Changes in dietary intake during puberty and their determinants: results from the GINIplus birth cohort study

Undiagnosed Pediatric Elevated Blood Pressure Is Characterized by Induction of Proinflammatory and Cytotoxic Mediators

BACKGROUND

Inflammatory processes have been suggested as a culprit of vascular damage in pediatric hypertension. We aimed to investigate transcriptional changes of immune modulators and determine their association with office blood pressure in adolescents who were not diagnosed with hypertension at the time of the study visit.

METHODS

Office blood pressure measurements and blood samples were taken from adolescents of 2 German birth cohorts, GINIplus (The German Infant Study on the Influence of Nutrition Intervention Plus Air Pollution and Genetics on Allergy Development; discovery cohort, n=1219) and LISA (Influences of Lifestyle-related factors on the Immune System and the Development of Allergies in Childhood; validation cohort, n=809), during the 15-year follow-up visit and categorized based on the European Society of Hypertension Guideline. Hs-CRP (high-sensitivity C-reactive protein) and expression of 51 genes encoding cytokines/receptors and transcription factors were analyzed.

RESULTS

The prevalence of elevated systolic blood pressure (overweight/obese) was 14.0% (5.1%) and 16.4% (5.2%) in the discovery and validation cohorts, respectively. An enhanced cytotoxic (GZMB, PRF1, IL2RB) and proinflammatory (FOS, IL1B, hs-CRP) immune profile was observed in association with the hypertension class in both cohorts. Expression of hs-CRP and IL1B was driven by overweight with IL1B being identified as a mediator between body mass index and elevated systolic blood pressure (adj.β/95% CI, 0.01/0.0002-0.02). The association of GZMB (adjusted odds ratio/95% CI, 1.67/1.26-2.21; P=0.0004) and PRF1 (adjusted odds ratio/95% CI, 1.70/1.26-2.29; P=0.0005) in the hypertension class remained significant in normal-weight individuals without parental predisposition. These effects were confirmed in LISA.

CONCLUSIONS

Adolescent hypertension is not limited to known risk groups. As adolescents in the hypertension class show an inflammatory profile similar to that of established hypertension in adults, blood pressure monitoring at a young age is critical to ensure early intervention and prevention of adverse sequelae.

Dietary digestible carbohydrates are associated with higher prevalence of asthma in humans and with aggravated lung allergic inflammation in mice

BACKGROUND

Dietary carbohydrates and fats are intrinsically correlated within the habitual diet. We aimed to disentangle the associations of starch and sucrose from those of fat, in relation to allergic sensitization, asthma and rhinoconjuctivitis prevalence in humans, and to investigate underlying mechanisms using murine models.

METHODS

Epidemiological data from participants of two German birth cohorts (age 15) were used in logistic regression analyses testing cross-sectional associations of starch and sucrose (and their main dietary sources) with aeroallergen sensitization, asthma and rhinoconjunctivitis, adjusting for correlated fats (saturated, monounsaturated, omega-6 and omega-3 polyunsaturated) and other covariates. For mechanistic insights, murine models of aeroallergen-induced allergic airway inflammation (AAI) fed with a low-fat-high-sucrose or -high-starch versus a high-fat diet were used to characterize and quantify disease development. Metabolic and physiologic parameters were used to track outcomes of dietary interventions and cellular and molecular responses to monitor the development of AAI. Oxidative stress biomarkers were measured in murine sera or lung homogenates.

RESULTS

We demonstrate a direct association of dietary sucrose with asthma prevalence in males, while starch was associated with higher asthma prevalence in females. In mice, high-carbohydrate feeding, despite scant metabolic effects, aggravated AAI compared to high-fat in both sexes, as displayed by humoral response, mucus hypersecretion, lung inflammatory cell infiltration and T_H 2-T_H 17 profiles. Compared to high-fat, high-carbohydrate intake was associated with increased pulmonary oxidative stress, signals of metabolic switch to glycolysis and decreased systemic anti-oxidative capacity.

CONCLUSION

High consumption of digestible carbohydrates is associated with an increased prevalence of asthma in humans and aggravated lung allergic inflammation in mice, involving oxidative stress-related mechanisms.

Healthy eating index and diet diversity score as determinants of serum perfluoroalkyl acid (PFAA) concentrations in a national survey of Swedish adolescents

Food is an important source of perfluoroalkyl acid (PFAA) exposure for the general adult population, but few data exist for adolescents. Healthy food habits established during adolescence may positively influence health later in life. Associations between serum PFAA concentrations and a healthy eating index (SHEIA15), as well as a diet diversity score (RADDS), were determined in a nationally representative adolescent population from Sweden (Riksmaten Adolescents 2016-2017, RMA). Using consumption data from food registrations and frequency questionnaires, we additionally analyzed associations with commonly consumed food groups. Associations were analyzed by fitting a cumulative probability model using ordinal regression. Among the seven PFAAs detected in ≥70% of the 1098 participants (age 10-21 years), median concentrations ranged from <1 ng/g serum of perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perflurorundecanoic acid (PFUnDA), linear (lin-) perfluorohexanesulfonic acid (PFHxS) and branched (br-) perfluorooctanesulfonic acid (PFOS) to 1-2 ng/g serum of lin-perfluorooctanoic acid (PFOA) and lin-PFOS. PFNA, PFDA, PFUnDA and lin-PFOS concentrations were positively associated with both SHEIA15 and RADDS, a finding most likely driven by higher consumption of seafood. PFDA, PFUnDA and lin-PFOS concentrations were positively related to commonly consumed fish/shellfish groups, such as lean marine fish and shellfish. Inverse associations between PFAA concentrations and dairy consumption suggest an underlying factor behind dairy consumption that similarly affects adolescent exposure to the different PFAAs. Isomeric differences in dietary exposure between lin-PFOS and br-PFOS were suggested, as br-PFOS concentrations, in contrast to lin-PFOS, were not associated with SHEIA15, RADDS and consumption of different food groups. We conclude that Swedish adolescents, adhering to a diverse and healthy diet, appears to be more highly exposed to legacy PFAAs than those eating less healthy. Additional research is necessary for a better understanding of the health implications of healthy eating from a PFAA exposure perspective.

Association between gut MIcrobiota, GROWth and Diet in peripubertal children from the TARGet Kids! cohort (The MiGrowD) study: protocol for studying gut microbiota at a community-based primary healthcare setting

INTRODUCTION

The gut microbiota interacts with diet to affect body health throughout the life cycle. Critical periods of growth, such as infancy and puberty, are characterised by microbiota remodelling and changes in dietary habits. While the relationship between gut microbiota and growth in early life has been studied, our understanding of this relationship during puberty remains limited. Here, we describe the MIcrobiota, GROWth and Diet in peripubertal children (The MiGrowD) study, which aims to assess the tripartite growth-gut microbiota-diet relationship at puberty.

