Frequency and quality of mid-afternoon snack among Spanish children

Introduction: There are increasing concerns about the types of foods and beverages consumed by children during mid-afternoon snack in Spain. Aim: To describe the frequency and quality of the mid-afternoon snack in a representative sample of Spanish children. Methods: A total of 1, 233 younger (three to six years) and 1, 618 older (seven to twelve years) children participated in the study. The report of food and beverages consumed per week during the mid-afternoon snack meal (merienda) was obtained by an online platform. Results: An 84.4% of younger and 78.3% of older children were mid-afternoon snack consumers. Regular consumers were more likely to be from the South and the Centre regions. Sandwich was the most consumed food item among younger (49.5%) and older (59.7%) consumers; 46.5% of mid-afternoon snacks contained two food items among younger children, and 50.1% of mid-afternoon snacks contained one food item among older children. “Fruit”, “milk and biscuits”, and “fruit, biscuits and juices” were the most consumed combinations when considering one, two and three or more food items during one-time mid-afternoon occasion, respectively. Conclusions: The frequency of mid-afternoon snack occasions and the number and quality of food items consumed during one-time mid-afternoon snack occasion decrease with age. Spanish children should increase the frequency of mid-afternoon snack consumption and include healthy options in their menus. Longitudinal and intervention studies are needed to address the health impact of snacking and how to use this meal occasion to balance children’s diets

Food portion sizes, obesity, and related metabolic complications in children and adolescents [Tamaño de las porciones de alimentos, obesidad y complicaciones metabólicas asociadas en niños y adolescentes]

The purpose of this narrative review is to provide evidence for the impact of food portion sizes on the development of obesity in children and adolescents. Strategies are needed on portion size estimation and on the relationship of portion size with certain health problems such as obesity, insulin resistance, and emotional eating in all age groups, in order to provide information for parents, teachers, and health professionals aiming to promote healthy eating. A wide range of controlled laboratory studies have found that portion size (PS) had the strongest effect on the amount of food consumed. The effect of PS on total energy intake has been already observed with different types of foods and beverages, especially with energy-dense foods. The influence of large PS was persistent and happened regardless of demographic characteristics such as age, gender, income level, or body mass index. Although a direct causal link between PS and obesity remains controversial, some health and dietetics organi-zations recommend to moderate PS, especially for energy-dense foods. Research studies in both laboratory and free-living contexts are needed to determine the causal link between increased PS, obesity, and related metabolic complications in children and adolescents

Effectiveness and process evaluation in obesity and type 2 diabetes prevention programs in children: a systematic review and meta-analysis

Background: Obesity in children is one of the most severe public health challenges of the current century and Type 2 Diabetes Mellitus (T2DM) frequency is also escalating. More so, the importance of process evaluation (PE) in complex interventions is increasingly recognized. The present review, aims to identify the effectiveness in terms of body composition parameters in a generation of articles to prevent obesity and T2DM in children. We hypothesise that those studies reporting PE applying the latest implementation guidelines suggested by the researchers would potentially show positive changes in body composition compared to those not reporting it. Additionally, we will evaluate the implementation degree of PE in those articles considering it and describe the PE subcomponents. Lastly, we aim to assess the intervention target used and its results. Methods: A literature review was performed in parallel by 2 independent reviewers. A final number of 41 studies were selected for inclusion criteria. Results: Meta-analysis of BMI and zBMI found non-significant effects of the proposed interventions. Sub-group analysis revealed only a significant effect in studies which performed PE. Moreover, PE was reported in 42% effective studies and 57% non-effective studies. Fidelity and satisfaction were the most implemented PE subcomponents, although there was a generally low grade of PE use (7/41). The highest proportion of effectiveness (83%) was shown in interventions of physical activity alone while the intervention most used was 3-arm target (diet, PA and BS). Conclusions: Overall, obesity and T2DM prevention studies included in this review are not effective in terms of BMI and zBMI. Those studies performing PE reported to be effective in terms of BMI, while studies not reporting PE did not have positive results in terms of BMI and zBMI. In addition, none of the intervention studies included all PE indicators and most studies, which included PE in their interventions, did not provide full report of the PE components, according to the guidelines used for the present review. PROSPERO registration number: CRD42018093667

Breakfast characteristics and its association with daily micronutrients intake in children and adolescents–a systematic review and meta-analysis

