Lifestyle In Europe Research Articles

Estimated Dietary Intakes of Vitamin A5

Background: A new vitamin concept, termed vitamin A5, an umbrella term for vitamin A derivatives being direct nutritional precursors for 9-cis-13,14-dihydroretinoic acid and further induction of RXR-signaling, was recently identified with global importance for mental health and healthy brain and nerve functions. Dietary recommendations in the range of 1.1 (0.5–1.8) mg vitamin A5 / day were suggested by an international expert consortium. The ensuing question arises as to the current daily dietary intake amounts in Western civilization. Methods: Addressing this answer included calculating the intake based on known amounts of vitamin A5 in frequently consumed food items of the human diet that are high in this vitamin, as well as the known daily dietary intake amounts of those selected food components in Westernized countries. Results: Regarding food items, amounts of vitamin A5 in the form of provitamin A5 (i.e., 9-cis-beta-carotene (9CBC)), the predominant form in the diet, were found to range from 0.1 to 39 µg 9CBC / g for individual fruits and vegetables, with the highest concentrations being in leafy vegetables. The average intake amounts of vitamin A5 in adults of the general population following a Western lifestyle in Europe averaged 0.9, with a range from 0.5 (for Austria) to 1.3 (for Italy) mg 9CBC/day. Furthermore, based on our calculations, large parts, i.e., approximately two-thirds, of the population are low, even too low (<1.1 mg/day), in daily vitamin A5 intake. Conclusion: In addition to the importance of nudging the population toward a regrettably non-well-accepted higher intake of fruits and vegetables, an additional fortification and supplementation of vitamin A5 could be considered, similar to other micronutrients that are low in a Westernized diet.

Transforming provisioning systems to enable 1.5° lifestyles in Europe? Expert and stakeholder views on overcoming structural barriers

This article explores the urgent need for transformative change toward provisioning systems that align with staying as close as possible to the Paris Agreement’s 1.5 °C limit for climate change. Despite historical awareness of the need for change, current unsustainable patterns of production and consumption persist, prompting an examination of the role of societal structures in hindering transformative change. Using the framework of provisioning systems, this study analyses expert and stakeholder views on structural barriers and steps to overcome them. Based on 36 expert interviews and Stakeholder Thinking Labs with 113 participants in five European Union case countries, the study identifies and discusses seven key structural barriers that affect the sustainability of provisioning systems for food, mobility, housing, and leisure. These barriers include the economic growth paradigm, policy incoherence, vested interests, the externalization of environmental costs, dominant narratives of the good life, inequality, and an insufficient integration of environmental concerns in educational systems. When considering the actualization of these structures in concrete provisioning systems, stakeholders emphasize the need for welfare provision with improved resource efficiency; argue for radical measures such as bans, limits, and taxes to address these challenges; and highlight governance challenges related to participation and power. The analysis underlines the complexity of promoting transformative structural change and the interplay of structures in different provisioning systems, emphasizing the need for a holistic approach to achieve sustainable provisioning systems and 1.5° lifestyles.

The body mass index increases the genetic risk scores' ability to predict risk of hepatic damage in European adolescents: The HELENA study.

