Effects of Cervical Spinal Manipulation on Saccadic Eye Movements.

Quantifying saccadic eye movements can assist in identifying dysfunctional brain networks in both healthy and diseased people. Infrared Oculography is a simple and non-invasive approach to capturing and quantifying saccades, providing information that might aid in diagnosis and outcome assessments. The effect of spinal manipulation on quantified saccadic performance parameters has not been fully studied despite known post-manipulative effects on the brain and brainstem regions controlling them. This case study investigates spinal manipulation's immediate and long-term effects on saccadic eye movements by quantifying the saccades of a male patient diagnosed with post-concussion syndrome. The patient performed horizontal saccades that were quantified before and immediately following cervical spinal manipulation both at the case study's start and following a 2-week interim, during which the subject received six manipulative treatments. Immediate and long-term post-manipulative effects were observed, and the results revealed various post-manipulative effects across all quantified parameters in addition to between right and leftward saccades. The immediate post-manipulative effect was greatest at the case study's onset, while the long-term right and leftward saccadic symmetry were most affected. The observations in this case study demonstrate that cervical spinal manipulation influences saccadic eye movements, providing new insights into its central neurological effects and therapeutic applications beyond its most commonly known use in pain management. More importantly, it encourages scientists to undertake further clinical investigations on wider scales.

Exercise improves depression through positive modulation of brain-derived neurotrophic factor (BDNF). A review based on 100 manuscripts over 20 years.

The aim of this review was to explore the relevant neurobiology and the association between peripheral levels of brain-derived neurotrophic factor (BDNF) and acute and short to long-term exercise regimes, as well as its relation to depression and antidepressant treatment. A 20-year literature search was conducted. The screening process resulted in 100 manuscripts. Antidepressants as well as acute exercise, particularly high-intensity, elevates BDNF in healthy humans and clinical populations, as evidenced from aerobic and resistance-based studies. Although exercise is increasingly recognised in the management of depression, acute and short-term exercise studies have failed to establish a relationship between the severity of depression and changes in peripheral BDNF. The latter rapidly returns to baseline, possibly indicating a quick re-uptake by the brain, aiding its neuroplasticity functions. The timescale of administration needed for the antidepressants to stimulate biochemical changes is longer than similar increases with acute exercise.

Effects of a Football Simulated Exercise on Injury Risk Factors for Anterior Cruciate Ligament (ACL) Injury in Amateur Female Players.

Females are more at risk of Anterior Cruciate Ligament (ACL) injuries than males; however, there is limited literature on neuromuscular risk factors such as angle-specific hamstring/quadriceps functional strength ratios (Hecc/Qcon) and rate of torque development (RTD) in female footballers. The aim of this study was to investigate the effects of fatigue on these neuromuscular risk factors. Thirty-three amateur players (20.3 ± 2.0 years old, 1.67 ± 9.31 m, 63.4 ±8.1 kg, 23.6 ± 5.7% body fat) performed strength assessments of the quadriceps (concentrically, Qcon) and hamstrings (eccentrically, Hecc) on both legs on an isokinetic dynamometer, before and immediately after a football-specific exercise. Results showed significantly lower peak Hecc (-15.1 to -15.5%), peak Hecc/Qcon (-8.8 to -12.9%) and RTD (-14.0 to -17.0%) for hamstring eccentric contractions after fatigue in the dominant and non-dominant legs. Furthermore, significant decreases in Hecc/Qcon were observed at 10° only in the dominant leg (-15.5%), and at 10°, 20° and 30° in the non-dominant leg (-15.1 to -21.8%). These results suggest a reduced capacity of the hamstrings to stabilise the knee joint with fatigue. Unlike results previously shown on men, the non-dominant leg seemed more affected, highlighting the need to consider specific prevention measures in females.

Kinetic and Kinematic Analysis of Landing during Standing Back Somersault Using Three Technical Arm Swings in Artistic Gymnastics.

