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

Summary: Dietary scores, rather than individual nutrients, allow exploring associations between overall diet and bone health. The aim of the present study was to assess the associations between the Mediterranean Diet Score for Adolescents (MDS-A) and the Diet Quality Index for Adolescents (DQI-A) and bone mineral content (BMC) among Spanish adolescents. Our results do not support an association between dietary scores or indices and BMC in adolescents. Introduction: To assess the associations between the MDS-A and a DQI-A with the BMC measured with dual-energy X-ray absorptiometry. Methods: 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. Results: 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. Conclusion: An overall dietary score or index is not associated with BMC in our adolescent Spanish sample

Correlates of ideal cardiovascular health in European adolescents: The HELENA study

Background and aims: The ideal cardiovascular health (iCVH) construct consists of 4 health behaviors (smoking status, body mass index, physical activity and diet) and 3 health factors (total cholesterol, blood pressure and fasting glucose). A greater number of iCVH components in adolescence are related to better cardiovascular health, but little is known about the correlates of iCVH in adolescents. Thus, the aim of the study was to examine correlates of iCVH in European adolescents. Methods and results: The study comprised 637 European adolescents with complete iCVH data. Participants were part of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional, multicenter study conducted in 9 different European countries. Correlates investigated were sex and age, family affluence scale, maternal education, geographic location, sleep time, television viewing, duration of pregnancy, birth weight and breastfeeding. Younger adolescents, those whose mothers had medium/high education or those whowatched television less than 2 h per day had a greater number of iCVH components compared to those who were older, had a mother with low education or watched television 2 h or more daily (P <= 0.01). Conclusion: Since in our study older adolescents had worse iCVH than younger adolescents, early promotion of cardiovascular health may be important. Future studies mayalso investigate the usefulness of limiting television viewing to promote iCVH. Finally, since adolescents of mothers with low education had poorer iCVH, it may be of special interest to tailor public health promotion to adolescents from families with low socioeconomic status

Prospective physical fitness status and development of cardiometabolic risk in children according to body fat and lifestyle behaviours: The IDEFICS study

Background: Elevated cardiometabolic risk (CMR) is an important factor for cardiovascular diseases later in life while physical fitness seems to decrease CMR. Objective: Thus, the aim of the present study is to assess the association between muscular fitness (MF) and cardiorespiratory fitness (CRF) on CMR in European children, both cross-sectional and longitudinally. Methods: A total of 289 children (49.5% males) from eight European countries, aged 6 to 9, with longitudinal information on blood pressure, triglycerides, total cholesterol, HDL-cholesterol, homoeostasis model assessment, body mass index, data on fitness level, objectively measured physical activity (PA), diet quality, and total screen time were included. A CMR score was calculated and dichotomized. MF and CRF were also dichotomized. Cross-sectional and longitudinal multilevel logistic regressions adjusting for lifestyle behaviours were performed. Results: Reaching a high level of MF during childhood as well as remaining in that level over-time were associated with an 82% and 62% lower probability of high CMR at follow-up, respectively. Also, children who became top CRF over time, showed a 77% lower probability (P < 0.05) of being in the highest CMR quartile at follow-up, independently of sociodemographic and lifestyle indicators. Conclusions: A high MF at early childhood and during childhood reduces the odds of having CMR. Same occurs with the improvement of CRF during childhood. These findings highlight the importance of enhancing fitness to avoid CMR already in children. © 2021 The Authors. Pediatric Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation

Inflammation and insulin resistance according to body composition in European adolescents: the HELENA study

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Open access journalIntroduction: Inflammation is related to insulin resistance in adults, especially on those individuals with high levels of body composition. Objectives: The aim of this study is to assess the relationship between a set of inflammatory biomarkers and insulin resistance by levels of body composition in a sample of European adolescents. Material and methods: 962 adolescents (442 boys and 520 girls) from 9 European countries met the inclusion criteria of having measurements for the homeostasis model assessment (HOMA) and a set of inflammation-related biomarkers: C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin (IL-6), complement factors C3 and C4 and selected cell adhesion molecules. Body mass index (BMI), fat mass index (FMI) and waist circumference (WC) were categorized using tertiles. To assess the associations stratifying by body composition indexes, ANOVA and linear regression models were performed Results: Mean biomarkers’ concentrations differed across BMI, FMI and WC tertiles (p<0.05), by sex. In both sexes, insulin, HOMA, CRP, C3 and C4 were significantly different between categories (p<0.001), always showing the highest mean concentration in the upper category of BMI, FMI and WC. The most consistent finding was an association between insulin resistance and C3 concentrations (p<0.05), in the adolescents in the highest tertile of BMI, FMI and WC, except in the case of FMI in girls. Conclusion: Inflammatory and glucose metabolism markers differed by tertiles of body composition, being usually higher in the highest tertile. C3 complement factor was associated with insulin resistance in adolescents, especially those with high total and abdominal adiposity

