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Purpose To examine the adherence to the Mediterranean dietary pattern (MDP) in metabolically healthy overweight or obese (MHO) and metabolically unhealthy obese (MUO) European adolescents. Methods In this cross-sectional study, 137 overweight/obese adolescents aged 12-17 years old from the HELENA study were included. Height, weight, waist circumference and skinfold thickness were measured and body mass index and body fat percent were calculated. Systolic and diastolic blood pressure, glucose, HDL cholesterol, triglycerides and cardiorespiratory fitness (20 m shuttle run test) were measured. MHO and MUO phenotypes were categorized following the Jolliffe and Janssen criteria. Two non-consecutive 24 h recalls were used for dietary intake assessment and the adherence to the MDP was calculated using the Mediterranean dietary pattern score (MDP score) (range 0-9). Results A total of 45 (22 girls) adolescents (32.8%) were categorized as MHO. The adherence to the MDP was significantly higher in MHO than in MUO adolescents regardless of age, sex, body fat percentage, energy intake and center (MDP score: 4.6 +/- 1.6 vs. 3.9 +/- 1.5, p = 0.036), but this difference became non-significant after further adjustment for cardiorespiratory fitness. Participants who had a low adherence to the MDP (MDP score <= 4) had a higher likelihood of having MUO phenotype regardless of sex, age, energy intake, center and body fat percentage (OR 2.2; 95% CI 1.01-4.81, p = 0.048). Conclusions Adherence to the MDP might be beneficial to maintain metabolic health in overweight/obese adolescents, yet cardiorespiratory fitness seems to play a key role on the metabolic phenotype. ; The HELENA project was supported by the European Community Sixth RTD Framework Programme (contract FOODCT-2005-007034), by the Education Department of the Government of the Basque Country (PRE_2016_1_0057, PRE_ 2017_2_0224), by the Spanish Ministry of Science and Innovation (RYC-2011-09011), by the University of the Basque Country (GIU14/21), and by the University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES). Furthermore, the current study was supported by the Spanish Ministry of Health (CIBERobn CB12/03/30038).

Introduction: Previous studies suggested that green space is beneficial for the cognitive development in children. However, evidence in adolescents is limited. Therefore, we aim to investigate green space exposure in association with attention and behaviour in adolescents. Methods: This study includes 596 Flemish adolescents between 13 and 17 years old. Attention was assessed with Stroop Test (selective attention) and Continuous Performance Test (sustained and selective attention). Behaviour was determined based on the Strengths and Difficulties Questionnaire. Green space was estimated in several radius distances around their current residence and school based on high-resolution land cover data. Multilevel regression analyses were used adjusting for participant's age, sex, education level of the mother, and area deprivation index. Results: Surrounding green space in a 2000 m radius is associated with a faster reaction time in adolescents. An IQR (13%) increment in total green space within 2000 m of the residence and school combined, is associated with a 32.7 ms (95% CI: -58.9 to -6.5; p = 0.02) and a 7.28 ms (95% CI: -11.7 to -2.8; p = 0.001) shorter mean reaction time between the presentation of a stimulus and the response based on the Stroop Test and the Continuous Performance Test. Subdividing green space based on vegetation height, shows that green space higher than 3 m is associated with a faster reaction time of the Continuous Performance Test (-6.50 ms; 95% CI: -10.9 to -2.2; p = 0.004), while low green is not. We did not find an association between green space and behavioural development in adolescents. Conclusions: Our study shows that green space, especially trees, surrounding the residence and school combined is associated with better sustained and selected attention in adolescents. These findings indicate that the availability of green is important for adolescents that are growing up in a rapidly urbanizing world. ; Government of Flanders, Department of Environment & Spatial Development;