METHODS AND ANALYSIS

The MiGrowD study will be a cross-sectional, community-based study involving children 8-12 years participating in the TARGet Kids!

COHORT

TARGet Kids! is a primary healthcare practice-based research network in Canada. Children will be asked to provide a stool sample, complete two non-consecutive 24-hour dietary recalls and a pubertal self-assessment based on Tanner Stages. Anthropometry will also be conducted. The primary outcome is the association between gut microbiota composition and longitudinal growth from birth until entry into the study. Anthropometrics data from birth will be from the data collected prospectively through TARGet Kids!. Body mass index z-scores will be calculated according to WHO. The secondary outcome is the association between gut microbiota, diet and pubertal stage.

ETHICS AND DISSEMINATION

Ethics approval has been obtained by the Hospital for Sick Children and St. Michael's Hospital-Unity Health, and the University of Toronto. Results will be disseminated in the public and academic sector, including participants, TARGet Kids! primary healthcare physicians teams, scientists via participation in the TARGet Kids! science and physician meetings, conferences and publications in peer-reviewed journals. The MiGrowD study results will help researchers understand the relationships underlying growth, gut microbiota and pubertal maturation in children.

Obesogenic eating behaviour and dietary intake in German children and adolescents: results from the GINIplus and LISA birth cohort studies

BACKGROUND/OBJECTIVES

The transition to adolescence is characterised by considerable behavioural changes, including diet. This study describes the level of obesogenic eating behaviours in 10- and 15-year-olds, and their association with dietary intake.

SUBJECTS/METHODS

Participants of the 10- and 15-year follow-ups of the German GINIplus and LISA birth cohort studies were included (N₁₀ = 2257; N₁₅ = 1880). Eating behaviours and dietary intake were assessed via self-report questionnaires. Sex-stratified, cross-sectional associations of "external eating", "emotional eating" and "dietary restraint" (the latter at age 15 years only) with dietary intake (17 food groups-categorised into tertiles, macronutrients, and total energy) were assessed using multinomial logistic or multiple linear regression as required, adjusting for covariates and correcting for multiple testing.

RESULTS

Reported levels of eating behaviours were low in both age-groups. External eating was higher in 10-year-old males than females, while all eating behaviours were most pronounced in 15-year-old females. At 10 years, emotional eating was associated with medium vegetable intake in females (Relative Risk Ratio (RRR) = 1.84, p = 0.0017). At 15 years, external eating was associated with total energy (kJ) in females (β = 718, p = 0.0002) and high butter intake in males (RRR = 1.96, p = 0.0019). Dietary restraint in females was inversely associated with total energy (β = -967, p < 0.0001) and omega-3 fatty acids (Means Ratio (MR) = 0.94, p = 0.0017), and positively associated with high fruit (RRR = 2.20, p = 0.0003) and whole grains (RRR = 1.94, p = 0.0013).

CONCLUSION

Obesogenic eating behaviour scores are low among children and adolescents of a predominantly high socioeconomic status population and present only few associations with specific aspects of diet, mainly among adolescent females.

Review Nutritional interventions during adolescence and their possible effects

Nutrition is one of the most important factors affecting pubertal development. Increasing demands for energy proteins and micronutrients are necessary to cope with the rapid linear pubertal growth and development, change in body composition, and increased physical activity. Adequate nutrition is a key permissive factor for the normal timing and tempo of pubertal development. Severe primary or secondary malnutrition also can adversely delay the onset and progression of puberty. The higher incidence of anorexia nervosa and bulimia in adolescents imposes a nutritional risk on pubertal development. Here we provide an overview of nutritional requirements (macronutrients and micronutrients) necessary to cope with these changes. In addition, we discuss possible nutritional interventions trials and their effects on several aspects of growth and development in undernourished and stunted adolescents, in low- and middle-income countries (LMIC), who require nutritional rehabilitation. This mini-review sums up some important findings in this important complex that links between nutrition, nutritional interventions, and pubertal development.

The influence of macronutrient intake, stress and prostaglandin levels (pgf2α) of urine with the incidence of dysmenorrhea in adolescents

OBJECTIVES

This study aimed to analyze the influence of macronutrient intake, stress, and prostaglandin levels (pgf2α) on adolescent dysmenorrhea incidence.

METHOD

This type of study is observational analytic with a cohort study draft done in January-March 2020 at High junior school 21 Makassar. Respondents in this study were grade X and XI students divided into 64 teenagers who had dysmenorrhea and 64 adolescents who did not experience Dysmenrhea. The criteria of the respondent in this study were the reproductive age, already experiencing menstruation, knowing the time and date of menstruation, menstrual cycles were regular, and willing to be respondents. The study used Menstrual Symptoms Questionnaire (MSQ) and used an ultrasonography (ultrasound) examination to perform the sample cervical. Food recall 24 hours to assess the intake of macronutrients, Depression Anxiety Stress Scales (DASS 42) to measure stress levels, and an examination of urine prostaglandin levels using the method Enzyme-Linked Immunosorbent Assay (ELISA). Urine intake is carried out on the second day as much as 2-5cc. Data were analyzed by the Chi-square test and logistics regression backward.

RESULT

A multivariate analysis showed a variable that strongly affects dysmenorrhea is stress with the value p=0.000 and the level of prostaglandins with p-value=0.003 compared to other variables.

CONCLUSION

Stress and prostaglandin levels significantly affect the occurrence of dysmenorrhea in adolescents.

Acute Daily Stress, Daily Food Consumption, and the Moderating Effect of Disordered Eating among Adolescents with Overweight/Obesity

Objective: The purpose of this study was to examine the associations between acute daily stress dimensions (frequency, sum) and food intake in adolescents with overweight/obesity, and to explore the potential moderating effect of disordered eating behaviors on these associations. Methods: One hundred eighty-two adolescents with overweight/obesity (65% females; 68.7% non-white; 16.2 ± 1.8 years of age) were included in this analysis. Acute daily stress was measured using the Daily Stress Inventory, and daily caloric intake was measured using a food frequency questionnaire. Disordered eating behavior was assessed using the Eating Attitudes Test (EAT-26). Results: Acute daily stress frequency (B = 0.013 ± 0.003; p < 0.001) and acute daily stress sum (B = 0.003 ± 0.001; p < 0.001) were associated with greater daily caloric intake. Disordered eating behavior moderated the association between acute daily stress frequency and caloric intake (p_interaction = 0.039), with greater daily caloric intake among those with higher levels of disordered eating. Disordered eating behavior did not significantly moderate the association between acute daily stress sum and daily caloric intake (p_interaction = 0.053). Conclusions: These findings suggest that greater exposure to acute daily stressors may increase daily food intake in adolescents with overweight/obesity, with greater susceptibility among those engaging in high levels of disordered eating. Longitudinal research is warranted to elucidate the long-term effect of acute daily stressors and disordered eating on food intake among adolescents with overweight/obesity. The Health and Culture Project is registered at www.clinicaltrials.gov (No. NCT02938663).

