Diet Quality Index For Adolescents Research Articles

Influence of income on diet quality and daily iron and zinc intake: analysis of the National Diet and Nutrition Survey of British females aged 11–14 and 15–18 years

PurposeA negative socio-economic gradient exists for diet and health outcomes. Since cheaper diets are associated with increased energy and lower nutrient density, we investigated the influence of income on iron and zinc intakes and overall diet quality for adolescent (DQI-A) females aged 11–18 years.MethodsNational Diet and Nutrition Survey (NDNS years 7 and 8) data for iron and zinc intake and overall diet quality was assessed by household income quintile across females aged 11–18 years.ResultsEquivalised household income positively correlated with Diet quality index for adolescents (DQI-A) (P < 0.001) Females aged 15–18 years in income quintiles (IQs) I and 2, had a greater proportion of respondents with low to intermediate DQI-A score compared to higher IQs (P = 0.002). NDNS data showed intake was negatively influenced by income amongst females aged 11–14 years for iron (P = 0.009) and zinc (P = 0.001) with those from the lowest incomes consistently consuming significantly less than those from the highest. DQI-A was positively correlated with iron intakes for 11–14 (P = 0.001) and 15–18 years (P < 0.001). Forty-one percent of 15–18-year-olds plasma ferritin stores were below the 15 µg L−1 and 21% had some form of anaemia. Cereal and cereal products were the greatest contributors to iron in all groups.ConclusionFemales in the lowest income groups are at greater risk of lower overall diet quality and inadequate iron and zinc intakes. Amongst older adolescents, there is evidence of iron stores being depleted and an increased prevalence of anaemia.

Relationship of Sleep Duration, Concentration, BMI and Dietary Behavior of European Adolescents – Results From the HELENA-Study

ObjectivesLow sleep quality and duration are associated with the development of overweight and obesity. This link is discussed to result from an unfavorable selection of food items after sleep deprivation on the one hand; on the other hand, fatigue also reduces the willingness to engage in physical activity. Furthermore, sleep duration and quality seem to be associated with cognitive development in children. The aim of this analysis was to assess these associations in European adolescents.MethodsAs part of the Healthy Lifestyle in Europe by Nutrition in Adolescence “HELENA” study (October 2006 - June 2007), concentration ability was assessed in 500 adolescents (12.5–17.4 years) using d2 test which was evaluated in age-corrected percentiles (concentration index). Sleep duration during the week and during the weekend was surveyed and divided into age-appropriate groups (too short, optimal, too long) with an optimal sleep duration of 9–12 h for 12-year-olds and 8–10 h for 13–18-year-olds. Dietary behavior was assessed using two 24 h recalls, which were subsequently summarized in the Diet Quality Index for adolescents (DQI). Body height and weight were collected and the calculated BMI was subsequently transformed to percentiles. Whether sleep duration was associated with BMI, dietary behavior, or attention was examined using the Kruskal-Wallis test. Furthermore, Spearman correlations were performed.ResultsOn average, 59.4% (n: ♀ = 167; ♂ = 130) of adolescents slept for the optimal duration, 36.4% (n: ♀ = 96; ♂ = 86) slept too short, and 4.2% slept longer than recommended. No significant difference was observed between groups of sleep duration within BMI percentiles (p = 0.193), attention (p = 0.520), and DQI (p = 0.742). In addition, no significant correlation was observed between average sleep duration, BMI percentile, attention, and DQI. There was a significant negative correlation between age and sleep duration (r = −0.317; p < 0.001).ConclusionsEven though slightly more than one third of the adolescents within the HELENA study got less than optimal sleep, no differences were found in terms of their BMI, dietary behavior or ability to concentrate, but age might play a role.Funding SourcesEuropean Community sixth RTD Framework Programme.

Relationships of Child-, Parents-, and Environment-Associated Determinants with Diet Quality, Physical Activity, and Smoking Habits Among Indonesian Urban Adolescents.