The crucial criteria when assessing technical performance in artistic gymnastics is the higher elevation of the gymnast's body and a stable landing (i.e., stick-landing). The purpose of this study was to compare kinetic and kinematic parameters during the landing phase of standing back somersaults (SBS) following three technical arm-swing performed during the preparatory phase in high-level male gymnasts. The three different arm-swing pertain to three "gymnastics schools", i.e., Russian, Chinese, and Romanian. Six high-level male gymnasts participated in this study. Three arm-swing with different angles (i.e., SBS270°, SBS180°, and SBS90°) were randomly performed. A 3D kinetic and kinematic analysis was conducted. Results showed significant variation in the landing angle (p = 0.009) across the three arm-swing techniques. The SBS90° arm-swing resulted in the closest angle to the vertical. Additionally, the SBS90° arm-swing technique induced the lowest horizontal and vertical force values upon landing compared to the other arm-swing techniques (SBS270°: p = 0.023 and 0.009, respectively; SBS180°: p = 0.004 and 0.080, respectively). The same was noted for the horizontal velocity (p = 0.021) with the lowest values noted for the SBS90° arm-swing technique. However, the best opening angle was observed during the SBS270° technique, since it presented the best vertical displacement. In conclusion, the SBS with a SBS90° arm-swing seems to favor a better absorption of the ground reaction force upon landing by reducing the intensity of the impact with the ground and by affording a landing angle closer to the vertical in high-level male gymnasts.

Salivary endocrine response following a maximal incremental cycling protocol with local vibration.

The aim of this study was to compare the effects of vibration (Vib versus noVib) during a maximal graded cycling exercise on hormonal response, precisely on cortisol (C) and testosterone (T). Twelve active males (25 ± 5yrs; 181 ± 5cm; 80.7 ± 11.1kg) randomly performed two maximal incremental cycling tests on two separate days and at the same time of the day (09:00). The protocol consisted of incremental steps of 3 min duration performed on a PowerBIKETM that induces vibration cycling. The study was a repeated measures design and participants performed the test with and without vibration. Gas exchange and heart rate (HR) were continuously assessed and blood lactate (Bla) was recorded at the end of each incremental stage. Saliva samples were collected before and immediately after the test, and analysed for (C) and (T). The results show that C and T increased in both cycling conditions; however, the C's magnitude of change was significantly higher by 83% after Vib cycling in comparison to the no Vib (p = 0.014), whereas the T's magnitude of change were not statistically different between trials (p = 0.715). Vibration induced a decrease of the T/C ratio (p = 0.046) but no significant changes were observed following noVib (p = 0.476). As a conclusion, the investigation suggests that adding mechanical vibration to cycling may potentiate a catabolic exercise-induced state, which could have potential clinical implications in rehabilitation and injury treatment. Sport experts should take this message home to carefully plan the recovery process and time during training and competitions.

Retraction Note: Assessing cardiorespiratory fitness of soccer players: is test specificity the issue?-a review.

The editors have retracted this article [1] because it contains substantial text and figure overlap with the following articles [2-5].

Vibration Cycling Did Not Affect Energy Demands Compared to Normal Cycling During Maximal Graded Test.

The aim of this study was to compare the physiological responses between a vibration induced cycling step protocol (Vib) and normal cycling (without vibration, no-Vib). Eighteen moderate trained males (age 24.1 ± 4.3 years; weight 76.5 ± 10.5 kg; height 178.0 ± 6.4 cm) have participated in this study. They randomly performed two gradual maximal exercise tests on two separate days using a new bike that automatically induces vibration cycling and the Corival cycle ergometer. The choice of two different bikes was made because of the impossibility to recreate the same power output without altering the cycling cadence on the vibration Bike. Both protocols were matched for power output and cycling cadence incrementations. Oxygen uptake (VO2), carbon dioxide production (VCO2), ventilation (VE), heart rate (HR), blood lactate and rating of perceived exertion (RPE) during each stage were continuously recorded. No statistical differences were founded for all variables when comparing the Vib to no-Vib trials, except a higher ventilation during the vibration trial at submaximal levels. The results of this study do not confirm those of previous studies stated that Vib increased metabolic demands during cycling exercise. Added vibration stimulus to an incremental cycling protocol does not affect physiological parameters.

Lifestyle Factors and Mental Health.

