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BACKGROUND: The EAT-Lancet Commission proposed a global reference diet to promote healthy diets within planetary boundaries. Studies evaluating the associations between the reference diet with health outcomes among adolescents are scarce. Thus, our aim was to assess the association between adherence to the EAT-Lancet diet and cardiovascular health among European adolescents. METHODS: Data from the HELENA study were used. Usual dietary intake was assessed using two 24-h dietary recalls and adherence to the EAT-Lancet diet was assessed using the Planetary Health Diet Index (PHDI), a 16-component index that ranges from 0 to 150 points. Cardiovascular health was assessed through the seven-component Ideal Cardiovascular Health (ICH) score: never smoked, eutrophic body mass index, moderate-to-vigorous physical activity, healthy dietary pattern, low blood pressure, low fasting plasma glucose, and low total cholesterol. Total ICH score was categorized into ideal (5-7) and non-ideal (0-4). RESULTS: A 10-point increment in the PHDI was associated with a lower probability of a non-ideal ICH status (OR 0.84, [95% CI: 0.75, 0.94]) among European adolescents, after adjusting for age, sex, socio-economic status, and total energy intake. Furthermore, a 10-point increment in the PHDI was associated with lower probability of high blood pressure (OR: 0.87 [0.79, 0.96]) and a lower probability of high blood cholesterol (OR: 0.88 [0.78, 0.99]). CONCLUSION: Our study suggests that a higher PHDI may be associated with a better cardiovascular health status among European adolescents.
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Dieta , Ingestão de Energia , Humanos , Adolescente , Índice de Massa Corporal , Dieta Saudável , ColesterolRESUMO
BACKGROUND AND AIMS: Blood 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 RESULTS: The 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. CONCLUSION: TG/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.
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Hipertensão , Resistência à Insulina , Feminino , Humanos , Masculino , Adolescente , Estudos Transversais , Triglicerídeos , Índice de Massa Corporal , BiomarcadoresRESUMO
Obesity in children and adolescents is a public health problem and diet can play a major role in this condition. We aimed to identify sex-specific dietary patterns (DP) and to evaluate the association with overweight/obesity in European adolescents. We conducted a cross-sectional analysis with 2327 adolescents aged between 12.5 to 17.5 years from a multicenter study across Europe. The body mass index was categorized in "normal weight" and "overweight/obesity". Two non-consecutive 24-h dietary recalls were collected with a computerized self-reported software. Principal component factor analysis was used to identify DP. Mixed-effect logistic regression models were used to evaluate the association between the sex-specific DP and overweight/obesity outcome. As a result, we found three DP in boys (snacking and bread, Mediterranean diet, and breakfast) and four DP in girls (convenience, plant-based and eggs, Western, and breakfast). The association between DP and overweight/obesity highlights that those adolescents with higher adherence to the breakfast DP had lower odds for overweight/obesity, even after the inclusion of covariables in the adjustments. In European adolescents, the breakfast DP positively characterized by breakfast cereals, fruit, milk, and dairy and negatively characterized by sugar-sweetened beverages in boys and negatively characterized by cereals (pasta, rice, and others) in girls, was inversely associated with overweight/obesity.
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OBJECTIVE: To analyse the Nutritional Knowledge Test (NKT) using Item Response Theory (ITR) analysis and to assess the construct validity of the Nutritional Knowledge Scale (NKTS) and its associations with adolescent food group consumption and nutritional biomarkers. DESIGN: Cross-sectional study. SETTING: Multicentre investigation conducted in ten European cities.ParticipantsAdolescents aged 12·5-17·5 years (n 3215) who completed over 75 % of the NKT. RESULTS: Factor analysis indicated that the NKT can be analysed with a one-dimensional model. Eleven out of twenty-three items from the NKT presented adequate parameters and were selected to be included in the NKTS. Nutrition knowledge was positively associated with consumption of fruits, cereals, dairy products, pulses, meat and eggs, and fish, as well as with blood concentrations of vitamin C, ß-carotene, n-3 fatty acids, holo-transcobalamin, cobalamin and folate; nutrition knowledge was negatively associated with intake of olives and avocado, alcohol and savoury snacks. CONCLUSIONS: The NKTS assessed nutritional knowledge adequately and it is proposed as a new tool to investigate this subject in future studies.