Dietary Macronutrient Composition in Relation to Circulating HDL and Non-HDL Cholesterol: A Federated Individual-Level Analysis of Cross-Sectional Data from Adolescents and Adults in 8 European Studies

BACKGROUND

Associations between increased dietary fat and decreased carbohydrate intake with circulating HDL and non-HDL cholesterol have not been conclusively determined.

OBJECTIVE

We assessed these relations in 8 European observational human studies participating in the European Nutritional Phenotype Assessment and Data Sharing Initiative (ENPADASI) using harmonized data.

METHODS

Dietary macronutrient intake was recorded using study-specific dietary assessment tools. Main outcome measures were lipoprotein cholesterol concentrations: HDL cholesterol (mg/dL) and non-HDL cholesterol (mg/dL). A cross-sectional analysis on 5919 participants (54% female) aged 13-80 y was undertaken using the statistical platform DataSHIELD that allows remote/federated nondisclosive analysis of individual-level data. Generalized linear models (GLM) were fitted to assess associations between replacing 5% of energy from carbohydrates with equivalent energy from total fats, SFAs, MUFAs, or PUFAs with circulating HDL cholesterol and non-HDL cholesterol. GLM were adjusted for study source, age, sex, smoking status, alcohol intake and BMI.

RESULTS

The replacement of 5% of energy from carbohydrates with total fats or MUFAs was statistically significantly associated with 0.67 mg/dL (95% CI: 0.40, 0.94) or 0.99 mg/dL (95% CI: 0.37, 1.60) higher HDL cholesterol, respectively, but not with non-HDL cholesterol concentrations. The replacement of 5% of energy from carbohydrates with SFAs or PUFAs was not associated with HDL cholesterol, but SFAs were statistically significantly associated with 1.94 mg/dL (95% CI: 0.08, 3.79) higher non-HDL cholesterol, and PUFAs with -3.91 mg/dL (95% CI: -6.98, -0.84) lower non-HDL cholesterol concentrations. A statistically significant interaction by sex for the association of replacing carbohydrates with MUFAs and non-HDL cholesterol was observed, showing a statistically significant inverse association in males and no statistically significant association in females. We observed no statistically significant interaction by age.

CONCLUSIONS

The replacement of dietary carbohydrates with fats had favorable effects on lipoprotein cholesterol concentrations in European adolescents and adults when fats were consumed as MUFAs or PUFAs but not as SFAs.

Plasma polyunsaturated fatty acids and mental disorders in adolescence and early adulthood: cross-sectional and longitudinal associations in a general population cohort

Polyunsaturated fatty acids (PUFAs) may be pertinent to the development of mental disorders, for example via modulation of inflammation and synaptogenesis. We wished to examine cross-sectional and longitudinal associations between PUFAs and mental disorders in a large cohort of young people. Participants in the Avon Longitudinal Study of Parents and Children were interviewed and provided blood samples at two sampling periods when approximately 17 and 24 years old. Plasma PUFA measures (total omega-6 [n-6], total omega-3 [n-3], n-6:n-3 ratio and docosahexaenoic acid [DHA] percentage of total fatty acids) were assessed using nuclear magnetic resonance spectroscopy. Cross-sectional and longitudinal associations between standardised PUFA measures and three mental disorders (psychotic disorder, moderate/severe depressive disorder and generalised anxiety disorder [GAD]) were measured by logistic regression, adjusting for age, sex, body mass index and cigarette smoking. There was little evidence of cross-sectional associations between PUFA measures and mental disorders at age 17. At age 24, the n-6:n-3 ratio was positively associated with psychotic disorder, depressive disorder and GAD, while DHA was inversely associated with psychotic disorder. In longitudinal analyses, there was evidence of an inverse association between DHA at age 17 and incident psychotic disorder at age 24 (adjusted odds ratio 0.44, 95% confidence interval 0.22-0.87) with little such evidence for depressive disorder or GAD. There was little evidence for associations between change in PUFA measures from 17 to 24 years and incident mental disorders at 24 years. These findings provide support for associations between PUFAs and mental disorders in early adulthood, and in particular, for DHA in adolescence in relation to prevention of psychosis.

Longitudinal association of dietary sources of animal and plant protein throughout childhood with menarche

Background

Inconsistent findings have been reported for associations between protein intake and age at menarche. We aimed to investigate the association between intake of protein and protein-containing food groups during childhood with menarche among Iranian girls.

Methods

Girls aged 6–18 years who did not experience menarche in the third or fourth examination cycles of the Tehran Lipid and Glucose Study were selected and were followed to the fifth examination cycle. Daily intakes of protein from different animal/plant sources and ten protein-containing food groups were assessed using a food frequency questionnaire at baseline (the third or fourth examination cycles). Occurrence of menarche and its onset age were asked during each examination cycle. Cox proportional hazards regression was used to estimating hazard ratios (HRs) and 95% confidence interval (95%CI) for the occurrence of menarche per one standard deviation (SD) of dietary intakes. Logistic regression was also used to estimate the odds of reaching menarche ≤12 years.

Results

During the study, 147(61%) of girls reached menarche, the median age at menarche was 12 years. The adjusted HRs (95% CI) for the occurrence of menarche per one-SD of dietary intakes were 0.68 (0.48, 0.98; p = 0.040) for plant protein and 1.36 (1.01, 1.84; p = 0.042) for animal protein after adjusting for baseline age, BMI Z-score, energy intake, and mother’s early menarche and education. Substituting 10-g animal protein with plant protein was associated with a 16% (95%CI: 5–25%; p = 0.006) lower risk of menarche. Dietary intakes of poultry (adjusted HR: 1.35; 95% CIs: 1.00–1.82; p = 0.049) and low-fat dairy (adjusted HR: 1.20; 95%CIs: 0.99–1.46; p = 0.064) were marginally associated with the increased risk of menarche. However, the odds of early menarche was significant only for plant protein (adjusted odds ratio = 0.39; 95% CI: 0.16–0.96; p = 0.040).

Conclusions

Our findings indicate that the risk of menarche increases by higher intakes of animal protein and decreases by plant protein. Intakes of poultry and low-fat dairy associate with a higher risk of menarche. The odds of menarche occurrence ≤12 years reduces by higher intakes of plant protein.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02670-8.