The trend of unhealthy lifestyles is increasing among adolescents and has been associated with the rising burden of noncommunicable diseases (NCDs). However, specific determinants of unhealthy lifestyles among adolescents in low- and middle-income countries remain limited. To investigate the relationships of child-, parents-, and environment-associated determinants with diet quality, physical activity, and smoking habits among low-socioeconomic urban adolescents. A cross-sectional study involving 238 adolescents aged 11 to 17 years was conducted in Jakarta, Indonesia. Adolescents and their parents were interviewed to assess the determinants of healthy lifestyles that included diet quality, physical activity, and smoking habits. Diet and physical activity were quantified using the Diet Quality Index for Adolescents (DQI-A) and Physical Activity Questionnaire for Older Children (PAQ-C), respectively. Multiple regression was used to determine the β coefficients and odds ratios predictive of healthy lifestyles. Mean scores of DQI-A and PAQ-C were considered low (33.5% ± 8.9% and 2.1 ± 0.5, respectively). Overall, 17.6% of adolescents were smokers, with 88% of these being males. Predictors of diet quality were child- (age, gender) and environment-associated (house size, access to a computer) determinants with β coefficients of -6.52 to 3.26. The PAQ-C score was associated with child- (female) and environment-associated (living area) determinants with β coefficients of -0.45 and 0.14, respectively. Younger adolescents and females were protective factors for smoking. Parents-associated determinants were not associated with any lifestyle indicators. Child- and environment-associated determinants were predictors of healthy lifestyles among adolescents. Thus, personal empowerment and environment transformation are needed to facilitate a healthy lifestyle and reduce the burden of NCDs among adolescents.

Association between diet quality index, food and nutrient intake and metabolic parameters in adolescents from Recife, northeastern Brazil.

Nutritional studies shifted the focus of attention to the analysis of food quality, addressing general diet considering the foods, food groups and nutrients included. This study evaluates the association between diet quality index, food and nutrient intake and metabolic parameters of adolescents from Recife, northeastern Brazil. It is a cross-sectional study involving adolescents aged 12 to 19 years. Food intake was assessed using the FFQ to estimate the adapted Diet Quality Index for Adolescents for Brazilians (DQIA-BR-A). The analysis included metabolic parameters (glucose, lipid profile, apo A1 and B, α-1-acid glycoprotein, retinol, β-carotene, α-tocopherol, 25-hydroxyvitamin D and parathormone). Multiple linear regression analysis between the DQIA-BR-A and daily nutrient intake showed a positive correlation (R2adjusted = 0·29) for linoleic fatty acid, Ca and folate and a negative correlation for oleic fatty acid, carbohydrates and vitamins B2 and C, in addition to a low correlation (R2adjusted < 0·07) with all metabolic parameters. However, the DQIA-BR-A correlated significantly (R2adjusted = 0·62; P < 0·001) with food intake. In this way, the DQIA-BR-A can be considered as an accurate and useful instrument for assessing the overall quality of adolescent diets. The diet of the adolescents was considered to be of moderate quality. Changes are required to ensure a balanced diet, considering the high-sugar intake and consumption of sweets as well as the low consumption of vegetables, milk and dairy products, oils, fats and seeds. Such changes should prioritise the consumption of foods rich in essential fatty acids and poor in saturated fat.

Association between diet quality index and cardiometabolic risk factors in adolescents: Study of Cardiovascular Risks in Adolescents (ERICA)