Ideal cardiovascular health and inflammation in European adolescents: The HELENA study

Background and aims Inflammation plays a key role in atherosclerosis and this process seems to appear in childhood. The ideal cardiovascular health index (ICHI) has been inversely related to atherosclerotic plaque in adults. However, evidence regarding inflammation and ICHI in adolescents is scarce. The aim is to assess the association between ICHI and inflammation in European adolescents. Methods and results As many as 543 adolescents (251 boys and 292 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional multi-center study including 9 European countries, were measured. C-reactive protein (CRP), complement factors C3 and C4, leptin and white blood cell counts were used to compute an inflammatory score. Multilevel linear models and multilevel logistic regression were used to assess the association between ICHI and inflammation controlling by covariates. Higher ICHI was associated with a lower inflammatory score, as well as with several individual components, both in boys and girls (p < 0.01). In addition, adolescents with at least 4 ideal components of the ICHI had significantly lower inflammatory score and lower levels of the study biomarkers, except CRP. Finally, the multilevel logistic regression showed that for every unit increase in the ICHI, the probability of having an inflammatory profile decreased by 28.1% in girls. Conclusion Results from this study suggest that a better ICHI is associated with a lower inflammatory profile already in adolescence. Improving these health behaviors, and health factors included in the ICHI, could play an important role in CVD prevention

Longitudinal determinants of 12-month changes on bone health in adolescent male athletes

Summary: We identified the determinants of 12-month changes of areal bone mineral density (aBMD), hip geometry and trabecular bone score (TBS) in adolescent male athletes. Changes in region-specific lean mass and the type of sport are the most consistent determinants in this population. Purpose: This study aims to identify the determinants of 12-month changes of areal bone mineral density (aBMD), hip geometry and trabecular bone score (TBS) in adolescent male athletes. Methods: The sample was 104 adolescent males aged 12–14 years at baseline that were followed over 12 months: 39 swimmers, 37 footballers (or soccer players) and 28 cyclists. Dual-energy X-ray absorptiometry measured aBMD at the whole body, lumbar spine and dual hip. Hip geometry estimates at the femoral neck were measured using hip structural analysis. Lumbar spine texture was measured by TBS. Results: Multivariate regression models significantly explained 38–60% of the variance in the aBMD changes, 36–62% in the hip geometry estimates changes and 45% in the TBS changes. Δregion-specific lean mass was the most consistent predictor of changes in aBMD outcomes (β = 0.591 to 0.696), followed by cycling participation (β = − 0.233 to − 0.262), swimming participation (β = − 0.315 to − 0.336) and ΔMVPA (β = 0.165). Cycling participation was the most consistent predictor of changes in hip geometry estimates (β = − 0.174 to − 0.268), followed by Δregion-specific lean mass (β = 0.587) and Δcardiorespiratory fitness (β = 0.253). Finally, cycling and swimming participation (β = − 0.347 to − 0.453), Δregion-specific lean mass (β = 0.848) and Δstature (β = 0.720) were predictors of change in TBS. Conclusions: Changes in region-specific lean mass and the type of sport are the most consistent determinants of 12-month changes in aBMD, hip geometry estimates and TBS in adolescent male athletes. Trial registration: ISRCTN17982776. © 2018, The Author(s)

The Impact of Sport Participation on Bone Mass and Geometry in Male Adolescents

Purpose Exercise is an effective approach for developing bone mass and adolescence is a key period to optimize bone health. However, sports-specific training may have different effects on bone outcomes. This study examined the differences on bone outcomes between osteogenic (football) and nonosteogenic (swimming and cycling) sports and a control group in male adolescents. Methods One hundred twenty one males (13.1 ± 0.1 yr) were measured: 41 swimmers, 37 footballers, 29 cyclists, and 14 controls. Dual energy X-ray absorptiometry measured bone mineral density (BMD) and bone mineral content at lumbar spine, right and left hip, and total body. Hip Structural Analysis evaluated bone geometry at the femoral neck. Quantitative ultrasound evaluated bone stiffness at both feet. Results Footballers had significantly higher BMD at total body less head (7%-9%), total hip (12%-21%), and legs (7%-11%) compared with all groups and significantly higher BMD at the femoral neck than controls (14%). Cyclists had higher BMD at the trochanter (10%) and bone mineral content at the arms (10%) compared with controls. Geometrical analysis showed that footballers had significantly higher cross-sectional area (8%-19%) compared with all groups, cross-sectional moment of inertia (17%) compared with controls and section modulus compared with cyclists (11%) and controls (21%). Footballers had significantly higher bone stiffness compared with all groups (10%-20%) at the dominant foot and (12%-13%) at the nondominant foot compared with swimmers and controls. Conclusions Adolescent male footballers exhibited higher bone density, geometry, and stiffness compared with swimmers, cyclists and controls. Although swimmers and cyclists had higher bone outcomes compared with controls, these differences were not significant. © 2016 by the American College of Sports Medicine