Sex- and weight-specific changes in the frequency of sweet treat consumption during early adolescence: a longitudinal study

The transition from childhood to adolescence is a sensitive period, triggering changes in health- and weight-related behaviours including eating habits which likely vary between girls and boys. We aimed to characterise the changes in the frequency of consumption of select sugary foods and drinks ('sweet treats') among 4237 Finnish girls and boys during a 2-year follow-up period. Additionally, we examined four subgroups: children whose weight or waist normalised as well as children whose weight or waist circumference increased during follow-up. An FFQ was completed at 11·1 (sd 0·9) and again at 13·4 (sd 1·1) years of age. A sum variable sweet treat index (STI, range 0-84) captured the weekly consumption frequencies of sweet treats. From baseline to follow-up, the mean STI decreased among girls from 7·1 (95 % CI 6·9, 7·3) to 6·0 (95 % CI 5·9, 6·2) (P < 0·001) and boys from 8·5 (95 % CI 8·3, 8·8) to 7·8 (95 % CI 7·6, 7·8) (P < 0·001), although both sexes increased their chocolate/sweets consumption: girls from 1·3 (95 % CI 1·3, 1·4) to 1·6 (95 % CI 1·5, 1·6) (P < 0·001) and boys from 1·4 (95 % CI 1·3, 1·4) to 1·6 (95 % CI 1·6, 1·7) (P < 0·001), and boys increased their soft drink consumption from 1·4 (95 % CI 1·3, 1·4) to 1·5 (95 % CI 1·4, 1·5) (P = 0·020). We found similar decreases in both the weight and waist subgroups. To conclude, the total frequency of consumption of sweet treats decreased during early adolescence. A similar trend across subgroups suggests that the frequency of consumption of sweet treats is unrelated to becoming overweight.

New Diet Quality Index for children and adolescents in Costa Rica

Introduction

Introduction: there is an increasing interest in the study of total diet quality indicators through the study of food groups in certain dietary patterns. Objective: to analyze the diet of students in Costa Rica with construction of a contextualized new diet quality index. Material and methods: a cross-sectional study was performed in a population of 2,677 students from 64 educational centers. Data on habits and food intake frequency were collected through interviews and questionnaires. A new Diet Quality Index was constructed and applied, which assessed the adjustment of intake frequency for 22 food groups, corrected with five preventive dietary factors and five risk factors for chronic non-communicable diseases. Descriptive statistics were evaluated using the program SPSS, version 24.0. A p-value ˂ 0.05 was considered significant. Results: the population was made up of 1,259 (43%) men and 1,418 women (57%). According to the new Diet Quality Index-Costa Rica classification, 1.2% (n = 33) of participants have a healthy diet; 9.0% (n = 239) require dietary changes, and 89.8% (n = 2 395) have an unhealthy diet because of excessive intake of processed foods (rich in sodium and fat) and a low consumption of fruits and vegetables. Significant differences were found in the averages of the Diet Quality Index-Costa Rica by sex, educational level, and socioeconomic status. Conclusions: around 90% of the studied population do not comply with the recommendations issued for a healthy diet. Nutritional education should be strengthened in Costa Rican education centers.

Energy Dense Salty Food Consumption Frequency Is Associated with Diastolic Hypertension in Spanish Children

High blood pressure (BP) is a risk factor for cardiovascular disease and sodium consumption is related to high BP. Moreover, sugar-sweetened beverages (SSB) and the Dietary Approach to Stop Hypertension (DASH) influence BP. For this reason, we investigated whether: 1) children with risk of elevated BP had a higher consumption frequency (CF) of energy-dense salty foods (EDSF), high-sugary foods (HSF) and SSB or a low DASH score; and 2) children with a higher CF of EDSF showed a worse anthropometric and metabolic profile. Anthropometry, BP and general biochemical parameters were measured in 687 Spanish children (5-16 years) with normal or excess weight. A food frequency questionnaire was used to calculate EDSF, HSF and SSB consumption, and modified DASH score. Results showed that sex and pubertal stage influenced modified DASH score. Diastolic hypertension was associated to higher CF of EDSF in the whole sample and to higher CF of SSB in pubertal children, both independently of nutritional status. In addition, CF of EDSF was positively associated with CF of HSF and SSB and inversely associated with modified DASH score. Targeted policies and intervention programs, specific for different age ranges, should be established that aim to reduce salt consumption from snacks and processed foods, which could reduce HSF and SSB consumption as well.

Association of sugar-sweetened drinks with caries in 10- and 15-year-olds

BACKGROUND

Sugar-sweetened drinks (SSDs) are known to be cariogenic, but this association has not been well investigated in population-based repeated cross-sectional studies in recent years. Therefore, this study examined whether SSD intake is associated with higher caries experience in 10- and 15-year-olds.

METHODS

The study sample included participants from the Munich study centre of two birth cohorts with data on non-cavitated caries lesions (NCCL/S), caries experience (DMF/S index), overall caries burden (DMF + NCCL/S) and SSD intake. In total, 915 and 996 children were included from the 10- and 15-year follow-ups, respectively. Intake (g/day) of SSDs, comprising cola, lemonade, ice-tea, sport/energy drinks, fruit squashes and nectars, was calculated from food frequency questionnaires. For analyses, the SSD intake was converted into portions (250 ml/day). Multiple logistic regression and prospective analysis models were performed to test associations between SSD intake and various definitions of caries, adjusting for sex, parental education, body mass index (BMI) categories, study cohort, plaque-affected sextants, mode of SSD consumption, energy content of SSDs, and total energy intake.

RESULTS

The mean overall caries burden at 10 and 15 years of age was 1.81 (SD: 2.71) and 6.04 (SD: 8.13), respectively. The average consumption of SSDs at the 10- and 15-year follow-ups was 0.48 (SD: 0.85) and 0.83 (SD 1.40) portions/day, respectively. After adjusting for confounders, in 10-year-olds, SSD intake was significantly associated with higher caries experience based on the indices DMF/S (adjusted odds ratio: 1.29; 95% CI: 1.06-1.57), NCCL/S (1.24; 1.03-1.49) and DMF + NCCL/S (1.27; 1.05-1.55). At the 15-year follow-up, SSD consumption was significantly associated with increased DMF/S index (1.12; 1.01-1.25) only. Prospective model associating 10-year SSD intake with 15-year caries experience was not significant.

CONCLUSIONS

SSD intake significantly increases the caries burden in 10-year-olds, with attenuated effects in 15-year-olds. To prevent caries, SSD consumption should be reduced, especially in children and adolescents.

Socio-economic and cultural disparities in diet among adolescents and young adults: a systematic review

OBJECTIVE

To explore dietary differences according to socio-economic and sociocultural characteristics of adolescents and young adults.

DESIGN

A systematic review was conducted.

SETTING

The main search source was MEDLINE, consulted between January 2012 and March 2017. Quality of selected studies was assessed based on dietary measurement method, sample selection, socio-economic indicator choice and statistical modelling.

PARTICIPANTS

Cross-sectional and longitudinal studies, assessing relationships between socio-economic status and dietary intake (patterns, scores and food groups) in the 10- to 40-year-old general population of high-income countries, were selected.

RESULTS

Among the 7250 reports identified, forty were selected, seventeen of which were of high quality; their conclusions, related only to adolescents, were combined and presented. The most favourable dietary patterns, higher dietary scores, greater consumption of fruits, vegetables and dairy products, and lower consumption of sugary sweetened beverages and energy-dense foods, were associated with better parental socio-economic status, particularly in terms of higher education. Migrant status was associated with plant-based patterns, greater consumption of fruits and vegetables and of sugary sweetened beverages and energy-dense foods. For the other food groups, and for young adults, very few high-quality studies were found.