ObjectiveThis study evaluated the association between diet quality, assessed by the Diet Quality Index for Adolescents adapted for Brazilians (DQIA-BR), and cardiometabolic markers in adolescents. MethodsThe DQIA-BR and cardiometabolic markers were assessed in 36 956 Brazilian adolescents (12–17 y old) enrolled in the Study of Cardiovascular Risks in Adolescents (ERICA), a national school-based cross-sectional multicenter study in Brazil. For analyses, the sample was stratified by sex and nutritional status. Multiple linear regressions were used to investigate the association between DQIA-BR and cardiometabolic markers (total cholesterol, HDL-c, LDL-c, triglycerides, fasting glucose and HOMA-IR). Adjusted models were constructed with two input levels of covariates. The first model was adjusted for sex, age, and socioeconomic status; in the second model, total energy intake, physical activity, and sedentary behavior were included. ResultsA higher DQIA-BR score was associated with a better cardiometabolic profile in girls with normal weight; however, no association was observed in those with overweight/obesity. In boys with overweight/obesity, a better quality of diet was associated with lower concentrations of total cholesterol (β = −0.338, 95% confidence interval [CI]: −0.611 to −0.066) and LDL-c (β = −0.227, 95% CI: −0.448 to −0.005), but only LDL-c remained significant in those with normal weight (β = −0.115, 95% CI: −0.224 to 0.005). ConclusionThe effects of diet quality on cardiometabolic risk factors differ according to sex and the presence of overweight/obesity. Overall, DQIA-BR is a suitable tool to evaluate the association between diet quality and cardiometabolic markers in normal-weight adolescents, but not for adolescents, especially girls, with overweight/obesity.

Associations of telomere length with two dietary quality indices after a lifestyle intervention in children with abdominal obesity: a randomized controlled trial.

Dietary factors seem to influence telomere length. Moreover, associations between changes in adiposity indices and telomere length (TL) have been found in intervention studies. We evaluated changes in two diet quality indices and their association with TL in children with abdominal obesity in a 12-month lifestyle intervention. Eighty-seven participants (7-16 years old) were assigned to the intervention (moderate hypocaloric Mediterranean diet) or usual care group (standard paediatric recommendations) for a 2-month intensive phase and a subsequent 10-month follow-up. Diet quality was assessed using the Diet Quality Index for Adolescents (DQI-A) and the Healthy Lifestyle Diet Index (HLD-I). TL was measured by monochrome multiplex real-time quantitative PCR. The intra-class correlation coefficient for TL was 0.793 (95% CI 0.707, 0.857). After a 12-month lifestyle intervention, a significant reduction in BMI-SDS (-0.57 and -0.49 for the intervention and usual care groups, respectively) and fat mass was observed in all subjects without differences between groups. Changes in DQI-A (+12.36% vs +5.53%, P = .005) and HLD-I (+4.43 vs +1.09, P < .001) were higher in the intervention subjects compared with usual care subjects after 2 months. Interestingly, we observed a positive change in TL between 2 and 12 months (P = .025), which was associated with higher scores on the DQI-A (β = 0.008, R2 = 0.088, P = .010) and HLD-I (β = 0.022, R2 = 0.198, P = .015), in the intervention group after the 2-month intensive phase. Favourable changes in diet quality indices could contribute to telomere integrity in children with abdominal obesity enrolled in an intensive lifestyle intervention.

Cross-sectional associations between lunch-type consumed on a school day and British adolescents' overall diet quality.

Diet quality of children consuming school meals tends to be better than that of children consuming packed lunches (from home) or food bought outside school. This study investigates the association between different types of lunch consumed in a school day and diet quality of UK adolescents. A total of 2118 British adolescents were included from the National Diet and Nutrition Survey (Years 1-8; between 2008 and 2016). All participants attended school and were aged 11-18years with valid 3 or 4-day diary records and the analyses were stratified by age group (11-14 and 15-18years). The Diet Quality Index for Adolescents (DQI-A) tool consisting of three components; diet quality, diversity and equilibrium, was used to assess adherence to dietary recommendations. Overall DQI-A scores range from -33 to 100%. Overall mean DQI-A score for all adolescents was low at 21.1%. Fewer (17.4%) adolescents reported buying lunches from cafés and shops, compared to adolescents consuming cooked school meals and packed lunches (28.3% and 36.6%, respectively), and they had the lowest DQI-A% score of 14.8%. Adolescents having cooked school meals (reference group) had a higher overall DQI-A% of 21.8%. Diet quality scores of older adolescents having packed lunches and shop/café-bought lunches were 5.5% higher (CI 2.7 to 8.4%; p<0.01) and 5.0% lower (CI 8.1 to 2.0%; p<0.01) than cooked school meals respectively, after adjusting for gender, region, energy under-reporting and equivalised household income. For younger adolescents the results were attenuated particularly among packed lunch consumers. UK adolescents generally consume a poor quality diet and adolescents purchasing lunches from outside the school gates have the lowest quality diets. Unlike with older children there is little difference between school meals and packed lunches for younger children. Regulation policies on food outlets around secondary schools as well as improving food choices within school premises are needed.