Hepatic disorders are often complex and multifactorial, modulated by genetic and environmental determinants. During the last years, the hepatic disease has been progressively established from early stages in life. The use of genetic risk scores (GRS) to predict the genetic susceptibility to a particular phenotype among youth has gained interest in recent years. Moreover, the alanine aminotransferase (ALT) blood biomarker is often considered as hepatic screening tool, in combination with imaging techniques. The aim of the present study was to develop an ALT-specific GRS to help in the evaluation of hepatic damage risk in European adolescents. A total of 972 adolescents (51.3% females), aged 12.5-17.5 years, from the Healthy Lifestyle in Europe by Nutrition in Adolescence study were included in the analyses. The sample incorporated adolescents in all body mass index (BMI) categories and was divided considering healthy/unhealthy ALT levels, using sex-specific cut-off points. From 1212 a priori ALT-related single nucleotide polymorphisms (SNPs) extracted from candidate gene selection, a first screening of 234 SNPs univariately associated was established, selecting seven significant SNPs (p < .05) in the multivariate model. An unweighted GRS (uGRS) was developed by summing the number of reference alleles, and a weighted GRS (wGRS), by multiplying each allele to its estimated coefficient. The uGRS and wGRS were significantly associated with ALT (p < .001). The area under curve was obtained integrating BMI as clinical factor, improving the predictive ability for uGRS (.7039) and wGRS (.7035), using 10-fold internal cross-validation. Considering BMI status, both GRSs could contribute as complementary tools to help in the early diagnosis of hepatic damage risk in European adolescents.

Development of a genetic risk score to predict the risk of hypertension in European adolescents from the HELENA study.

From genome wide association study (GWAS) a large number of single nucleotide polymorphisms (SNPs) have previously been associated with blood pressure (BP) levels. A combination of SNPs, forming a genetic risk score (GRS) could be considered as a useful genetic tool to identify individuals at risk of developing hypertension from early stages in life. Therefore, the aim of our study was to build a GRS being able to predict the genetic predisposition to hypertension (HTN) in European adolescents. Data were extracted from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study. A total of 869 adolescents (53% female), aged 12.5-17.5, with complete genetic and BP information were included. The sample was divided into altered (≥130 mmHg for systolic and/or ≥80 mmHg for diastolic) or normal BP. Based on the literature, a total of 1.534 SNPs from 57 candidate genes related with BP were selected from the HELENA GWAS database. From 1,534 SNPs available, An initial screening of SNPs univariately associated with HTN (p < 0.10) was established, to finally obtain a number of 16 SNPs significantly associated with HTN (p < 0.05) in the multivariate model. The unweighted GRS (uGRS) and weighted GRS (wGRS) were estimated. To validate the GRSs, the area under the curve (AUC) was explored using ten-fold internal cross-validation for uGRS (0.802) and wGRS (0.777). Further covariates of interest were added to the analyses, obtaining a higher predictive ability (AUC values of uGRS: 0.879; wGRS: 0.881 for BMI z-score). Furthermore, the differences between AUCs obtained with and without the addition of covariates were statistically significant (p < 0.05). Both GRSs, the uGRS and wGRS, could be useful to evaluate the predisposition to hypertension in European adolescents.

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.

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. We used cross-sectional data from 1804 adolescents (12.5-17.5years) 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. 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. 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.

New indices in predicting cardiometabolic risk and its relation to endothelial dysfunction in adolescents: The HELENA study

Background and aimsBlood pressure (BP) changes and insulin resistance (IR) are important cardiometabolic risk (CMR) factors; their early identification can contribute to the reduction of cardiovascular events in adulthood. This necessitates the search for more accessible and easily applied indicators for their prediction. Therefore, this study aimed to evaluate the predictive power of the indices, TyG, TG/HDL-c, height-corrected lipid accumulation product (HLAP), and visceral adiposity index (VAI), in identifying the CMR obtained by high BP and IR and to verify their relationship with biomarkers of endothelial dysfunction (ED) in European adolescents. Methods and resultsThe anthropometric data and blood biomarkers of 744 adolescents (343 boys and 401 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS), with a mean age of 14.67 (SD 1.15) years, were assessed. The adolescents were then classified according to the presence or absence of high BP and IR. The cut-off points of the indices evaluated for the identification of CMR were determined. The relationship between CMR diagnosed using these indices and ED biomarkers was tested. The HLAP and TG/HDL-c were fair predictors of CMR obtained by IR in male adolescents. These indices showed association with hsCRP in sVCAM-1 in boys, but it lost significance after adjusting for age and body mass index. ConclusionTG/HDL-c and HLAP indices showed a fair performance in predicting CMR, obtained by IR, in male adolescents. ED showed no association with the CMR identified by the indices.