CONCLUSIONS

The socio-economic gradient in adolescent diets requires confirmation by higher-grade studies of a wider set of food groups and must be extended to young adult populations. Future nutritional interventions should involve the most vulnerable adolescent populations, taking account of socio-economic status and migration.

Food Consumption in Adolescents and Young Adults: Age-Specific Socio-Economic and Cultural Disparities (Belgian Food Consumption Survey 2014)

A key issue in nutritional public health policies is to take into account social disparities behind health inequalities. The transition from adolescence toward adulthood is a critical period regarding changes in health behaviors. This study aimed to determine how consumption of four emblematic food groups (two to favor and two to limit) differed according to socio-economic and cultural characteristics of adolescents and young adults living in Belgium. Two non-consecutive 24-h dietary recalls were carried out in a nationally representative sample of 10–39 year old subjects (n = 1505) included in the Belgian food consumption survey 2014. Weighted daily mean consumption of “fruits and vegetables”, “whole grain bread and cereals”, “refined starchy food”, and “sugary sweetened beverages” (SSB) was calculated and explored in multivariable linear regressions stratified into four age groups. After adjustment, 10–13 year old adolescents living in less educated households daily consumed lower amounts of “fruits and vegetables” (adjusted mean: 165.6 g/day (95% CI: 125.3–206.0)) and “whole grain bread and cereals” (40.4 g/day (22.9–58.0)), and higher amounts of SSB (309.7 g/day (131.3–488.1) than adolescents of same ages living in more educated households (220.2 g/day (179.8–260.7); 59.0 g/day (40.3–77.8); and 157.8 g/day (1.7–314.0), respectively). The same trends were observed in older groups, along with strong consumption disparities according to region of residency, country of birth, and occupation, with specificities according to age. Our findings suggest the need to better explore such disparities by stage of transition to adulthood, and to adapt nutritional health programs.

Dietary saturated fat and low-grade inflammation modified by accelerometer-measured physical activity in adolescence: results from the GINIplus and LISA birth cohorts

BACKGROUND

Saturated fatty acids (SFA) have been reported to promote inflammation. Nevertheless, evidence linking dietary SFA and low-grade inflammation in adolescents is scarce and inconsistent. The modulatory role of physical activity (PA) on fat metabolism and inflammation may provide a potential explanation. Thus, we assessed the association of dietary SFA with high-sensitivity C-reactive protein (hsCRP), a marker of low-grade inflammation, in 15-year-olds, and evaluated possible interactions between dietary SFA and different levels of PA.

METHODS

Children participating in the 15-year follow-ups of the GINIplus and LISA German birth cohort studies were included (N = 824). SFA intake was estimated by means of a food frequency questionnaire and PA recorded by accelerometers. Average daily minutes of PA were classified into "sedentary", "light" and "moderate-to-vigorous" (MVPA), using Freedson's cut-offs. HsCRP concentrations were measured in serum and categorized into 3 sex-specific levels (below detection limit (I), above 75th percentile (III), in between (II)). Sex-stratified cross-sectional associations between SFA and hsCRP were assessed using multinomial logistic regression, adjusting for potential confounders. Interaction terms were included between SFA and the different PA levels; and if significant interactions were observed, analyses stratified by tertiles of the relevant PA levels were performed. Relative risk ratios (RRR) and 95% confidence intervals (95%CI) were presented for a 1% increase in SFA.

RESULTS

An inverse association was observed between SFA intake and hsCRP (II vs. I) in males (RRR = 0.85 [95%CI = 0.76;0.96], p = 0.008), whereas no significant association was observed in females. A significant interaction was observed with "sedentary" and "light" PA but not with MVPA in both sexes (p < 0.05). Stratified analyses indicated a significant inverse association between SFA and medium hsCRP levels in males in the highest light PA tertile (hsCRP II vs. I: 0.67 [0.517;0.858], p = 0.002).

CONCLUSION

Our findings do not support a detrimental role of dietary SFA in low-grade inflammation among adolescents. In males, higher dietary SFA was associated with lower hsCRP, although this should be interpreted in the context of possibly correlated nutrients. Children spending the most time in light PA drove the observed inverse association, suggesting a synergistic effect of SFA and lifestyle PA in the resultant inflammatory response.

Beyond Meat: A Comparison of the Dietary Intakes of Vegetarian and Non-vegetarian Adolescents

Dietary intake of adult vegetarians from large prospective studies has been well-characterized but is rarely reported in vegetarian adolescents. Our objective was to describe and compare the dietary intake of vegetarian adolescents with their non-vegetarian counterparts in a population known to espouse healthy living. Adolescents (n = 534) aged 12–18 years old from middle and high schools near major Adventist universities in Michigan and Southern California provided dietary, demographic, and anthropometric data. Dietary intake was measured with a validated 151-item self-administered web-based food frequency questionnaire; weight and height were measured during school visits. Vegetarian was defined as the combined intake of meat, meat derivatives, poultry, and fish of <1 serving per week. Descriptive statistics and ANCOVA were used to compare the intake of vegetarians and non-vegetarians. Vegetarians significantly ate more fruits, vegetables, and other plant-based foods, but significantly less foods of animal origin, sugar-sweetened beverages, and coffee/tea compared to non-vegetarians. Vegetarians had significantly higher intakes of carbohydrates and total protein but lower intakes of fats, animal protein, and zinc compared to their counterparts. A majority (75% or more) of both groups met the 2015 Dietary Guidelines' age-and-gender-specific recommendations for most nutrients but only 16–18% of vegetarians/non-vegetarians did not exceed the upper limit for sodium. More vegetarians (49%) than non-vegetarians (25%) had <10% of their caloric intake from SFA. More than 90% of both groups met dairy recommendations, but greater proportions of vegetarians met recommendations for vegetables, fruits, nuts/soy products, and legumes than non-vegetarians. Of the non-vegetarians, only 7% and 44% met the fish and meats/poultry/eggs recommendation, respectively, which none of the vegetarians met. Compared to the general US adolescent population, both diet groups ate more fruits, vegetables, dairy and protein foods, and also consumed more micronutrients but less macronutrients. Overall, vegetarian adolescents have a more favorable dietary intake profile than non-vegetarians, but both vegetarians and non-vegetarians in this study population have a more adequate diet than the general US adolescent population. The influence of the Adventist plant-based diet culture that is translated both at home and at school is evident in our findings.

Dietary habits of adolescents living in North America, Europe or Oceania: A review on fruit, vegetable and legume consumption, sodium intake, and adherence to the Mediterranean Diet

AIMS

This review aimed at investigating fruit, vegetable and legume consumption, salt/sodium intake, and the adherence to the Mediterranean dietary pattern in adolescents, three key aspects towards the adoption of a healthy diet.