Breakfast is an important source of key nutrients in the diet. For this reason, the aim of this review was to investigate the associations between breakfast consumption and daily micronutrients intake in both children and adolescents (aged 2–18 years). A peer-reviewed systematic search was conducted in three datasets (PubMed, Scopus and Cochrane Library) in February 2020 in English and Spanish. Two independent reviewers evaluated 3188 studies considering the AXIS critical appraisal and PRISMA methodologies. Meta-analysis was carried out comparing results according to type of breakfast consumed (Ready to eat cereals (RTEC) breakfast or other types of breakfast) and breakfast skipping. Thirty-three articles were included in the systematic review (SR) and 7 in the meta-analysis. In the SR, we observed that those children and adolescents who usually consume RTEC at breakfast had a higher consumption of B-vitamins than those not consuming RTEC at breakfast. Breakfast consumers had a higher mineral intake (iron, calcium, magnesium, potassium, zinc, and iodine) than breakfast skippers. In the Meta-Analysis, RTEC consumers had significantly higher vitamin C intake than breakfast skippers (SMD, -4.12; 95% confidence intervals (CI): -5.09, -3.16). Furthermore, those children who usually consume breakfast had significantly higher daily intake of calcium than breakfast skippers (SMD, -7.03; 95%CI: -9.02, -5.04). Our review proposes that breakfast consumption seems to be associated with higher daily micronutrients intake than breakfast skippers

Is it important to achieve physical activity recommendations at early stages of life to improve bone health?

Research in bone health during childhood is limited and important to prevent future diseases, particularly, osteoporosis. Bone parameters using DXA and pQCT in 295 Spanish children were evaluated and we found a benefit of meeting the World Health Organization physical activity recommendations in bone composition in childhood. Purpose To investigate the association between physical activity (PA) and bone health in a Spanish paediatric cohort, considering the influence of meeting/not meeting the current World Health Organization (WHO) PA recommendations and to elucidate if there are differences between boys and girls. Methods In a cohort of children born in the region of Aragon (Spain) in 2009, followed until the age of 7 years, bone parameters were assessed using dual-energy X-ray absorptiometry (DXA) (whole body scan) and peripheral quantitative computed tomography (pQCT) (tibia scanned at the 8% (distal) and 38% (diaphyseal) of the total tibia length) in 295 7-year-old children (154 boys) in the last evaluation performed between 2016 and 2017. PA was assessed using GT3X Actigraph accelerometers. Results Boys had significantly higher areal bone mineral density (aBMD), higher total bone mineral content (BMC) at the diaphyseal site and higher trabecular BMC and vBMD, and higher total bone area at the distal site than girls (p<0.01 for all of them). Both boys and girls complying with the WHO PA recommendations had significantly higher trabecular BMC than their inactive counterparts. Conclusions Meeting WHO PA recommendations has a beneficial effect in bone composition in childhood both in boys and in girls

Feel4Diabetes healthy diet score: Development and evaluation of clinical validity

Background: The aim of this paper is to present the development of the Feel4Diabetes Healthy Diet Score and to evaluate its clinical validity. Methods: Study population consisted of 3268 adults (63% women) from high diabetes risk families living in 6 European countries. Participants filled in questionnaires at baseline and after 1 year, reflecting the dietary goals of the Feel4Diabetes intervention. Based on these questions the Healthy Diet Score was constructed, consisting of the following components: breakfast, vegetables, fruit and berries, sugary drinks, whole-grain cereals, nuts and seeds, low-fat dairy products, oils and fats, red meat, sweet snacks, salty snacks, and family meals. Maximum score for each component was set based on its estimated relative importance regarding T2DM risk, higher score indicating better quality of diet. Clinical measurements included height, weight, waist circumference, heart rate, blood pressure, and fasting blood sampling, with analyses of glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides. Analysis of (co) variance was used to compare the Healthy Diet Score and its components between countries and sexes using baseline data, and to test differences in clinical characteristics between score categories, adjusted for age, sex and country. Pearson''s correlations were used to study the association between changes from baseline to year 1 in the Healthy Diet Score and clinical markers. To estimate reproducibility, Pearson''s correlations were studied between baseline and 1 year score, within the control group only. Results: The mean total score was 52.8 ± 12.8 among women and 46.6 ± 12.8 among men (p < 0.001). The total score and its components differed between countries. The change in the Healthy Diet Score was significantly correlated with changes in BMI, waist circumference, and total and LDL cholesterol. The Healthy Diet Score as well as its components at baseline were significantly correlated with the values at year 1, in the control group participants. Conclusion: The Feel4Diabetes Healthy Diet Score is a reproducible method to capture the dietary information collected with the Feel4Diabetes questionnaire and measure the level of and changes in the adherence to the dietary goals of the intervention. It gives a simple parameter that associates with clinical risk factors in a meaningful manner