Background Evidence suggests possible synergetic effects of multiple lifestyle behaviors on health risks like obesity and other health outcomes. Therefore it is important to investigate associations between dietary and physical activity behavior, the two most important lifestyle behaviors influencing our energy balance and body composition. The objective of the present study is to describe the relationship between energy, nutrient and food intake and the physical activity level among a large group of European adolescents. Methods The study comprised a total of 2176 adolescents (46.2% male) from ten European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Dietary intake and physical activity were assessed using validated 24-h dietary recalls and self-reported questionnaires respectively. Analyses of covariance (ANCOVA) were used to compare the energy and nutrient intake and the food consumption between groups of adolescents with different physical activity levels (1st to 3rd tertile). Results In both sexes no differences were found in energy intake between the levels of physical activity. The most active males showed a higher intake of polysaccharides, protein, water and vitamin C and a lower intake of saccharides compared to less active males. Females with the highest physical activity level consumed more polysaccharides compared to their least active peers. Male and female adolescents with the highest physical activity levels, consumed more fruit and milk products and less cheese compared to the least active adolescents. The most active males showed higher intakes of vegetables and meat, fish, eggs, meat substitutes and vegetarian products compared to the least active ones. The least active males reported the highest consumption of grain products and potatoes. Within the female group, significantly lower intakes of bread and cereal products and spreads were found for those reporting to spend most time in moderate to vigorous physical activity. The consumption of foods from the remaining food groups, did not differ between the physical activity levels in both sexes. Conclusion It can be concluded that dietary habits diverge between adolescents with different self-reported physical activity levels. For some food groups a difference in intake could be found, which were reflected in differences in some nutrient intakes. It can also be concluded that physically active adolescents are not always inclined to eat healthier diets than their less active peers. ; The HELENA study took place with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT: 2005-007034). This work was also partially supported by the European Union, in the framework of the Public Health Programme (ALPHA project, Ref: 2006120), the Swedish Council for Working Life and Social Research (FAS), the Spanish Ministry of Education (EX-2007-1124, and EX-2008-0641), and the Spanish Ministry of Health, Maternal, Child Health and Development Network (number RD08/0072) (JPRL, LAM).

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. ; The HELENA study received funding from the European Union's Sixth RTD Framework Programme (Contracts FOOD-CT-2007-036196-2 and FOODCT-2005-007034, respectively). Additional support was received from the Spanish Ministry of Education (AGL2007-29784-E/ALI), Axis-Shield Diagnostics Ltd. (Oslo, Norway), Abbot Científica S.A. (Spain). The HBS was funded by the Ministry of Health of Brazil (agreement number 4652/2005; grant number 25000.202044/2005-16). The funder contributed to the HBS design and conduct of the study. C.A.B. received a fellowship from the Brazilian Federal Agency (Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior-CAPES) and A.M.S.P received financial support by Fundación Cuenca Villoro (Spain) both for the improvement of higher education. D.J.P was supported by a grant from the Spanish Ministry of Science and Innovation—MINECO (RYC-2014-16938).

Objective To examine the association of breakfast consumption with objectively measured and self-reported physical activity, sedentary time and physical fitness. Design The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Cross-Sectional Study. Breakfast consumption was assessed by two non-consecutive 24 h recalls and by a 'Food Choices and Preferences' questionnaire. Physical activity, sedentary time and physical fitness components (cardiorespiratory fitness, muscular fitness and speed/agility) were measured and self-reported. Socio-economic status was assessed by questionnaire. Setting Ten European cities. Subjects Adolescents (n 2148; aged 12·5–17·5 years). Results Breakfast consumption was not associated with measured or self-reported physical activity. However, 24 h recall breakfast consumption was related to measured sedentary time in males and females; although results were not confirmed when using other methods to assess breakfast patterns or sedentary time. Breakfast consumption was not related to muscular fitness and speed/agility in males and females. However, male breakfast consumers had higher cardiorespiratory fitness compared with occasional breakfast consumers and breakfast skippers, while no differences were observed in females. Overall, results were consistent using different methods to assess breakfast consumption or cardiorespiratory fitness (all P ≤ 0·005). In addition, both male and female breakfast skippers (assessed by 24 h recall) were less likely to have high measured cardiorespiratory fitness compared with breakfast consumers (OR = 0·33; 95 % CI 0·18, 0·59 and OR = 0·56; 95 %CI 0·32, 0·98, respectively). Results persisted across methods. Conclusions Skipping breakfast does not seem to be related to physical activity, sedentary time or muscular fitness and speed/agility as physical fitness components in European adolescents; yet it is associated with both measured and self-reported cardiorespiratory fitness, which extends previous findings. ; Sources of funding: The HELENA Study took place with the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT: 2005-007034). This work was also partially supported by the European Union, in the framework of the Public Health Programme (ALPHA project, ref. 2006120); the Swedish Council for Working Life and Social Research (FAS); the Spanish Ministry of Education (grant nos. AP-2008-03806, RYC-2010-05957, RYC-2011-0901); the Spanish Ministry of Health, Maternal, Child Health and Development Network (grant no. RD08/0072 to L.A.M.); the Universidad Politécnica of Madrid (grant no. CH/018/2008); and the Swedish Heart-Lung Foundation (grant no. 20090635).