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.

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. 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. Nine European countries. 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. 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). 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.

Diet quality index for Brazilian adolescents: the ERICA study.

This study aimed to assess the dietary patterns of adolescents using a food-based diet quality index and their compliance with a healthy dietary guideline METHODS: Participants included 71,553 Brazilian adolescents (12-17years old) from the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional school-based multicenter study.. Dietary intake was measured by one 24-h recall. A second recall was collected in a random subsample (~ 10%) to correct within-person variability. The Diet Quality Index for Adolescents adapted for Brazilians (DQIA-BR) was used to measure the overall quality of the dietary intake. The National Cancer Institute method was applied to estimate usual dietary intake. The DQIA-BR and the distribution of its components (quality, diversity, and equilibrium) were analyzed according to sex, geographical area, and type of school RESULTS: The mean (SD) DQIA-BR scores were 14.8% (6.1%) for females and 19.0% (6.3%) for males. All analyzed strata revealed low scores of DQIA-BR and its components. The median usual intake was five to sevenfold below the recommendations for vegetables and fruits and approximately twofold below the recommendations for dairy. The highest DQIA-BR mean scores were found in the northern region [17.0% (6.4%), females; 20.7% (6.3%), males]. Adolescents in both types of schools had relatively similar median intakes of snacks (~ 85g) and sugared drinks (~ 600ml) CONCLUSIONS: The overall diet quality of Brazilian adolescents is inadequate based on evaluated parameters in all regions and socioeconomic backgrounds.

The cross-sectional relationships between consumption of takeaway food, eating meals outside the home and diet quality in British adolescents.

The present study aimed to evaluate the association of frequency of consuming takeaway meals and meals out with diet quality of UK adolescents. The Diet Quality Index for Adolescents (DQI-A) tool was used to assess diet quality, where adolescents' food intake was based on 4d diary records obtained from the UK cross-sectional National Diet and Nutrition Survey (NDNS) rolling programme Years 1-6. Models included confounders. The DQI-A relies on three components, specifically diet quality, diversity and equilibrium, which reflect the degree of adherence of an adolescent's diet with food-based dietary guidelines.ParticipantsBritish (n 2045) adolescents aged 11-18 years. Mean diet quality score for all adolescents was 20·4 % (overall DQI-A score range: -33 to 100 %). After adjusting for age, gender and equivalised household income, DQI-A% score was higher for low and moderate takeaway consumers by 7·4 % (95 % CI 5·5, 9·2; P&lt;0·01) and 3·5 % (95 % CI 1·9, 5·1; P&lt;0·01), respectively, v. frequent consumers. Significant differences were also observed between low, moderate and frequent takeaway consumers among all DQI-A components and sub-components (P&lt;0·05), except for the diet adequacy sub-component (DAx). Results for frequent consumption of meals out were similar but attenuated and not statistically significant for individual components before or after adjusting for confounders. Frequent consumption of takeaway meals may have a negative impact on adolescents' diet quality and therefore policies to reduce the intake of takeaways should be considered in this age group.

Improved Diet Quality and Nutrient Adequacy in Children and Adolescents with Abdominal Obesity after a Lifestyle Intervention.

