Theodora Mouratidou

Beverage consumption among European adolescents in the HELENA study.

Background/Objectives:Our objective was to describe the fluid and energy consumption of beverages in a large sample of European adolescents.Subjects/Methods:We used data from 2741 European adolescents residing in 8 countries participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS). We averaged two 24-h recalls, collected using the HELENA-dietary assessment tool. By gender and age subgroup (12.5–14.9 years and 15–17.5 years), we examined per capita and per consumer fluid (milliliters (ml)) and energy (kilojoules (kJ)) intake from beverages and percentage consuming 10 different beverage groups.Results:Mean beverage consumption was 1611 ml/day in boys and 1316 ml/day in girls. Energy intake from beverages was about 1966 kJ/day and 1289 kJ/day in European boys and girls, respectively, with sugar-sweetened beverages (SSBs) (carbonated and non-carbonated beverages, including soft drinks, fruit drinks and powders/concentrates) contributing to daily energy intake more than other groups of beverages. Boys and older adolescents consumed the most amount of per capita total energy from beverages. Among all age and gender subgroups, SSBs, sweetened milk (including chocolate milk and flavored yogurt drinks all with added sugar), low-fat milk and fruit juice provided the highest amount of per capita energy. Water was consumed by the largest percentage of adolescents followed by SSBs, fruit juice and sweetened milk. Among consumers, water provided the greatest fluid intake and sweetened milk accounted for the largest amount of energy intake followed by SSBs. Patterns of energy intake from each beverage varied between countries.Conclusions:European adolescents consume an average of 1455 ml/day of beverages, with the largest proportion of consumers and the largest fluid amount coming from water. Beverages provide 1609 kJ/day, of which 30.4%, 20.7% and 18.1% comes from SSBs, sweetened milk and fruit juice, respectively.

Relative validity of the Children's Eating Habits Questionnaire–food frequency section among young European children: the IDEFICS Study

OBJECTIVE To compare, specifically by age group, proxy-reported food group estimates obtained from the food frequency section of the Childrens Eating Habits questionnaire (CEHQ-FFQ) against the estimates of two non-consecutive 24 h dietary recalls (24-HDR). DESIGN Estimates of food group intakes assessed via the forty-three-food-group CEHQ-FFQ were compared with those obtained by a computerized 24-HDR. Agreement on frequencies of intakes (equal to the number of portions per recall period) between the two instruments was examined using crude and de-attenuated Pearsons correlation coefficients, cross-classification analyses, weighted kappa statistics (κ w) and Bland-Altman analysis. SETTING Kindergartens/schools from eight European countries participating in the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) Study cross-sectional survey (2007-2008). SUBJECTS Children aged 2-9 years (n 2508, 50·4% boys). RESULTS The CEHQ-FFQ provided higher intake estimates for most of the food groups than the 24-HDR. De-attenuated Pearson correlation coefficients ranged from 0·01 (sweetened fruit) to 0·48 (sweetened milk) in children aged 2-<6 years (mean = 0·25) and from 0·01 (milled cereal) to 0·44 (water) in children aged 6-9 years (mean = 0·23). An average of 32% and 31% of food group intakes were assigned to the same quartile in younger and older children, respectively, and classification into extreme opposite quartiles was ≤12% for all food groups in both age groups. Mean κ w was 0·20 for 2-<6-year-olds and 0·17 for 6-9-year-olds. CONCLUSIONS The strength of association estimates assessed by the CEHQ-FFQ and the 24-HDR varied by food group and by age group. Observed level of agreement and CEHQ-FFQ ability to rank children according to intakes of food groups were considered to be low.

A systematic approach for the development of a kindergarten‐based intervention for the prevention of obesity in preschool age children: the ToyBox‐study

The increasing childhood obesity epidemic calls for appropriate measures and effective policies to be applied early in life. Large‐scale socioecological frameworks providing a holistic multifactorial and cost‐effective approach necessary to support obesity prevention initiatives in this age are however currently missing. To address this missing link, ToyBox‐study aims to build and evaluate a cost‐effective kindergarten‐based, family‐involved intervention scheme to prevent obesity in early childhood, which could potentially be expanded on a pan‐European scale. A multidisciplinary team of researchers from 10 countries have joined forces and will work to realize this according to a systematic stepwise approach that combines the use of the PRECEDE‐PROCEED model and intervention mapping protocol. ToyBox‐study will conduct systematic and narrative reviews, secondary data analyses, focus group research and societal assessment to design, implement and evaluate outcome, impact, process and cost effectiveness of the intervention. This is the first time that such a holistic approach has been used on a pan‐European scale to promote healthy weight and healthy energy balance‐related behaviours for the prevention of early childhood obesity. The results of ToyBox‐study will be disseminated among key stakeholders including researchers, policy makers, practitioners and the general population.