Determinants of Bone Outcomes in Adolescent Athletes at Baseline: The PRO-BONE Study

Purpose The determinants of areal bone mineral density (aBMD) and hip geometry estimates in adolescent athletes are poorly understood. This study aimed to identify the determinants of aBMD and hip geometry estimates in adolescent male athletes. Methods One hundred twenty-one men (13.1 ± 0.1 yr) were measured: 41 swimmers, 37 footballers, 29 cyclists, and 14 controls. Dual energy X-ray absorptiometry measured aBMD at lumbar spine, femoral neck and total body. Hip structural analysis evaluated hip geometry estimates at the femoral neck. Multiple linear regression examined the contribution of the sports practised, stature, lean and fat mass, serum calcium and vitamin D, moderate to vigorous physical activity, vertical jump and cardiorespiratory fitness with aBMD and hip geometry estimates. Results Region-specific lean mass was the strongest positive predictor of aBMD (β = 0.614-0.931) and football participation was the next strongest predictor (β = 0.304-0.579). Stature (β = 0.235-0.380), fat mass (β = 0.189), serum calcium (β = 0.103), serum vitamin D (β = 0.104-0.139), and vertical jump (β = 0.146-0.203) were associated with aBMD across various specific sites. All hip geometry estimates were associated with lean mass (β = 0.370 - 0.568) and stature (β = 0.338-0.430). Football participation was associated with hip cross-sectional area (β = 0.322) and moderate to vigorous physical activity (β = 0.140-0.142). Cardiorespiratory fitness (β = 0.183-0.207) was associated with section modulus and cross-sectional moment of inertia. Conclusions Region-specific lean mass is the strongest determinant of aBMD and hip geometry estimates in adolescent male athletes. Football participation and stature were important determinants for aBMD and hip geometry estimates, whereas the contribution of the other predictors was site specific. © 2017 by the American College of Sports Medicine

Prospective BMI changes in preschool children are not effected by changes in EBRBs but by parental characteristics and body weight perceptions: The ToyBox-study.

Objective: To examine the effect of the intervention implemented in the ToyBox study on changes observed in age and sex specific BMI percentile and investigate the role of perinatal factors, parental perceptions and characteristics on this change. Design: A multicomponent, kindergarten-based, family-involved intervention with a cluster-randomized design. A standardized protocol was used to measure children’s body weight and height. Information was also collected from parents/caregivers via the use of validated questionnaires. Linear mixed effect models with random intercept for country, socioeconomic status and school were used. Setting: Selected preschools within the provinces of Oost-Flanders and West-Flanders (Belgium), Varna (Bulgaria), Bavaria (Germany), Attica (Greece), Mazowieckie (Poland) and Zaragoza (Spain). Participants: A sample of 6, 268 pre-schoolers aged 3.5-5.5 (51.9% boys). Results: There was no intervention effect on the change in children’s BMI percentile. However, parents’ underestimation of their children’s actual weight status, parental overweight and mothers’ pre-pregnancy overweight/obesity were found to be significantly and independently associated with increases in children’s BMI percentile in multivariate modelling. Conclusion: Before or as part of the implementation of any childhood obesity intervention initiative, it is important to assist parents/caregivers to correctly perceive their own and their children’s weight status. Recognition of excessive weight by parents/caregivers can increase their readiness to change and as such facilitate higher adherence to favourable behavioural changes within the family. © 2021 Lippincott Williams and Wilkins. All rights reserved

Prospective BMI changes in preschool children are associated with parental characteristics and body weight perceptions: the ToyBox-study

Objective: To examine the effect of the intervention implemented in the ToyBox-study on changes observed in age- and sex-specific BMI percentile and investigate the role of perinatal factors, parental perceptions and characteristics on this change. Design: A multicomponent, kindergarten-based, family-involved intervention with a cluster-randomised design. A standardised protocol was used to measure children's body weight and height. Information was also collected from parents/caregivers via the use of validated questionnaires. Linear mixed effect models with random intercept for country, socio-economic status and school were used. Setting: Selected preschools within the provinces of Oost-Flanders and West-Flanders (Belgium), Varna (Bulgaria), Bavaria (Germany), Attica (Greece), Mazowieckie (Poland) and Zaragoza (Spain). Participants: A sample of 6268 preschoolers aged 3·5-5·5 years (51·9 % boys). Results: There was no intervention effect on the change in children's BMI percentile. However, parents' underestimation of their children's actual weight status, parental overweight and mothers' pre-pregnancy overweight/obesity were found to be significantly and independently associated with increases in children's BMI percentile in multivariate modelling. Conclusions: As part of a wide public health initiative or as part of a counseling intervention programme, it is important to assist parents/caregivers to correctly perceive their own and their children's weight status. Recognition of excessive weight by parents/caregivers can increase their readiness to change and as such facilitate higher adherence to favourable behavioural changes within the family.