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

Relative validity of food frequency questionnaires to assess food items, energy, macronutrient and micronutrient intake in children and adolescents: A systematic review with meta-analysis

Food Frequency Questionnaires (FFQs) are one of the most widely used tools of research into nutritional epidemiology, and many studies have been conducted in several countries using this dietary assessment method. This study aimed to evaluate the relative validity of FFQs, in comparison with other methods, in assessing dietary intake of children and adolescents, through a systematic review. Four electronic databases (Embase, PubMed, Scopus and Web of Science) found 67 articles, which met the inclusion criteria (healthy children and adolescents from 3 to 18 years; journal articles written in English, Spanish and Portuguese between 1988 and March 2019; results showing the comparison between the FFQ with other methods of assessment of dietary intake). The articles were analyzed by two independent reviewers. A meta-analysis was conducted using correlation coefficients as estimate effects between the FFQ and the reference standard method. Subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity. In 55 of the 67 studies, a single dietary assessment method was used to evaluate the FFQ; 9 combined the two methods and 3 used three reference methods. The most widely used reference method was the 24-Hour Recall, followed by the Food Record. The overall relative validity of the FFQ to estimate energy, macronutrient, certain micronutrient, and certain food item intakes in children and adolescents may be considered weak. The study protocol was registered in PROSPERO under number CRD42016038706

Associations between Spanish children’s physical activity and physical fitness with lean body mass: The CALINA study

The present study investigated the associations between physical activity (PA) and physical fitness (PF) with lean body mass (LBM) and evaluated whether PA mediates the association between PF and LBM. 279 children (150 boys) aged 7.5 ± 0.3 years participated in the study. PA was assessed by accelerometry and PF with handgrip and the standing long jump test. Total lean soft tissue mass index (TLSTMI), muscle cross-sectional area index (MCSAI), and fat-free mass index (FFMI) were evaluated using dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, and bioimpedance analysis, respectively. Total (β = 0.247) and vigorous PA (β = 0.143) were associated with TLSTMI in girls. In boys, total (β = 0.337), light (β = 0.290), vigorous (β = 0.200), and moderate-vigorous PA (β = 0.189) were associated with TLSTMI. Total PA was associated with FFMI (β = 0.299). Handgrip strength does not mediate the relationship between total PA and TLSTMI. Positive associations were found between handgrip strength and TLSTMI, MCSAI, and FFMI in both girls and boys. In children, there is a positive association between total and vigorous PA with TLSTMI. Handgrip strength does not mediate the relationship between total PA and TLSTMI. It was associated with TLSTMI, MCSAI, and FFMI

Compliance with the 24-hour movement behavior guidelines and associations with adiposity in european preschoolers: Results from the toybox-study

In 2019, the World Health Organization (WHO) published 24 h movement behavior guidelines for preschoolers with recommendations for physical activity (PA), screen time (ST), and sleep. The present study investigated the proportion of preschoolers complying with these guidelines (on a total week, weekdays and weekend days), and the associations with adiposity. This cross-sectional study included 2468 preschoolers (mean age: 4.75 years; 41.9% boys) from six European countries. The associations were investigated in the total sample and in girls and boys separately. PA was objectively assessed by step counts/day. Parent-reported questionnaires provided ST and sleep duration data. Generalized estimating equations were used to analyze the association between guideline compliance and adiposity indicators, i.e., body mass index (BMI) z-score and waist to height ratio (WHR). Only 10.1% of the preschoolers complied with the 24 h movement behavior guidelines, 69.2% with the sleep duration guideline, 39.8% with the ST guideline and 32.7% with the PA guideline. No association was found between guideline compliance with all three movement behaviors and adiposity. However, associations were found for isolated weekday screen time (BMI z-scores and WHR: p = 0.04) and weekend day sleep duration (BMI z-scores and WHR: p = 0.03) guideline compliance with both lower adiposity indicators. The latter association for sleep duration was also found in girls separately (BMI z-scores: p = 0.02; WHR: p = 0.03), but not in boys. Longitudinal studies, including intervention studies, are needed to increase preschoolers’ guideline compliance and to gain more insight into the manifestation of adiposity in children and its association with 24 h movement behaviors from a young age onwards. © 2021 by the authors. Licensee MDPI, Basel, Switzerland