Food portion sizes and their relationship with energy, and nutrient intakes in adolescents: The HELENA study

ObjectivesThis study aimed to investigate the associations between portion sizes (PSs) from different food groups and energy, as well as nutrient intakes in European adolescents. MethodsA sample of 1631 adolescents (54.2 % girls) were included from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional (HELENA) study. Mean food PS was calculated by dividing the total intake of the items by the number of eating occasions of these consumed items. To determine the key items for analysis, foods were ranked by frequency of consumption. A one-way between-groups analysis of covariance was used to test for significant differences in means across tertiles. A multivariable linear regression analysis was carried out, adjusting for age, sex, maternal education, body mass index, and using country as a level. ResultsEnergy intake increased with elevated intakes of energy-dense foods. Large portions of rice and other grains, starch roots and potatoes, and meat substitutes, nuts, and pulses were associated with increased carbohydrate and fiber intake. Larger portions of cheese and butter and animal fat were significantly associated with a higher fat intake. Lower intakes of some vitamins and micronutrients were noticed with consumption of larger portions of high energy-dense foods, such as desserts and pudding, margarine and vegetable oil, and butter and animal fat. ConclusionsLarge food PSs may be associated with positive energy, as well as macro- and micronutrient intake. Moreover, the findings from this study may help the future development of dietary guidance in general and specific to PSs, and support targeted strategies to address intakes of certain nutrients in European adolescents.

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.

Associations between food portion sizes, insulin resistance, VO2 max and metabolic syndrome in European adolescents: The HELENA study

Background and aimsThis 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. MethodsA 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. ResultsLarger 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). ConclusionThe 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.

Identification of Lifestyle Risk Factors in Adolescence Influencing Cardiovascular Health in Young Adults: The BELINDA Study.

Cardiovascular diseases are the leading cause of mortality worldwide. These diseases originate in childhood, and a better understanding of their early determinants and risk factors would allow better prevention. The BELINDA (BEtter LIfe by Nutrition During Adulthood) study is a 10–14-year follow-up of the HEalthy Lifestyle in Europe by Nutrition in Adolescence study (the HELENA study, a European cross-sectional study in adolescents). The study aims to evaluate cardiovascular risk using the PDAY (Pathobiological Determinants of Atherosclerosis in Youth) risk score during young adulthood (21–32 years), and to examine the impact of risk factors identified during adolescence (12.5–17.5 years). Our secondary objective is to compare the characteristics of the BELINDA study population with the HELENA population not participating in the follow-up study. The HELENA study recruited 3528 adolescents during 2006–2007 and reassessed 232 of them 10–14 years later as young adults. We assessed clinical status, anthropometry, nutrition, physical activity (including sedentary behavior), physical fitness, and mental health parameters, and collected biological samples (blood, stool, and hair). Dietary intake, and physical activity and fitness data were also collected. A multivariable linear regression model will be used for the analysis of the primary outcome. A Chi-square and T-test were conducted for the comparison of the descriptive data (gender, age, weight, height, body mass index (BMI), and maternal school level) between participating and non-participating BELINDA adolescents. When comparing the 1327 eligible subjects with the 232 included in the BELINDA study, no significant differences regarding gender (p = 0.72), age (p = 0.60), height (p = 0.11), and weight (p = 0.083) at adolescence were found. However, the participating population had a lower BMI (20.4 ± 3.1 kg/m2 versus 21.2 ± 3.6 kg/m2; p < 0.001) and a higher maternal educational level (46.8% high school or university level versus 38.6%; p = 0.027) than the HELENA population who did not participate in the BELINDA study. The complete phenotyping obtained at adolescence through the HELENA study is a unique opportunity to identify adolescent risk factors for cardiovascular diseases. This paper will serve as a methodological basis for future analysis of this study.