Parental education and frequency of food consumption in European children: the IDEFICS study.

OBJECTIVE To assess the relationship between parental education level and the consumption frequency of obesity-related foods in European children. DESIGN The analysis was based on data from the cross-sectional baseline survey of a prospective cohort study. The effects of parental education on food consumption were explored using analysis of covariance and logistic regression. SETTING Primary schools and pre-schools of selected regions in Italy, Estonia, Cyprus, Belgium, Sweden, Hungary, Germany and Spain. SUBJECTS Participants (n 14,426) of the IDEFICS baseline cohort study aged 2 to 9 years. RESULTS Parental education level affected the intake of obesity-related foods in children. Children in the low and medium parental education level groups had lower odds of more frequently eating low-sugar and low-fat foods (vegetables, fruits, pasta/noodles/rice and wholemeal bread) and higher odds of more frequently eating high-sugar and high-fat foods (fried potatoes, fruits with sugar and nuts, snacks/desserts and sugared beverages; P < 0.001). The largest odds ratio differences were found in the low category (reference category: high) for vegetables (OR = 0.56; 95 % CI 0.47, 0.65), fruits (OR = 0.56; 95% CI 0.48, 0.65), fruits with sugar and nuts (OR = 2.23; 95% CI 1.92, 2.59) and sugared beverages (OR = 2.01; 95% CI 1.77, 2.37). CONCLUSIONS Low parental education level was associated with intakes of sugar-rich and fatty foods among children, while high parental education level was associated with intakes of low-sugar and low-fat foods. These findings should be taken into account in public health interventions, with more targeted policies aiming at an improvement of childrens diet.

Food Consumption and Screen-Based Sedentary Behaviors in European Adolescents: The HELENA Study

OBJECTIVE To examine the association between time spent on different sedentary behaviors and consumption of certain food and beverage groups in a sample of European adolescents. DESIGN Data from the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-sectional Study. SETTING Eight survey centers (Athens, Dortmund, Ghent, Lille, Rome, Stockholm, Vienna, and Zaragoza). PARTICIPANTS A total of 2202 participants (45.5% boys) aged 12½ to 17½ years. MAIN OUTCOME MEASURES Information on sedentary behaviors (weekdays and weekends) collected via a standardized self-reported questionnaire, including watching television, playing computer and video games, using the Internet for studying or recreation, and studying. Food and beverage consumption data of selected groups were obtained using 2 nonconsecutive 24-hour recalls. RESULTS Boys reporting more than 4 h/d of watching television, playing computer games, and using the Internet for recreation were more likely to consume sweetened beverages (weekends) (odds ratio [OR], 1.83 [95% CI, 1.21-2.75]; 1.99 [1.31-3.01]; and 1.73 [1.03-2.91], respectively), and less likely to consume fruit (weekdays) (0.39 [0.21-0.72], 0.37 [0.18-0.77], and 0.39 [0.19-0.78], respectively) than those who spent less than 2 h/d. Girls spending more time per day watching television and playing computer or video games (weekdays) and playing computer games or surfing the Internet for recreation (weekends) were more likely to drink sweetened beverages (OR, 1.89 [95% CI, 1.21-2.94]; 1.57 [1.00-2.46]; 2.14 [1.16-3.97]; and 2.30 [1.24-4.28], respectively) and less likely to consume fruit (weekdays) (0.43 [0.23-0.80], 0.40 [0.19-0.83], 0.37 [0.14-0.94], and 0.42 [0.20-0.85], respectively) than those who spent less than 2 h/d. CONCLUSION Increased television viewing and computer and Internet use during adolescence is associated with higher odds of consumption of sweetened beverages and lower odds of fruit consumption.

Is dairy consumption associated with low cardiovascular disease risk in European adolescents? Results from the HELENA Study

Although there is no clear evidence of the role of dairy consumption on cardiovascular disease (CVD) risk development in adults, several studies have suggested dairy consumption to have a protective effect. Limited evidence on the relationship between milk and dairy products consumption and CVD risk factors among adolescents.

Food consumption and cardiovascular risk factors in European children: the IDEFICS study.

Few studies addressing the relationship between food consumption and cardiovascular disease or metabolic risk have been conducted in children. Previous findings have indicated greater metabolic risk in children with high intakes of solid hydrogenated fat and white bread, and low consumption of fruits, vegetables and dairy products.