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Dieta/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Avaliação Nutricional , Adolescente , Criança , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Estado Nutricional , Psicometria/métodos , Psicometria/normasRESUMO
Stress increases inflammation but whether adherence to Mediterranean diet counteracts this association and how early can these effects be observed is not well known. We tested whether (1) cortisol is associated to inflammation, (2) cortisol is associated to the adolescent Mediterranean diet score (aMDS), (3) aMDS lessens inflammation, (4) aMDS associates with cortisol levels and inflammation. Two hundred and forty-two adolescents (137 females; 12.5â»17.5 years old) provided salivary cortisol, blood and 2-day 24-h dietary recall from which aMDS was derived. Cortisol levels were associated with increased tumor necrosis factor (TNF-α B = 11.887, p = 0.001) when adjusted for age, gender, parental education and body mass index (BMI). Moreover, cortisol levels were inversely associated to adherence to the Mediterranean Diet (B = -1.023, p = 0.002). Adolescents with higher adherence to aMDS had lower levels of interleukins (IL) IL-1, IL-2, IL-6 and TNF-α, compared to those who did not adhere. The association between cortisol and TNF-α was no longer significant when aMDS was included in the model (B = 6.118, p = 0.139). In addition, comparing lower and higher aMDS groups, the association between cortisol and TNF-α was only observed in those with lower aMDS adherence. Our study suggests that adherence to the Mediterranean Diet may counteract the effect of stress on inflammatory biomarkers which may contribute to decreasing the risk of future mental health.
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Dieta Mediterrânea , Hidrocortisona/metabolismo , Mediadores da Inflamação/metabolismo , Estresse Fisiológico/fisiologia , Estresse Psicológico/fisiopatologia , Adolescente , Biomarcadores/metabolismo , Criança , Registros de Dieta , Europa (Continente) , Feminino , Humanos , Inflamação , Masculino , Fatores de Proteção , Saliva/metabolismo , Fator de Necrose Tumoral alfa/sangueRESUMO
Background Adolescents having early puberty (EP) are more likely to have obesity and increased cardiometabolic and inflammatory markers and atherosclerosis risk. We aimed to assess the indirect and mediated effects of leptin and adiposity on the relation between EP and cardiometabolic and inflammatory markers in European adolescents. Methods A sample of 511 adolescents with EP (12.5-17.5 years) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study was studied. To assess whether leptin levels and adiposity mediate the relation between EP and several biomarkers, linear regression models for mediation analyses were performed. Results EP was positively associated with the atherogenic index (Ath-I) (ß=0.174; 95%CI 0.029-0.265) and negatively associated with the C-reactive protein (CRP) (ß=-0.284; 95%CI -0.542 to -0.028) in girls. These associations were fully mediated by leptin levels (9.5%) and adiposity (44%), respectively. Moreover, EP has indirect effects on the apolipoprotein A-1 (ApoA-1) levels through adiposity in girls (for body mass index [BMI], ß=0.014; 95%CI 0.005-0.028, and for waist circumference [WC], ß=0.011; 95%CI 0.003-0.024), and on ApoA-1 (ß=0.012; 95%CI 0.004-0.025), apolipoprotein B (ApoB) (ß=-0.004; 95%CI -0.011 to -0.0004) and CRP (ß=-0.265; 95%CI -0.819 to -0.047) through abdominal fat in boys. Conclusions Leptin levels and adiposity seem to play an important indirect and mediation role in the association between EP and cardiometabolic and inflammatory markers in adolescents. Weight control should be recommended in order to control the impaired cardiometabolic and inflammatory status arising in early pubertal adolescents.
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Adiposidade/fisiologia , Índice de Massa Corporal , Leptina/sangue , Puberdade Precoce/sangue , Puberdade/sangue , Circunferência da Cintura/fisiologia , Adolescente , Apolipoproteína A-I/sangue , Biomarcadores , Proteína C-Reativa/metabolismo , Criança , Estudos Transversais , Europa (Continente) , Feminino , Humanos , Masculino , Puberdade Precoce/fisiopatologiaRESUMO
Associations between dietary patterns (DP) and socioeconomic factors have been little explored in adolescents. The aim of this study was to identify DP in European and Brazilian adolescents and to investigate their associations with a range of socioeconomic indicators. Adolescents from the HELENA-study and the Household Budget Survey were analyzed. Factor analysis was used to obtain DP. Linear regression was used to examine the association between DP and SES. In Europeans, the Western DP was associated with low education of the mother, high socioeconomic status (boys), older age (boys), and living in cities of the Northern Europe; in Brazilians, the Western DP was associated with high secondary education of the mother, high socioeconomic status and living in Southern areas of the country. The Traditional European DP, in both genders, was associated with high secondary education of the mother and inversely associated with a high socioeconomic status; the Traditional Brazilian DP, was associated with university level education of the mother and older age (boys). The association between DP and socioeconomic factors is relevant for the understanding of food-related practices and highlight the importance of performing a complete assessment of the socioeconomic influence in adolescent's DP from developed and developing countries.