A number of lifestyle factors have been recognised to play an important role in positively modifying medical and psychiatric diseases and their associated morbidity and mortality. These include, eating healthy food, greater physical activity, cessation of smoking, avoidance of alcohol and illicit substances. Additional lifestyle factors for healthy living include, safe and peaceful environment, optimal sleep, de-stressing and enjoyable activities, social connections/support and healthy mental activities. Physicians from the ancient times, through the middle ages to the early 20th century have recommended adoption of healthy lifestyle factors such as diet and exercise to manage medical and psychiatric disorders without really understanding their scientific basis. In this short paper, we discuss the important role lifestyle factors play in morbidity and mortality related to many important and common medical and psychiatric diseases. We explore how and if positively modifying lifestyle factors can help to improve and or prevent medical and psychiatric disorders with particular emphasis on food, diet and exercise.

Profiles of Physical Fitness Risk Behaviours in School Adolescents from the ASSO Project: A Latent Class Analysis.

The aim of the present investigation was to describe profiles of adolescents' fitness level, identify latent classes of fitness-related risk behaviours, and describe their sociodemographic and environmental predictors. In total, 883 adolescents (16.4 ± 1.4 years; 167.3 ± 10.4 cm; 62.8 ± 13.5 kg; 62.2% males) were assessed for personal and lifestyle information and for physical fitness components. Eleven possible fitness determinants and seven predictors were included. Latent class analysis (LCA) was used to determine fitness-related risk behaviours. Logistic regressions predicted class membership and assessed associations with fitness levels and fitness components. Five latent classes were recognised: 1-virtuous, 30.7% of respondents; 2-low physical activity/sport, 18.8%; 3-incorrect alcohol/food habits, 25.8%; 4-health risk/overweight, 15.9%; 5-malaise/diseases, 8.8%. Sex, age, parents' overweightness/obesity and education, and school type predicted most classes significantly. Compared to class 1, class 2 had higher odds of having all poor fitness components except upper body maximal strength; class 4 had higher risk of low muscular endurance; and class 5 was likely to have lower maximal strength, muscular endurance, and speed/agility. Educating adolescents to reach a sufficient practice of PA/sport could help decreasing the risk of low health-related fitness more than discouraging them from using alcohol, addressing proper food behaviours and habits, and helping them understand their psychophysical malaise symptoms.

Assessing Cardiorespiratory Fitness of Soccer Players: Is Test Specificity the Issue?-A Review.

It is important that players and coaches have access to objective information on soccer player's physical status for team selection and training purposes. Physiological tests can provide this information. Physiological testing in laboratories and field settings are very common, but both methods have been questioned because of their specificity and accuracy respectively. Currently, football players have their direct aerobic fitness assessed in laboratories using treadmills or cycle ergometers, whilst indirect measures (using estimation of aerobic performance) are performed in the field, typically comprising multiple shuttle runs back and forth over a set distance. The purpose of this review is to discuss the applied techniques and technologies used for evaluating soccer players' health and fitness variables with a specific focus on cardiorespiratory testing. A clear distinction of the functionality and the specificity between the field tests and laboratory tests is well established in the literature. The review findings prioritize field tests over laboratory tests, not only for commodity purpose but also for motivational and specificity reasons. Moreover, the research literature suggests a combination of various tests to provide a comprehensive assessment of the players. Finally, more research needs to be conducted to develop a specific and comprehensive test model through the combination of various exercise modes for soccer players.

Bioelectrical impedance vector analysis (BIVA) in sport and exercise: Systematic review and future perspectives.

BACKGROUND: Bioelectrical impedance vector analysis (BIVA) is a general concept that includes all methodologies used in the analysis of the bioelectrical vector, whereas the "classic" BIVA is a patented methodology included among these methods of analysis. Once this was clarified, the systematic review of the literature provides a deeper insight into the scope and range of application of BIVA in sport and exercise. OBJECTIVE: The main goal of this work was to systematically review the sources on the applications of BIVA in sport and exercise and to examine its usefulness and suitability as a technique for the evaluation of body composition, hydration status, and other physiological and clinical relevant characteristics, ultimately to trace future perspectives in this growing area, including a proposal for a research agenda. METHODS: Systematic literature searches in PubMed, SPORTDiscus and Scopus databases up to July, 2017 were conducted on any empirical investigations using phase-sensitive bioimpedance instruments to perform BIVA within exercise and sport contexts. The search included healthy sedentary individuals, physically active subjects and athletes. RESULT: Nineteen eligible papers were included and classified as sixteen original articles and three scientific conference communications. Three studies analysed short-term variations in the hydration status evoked by exercise/training through whole-body measurements, eleven assessed whole-body body composition changes induced by long-term exercise, four compared athletic groups or populations using the whole-body assessment, and two analysed bioelectrical patterns of athletic injuries or muscle damage through localised bioimpedance measurements. CONCLUSIONS: BIVA is a relatively new technique that has potential in sport and exercise, especially for the assessment of soft-tissue injury. On the other hand, the current tolerance ellipses of "classic" BIVA are not a valid method to identify dehydration in individual athletes and a new approach is needed. "Specific" BIVA, a method which proposes a correction of bioelectrical values for body geometry, emerges as the key to overcome "classic" BIVA limitations regarding the body composition assessment. Further research establishing standardised testing procedures and investigating the relationship between physiology and the bioelectrical signal in sport and exercise is needed.