Increased sedentary behaviour is associated with unhealthy dietary patterns in European adolescents participating in the HELENA study

Background/Objectives:To assess dietary patterns (DPs) in European adolescents and to examine their relationship with several indicators of sedentary behaviour.Subjects/Methods:A multinational cross-sectional study was carried out in 2202 adolescents (45.4% boys) aged 12.5–17.5 years. A self-reported questionnaire with information on sedentary behaviours, separately for weekdays and weekend days, and two non-consecutive 24 h-recalls were used. Principal component analysis was used to obtain DPs, and linear regression examined the association between DPs scores and sedentary behaviour.Results:Four DPs for boys (‘plant based’, ‘snacking’, ‘breakfast’ and ‘health conscious’) and five DPs for girls (‘confectionary and snacking’, ‘plant based’, ‘breakfast’, ‘animal protein’ and ‘health conscious’) were obtained. Boys who spent >4 h/day watching television (TV) had lower adherence to the ‘plant based’, ‘breakfast’ and ‘health conscious’ DPs, and higher adherence to the ‘snacking’ DP. Higher computer use and internet use for recreational reason were associated with higher adherence to the ‘snacking’ DP. In girls, TV viewing and using internet for recreational reasons for >4 h/day was associated with higher adherence to the ‘confectionary and snacking’ and lower adherence with ‘health conscious’ DP. Also, studying between 2 and 4 h during weekend days was associated with lower adherence to the ‘snacking’ and with higher adherence to the ‘plant based’ and ‘breakfast’ DPs.Conclusion:Adolescents’ DPs are related with the time spent in several sedentary behaviours. Such findings may help to generate interventions focusing on decreasing unhealthy dietary habits and specific sedentary behaviours.

Associations of Dietary Calcium, Vitamin D, Milk Intakes, and 25-Hydroxyvitamin D With Bone Mass in Spanish Adolescents: The HELENA Study

Adequate nutrition is needed for the accrual of bone mass during the pre- and postpubertal growth periods. This study aimed to examine the associations between dietary calcium, vitamin D (calciferol), and milk intakes and 25-hydroxyvitamin D [25(OH)D] status and bone mineral content (BMC) and bone mineral density (BMD) in Spanish adolescents, aged 12.5-17.5 years, participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS). Bone mass was measured with dual-energy X-ray absorptiometry and diet via 2 nonconsecutive 24-h dietary recalls (n=227; 48% males). A random subsample of 101 adolescents (46% males) had available measures of 25(OH)D. Multiple linear regression was applied. Significant adjusted associations were observed in males, among milk intakes and BMC and BMD. Also in males, whole-body, head, and right arm BMD were positively related to calcium intakes. In females, 25(OH)D was positively related among others to whole-body, subtotal, and left and right arm BMC and BMD. It could be speculated that diet is not a limiting factor of bone mass development in this group of healthy adolescents, and further research on the effect of other factors in addition to diet in a larger sample should be undertaken.

Determinants of vitamin D status in young children: results from the Belgian arm of the IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants) Study

OBJECTIVE To describe the vitamin D status of Belgian children and examine the influence of non-nutritional determinants, in particular of anthropometric variables. DESIGN Cross-sectional data of Belgian participants of the EU 6th Framework Programme IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants) Study. SETTING 25-Hydroxyvitamin D (25(OH)D) was measured using RIA. Vitamin D status was categorized as deficient (<25 nmol/l), insufficient (25-50 nmol/l), sufficient (50-75 nmol/l) and optimal (≥75 nmol/l). Anthropometric measurements included height, weight, waist and hip circumferences and triceps and subscapular skinfold thicknesses. SUBJECTS Children (n 357) aged 4-11 years. RESULTS Serum 25(OH)D ranged from 13·6 to 123·5 nmol/l (mean 47·2 (sd 14·6) nmol/l); with 5 % deficient, 53 % insufficient, 40 % sufficient and 2 % optimal. No significant differences were found by age and gender. Significant differences in 25(OH)D were observed for month of sampling (P < 0·001), number of hours playing outside per week (r = 0·140), weight (r = -0·121), triceps (r = -0·112) and subscapular (r = -0·119) skinfold thickness, sum of two skinfold thicknesses (r = -0·125) and waist circumference (r = -0·108). Linear regression analysis of 25(OH)D adjusted for age, month of sampling and hours playing outside per week suggested that (i) weight, (ii) BMI Z-score, (iii) waist circumference and (iv) triceps and subscapular skinfold thickness (as well as the sum of both) independently influenced 25(OH)D. CONCLUSIONS The majority of Belgian children had a suboptimal vitamin D status, with more than half having an insufficient status in winter and spring. Month of the year, weekly number of hours playing outside and body composition - both central and abdominal obesity - were identified as important determinants of vitamin D status in Belgian children.