High rates of childhood obesity require integral treatment with lifestyle modifications that achieve weight loss. We evaluated a lifestyle intervention on nutrient adequacy and diet quality in children and adolescents with abdominal obesity. A randomized controlled trial was performed on 107 participants, assigned either to a usual care group or to an intensive care group that followed a moderate hypocaloric Mediterranean diet and received nutritional education. Intake adequacy was evaluated using Dietary Reference Intakes and diet quality through the Diet Quality Index for Adolescents (DQI-A), the Healthy Lifestyle Diet-Index (HLD-I) and the Mediterranean Diet Quality Index (KIDMED). Both groups achieved a significant reduction in BMI standard deviation score (BMI-SDS), glucose and total cholesterol levels. Intake of Calcium, Iodine and vitamin D were higher in the intensive care group, with enhanced compliance with recommendations. Higher dietary scores were associated with lower micronutrient inadequacy. DQI-A and HLD-I were significantly higher in the intensive care group vs. usual care group after the treatment. In conclusion, we observed that an intensive lifestyle intervention was able to reduce BMI-SDS in children with abdominal obesity. Furthermore, participants significantly improved dietary indices getting closer to the nutritional recommendations. Therefore, these diet quality indices could be a valid indicator to evaluate micronutrient adequacy.

Adolescents' diet quality in relation to their relatives' and peers' diet engagement and encouragement: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study.

To examine the associations between adolescents' diet quality and their perceived relatives' and peers' diet engagement and encouragement. Cross-sectional study performed in European countries. Diet quality was scored using the Diet Quality Index for Adolescents (DQI-A) based on four components: quality, diversity, balance and meal frequency. Perceived diet quality engagement and perceived encouragement of the relatives/peers were assessed using the questions 'How healthy is each of the following persons' diet?' and 'How often does each of the following persons encourage you to eat a healthy diet?' Vienna, Ghent, Lille, Athens, Heraklion, Pecs, Rome, Dortmund, Zaragoza and Stockholm. Healthy adolescents (n 2943). The perceived engagement level of the mother, father and sister was each positively associated with the DQI-A (P<0·05). A positive association was found for the perceived engagement level of siblings, father and mother with all specific components (P<0·05). DQI-A was negatively associated with the perceived encouragement level from a best friend and positively associated with the encouragement level of the mother and father (P<0·05). Diversity, balance and quality components were positively associated with the perceived encouragement level from the mother and father (P<0·05), whereas the best friend's perceived encouragement was negatively associated with the meal frequency component (P<0·01). These findings highlight the role of social engagement and encouragement of relatives and peers in adolescents' diet quality. Intervention or promotion programmes aimed at enhancing diet quality in adolescents should target both family and peers.

Parental adherence to Mediterranean diet is associated with their adolescents´ cereals intake

The Mediterranean diet (MD), abundant in whole grains, is known to be one of the healthiest dietary patterns. Given the health benefits of whole grain cereals as a rich source of nutrients and phytochemicals, this study examined parental adherence to MD and its association with their adolescents’ cereals intake, in 203 parent-adolescent dyads. Adherence to MD was evaluated using the Mediterranean Diet Quality Index for adolescents (13.5±1.2y) and the Short Mediterranean Diet Questionnaire for parents (41.53±5.99y). Although the level of the parents’ adherence to MD did not significantly influence the adolescents´ weekly consumption frequency of pasta and rice, adolescents whose parents had higher adherence to MD (44.3%) more often ate cereals or grains for breakfast (p=0.045) and less frequently, commercially baked goods or pastries (p=0.043). Adolescents of parents who had lower adherence to MD (55.7%) stated that they would eat more whole grain bakery products (p=0.049) and more breakfast cereals (p=0.039) if those foods were more often available at home. Adolescents with parents who had higher adherence to MD stated that they were more often encouraged by their parents to eat whole grain bakery products (p=0.030), compared with their counterparts whose parents had lower adherence to MD. With this study, we revealed that food environment and parental eating behaviour are notable factors that influence adolescents’ dietary intake. Disease prevention health programs should focus more strongly on encouraging parents to adopt MD features in their family food environment.