Incluye material complementario ; Obesity and metabolic syndrome (MetS) are worldwide major health challenges. The Mediterranean diet (MD) is associated with a better cardiometabolic profile, but these beneficial effects may be influenced by genetic variations, modulating the predisposition to obesity or MetS. The aim was to assess whether interaction effects occur between an obesity genetic risk score (obesity-GRS) and the MD on adiposity and MetS in European adolescents. Multiple linear regression models were used to assess the interaction effects of an obesity-GRS and the MD on adiposity and MetS and its components. Interaction effects between the MD on adiposity and MetS were observed in both sex groups (p < 0.05). However, those interaction effects were only expressed in a certain number of adolescents, when a limited number of risk alleles were present. Regarding adiposity, a total of 51.1% males and 98.7% females had lower body mass index (BMI) as a result of higher MD adherence. Concerning MetS, only 9.9% of males with higher MD adherence had lower MetS scores. However, the same effect was observed in 95.2% of females. In conclusion, obesity-related genotypes could modulate the relationship between MD adherence and adiposity and MetS in European adolescents; the interaction effect was higher in females than in males. ; Miguel Seral-Cortes, the corresponding author, has received funding from the Iberus Talent Pre-doctoral fellowships 2018, under the European Union's H2020 research and innovation programme under Marie Sklodowska-Curie grant agreement No 801586. Pilar de Miguel-Etayo was supported by ISCIII-CB15/00043 (Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición, CIBERObn). This work was part of the HELENA Study (http://www.helenastudy.com/). We gratefully acknowledge financial support of the European Community Sixth RTD Framework Programme (contract FOOD-CT-2005-007034). The data for this study were gathered under the auspices of the HELENA project, and further analysis was additionally supported by the Spanish Ministry of Economy and Competitiveness (Grants RYC-2010-05957 and RYC-2011-09011), the Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn).

Background: Previous studies suggest that dietary protein might play a beneficial role in combating obesity and its related chronic diseases. Total, animal and plant protein intakes and their associations with anthropometry and serum biomarkers in European adolescents using one standardised methodology across European countries are not well documented. ; Objectives: To evaluate total, animal and plant protein intakes in European adolescents stratified by gender and age, and to investigate their associations with cardio-metabolic indicators (anthropometry and biomarkers). ; Methods: The current analysis included 1804 randomly selected adolescents participating in the HELENA study (conducted in 2006–2007) aged 12.5-17.5 y (47% males) who completed two non-consecutive computerised 24-h dietary recalls. Associations between animal and plant protein intakes, and anthropometry and serum biomarkers were examined with General linear Model multivariate analysis. ; Results: Average total protein intake exceeded the recommendations of World Health Organization and European Food Safety Authority. Mean total protein intake was 96 g/d (59% derived from animal protein). Total, animal and plant protein intakes (g/d) were significantly lower in females than in males and total and plant protein intakes were lower in younger participants (12.5-14.9 y). Protein intake was significantly lower in underweight subjects and higher in obese ones; the direction of the relationship was reversed after adjustments for body weight (g/(kg.d)). The inverse association of plant protein intakes was stronger with BMI z-score and body fat percentage (BF%) compared to animal protein intakes. Additionally, BMI and BF% were positively associated with energy percentage of animal protein. ; Conclusions: This sample of European adolescents appeared to have adequate total protein intake. Our findings suggest that plant protein intakes may play a role in preventing obesity among European adolescents. Further longitudinal studies are needed to investigate the potential beneficial effects observed in this study in the prevention of obesity and related chronic diseases. ; The HELENA-study took place with the financial support of the European Community Sixth RTD Framework Programme. This work was also partially supported by the European Union in the framework of the Public Health Programme, the Swedish Council for Working Life and Social Research (FAS), the Spanish Ministry of Education, and the Spanish Ministry of Health, Maternal, Child Health and Development Network and the Spanish Ministry of Science and Innovation AGL2007-29784-E. The content of this paper reflect only the authors' views and the rest of HELENA-study members and the European Community is not liable for any use that may be made of the information contained therein. Augusto César F. de Moraes is in receipt of a PhD scholarship from the São Paulo State Research Foundation (FAPESP: proc. 2011/11137-1 and 2011/20662-2) and Postdoctoral Research Fellow scholarship from National Counsel of Technological and Scientific Development (CNPq: proc. 313772/2014-2); Luis A. Moreno was given scholarship of Visiting Professor from Brazilian government by Science without Borders Program by CNPq and CAPES (Coordination of Improvement of Higher Education Personnel) (proc. 007/2012). The GENUD Research Group co-financed by the European Regional Development Fund (MICINN-FEDER).