Effect of Two Different Types of Olympic Rotation Order on Cardiovascular and Metabolic Variables in Men's Artistic Gymnastics.

The rotation sequence-order differs from a gymnast to another according to the draw at the time of the qualifying competitions in men's artistic gymnastics. Only the six best gymnasts start on the floor exercises, the others could start on any of the other five apparatuses. It has been demonstrated that some gymnastics events are physiologically less taxing than others; hence some gymnasts could experience lower and/or higher levels of cardiovascular and metabolic stress compared to others, depending on the apparatus they start with. In this regard, the objective of this investigation was to compare cardiovascular and metabolic variables between two different types of Olympic rotation-order; one began with the floor exercises and the other began with the pommel horse. Six elite male gymnasts took part in this investigation. Heart rates, synchronized with real-time video acquisition, as well as capillary lactate concentration following each apparatus routine were monitored. Cardiovascular and metabolic stresses were significantly higher when gymnasts started their rotation with the pommel horse in all apparatuses except the pommel horse. The floor exercises' score was significantly affected when gymnasts ended up their competition on this apparatus. As a conclusion, starting gymnastics' competition on the floor exercises implicates less cardiovascular and metabolic stress associated with better performance compared with the other rotation order. As a matter of fact, best gymnasts who start on this apparatus could have a slight advantage compared with the other athletes.

Southern Italian teenagers: the older they get, the unfit they become with girls worse than boys: a cohort epidemiological study: The adolescents surveillance system for the obesity prevention project (ASSO).

Italy comprises a high proportion of people who never exercised. Low physical activity levels in adolescents is a risk factor for several disorders. The aim of this cohort epidemiological study was to compare physical fitness profiles between boys and girls with regard to age and gender and to identify health and fitness-related markers that contribute to the make-up of Southern Italian teenagers.Eight hundred eleven teenagers were assessed for anthropometric measurements and completed the 5 ASSO-fitness tests battery. Data were analyzed with a 2-way analysis of variance (ANOVA) for repeated measures to compare the effect of both age and gender on the fitness components.The boys' anthropometric measurements were superior than the girls as expected [weight, height, body mass index (BMI), and waist circumference]; the overall BMI was found in the normality range. The overall teenagers' fitness markers were found to be quite poor with the boys outperforming the girls in all fitness tests. The weak cardiorespiratory performance of the female teenagers was remarkable. The under 16 years old (-16 yrs) girls outperformed the over 16 years old (+16yrs) girls. There were less significant differences when comparing (-16) and (+16) yrs old mixed-gender groups. There were no correlations between the (-16) and (+16) yrs when both genders were considered. The trend analysis showed the younger teenagers might be "catching up" the older ones in both contexts.Gender significantly influenced all variables. Although age did not influence cardiorespiratory fitness, the older the teenagers the worse their health and fitness markers become with the older girls worse than their younger peers.

Modern Techniques and Technologies Applied to Training and Performance Monitoring.

Athlete preparation and performance continue to increase in complexity and costs. Modern coaches are shifting from reliance on personal memory, experience, and opinion to evidence from collected training-load data. Training-load monitoring may hold vital information for developing systems of monitoring that follow the training process with such precision that both performance prediction and day-to-day management of training become adjuncts to preparation and performance. Time-series data collection and analyses in sport are still in their infancy, with considerable efforts being applied in "big data" analytics, models of the appropriate variables to monitor, and methods for doing so. Training monitoring has already garnered important applications but lacks a theoretical framework from which to develop further. As such, we propose a framework involving the following: analyses of individuals, trend analyses, rules-based analysis, and statistical process control.