High Fructose Intake Contributes to Elevated Diastolic Blood Pressure in Adolescent Girls: Results from The HELENA Study.

Background: The association between high fructose consumption and elevated blood pressure continues to be controversial, especially in adolescence. The aim of this study was to assess the association between fructose consumption and elevated blood pressure in an European adolescent population. Methods: A total of 1733 adolescents (mean ± SD age: 14.7 ± 1.2; percentage of girls: 52.8%) were analysed from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study in eight European countries. Blood pressure was measured using validated devices and methods for measuring systolic blood pressure (SBP) and diastolic blood pressure (DBP). Dietary data were recorded via repeated 24 h recalls (using specifically developed HELENA–DIAT software) and converted into pure fructose (monosaccharide form) and total fructose exposure (pure fructose + fructose from sucrose) intake using a specific fructose composition database. Food categories were separated at posteriori in natural vs. were non-natural foods. Elevated BP was defined according to the 90th percentile cut-off values and was compared according to tertiles of fructose intake using univariable and multivariable mixed logistic regression models taking into account confounding factors: centre, sex, age and z-score–BMI, MVPA (Moderate to Vigorous Physical Activity) duration, tobacco consumption, salt intake and energy intake. Results: Pure fructose from non-natural foods was only associated with elevated DBP (DBP above the 10th percentile in the highest consuming girls (OR = 2.27 (1.17–4.40); p = 0.015) after adjustment for cofounding factors. Conclusions: Consuming high quantities of non-natural foods was associated with elevated DBP in adolescent girls, which was in part due to high fructose levels in these foods categories. The consumption of natural foods containing fructose, such as whole fruits, does not impact blood pressure and should continue to remain a healthy dietary habit.

School time is associated with cardiorespiratory fitness in adolescents: The HELENA study

ABSTRACT We assessed the association between school time and physical fitness in adolescents. The study included 2,024 adolescents, aged 12.5–17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Health-related physical fitness components were assessed using the physical fitness tests battery. Cardiovascular risk was categorized using the sex-specific cut-offs for a healthy cardiorespiratory fitness level in adolescents proposed by FitnessGram®. School time was classified as short or long. Multivariate analysis accounted for confounding factors such age, sex, body mass index, time spent in moderate to vigorous physical activity, pubertal status, and parents’ educational level. Cardiorespiratory fitness was higher in adolescents with a long school time than in those with a short school time (42.0 ± 7.6 vs 40.7 ± 7.2 mL.kg–1.min–1, respectively; p < 0.05). The percentage of adolescents at cardiovascular risk in adulthood was higher in the short than in the long time group (45.2% vs 31.7%, respectively) (p < 0.05). These findings suggest that a long school day is associated with higher cardiorespiratory fitness in adolescents and that school time should be considered in interventions and health promotion strategies.

Interplay of physical activity and genetic variants of the endothelial lipase on cardiovascular disease risk factors.

The aim of this study was to investigate the association of endothelial lipase gene (LIPG) polymorphisms with cardiovascular disease (CVD) risk factors in adolescents and their interaction with physical activity. Six polymorphisms of LIPG were genotyped in 1057 European adolescents (12-18 years old) enrolled in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study. CVD risk factors related to lipid profile, blood pressure, adiposity and glucose regulation were recorded. Physical activity was objectively measured by accelerometry. The major C allele of rs2000813, the minor T allele of rs2276269 and the minor G allele of rs9951026 were associated with lower levels of several CVD risk factors related to lipid profile. We also found a significant association of the TTACA LIPG haplotype (rs2000812, rs2000813, rs8093249, rs2276269 and rs9951026) with higher concentrations of low-density cholesterol and apolipoproteinB. Finally, the interaction between physical activity and the polymorphisms rs2000813, rs2276269 and rs9951026 had a significant influence on several CVD risk factors. LIPG polymorphisms were significantly associated with CVD risk factors in European adolescents. Interestingly, alleles of these polymorphisms were associated with a better cardiovascular profile in physically active adolescents only. High physical activity may reduce the development of CVD, modulating its genetic risk. Using gene-phenotype and gene × environment analyses, we detected associations between the endothelial lipase gene and cardiovascular risk factors, along with interactions with physical activity. This study shows that physical activity may modulate the influence of LIPG gene on cardiovascular risk in adolescents. These results bring insights into the mechanisms by which physical activity positively influences CVD in adolescents.