Parental adherence to Mediterranean diet is associated with their adolescents´ cereals intake

The Mediterranean diet (MD), abundant in whole grains, is known to be one of the healthiest dietary patterns. Given the health benefits of whole grain cereals as a rich source of nutrients and phytochemicals, this study examined parental adherence to MD and its association with their adolescents’ cereals intake, in 203 parent-adolescent dyads. Adherence to MD was evaluated using the Mediterranean Diet Quality Index for adolescents (13.5±1.2y) and the Short Mediterranean Diet Questionnaire for parents (41.53±5.99y). Although the level of the parents’ adherence to MD did not significantly influence the adolescents´ weekly consumption frequency of pasta and rice, adolescents whose parents had higher adherence to MD (44.3%) more often ate cereals or grains for breakfast (p=0.045) and less frequently, commercially baked goods or pastries (p=0.043). Adolescents of parents who had lower adherence to MD (55.7%) stated that they would eat more whole grain bakery products (p=0.049) and more breakfast cereals (p=0.039) if those foods were more often available at home. Adolescents with parents who had higher adherence to MD stated that they were more often encouraged by their parents to eat whole grain bakery products (p=0.030), compared with their counterparts whose parents had lower adherence to MD. With this study, we revealed that food environment and parental eating behaviour are notable factors that influence adolescents’ dietary intake. Disease prevention health programs should focus more strongly on encouraging parents to adopt MD features in their family food environment.

Mediterranean diet, diet quality, and bone mineral content in adolescents: the HELENA study.

To assess the associations between the MDS-A and a DQI-A with the BMC measured with dual-energy X-ray absorptiometry. 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. 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. An overall dietary score or index is not associated with BMC in our adolescent Spanish sample.

Diet quality and attention capacity in European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study.

Adolescence represents an important period for the development of executive functions, which are a set of important cognitive processes including attentional control. However, very little is known regarding the associations of nutrition with components of executive functions in adolescence. Thus, the aim of this study was to investigate associations of dietary patterns and macronutrient composition with attention capacity in European adolescents. This cross-sectional study included 384 (165 boys and 219 girls) adolescents, aged 12·5-17·5 years, from five European countries in the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Attention capacity was examined using the d2 Test of Attention. Dietary intake was assessed through two non-consecutive 24 h recalls using a computer-based self-administered tool. Three dietary patterns (diet quality index, ideal diet score and Mediterranean diet score) and macronutrient/fibre intakes were calculated. Linear regression analysis was conducted adjusting for age, sex, BMI, maternal education, family affluence scale, study centre and energy intake (only for Mediterranean diet score). In these adjusted regression analyses, higher diet quality index for adolescents and ideal diet score were associated with a higher attention capacity (standardised β=0·16, P=0·002 and β=0·15, P=0·005, respectively). Conversely, Mediterranean diet score or macronutrient/fibre intake were not associated with attention capacity (P>0·05). Our results suggest that healthier dietary patterns, as indicated by higher diet quality index and ideal diet score, were associated with attention capacity in adolescence. Intervention studies investigating a causal relationship between diet quality and attention are warranted.