Design, Implementation, and Evaluation of the Adolescents and Surveillance System for the Obesity Prevention Project.

The Adolescents Surveillance System for Obesity prevention (ASSO) Project aimed at developing standardized and web-based tools for collecting data on adolescents' obesity and its potential determinants. This has been implemented and piloted in the local area of Palermo city, Italy. The aim of the present study is to provide an overview of the Project's design, implementation, and evaluation, highlighting all the aspects for a potential scale-up of the surveillance system on the whole national territory and abroad, as a sustainable and effective source of data.The overall structure and management, the ASSO-toolkit, the ASSO-NutFit software, and all developed and used procedures for recruiting, training, and data collecting/analyzing are addressed. An interim evaluation has been performed through a feasibility study; a final Project evaluation has been performed reporting the Strengths, Weaknesses, Opportunities, and Threats (SWOT) and the attributes that a surveillance system should have.This article provides a detailed overview of the Project and highlights that ASSO can be considered a valid, logical, coherent, efficient, and sustainable surveillance system that is consistent with countries' needs and priorities.The system developed by the ASSO Project provides high-quality data and complies with several characteristics typical of a suitable surveillance system. It has a potential of being adopted within the National Health Service and other countries' Health Services for monitoring adolescents' obesity and its determinants, such as food intakes, behaviors, physical activity, and fitness profiles.

A meta-analysis of the validity of FFQ targeted to adolescents.

OBJECTIVE: The present work is aimed at meta-analysing validity studies of FFQ for adolescents, to investigate their overall accuracy and variables that can affect it negatively. DESIGN: A meta-analysis of sixteen original articles was performed within the ASSO Project (Adolescents and Surveillance System in the Obesity prevention). SETTING: The articles assessed the validity of FFQ for adolescents, compared with food records or 24 h recalls, with regard to energy and nutrient intakes. SUBJECTS: Pearson's or Spearman's correlation coefficients, means/standard deviations, kappa agreement, percentiles and mean differences/limits of agreement (Bland-Altman method) were extracted. Pooled estimates were calculated and heterogeneity tested for correlation coefficients and means/standard deviations. A subgroup analysis assessed variables influencing FFQ accuracy. RESULTS: An overall fair/high correlation between FFQ and reference method was found; a good agreement, measured through the intake mean comparison for all nutrients except sugar, carotene and K, was observed. Kappa values showed fair/moderate agreement; an overall good ability to rank adolescents according to energy and nutrient intakes was evidenced by data of percentiles; absolute validity was not confirmed by mean differences/limits of agreement. Interviewer administration mode, consumption interval of the previous year/6 months and high number of food items are major contributors to heterogeneity and thus can reduce FFQ accuracy. CONCLUSIONS: The meta-analysis shows that FFQ are accurate tools for collecting data and could be used for ranking adolescents in terms of energy and nutrient intakes. It suggests how the design and the validation of a new FFQ should be addressed.

Stretching the Spines of Gymnasts: A Review.

Gymnastics is noted for involving highly specialized strength, power, agility and flexibility. Flexibility is perhaps the single greatest discriminator of gymnastics from other sports. The extreme ranges of motion achieved by gymnasts require long periods of training, often occupying more than a decade. Gymnasts also start training at an early age (particularly female gymnasts), and the effect of gymnastics training on these young athletes is poorly understood. One of the concerns of many gymnastics professionals is the training of the spine in hyperextension-the ubiquitous 'arch' seen in many gymnastics positions and movements. Training in spine hyperextension usually begins in early childhood through performance of a skill known as a back-bend. Does practising a back-bend and other hyperextension exercises harm young gymnasts? Current information on spine stretching among gymnasts indicates that, within reason, spine stretching does not appear to be an unusual threat to gymnasts' health. However, the paucity of information demands that further study be undertaken.

A Fitness Index model for Italian adolescents living in Southern Italy: the ASSO project.