Relationship of cardiorespiratory fitness with screen time and physical activity in adolescents.

To determine the correlation of cardiorespiratory fitness with screen time and physical activity in healthy adolescents. The analytical cross-sectional study was conducted at the Foundation University, Islamabad, Pakistan, from February to July 2019, and comprised healthy adolescents aged 11-17 years of both genders who were enrolled from various schools of Rawalpindi and Islamabad. Cardiorespiratory fitness was evaluated through YMCA 3 min Step test, physical activity levels were evaluated using physical activity questionnaire for adolescents, and screen time was evaluated using Healthy Lifestyle in Europe by Nutrition in Adolescence screen time questionnaire. Data was analysed using SPSS 21. Of the 250 adolescents, 128(51.2%) were males and 122(48.8%) were females. The overall mean age was 14.24±2.177 years (range: 11-17 years). There was no significant correlation between cardiorespiratory fitness and physical activity (p=0.15), and between cardiorespiratory fitness and screen time (p=0.58). There was found to be no significant correlation between cardiorespiratory fitness and physical activity, and between cardiorespiratory fitness and screen time in healthy adolescents.

Application of artificial intelligence based on deep learning in breast cancer screening and imaging diagnosis

In recent years, with the change of lifestyle in Europe and America, the incidence of breast cancer in Chinese women is increasing. In order to find the model of breast cancer image screening and diagnosis with higher accuracy and better classification performance, this paper mainly constructs the breast cancer CT image detection model and the breast cancer screening model based on the convolution and deconvolution neural network (CDNN) through the convolution neural network (CNN). In this paper, the fuzzy C-means clustering algorithm (FCM) is used to improve and optimize the image of breast cancer, and the experimental results are analyzed. The optimized kernel fuzzy C-means clustering algorithm was tested on a common dataset to segment the region of interest more accurately. Our experiments show that the new deep learning model of this paper improves the automatic classification performance of breast cancer. In this paper, the research results of deep learning are applied to the medical field, and a new method based on CNN model for breast cancer screening and diagnosis is proposed, which provides a new idea for improving the artificial intelligence assisted medical diagnosis method.

The Association between Portion Sizes from High-Energy-Dense Foods and Body Composition in European Adolescents: The HELENA Study.

Obesity prevalence has been simultaneously increasing with high consumption of large food portion sizes (PS). However, there is scarce information on PS of energy-dense (ED) foods as a potential risk factor of obesity in adolescents. In the present study, we investigate the association between the PS of the most ED foods and body composition. A sample of 1889 adolescents (54.4% females) from the Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional multicenter study (HELENA–CSS) study were included. Most ED foods (e.g., cheese) were selected according to higher fat and/or sugar content and low fiber and water. Linear and ordinal logistic regression models were adjusted for age, physical activity, total energy intake (TEI), and socioeconomic status (SES). Analysis was performed both in those adolescents reporting plausible energy intake according to the approach of Goldberg et al. and in the whole sample. In male plausible reporters, PS from “breakfast cereals” showed a significant and positive association with BMI (β = 0.012; 0.048). PS from “carbonated soft drinks” in males (OR = 1.001; 95% CI 1.000; 1.002) and “bread and rolls” in females (OR = 1.002; 95% CI 1.000; 1.004) were associated with higher probability of having obesity, while “sweet bakery products” were associated with lower probability of having obesity (OR = 0.996; 95% CI 0.991; 0.999) in females. The present study suggests association between PS of ED foods and obesity in European adolescents. Prospective studies are needed to examine the effect of prolonged exposure to large PS and obesity development.