Do adolescents accurately evaluate their diet quality? The HELENA study

The aim of this study was to assess the diet quality awareness and associated factors in a large sample of European adolescents. The study included 3389 healthy adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study. The adolescents' diet quality was based on repeated 24h recalls and scored into a Diet Quality Index for Adolescents (DQI-A) considering four components: meal, equilibrium, diversity and quality. A self-rated diet quality questionnaire was administered to adolescents to assess their dietary awareness. The association of DQI-A with dietary awareness was studied using a linear mixed model including the center as the random effect and dietary awareness as the fixed effect. There was a positive association between DQI-A scores and diet quality perception levels (p<0.0001). The mean DQI-A was 59.0 (SD=14.8) in adolescents with a low dietary awareness compared with 65.4 (SD=12.6) in adolescents with high dietary awareness (p<0.0001). Similar results were found for all the DQI components. When analyses were stratified, we found a significant heterogeneity across the nutritional status, with no significant association between DQI-A and dietary awareness level in obese adolescents, but a positive association in overweight, normal and undernourished groups. We found also a significant heterogeneity associated with the lunch location (school or home). No other factor affected dietary awareness (gender, pubertal status and maternal educational level). European adolescents evaluate well their food quality whatever their pubertal status, gender and parental educational level, except for the obese who are not able to assess their diet quality. Improving the dietary awareness in obese adolescents might help to induce behavioral changes.

The effect of snacking and eating frequency on dietary quality in British adolescents.

To describe the effects of number of eating occasions and snacks on dietary quality (DQ), defined as adherence to dietary recommendations. A sample of 884 adolescents (11-18years) in the UK National Diet and Nutrition Survey (NDNS) were included. The Diet Quality Index for Adolescents (DQI-A) was implemented. The total number of eating occasions and snacks was frequency of food or beverages consumed over 24h and frequency of foods or beverages consumed outside of the three mealtimes, respectively. Results were generated with and without low-energy food under 210kJ (50kcal). Regression models were generated with DQ score as the outcome variable and number of eating occasions and snacks as predictors. The mean (95% CI) DQ score was 31.1% (30.2, 32.0). The mean number of eating occasions and snacks was 7.5 (7.3, 7.7) and 2.6 (2.6, 2.7) times/day, respectively. When low-energy events were excluded, the mean number of eating occasions and snacks reduced to 6.2 (6.1, 6.4) and 2.0 (2.0, 2.1) times/day, respectively. DQ score increased by 0.74 points (0.42, 1.05; p<0.01) and 0.55 points (-0.08, 0.69; p=0.17) for total eating occasions and snacks, respectively. When low-energy events were excluded, DQ score increased by 0.30 points (-0.84, 0.69; p=0.13) for each eating occasion and decreased by 1.20 points (-2.1, -0.3; p<0.01) for each snack. Eating more frequently improves dietary quality especially if some eating occasions are low in energy. A focus on replacing high-energy snacks with low-energy alternatives rather than reducing the number of eating occasions may result in improved dietary quality in adolescents.

Associations between macronutrient intake and serum lipid profile depend on body fat in European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study.

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.

Diet quality is associated with measures of body fat in adolescents from Otago, New Zealand.

To examine the potential associations between diet quality and multiple measures of body composition in a sample of New Zealand adolescents aged 14-18 years. Cross-sectional survey of eleven high schools in Otago, New Zealand. Each participant completed an online FFQ and a New Zealand Diet Quality Index for Adolescents (NZDQI-A) score was calculated based on variety and adequacy of intake for five major food groups. Besides height and waist circumference measurements, body composition was assessed using segmental bio-impedance analysis. Generalized estimating equations were used to examine associations between diet quality and body composition in models adjusted for sex, age, ethnicity and socio-economic status. High schools in Otago, New Zealand. High-school students (n 681, 56 % male, mean age 16·1 (sd 1·5) years) participating in the Otago School Students Lifestyle Survey Two. Higher NZDQI-A scores were significantly associated with lower body fat percentage (β=-0·19; 95 % CI -0·35, -0·04; P=0·014), fat-to-lean mass ratio (β=-0·26; 95 % CI -0·46, -0·05; P=0·016) and lower fat mass index (β=-0·23; 95 % CI -0·45, -0·004; P=0·046) after multivariate adjustment. No association was found between NZDQI-A and BMI, waist circumference or waist-to-height ratio. Diet quality, as measured by NZDQI-A, was associated only with measures of body fat, not measures of overall body size. Measures specific to body fat should be used for more accurate ascertainment of body composition in examining the diet-body composition associations in this age group.