BACKGROUND: Strong relations between physical fitness and health in adolescents have been established in the last decades. The main objectives of the present investigation were to assess major physical fitness components in a sample of Italian school adolescents, comparing them with international data, and providing a Fitness Index model derived from percentile cut-off values of five considered physical fitness components. METHODS: A total of 644 school pupils (15.9±1.1 years; M: N.=399; F: N.=245) were tested using the ASSO-Fitness Test Battery (FTB), a tool developed within the Adolescents and Surveillance System for the Obesity prevention project, which included the handgrip, standing broad-jump, sit-up to exhaustion, 4×10-m shuttle run and 20-m shuttle run tests. Stratified percentile values and related smoothed curves were obtained. The method of principal components analysis (PCA) was applied to the considered five fitness components to derive a continuous fitness level score (the Fit-Score). A Likert-type scale on the Fit-Score values was applied to obtain an intuitive classification of the individual level of fitness: very poor (X0.5) between the Fit-Score and all the fitness components. The median Fit-Score was equal to 33 for females and 53 for males (in a scale from 0 to 100). CONCLUSIONS: The ASSO-FTB allowed the assessment of health-related fitness components in a convenient sample of Italian adolescents and provided a Fitness Index model incorporating all these components for an intuitive classification of fitness levels. If this model is confirmed, the monitoring of these variables will allow early detection of health-related issues in a mass population, thus giving the opportunity to plan appropriate interventions.

A systematic review to determine reliability and usefulness of the field-based test batteries for the assessment of physical fitness in adolescents - The ASSO Project.

The aim of the present review is to investigate the main field-based tests, used alone or included in sport or fitness batteries, for the assessment of health- and skill-related physical fitness components in adolescents. Different scientific databases were searched through using the selected key words related to physical fitness and its components for adolescence. The search focused on original articles and reviews/meta-analyses using valid, reproducible and feasible tests that fit within the school environment. A total of 100 scientific manuscripts were included in the qualitative synthesis. The present systematic review pointed out 5 fitness tests that well adapt to the evaluation of the components of physical fitness of adolescents within a school environment: the 20 m shuttle run test for cardio-respiratory endurance; the handgrip strength test for upper body maximal strength; the standing broad jump test for lower body maximal strength; the sit-up test to exhaustion for muscular endurance and the 4×10 m shuttle run test for speed, agility and coordination. These fitness tests have been finally selected and incorporated into the Adolescents and Surveillance System for the Obesity prevention - Fitness Test Battery (ASSO-FTB), and will be adopted within the ASSO Project for evaluation purposes. This instrument could be also provided to teachers and people working in schools in order to assess physical fitness of adolescents over time and prevent obesity and related diseases.

Comparative validity of the ASSO-Food Frequency Questionnaire for the web-based assessment of food and nutrients intake in adolescents.

BACKGROUND: A new web-based food frequency questionnaire (the ASSO-FFQ) was developed within the ASSO Project funded by the Italian Ministry of Health. OBJECTIVE: The aim of the present study is to assess the validity of the ASSO-FFQ at food groups, energy, and nutrients level. DESIGN AND SUBJECTS: The validation study compared the ASSO-FFQ against a weighted food record (WFR) measuring foods, beverages and supplements intake, compiled during the week following the ASSO-FFQ administration. Ninety-two subjects aged 14-17, recruited from secondary schools in Palermo (Italy), completed the ASSO-FFQ and WFR. The intake of 24 food groups, energy, and 52 nutrients were taken as main outcomes. Tests for paired observations, Spearman and Pearson's correlation coefficients (cc), kappa statistics and classification in quintiles, Bland-Altman plots and multiple regressions, on untransformed and transformed data were used for the statistical analysis. RESULTS: High cc (≥0.40) were found for soft drinks, milk, tea/coffee, vegetables, and lactose; fair energy-adjusted cc (0.25-0.40) for water, alcoholic drinks, breakfast cereals, fishery products, savory food, fruit juice, eggs, and 19 nutrients. The subjects classified in the same or adjacent quintile for food groups ranged from 40% (alcoholic drinks) to 100% (dried fruit); for energy and nutrients from 43% (phosphorus, thiamin, niacin) to 77% (lactose). Mean differences were not significant for water, soft drinks, meat, sweets, animal fats, milk and white bread, and vitamin B12 and folate. Limits of Agreement were broad for all food groups and nutrients. School, gender, alcohol consumption and between meals mainly affected most food groups' intake differences. Gender stratification showed females had increased Pearson's cc for energy and 28 nutrients, such as almost all fats, carbohydrates, vitamins and minerals. CONCLUSIONS: The ASSO-FFQ could be applied in epidemiological studies for the assessment of dietary consumption in adolescents to adequately rank food, energy and nutrient intakes at a group level.