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Comportamento do Adolescente , Ingestão de Alimentos , Comportamento Alimentar , Fatores Socioeconômicos , Adolescente , Brasil , Escolaridade , Europa (Continente) , Pai , Feminino , Humanos , Modelos Lineares , Masculino , Mães , Ocupações , Análise de Componente Principal , Características de ResidênciaRESUMO
The objective of this study was to identify clustering patterns of four energy balance-related behaviors (EBRB): television (TV) watching, moderate and vigorous physical activity (MVPA), consumption of fruits and vegetables (F&V), and consumption of sugar-sweetened beverages (SSB), among European and Brazilian adolescents. EBRB associations with different body fat composition indicators were then evaluated. Participants included adolescents from eight European countries in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescents) study (n = 2,057, 53.8% female; age: 12.5-17.5 years) and from the metropolitan region of Rio de Janeiro/Brazil in the ELANA study (the Adolescent Nutritional Assessment Longitudinal Study) (n = 968, 53.2% female; age: 13.5-19 years). EBRB data allowed for sex- and study-specific clusters. Associations were estimated by ANOVA and odds ratios. Five clustering patterns were identified. Four similar clusters were identified for each sex and study. Among boys, different cluster identified was characterized by high F&V consumption in the HELENA study and high TV watching and high MVPA time in the ELANA study. Among girls, the different clusters identified was characterized by high F&V consumption in both studies and, additionally, high SSB consumption in the ELANA study. Regression analysis showed that clusters characterized by high SSB consumption in European boys; high TV watching, and high TV watching plus high MVPA in Brazilian boys; and high MVPA, and high SSB and F&V consumption in Brazilian girls, were positively associated with different body fat composition indicators. Common clusters were observed in adolescents from Europe and Brazil, however, no cluster was identified as being completely healthy or unhealthy. Each cluster seems to impact on body composition indicators, depending on the group. Public health actions should aim to promote adequate practices of EBRB.
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Composição Corporal , Comportamentos Relacionados com a Saúde , Obesidade Infantil/epidemiologia , Adolescente , Comportamento do Adolescente , Índice de Massa Corporal , Peso Corporal , Brasil , Análise por Conglomerados , Estudos Transversais , Dieta , Metabolismo Energético , Exercício Físico , Feminino , Frutas , Humanos , Estudos Longitudinais , Masculino , Avaliação Nutricional , Inquéritos Nutricionais , Comportamento Sedentário , Fatores Socioeconômicos , Inquéritos e Questionários , Televisão , Verduras , Circunferência da Cintura , Adulto JovemRESUMO
BACKGROUD: Several lifestyle-related behaviors are associated with cardiovascular health outcomes in adolescents. To examine the associations between clustered lifestyle-related behaviors and blood pressure (BP) levels in adolescents. METHODS: Participants were recruited by multistage random cluster in two cross-sectional studies; one conducted in 2006 and 2007 in ten cities from nine European countries: Athens and Heraklion in Greece, Dortmund in Germany, Ghent in Belgium, Lille in France, Pécs in Hungary, Rome in Italy, Stockholm in Sweden, Vienna in Austria, and Zaragoza in Spain; and another conducted in 2007 one city in Brazil (Maringá/PR). Systolic BP (SBP) and diastolic BP (DBP) (outcomes) and clustered behaviors (weekly consumption of fruits and vegetables, weekly consumption of sugar-sweetened beverages, sleep duration, screen time and physical activity) were analyzed. RESULTS: The Healthy Eating cluster was negatively associated with DBP in European girls, ß=-2.46 (-4.62; -0.30), and with SBP in Brazilian boys, ß=-2.79 (-3.10; -0.15). Furthermore, the Unhealthy Eating cluster was associated with increased SBP in European girls, ß=4.54 (1.29; 7.79), and in Brazilian boys, ß=4.10 (0.80; 7.40). CONCLUSION: The Healthy Eating cluster was associated with lower blood pressure, whereas the Unhealthy Eating cluster was associated with increased SBP in adolescents.