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

BackgroundDietary 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. ObjectivesTo 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. MethodsTwo 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. ResultsUnderreporting (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. ConclusionsCMR 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.

Development of a Genetic Risk Score to predict the risk of overweight and obesity in European adolescents from the HELENA study

Obesity is the result of interactions between genes and environmental factors. Since monogenic etiology is only known in some obesity-related genes, a genetic risk score (GRS) could be useful to determine the genetic predisposition to obesity. Therefore, the aim of our study was to build a GRS able to predict genetic predisposition to overweight and obesity in European adolescents. A total of 1069 adolescents (51.3% female), aged 11–19 years participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study were genotyped. The sample was divided in non-overweight (non-OW) and overweight/obesity (OW/OB). From 611 single nucleotide polymorphisms (SNP) available, a first screening of 104 SNPs univariately associated with obesity (p < 0.20) was established selecting 21 significant SNPs (p < 0.05) in the multivariate model. Unweighted GRS (uGRS) was calculated by summing the number of risk alleles and weighted GRS (wGRS) by multiplying the risk alleles to each estimated coefficient. The area under curve (AUC) was calculated in uGRS (0.723) and wGRS (0.734) using tenfold internal cross-validation. Both uGRS and wGRS were significantly associated with body mass index (BMI) (p < .001). Both GRSs could potentially be considered as useful genetic tools to evaluate individual’s predisposition to overweight/obesity in European adolescents.

Psychometric properties of 4-item questionnaire for sleep habits and time in a South American paediatric population.

ObjectivesTo assess the psychometric properties of 4-item questionnaire about sleep habits and time in South American children (3-10 years) and adolescents (11-18 years).Material and MethodsWe evaluated 459 participants from seven South American cities. Two items from week and weekend days wake up time and bedtime were asked twice, with a 2-week interval. We calculated time spent in bed (subtracting wake up time from bedtime). Participants also answered the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) sleep time questionnaire.ResultsThe questionnaire showed acceptable temporal stability in children and adolescents on total days (rho≥0.30; p<0.05). For total days, the questionnaire presented acceptable convergent validity only in children (rho from 0.48 to 0.62; p≤0.01) compared with the HELENA questionnaire.ConclusionThe 4-item questionnaire is a reliable and valid tool for children; however, its validity is not consistent in adolescents for sleep habits and time.

Single nucleotide polymorphisms of ADIPOQ gene associated with cardiovascular disease risk factors in European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence study.

Cardiovascular diseases (CVDs) are responsible of 31% of all deaths worldwide. Genetic predisposition to CVDs in adolescents remains largely unknown. Aims of present research are to examine the association of ADIPOQ gene polymorphisms with cardiovascular disease risk factors in European adolescents. A total of 14 polymorphisms in the ADIPOQ gene were genotyped in 1057 European adolescents (12-18 years old) from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study. We measured serum lipids and a CVD risk score, along with weight, height, triceps, and subscapular skinfold thickness, leptin, insulin and other markers of glucose regulation. The rs822393, rs822395 and rs7649121 polymorphisms of ADIPOQ gene were significantly associated with several CVD risk factors [i.e. high-density lipoprotein cholesterol (HDL-C), apolipoprotein (Apo) A1, SBP and CVD risk score] in European adolescents. We also found an association of the TGAAGT ADIPOQ haplotype (rs822393, rs16861210, rs822395, rs822396, rs12495941 and rs7649121) with HDL-C and ApoA1 levels. Several individual polymorphisms (rs822393, rs822395 and rs7649121) and a haplotype of ADIPOQ gene were significantly associated with cardiovascular disease risk factors in European adolescents.