.27) and obese (OR 4.31; 95% CI 1.92, 9.65) adolescents had higher odds for UR, whereas underweight individuals were more likely to over-report (OR 1.67; 95% CI 1.01, 2.76). Being content with their own figures (OR 0.61; 95% CI 0.41, 0.89) decreased the odds for UR, whereas frequently skipping breakfast (OR 2.14; 95% CI 1.53, 2.99) was linked with higher odds for UR. Those being worried about gaining weight (OR 0.55; 95% CI 0.33, 0.92) were less likely to OV. Weight status and psychosocial weight-related factors were found to be the major correlates of misreporting. Misreporting may reflect socially desirable answers and low ability to report own dietary intakes, but also may reflect real under-eating in an attempt to lose weight or real over-eating to reflect higher intakes due to growth spurts. Factors influencing misreporting should be identified in youths to clarify or better understand diet-disease associations

Ernährung und Lebensstil vor und während der Schwangerschaft – Handlungsempfehlungen des bundesweiten Netzwerks Gesund ins Leben

Diet and exercise before and during pregnancy affect the course of the pregnancy, the child's development and the short- and long-term health of mother and child. The Healthy Start - Young Family Network has updated the recommendations on nutrition in pregnancy that first appeared in 2012 and supplemented them with recommendations on a preconception lifestyle. The recommendations address body weight before conception, weight gain in pregnancy, energy and nutritional requirements and diet (including a vegetarian/vegan diet), the supplements folic acid/folate, iodine, iron and docosahexaenoic acid (DHA), protection against food-borne illnesses, physical activity before and during pregnancy, alcohol, smoking, caffeinated drinks, oral and dental hygiene and the use of medicinal products. Preparation for breast-feeding is recommended already during pregnancy. Vaccination recommendations for women planning a pregnancy are also included. These practical recommendations of the Germany-wide Healthy Start - Young Family Network are intended to assist all professional groups that counsel women and couples wishing to have children and during pregnancy with uniform, scientifically-based and practical information.Ernährung und Bewegung vor und während der Schwangerschaft wirken sich auf den Schwangerschaftsverlauf, die Entwicklung des Kindes und die kurz- und langfristige Gesundheit von Mutter und Kind aus. Das Netzwerk Gesund ins Leben hat die 2012 erstmals erschienenen Empfehlungen zur Ernährung in der Schwangerschaft aktualisiert und um Empfehlungen zum präkonzeptionellen Lebensstil ergänzt. Die Empfehlungen adressieren das Körpergewicht vor der Konzeption, die Gewichtsentwicklung in der Schwangerschaft, Energie- und Nährstoffbedarf sowie Ernährungsweise (inklusive vegetarische/vegane Ernährung), die Supplemente Folsäure/Folat, Jod, Eisen und Docosahexaensäure (DHA), den Schutz vor Lebensmittelinfektionen, körperliche Aktivität vor und in der Schwangerschaft, Alkohol, Rauchen, koffeinhaltige Getränke, Mund- und Zahngesundheit und den Umgang mit Arzneimitteln. Die Vorbereitung auf das Stillen wird bereits in der Schwangerschaft empfohlen. Für Frauen, die eine Schwangerschaft planen, sind zudem Impfempfehlungen enthalten. Diese Handlungsempfehlungen des bundesweiten Netzwerks Gesund ins Leben sollen alle Berufsgruppen, die Frauen und Paare mit Kinderwunsch und in der Schwangerschaft beraten, mit harmonisierten, wissenschaftsbasierten und anwendungsorientierten Informationen unterstützen

Inflammation in metabolically healthy and metabolically abnormal adolescents: The HELENA study

On behalf of the HELENA study group.[Background and aims] Inflammation may influence the cardio-metabolic profile which relates with the risk of chronic diseases. This study aimed to assess the inflammatory status by metabolic health (MH)/body mass index (BMI) category and to assess how inflammatory markers can predict the cardio-metabolic profile in European adolescents, considering BMI. [Methods and results] A total of 659 adolescents (295 boys) from a cross-sectional European study were included. Adolescents were classified by metabolic health based on age- and sex-specific cut-off points for glucose, blood pressure, triglycerides, high density cholesterol and BMI. C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin (IL-6), complement factors (C3, C4) and cell adhesion molecules were assessed. [Results] Metabolically abnormal (MA) adolescents had higher values of C3 (p < 0.001) and C4 (p = 0.032) compared to those metabolically healthy (MHy). C3 concentrations significantly increased with the deterioration of the metabolic health and BMI (p < 0.001). Adolescents with higher values of CRP had higher probability of being in the overweight/obese-MH group than those allocated in other categories. Finally, high C3 and C4 concentrations increased the probability of having an unfavorable metabolic/BMI status. [Conclusions] Metabolic/BMI status and inflammatory biomarkers are associated, being the CRP, C3 and C4 the most related inflammatory markers with this condition. C3 and C4 were associated with the cardio-metabolic health consistently.The HELENA Study was supported by the European Community Sixth RTD Framework Programme (Contract FOOD-CT-2005-007034) and the Stockholm County Council. This analysis was also supported by the Spanish Ministry of Science and Innovation (JCI-2010-07055) and the gs4:European Regional Development Fund (FEDER). CCS is supported by 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). AIR was funded by a Juan de la Cierva-Formación stipend from the Ministry of Economy and Competitiveness of the Spanish Government (FJCI-2014-19795).Peer Reviewe

Relative validity of the Planetary Health Diet Index by comparison with usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet among European adolescents: the HELENA study

Purpose The EAT-Lancet Commission proposed an evidence-based global reference diet to improve human health within planetary boundaries. Recently, the Planetary Health Diet Index (PHDI) was developed based on the EAT-Lancet recommendations and validated among Brazilian adults. However, the relative validity of the PHDI in adolescents has yet to be assessed. Thus, we aimed to evaluate the relative validity of the PHDI in European adolescents. Methods We used cross-sectional data from 1804 adolescents (12.5–17.5 years) enrolled in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. The PHDI (0–150 points) was calculated based on dietary intake data from two non-consecutive 24-h dietary recalls. Associations between the PHDI and usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet were evaluated using multivariable-adjusted mixed-effects linear regression models. Results Higher PHDI score was associated with greater intakes of nutrients predominantly from plant-source foods, such as vegetable protein, vitamin E, and folate and with lower intake of nutrients predominately from animal-source foods, such as total and saturated fat, cholesterol, and animal protein. Furthermore, a higher PHDI score was also positively associated with plasma β-carotene, vitamin C, vitamin D, folate, and ferritin concentrations, while negatively associated with trans-fatty acids concentration. Moreover, higher PHDI was related to a greater adherence to the Mediterranean dietary pattern. Conclusions The PHDI showed good relative validity among adolescents in the HELENA study. Hence, future research should assess adherence to the PHDI and long-term health outcomes

Scientific Opinion on the appropriate age range for introduction of complementary feeding into an infant’s diet.

publishedVersio

Cardiometabolic risk is positively associated with underreporting and inversely associated with overreporting of energy intake among european adolescents: The healthy lifestyle in Europe by nutrition in adolescence (HELENA) study

[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).Peer reviewe

Relative validation of the adapted Mediterranean Diet Score for Adolescents by comparison with nutritional biomarkers and nutrient and food intakes: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

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 center dot 5-17 center dot 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, beta-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 center dot 0001), except with monosaccharides and PUFA for KIDMED_A and cholesterol for both indices (P < 0 center dot 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