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Pressão Sanguínea/fisiologia , Comportamento Alimentar , Estilo de Vida , Adolescente , Comportamento do Adolescente , Brasil , Criança , Estudos Transversais , Europa (Continente) , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Fatores Sexuais , Fatores SocioeconômicosRESUMO
OBJECTIVE: To assess the relationships among physical activity, measured objectively, and attention capacity in European adolescents. STUDY DESIGN: The study included 273 adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Participants wore a uniaxial accelerometer for 7 days to measure physical activity. The d2 Test of Attention was administered to assess attention capacity. Multivariate analyses were used to study the association of attention capacity with each measure of physical activity. Receiver operating characteristic analysis was performed to determine thresholds that best discriminate between low and good attention capacity. RESULTS: After controlling for potential confounding variables (age, sex, body mass index, parental educational level, fat mass, aerobic fitness, and center), adolescents' attention capacity test performances were significantly and positively associated with longer time spent in moderate or moderate-to-vigorous physical activity (MVPA) in free-living conditions (P < .05). Receiver operating characteristic curve analyses revealed that the physical activity thresholds that best discriminated between low/good attention capacities were ≥41 min·day(-1) for moderate, ≥12 min·day(-1) for vigorous, and ≥58 min·day(-1) for MVPA. CONCLUSION: These findings suggest that promoting MVPA may be have a beneficial effect on attention capacity, an important component of cognition, in adolescents.
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Atenção , Atividade Motora , Adolescente , Criança , Estudos Transversais , Exercício Físico , Feminino , Humanos , MasculinoRESUMO
We hypothesized that physical activity and sedentary behavior could modify the associations between known genetic variants blood pressure-associated genes in European adolescents. Meeting current physical activity recommendations (≥ 60 minutes/day) was able attenuate the deleterious effect of the NOS3 rs3918227 polymorphism on systolic blood pressure in European adolescents.
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Pressão Sanguínea/genética , Exercício Físico/fisiologia , Hipertensão/genética , Óxido Nítrico Sintase Tipo III/genética , Polimorfismo de Nucleotídeo Único , Adolescente , Determinação da Pressão Arterial , Metabolismo Energético , Feminino , Humanos , Hipertensão/etiologia , Estilo de Vida , Masculino , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Polimorfismo Genético , População Branca/genéticaRESUMO
OBJECTIVE: To test whether youths who engage in vigorous physical activity are more likely to have lean bodies while ingesting relatively large amounts of energy. For this purpose, we studied the associations of both physical activity and adiposity with energy intake in adolescents. STUDY DESIGN: The study subjects were adolescents who participated in 1 of 2 cross-sectional studies, the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study (n = 1450; mean age, 14.6 years) or the European Youth Heart Study (EYHS; n = 321; mean age, 15.6 years). Physical activity was measured by accelerometry, and energy intake was measured by 24-hour recall. In the HELENA study, body composition was assessed by 2 or more of the following methods: skinfold thickness, bioelectrical impedance analysis, plus dual-energy X-ray absorptiometry or air-displacement plethysmography in a subsample. In the EYHS, body composition was assessed by skinfold thickness. RESULTS: Fat mass was inversely associated with energy intake in both studies and using 4 different measurement methods (P ≤ .006). Overall, fat-free mass was positively associated with energy intake in both studies, yet the results were not consistent across measurement methods in the HELENA study. Vigorous physical activity in the HELENA study (P < .05) and moderate physical activity in the EYHS (P < .01) were positively associated with energy intake. Overall, results remained unchanged after adjustment for potential confounding factors, after mutual adjustment among the main exposures (physical activity and fat mass), and after the elimination of obese subjects, who might tend to underreport energy intake, from the analyses. CONCLUSION: Our data are consistent with the hypothesis that more physically active and leaner adolescents have higher energy intake than less active adolescents with larger amounts of fat mass.
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Adiposidade/fisiologia , Ingestão de Energia/fisiologia , Estilo de Vida , Atividade Motora/fisiologia , Estado Nutricional , Adolescente , Índice de Massa Corporal , Criança , Estudos Transversais , Europa (Continente) , Feminino , Humanos , MasculinoRESUMO
OBJECTIVES: To examine the independent and combined association of physical activity (PA) and sedentary behavior (SB) on both systolic (SBP) and diastolic blood pressure (DBP) in adolescents from two observational studies. METHODS: Participants from two cross-sectional studies, one conducted in Europe (n = 3,308; HELENA study) and the other in Brazil (n = 991; BRACAH study), were selected by complex sampling. Systolic and diastolic blood pressure (outcomes), PA and SB, both independently and combined, and potential confounders were analyzed. Associations were examined by multilevel linear regression. RESULTS: Performing the recommended amount of PA (≥ 60 min/d) attenuated the effect of SB on DBP in BRACAH study girls and in boys from both studies. In contrast, PA did not attenuate the effects of SB on the SBP of girls in the HELENA study. The combination of less than recommended levels of PA with 2-4 h/d of sedentary behavior was found to be associated with increased SBP in boys from both studies. CONCLUSIONS: Meeting current PA recommendations could mediate the association between SB and DBP in both sexes. In boys, the joint effect of low levels of PA and excessive sedentary activity increases SBP levels. Longitudinal studies are required to confirm these findings.