DATA SYNTHESIS

Three separate searches were carried out on PubMed and Scopus, using the same procedure, searching for studies published in the previous decade with data on fruit and/or vegetable or legume consumption, salt or sodium intake, and adherence to the Mediterranean Diet assessed using the KIDMED questionnaire. The review included a total of 58 papers, which describe original investigations on healthy adolescents (10-19 years old) living in North America, Europe or Oceania, with a sample size >150 participants. The average fruit and vegetable consumption has been found strongly below the recommended values of 400 grams or 5 portions per day in almost all the examined populations. Very little is known about adolescents' legume consumption. Few available data have been found also for sodium intake and, for the majority of the screened populations, levels were far above the recommended 5 grams per day. Lastly, a medium-low adherence to the Mediterranean Diet has been found for adolescents living in Mediterranean Countries.

CONCLUSIONS

Adolescents living in North America, Europe or Oceania are far from being compliant with the nutritional recommendations for fruit, vegetables, legumes, and sodium, and they do not follow the principles of the Mediterranean Diet. Educational and behavioural interventions are required to improve adolescents' dietary patterns.

A Mentor-Led Text-Messaging Intervention Increases Intake of Fruits and Vegetables and Goal Setting for Healthier Dietary Consumption among Rural Adolescents in Kentucky and North Carolina, 2017

Introduction—Text-messaging interventions hold promise for successful weight loss interventions. However, there is limited research on text-messaging interventions to improve dietary intake among rural adolescents, who are at greater risk for obesity and related risk factors. The goal of this study was to test an eight-week, mentor-led text-messaging intervention among 14–16-year-old rural adolescents: the “Go Big and Bring It Home” Project to improve fruit and vegetable and healthy beverage intake. Methods and Materials—Eight rural high schools in eastern Kentucky and eastern North Carolina participated (n = 4 were randomized as intervention schools and n = 4 were randomized as control schools). Adolescents were recruited to participate in the eight-week text-messaging intervention. The text messages were primarily affective messages, and included a weekly challenge related to consuming fruits, vegetables, or healthy/low-calorie beverages. Undergraduate nutrition students sent text messages on Tuesday and Saturday every week over the eight-week period via the “Group Me” mobile application. Delayed controls received no information or text messages during the eight-week intervention. Fruit and vegetable intake was measured with the National Cancer Institute Fruit and Vegetable screener and beverage intake was assessed using the Beverage Questionnaire-10 (BEVQ-10). Intention-to-treat analyses were conducted among all those that completed the baseline and post-intervention survey (n = 277 intervention students and n = 134 delayed control students). All linear regression models were adjusted for race and were clustered on school to control for intraclass correlation. Results—In adjusted analyses, there was a statistically significant positive intervention effect on the primary outcome of fruit and vegetable servings/day with a mean difference between intervention and control participants of 1.28 servings/day (95% Confidence Interval 1.11, 1.48). There was no intervention effect on beverage intake. There was a statistically significant increase in the odds of goal setting for healthier dietary behaviors among intervention participants relative to controls. Conclusion—An eight-week text-messaging intervention led to increases in self-reported fruit and vegetable intake and improvements in goal setting for healthier dietary behaviors. Due to the use of undergraduate students to deliver the messages, and use of an existing web application, this text-messaging intervention can be sustained in underserved, rural environments. Thus there is potential for significant reach and public health impact to improve dietary patterns.

Association of Dietary Fatty Acids with Blood Lipids is Modified by Physical Activity in Adolescents: Results from the GINIplus and LISA Birth Cohort Studies

The role of consuming different types of fatty acids (FA) at the expense of carbohydrates (CHO), on the blood lipid profile of adolescents is largely unknown, as is the modulating effect of different levels of physical activity (PA). Children from the GINIplus and LISA birth cohorts, with complete data on dietary FA (assessed by food-frequency questionnaires), objectively-measured PA (assessed by accelerometers) and blood lipids (lipoprotein cholesterol and triglycerides) at age 15 years, were included (N = 837). Sex-stratified associations between dietary FA and blood lipids were assessed by linear regression in substitution models which represented isocaloric replacements of CHO with saturated FA (SFA), monounsaturated FA (MUFA), n-3 polyunsaturated FA (PUFA) or n-6 PUFA. To assess the interactions with PA, analyses were then performed stratified by tertiles of different PA levels (sedentary, lifestyle, moderate-to-vigorous (MVPA)). Both sexes presented a significant inverse association between MUFA and triglycerides, and females a direct association between n-3 PUFA and high-density lipoprotein. Stratifying by PA tertiles, associations were mainly restricted to participants with the lowest levels of lifestyle PA, or the highest time spent sedentary. The effects of dietary FA on the lipid profile vary in an activity-specific manner, emphasizing possible synergistic roles of diet and PA.

Protein intake trends and conformity with the Dietary Reference Intakes in the United States: analysis of the National Health and Nutrition Examination Survey, 2001-2014

Background

Systematic analysis of dietary protein intake may identify demographic groups within the American population that are not meeting the Dietary Reference Intakes (DRIs).

Objective

This cross-sectional study analyzed protein intake trends (2001-2014) and evaluated recent conformity to the DRIs (2011-2014) according to age, sex, and race or ethnicity in the US population.

Design

Protein intakes and trends during 2-y cycles of NHANES 2001-2014 (n = 57,980; ≥2 y old) were calculated as absolute (grams per day) and relative [grams per kilogram of ideal body weight (IBW) per day] intakes and as a percentage of total energy. Sex and race or ethnicity [Asian, Hispanic, non-Hispanic black (NHB), and non-Hispanic white (NHW)] differences were determined for protein intake and percentage of the population below the Estimated Average Requirement (EAR) and Recommended Dietary Allowance, and above and below the Acceptable Macronutrient Distribution Range (AMDR).

Results

Usual protein intakes (mean ± SE) averaged from 55.3 ± 0.9 (children aged 2-3 y) to 88.2 ± 1.1 g/d (adults aged 19-30 y). Protein comprised 14-16% of total energy intakes. Relative protein intakes averaged from 1.10 ± 0.01 (adults aged ≥71 y) to 3.63 ± 0.07 g · kg IBW-1 · d-1 (children aged 2-3 y), and were above the EAR in all demographic groups. Asian and Hispanic populations aged >19 y consumed more relative protein (1.32 ± 0.02 and 1.32 ± 0.02 g · kg IBW-1 · d-1, respectively) than did NHB and NHW (1.18 ± 0.01 g · kg IBW-1 · d-1). Relative protein intakes did not differ by race or ethnicity in the 2-18 y population. Adolescent (aged 14-18 y) females and older (aged ≥71 y) NHB men had the largest population percentages below the EAR (11% and 13%, respectively); <1% of any demographic group had intakes above the AMDR.

Conclusions

The majority of the US population exceeds minimum recommendations for protein intake. Protein intake remains well below the upper end of the AMDR, indicating that protein intake, as a percentage of energy intake, is not excessive in the American diet. This trial was registered at www.isrctn.com as ISRCTN76534484.

Dietary Acid Load and Mental Health Outcomes in Children and Adolescents: Results from the GINIplus and LISA Birth Cohort Studies

High dietary acid load may have detrimental effects on mental health during childhood and adolescence. We examined cross-sectional and prospective associations of dietary acid load and mental health problems in a population-based sample, using data from the German birth cohort studies GINIplus (German Infant Nutritional Intervention plus environmental and genetic influences on allergy development) and LISA (Influences of lifestyle-related factors on the immune system and the development of allergies in childhood). These studies included detailed assessments of dietary intake through a food frequency questionnaire (FFQ), mental health outcomes measured through the Strengths and Difficulties Questionnaire (SDQ), and covariates. Using logistic regression, cross-sectional associations between dietary acid load measured as potential renal acid load (PRAL) and SDQ subscales were assessed at age 10 years (N = 2350) and 15 years (N = 2061). Prospective associations were assessed, considering PRAL at 10 years as exposure and SDQ subscales at 15 years as outcome (N = 1685). Results indicate that children with a diet higher in PRAL have more emotional problems (OR = 1.33 (95% CI = 1.15; 1.54); p < 0.001), and show hyperactivity more often (1.22 (1.04; 1.43); p = 0.014) at 10 years. No significant associations were present either cross-sectionally at age 15 years, nor prospectively. Results were confirmed in sensitivity analyses. These findings reveal first evidence for potential relationships between PRAL and mental health in childhood, although we cannot exclude reverse causality, i.e., that dietary behavior and PRAL are influenced by mental status. Future studies should address confirmation and identify biological mechanisms.

Effect of an vitamin D deficiency on depressive symptoms in child and adolescent psychiatric patients - a randomized controlled trial: study protocol

BACKGROUND

Depression is a significant health and economic burden worldwide affecting not only adults but also children and adolescents. Current treatment options for this group are scarce and show moderate effect sizes. There is emerging evidence that dietary patterns and specific nutritional components might play a role in the risk for developing depression. This study protocol focusses on the role of vitamin D which is for long known to be relevant for calcium and phosphorous homeostasis and bone health but might also impact on mental health. However, the assessment of the vitamin D status of depressed juvenile patients, or supplementation of vitamin D is currently not part of routine treatment. Controlled intervention studies are indispensable to prove whether a vitamin D deficiency ameliorates depressive symptoms.

METHODS/DESIGN

This double blinded, randomized controlled trial will enroll 200 inpatients from a child and adolescent psychiatric department with a vitamin D deficiency defined by a 25(OH)-vitamin D-level < 30 nmol/l (12 ng/ml) and a Beck Depressions Inventory (BDI-II) score > 13 (indicating at least: mild depression). Upon referral, all patients will be screened, checked for inclusion criteria, and those eligible will be randomized after written consent into a supplementation or placebo group. Both study-arms will receive treatment-as-usual for their psychiatric disorder according to established clinical guidelines. The participants of the vitamin D supplementation group will receive 2640 I.E. vitamin D3 q.d. for 28 days in accordance with best practice in pediatric endocrinology. We hypothesize that delaying supplementation of vitamin D in the placebo arm will affect the treatment success of the depressive symptomatology in comparison to the vitamin D supplementation group. Patients will be enrolled for a period of 28 days based on the mean length of hospitalization of juveniles with depression.

DISCUSSION

Randomized controlled trials in children and adolescents with depression are needed to elucidate the role of a vitamin D deficiency for mental disorders and to investigate the relevance of a routine assessment and supplementation of vitamin D deficits.

TRIAL REGISTRATION

DRKS00009758, 16/06/2016 (retrospectively registered).

Joint Data Analysis in Nutritional Epidemiology: Identification of Observational Studies and Minimal Requirements

Background

Joint data analysis from multiple nutrition studies may improve the ability to answer complex questions regarding the role of nutritional status and diet in health and disease.

Objective

The objective was to identify nutritional observational studies from partners participating in the European Nutritional Phenotype Assessment and Data Sharing Initiative (ENPADASI) Consortium, as well as minimal requirements for joint data analysis.

Methods

A predefined template containing information on study design, exposure measurements (dietary intake, alcohol and tobacco consumption, physical activity, sedentary behavior, anthropometric measures, and sociodemographic and health status), main health-related outcomes, and laboratory measurements (traditional and omics biomarkers) was developed and circulated to those European research groups participating in the ENPADASI under the strategic research area of "diet-related chronic diseases." Information about raw data disposition and metadata sharing was requested. A set of minimal requirements was abstracted from the gathered information.

Results

Studies (12 cohort, 12 cross-sectional, and 2 case-control) were identified. Two studies recruited children only and the rest recruited adults. All studies included dietary intake data. Twenty studies collected blood samples. Data on traditional biomarkers were available for 20 studies, of which 17 measured lipoproteins, glucose, and insulin and 13 measured inflammatory biomarkers. Metabolomics, proteomics, and genomics or transcriptomics data were available in 5, 3, and 12 studies, respectively. Although the study authors were willing to share metadata, most refused, were hesitant, or had legal or ethical issues related to sharing raw data. Forty-one descriptors of minimal requirements for the study data were identified to facilitate data integration.

Conclusions

Combining study data sets will enable sufficiently powered, refined investigations to increase the knowledge and understanding of the relation between food, nutrition, and human health. Furthermore, the minimal requirements for study data may encourage more efficient secondary usage of existing data and provide sufficient information for researchers to draft future multicenter research proposals in nutrition.

Genetic Variations in Sweet Taste Receptor Gene Are Related to Chocolate Powder and Dietary Fiber Intake in Obese Children and Adolescents

Childhood obesity is a major public health problem. It has a direct impact on the quality of life of children and adolescents, as well as on their future risk of developing chronic diseases. Dietary patterns rich in fats and sugars and lacking dietary fibers, vitamins, and minerals, as well as lack of physical exercise have been associated with the rise of obesity prevalence. However, factors that contribute to the preference for foods rich in these nutrients are not well established. Taste is recognized as an important predictor of food choices, and polymorphisms in taste-related genes may explain the variability of taste preference and food intake. The aim of this research is to evaluate the influence of polymorphisms of the sweet taste receptor gene TAS1R2 on diet and metabolic profile in obese children and adolescents. A cross-sectional study with 513 obese children and adolescents and 135 normal-weight children was carried out. A molecular study was performed for the single nucleotide polymorphisms (SNPs) rs9701796 and rs35874116 of TAS1R2, and dietary intake, anthropometric parameters (weight, height, waist circumference, waist-to-height ratio (WHtR)), and metabolic profile (including fasting glucose, insulin, triglyceride, high-density lipoprotein (HDL)-cholesterol, and leptin levels) were analyzed. The variant rs9701796 was associated with increased waist-height ratio, as well as with a higher chocolate powder intake in obese children. The variant rs35874116 was associated with a lower dietary fiber intake. In conclusion, there was no relationship between genotypes and risk of obesity. Obese adolescents carrying the serine allele of SNP rs9701796 in TAS1R2 showed higher waist-to-height ratio and chocolate powder intake, whereas those carrying the valine allele of SNP rs35874116 in TAS1R2 were characterized by lower dietary fiber intake.

Changes in Dietary Patterns from Childhood to Adolescence and Associated Body Adiposity Status

The aims of this study were to identify cross-sectional dietary patterns (DPs) in a representative sample of 7–10-year-old schoolchildren, to examine how scores for these DPs tracked over a time period of five years (from age 7–10 years to 12–15 years), and to investigate longitudinal associations between changes in DPs scores and changes in BMI (Body Mass Index) z-scores. Children aged 7–10-years were examined in 2007 (n = 1158) and a subset of the sample participated in a follow-up in 2012 (n = 458). Factor analysis (FA) was applied to derive DPs at baseline. The change in DP from childhood to adolescence was analyzed by comparing factor scores using the complete cases, in which factor loadings were the ones evaluated at baseline. Associations of BMI change with DP change were assessed by multivariate linear regression. At baseline, four DP were identified that explained 47.9% of the food intake variance. On average, the factor scores of “DP II” (salty snacks, French fries, fast-food, sugary beverages) decreased in follow-up, while no changes were observed for “DP I” (rice, cooked beans, beef/poultry, leafy vegetables), “DP III” (fruits, cooked and leafy vegetables, fruit juices, pasta, milk, cheese), and “DP IV” (milk, coffee with milk, cheese, breads/biscuits). No significant linear association was shown between changes in BMI z-scores and changes in DP scores from childhood to adolescence. In conclusion, three out of four DP scores identified at baseline tracked slightly in adolescence.

Changes in diet from age 10 to 14 years and prospective associations with school lunch choice

BACKGROUND

There is limited evidence on how diet changes over the transition from primary to secondary school. In this study we investigated changes in diet from age 10 (2007) to age 14 years (2011) and the contribution of school-time consumption and school lunch choice to such changes.

METHODS

The 351 participants with dietary data (4 day food record) available at baseline (age 10 years) and follow-up (age 14 years) were included. Multi-level regression models were fitted for absolute or change in food and nutrient intake, cross-classified by primary and secondary school attended as appropriate, with adjustment for covariates and mis-reporting.

RESULTS

From age 10 to age 14 years, children decreased energy intake from sugars (-2.6% energy (%E)) (standard error (SE) 0.44) and from saturated fats (-0.54%E (SE 0.18)), decreased fruit (-3.13 g/MJ (SE 1.04)) and vegetables (-1.55 g/MJ (SE 0.46)) consumption and increased sugar sweetened beverage (SSB) (4.66  g/MJ (SE 1.87)) and fries (1.31  g/MJ (SE 0.39)) consumption. Intake of snack foods, SSBs, and fries, but also fruits and vegetables was higher outside school hours. Prospective change from non-school lunch to school lunch, compared to maintaining non-school lunch consumption, was associated with decreased consumption of savoury snacks (-8.32 g/day (SE 2.03)), increased consumption of fries (12.8 g/day (SE 4.01)) and decreased consumption of fruit (-25.16 g/day (SE 11.02)) during school hours.

CONCLUSIONS

Changes in diet from age 10 to age 14 years differed within and outside of school hours. Consumption of a school lunch, compared to lunch obtained elsewhere, was associated with negative as well as positive changes in diet, suggesting that any efforts to encourage school lunch take-up need to be accompanied by further efforts to improve school lunch provision to meet nutritional guidelines.

Energy Balance–Related Behavior and Anthropometric Measures Among Adolescents Across Three Educational Levels: A Cross-Sectional Study in Dutch Schools

Energy balance–related behavior on schooldays and beliefs about school-based interventions may differ between students in different educational levels, sexes, and BMI (body mass index) categories. In Zwolle (the Netherlands), 1,084 adolescents (13-15 years) at 9 secondary schools completed a questionnaire. Overweight prevalence (boys 18.1%, girls 19.3%) increased with decreasing educational level, especially in boys. Girls reported healthier behavior than boys regarding daily consumption of fruit (35% vs. 29%), vegetables (58% vs. 48%), ≤1 snack/candy (36% vs. 26%), ≤3 glasses of sugared drinks (80% vs. 73%; all p < .05). Unhealthier dietary behaviors were associated with lower educational level, except for eating sugary and savory snacks. Snacks and sugared drinks consumed at school were mostly brought from home (61.6% and 68.5%, respectively). Overweight students reported less frequent consumption of daily breakfast, snacks, and sugared drinks than nonoverweight students. Of all students, 40% spent ≥1 hour per day cycling to school. Lower educational level students reported less organized sports activities than higher level students, but more outside play and other activities. Overweight was associated with cycling to school (boys) and participating in organized sports (girls). More girls than boys were interested in lessons about healthy nutrition (44.4% vs. 31.7%). To stimulate physical activity, boys suggested more physical education classes (63%), girls advised more variation (47%) and choice (43%). A healthy school canteen (57%) and offering free fruit (67%) were suggested as promising interventions to stimulate healthy behavior. Educational and environmental interventions to tackle unhealthy dietary and physical activity behavior should be developed in collaboration with parents and tailored to educational level and gender.

Dietary Fatty Acids and Changes in Blood Lipids during Adolescence: The Role of Substituting Nutrient Intakes

The relevance of dietary fatty acids (FA) for blood lipids should be assessed in the context of substituting nutrients. Such evidence is lacking for adolescents. This study describes prospective associations of dietary FA with changes in serum lipids during adolescence, and considers the theoretical isocaloric replacements of saturated FA (SFA) with other FA or carbohydrates (CHO). Children from the GINIplus and LISAplus birth cohorts, with data on FA intakes (at age 10 years) and serum lipids (at age 10 and 15 years), were included (n = 1398). Associations of SFA, monounsaturated FA (MUFA), n-3 polyunsaturated FA (n-3 PUFA) and n-6 PUFA, with changes in low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TAG), and total cholesterol to HDL ratio (TOTAL:HDL), were assessed by linear regression. Substitution models assessed isocaloric replacements of SFA with MUFA, n-3 PUFA, n-6 PUFA or CHO. Higher SFA intakes were associated with decreasing TAG. No associations were observed for fatty acid intakes with LDL, HDL or TOTAL:HDL. In females, replacing SFA with CHO was associated with increasing LDL, TAG and TOTAL:HDL. Our findings confirm observations in adults, although sex-specific determinants seem relevant in our adolescent population. Overlooking the nutrient context when limiting SFA intakes might have detrimental consequences appreciable as early as adolescence.