Comparison of different approaches to calculate nutrient intakes based upon 24-h recall data derived from a multicenter study in European adolescents.

PURPOSE: The European "Healthy Lifestyle in Europe by Nutrition in Adolescence" (HELENA) project evaluated two different approaches to harmonize the matching procedures between 24-h recall data and food composition databases. In the first approach, the 24-h recall data were linked to the local/national food composition databases using standardized procedures, while in the second approach, the 24-h recall data were linked to the German BLS database which includes a larger food list. The aim of this paper was to compare the intakes of energy and eight nutrient components calculated via both approaches. METHODS: Two non-consecutive 24-h recalls were performed in 1268 adolescents. Energy, carbohydrates, proteins, fat, fiber, water, alcohol, calcium and vitamin C were calculated via the two approaches at individual level. Paired samples t test and Pearson's correlations were used to compare the mean intakes of energy and the eight mentioned nutrients and to investigate the possible associations between the two approaches. RESULTS: Small but significant differences were found between the intakes of energy and the eight food components when comparing both approaches. Very strong and strong correlations (0.70-0.95) were found between both methods for all nutrients. CONCLUSION: The dietary intakes obtained via the two different linking procedures are highly correlated for energy and the eight nutrients under study.

Dietary fiber intake and its association with indicators of adiposity and serum biomarkers in European adolescents: the HELENA study.

PURPOSE: To evaluate total, energy-adjusted dietary fiber (DF), water-soluble fiber (WSF), and water-insoluble fiber (WIF) intakes in European adolescents and to investigate their association with indicators of adiposity and serum biomarkers. METHODS: This study, conducted from 2006 to 2007, included 1804 adolescents aged 12.5-17.5 years (47% males) from eight European cities completing two non-consecutive computerized 24-h dietary recalls. GLM multivariate analysis was used to investigate associations. RESULTS: Mean DF intake (20 g/day) of the sample met the European Food Safety Authority recommendation, but was below those of the World Health Organization and of the Institute of Medicine. Total DF, WSF and WIF intakes were higher in males (P < 0.001), but following energy-adjustments significantly higher intakes were observed among females (P < 0.001). Bread and cereals contributed most to total DF, WSF and WIF intakes, followed by potatoes and grains, energy-dense but low-nutritious foods, fruits and vegetables. Moreover, energy-adjusted WSF and WIF were positively associated with body fat percentage (BF%), waist to height ratio and low-density lipoprotein cholesterol, while energy-adjusted WSF was inversely associated with serum fasting glucose (ß = -0. 010, P = 0.020). CONCLUSION: Total DF intakes are rather low in European adolescents. An inverse association with serum fasting glucose might indicate a possible beneficial role of DF in preventing insulin resistance and its concomitant diseases, even though DF intakes were positively associated with adolescents' BF%. Therefore, further longitudinal studies should elaborate on these potential beneficial effects of DF intake in the prevention of obesity and related chronic diseases.

Dietary animal and plant protein intakes and their associations with obesity and cardio-metabolic indicators in European adolescents: the HELENA cross-sectional study.

BACKGROUND: Previous studies suggest that dietary protein might play a beneficial role in combating obesity and its related chronic diseases. Total, animal and plant protein intakes and their associations with anthropometry and serum biomarkers in European adolescents using one standardised methodology across European countries are not well documented. OBJECTIVES: To evaluate total, animal and plant protein intakes in European adolescents stratified by gender and age, and to investigate their associations with cardio-metabolic indicators (anthropometry and biomarkers). METHODS: The current analysis included 1804 randomly selected adolescents participating in the HELENA study (conducted in 2006-2007) aged 12.5-17.5 y (47% males) who completed two non-consecutive computerised 24-h dietary recalls. Associations between animal and plant protein intakes, and anthropometry and serum biomarkers were examined with General linear Model multivariate analysis. RESULTS: Average total protein intake exceeded the recommendations of World Health Organization and European Food Safety Authority. Mean total protein intake was 96 g/d (59% derived from animal protein). Total, animal and plant protein intakes (g/d) were significantly lower in females than in males and total and plant protein intakes were lower in younger participants (12.5-14.9 y). Protein intake was significantly lower in underweight subjects and higher in obese ones; the direction of the relationship was reversed after adjustments for body weight (g/(kg.d)). The inverse association of plant protein intakes was stronger with BMI z-score and body fat percentage (BF%) compared to animal protein intakes. Additionally, BMI and BF% were positively associated with energy percentage of animal protein. CONCLUSIONS: This sample of European adolescents appeared to have adequate total protein intake. Our findings suggest that plant protein intakes may play a role in preventing obesity among European adolescents. Further longitudinal studies are needed to investigate the potential beneficial effects observed in this study in the prevention of obesity and related chronic diseases.

Trends in toothbrushing in 20 countries/regions from 1994 to 2010.

BACKGROUND: For maintaining good oral health, twice-a-day toothbrushing routine is recommended world-wide. As an association between oral diseases and the main non-communicable diseases is confirmed, the importance of brushing is rising. The aim of this article is to describe trends in more-than-once-a-day toothbrushing frequency in 20 countries/regions participating in five consecutive HBSC Surveys between 1994 and 2010. METHODS: Eleven-, 13-, and 15-year-old children, who replied to the questionnaire in any of the five surveys, were included (N = 474 760). Trends were analysed by logistic regression and multilevel logistic regression modelling. RESULTS: Prevalence of recommended toothbrushing behaviour increased in all countries except in Scandinavia, which had already attained a very high level in 1994. The highest increase (more than + 16%) was observed in Estonia, Russia, Latvia, Finland and in Flemish Belgium. Girls had higher prevalence of toothbrushing than boys (OR = 2.06, 99% CI 2.03-2.10). However, the increasing trend was stronger among boys (OR(2010 vs. 1994) for boys 1.60; for girls 1.48), and among the younger adolescents (OR(2010 vs. 1994) for 11-year-olds 1.64; for 15-year-olds 1.45). CONCLUSION: Recommended toothbrushing frequency increased in most of the studied countries/regions and differences between the countries diminished during 2004-2010.

Fruit and vegetable consumption trends among adolescents from 2002 to 2010 in 33 countries.

BACKGROUND: Fruit and vegetable consumption is linked to many positive health outcomes, nevertheless many adolescents do not consume fruit and vegetables on a daily basis. METHODS: Data of 488,951 adolescents, aged 11-, 13- and 15- years, from 33 mainly European and North American countries/regions participating in the cross-sectional Health Behaviour in School-aged Children surveys in 2002, 2006 and 2010, were used to investigate trends in daily fruit and vegetable consumption between 2002 and 2010. RESULTS: Multilevel logistic regression analyses showed an increase in daily fruit and vegetable consumption between 2002 and 2010 in the majority of countries for both genders and all three age groups. A decrease in consumption was noticed in five countries for fruit and five countries for vegetables. CONCLUSION: Overall, a positive trend was noticed, however increases in daily fruit and vegetable consumption are still indicated.

Changes in children's food group intake from age 3 to 7 years: comparison of a FFQ with an online food record.

Few studies have investigated the relative validity of FFQ in young children and no study has investigated the relative validity of changes in children's food intake in a longitudinal context. The aim of the present study was to compare the FFQ of the longitudinal Family Influences on Food Intake study, assessing children's food intake in the previous 3 months, with a 3 d online food record when children were 3 and 7 years old, as well as to investigate the relative validity of changes in food group intake over a 4-year period. Parents (n 89) completed the FFQ and an online food record over three non-consecutive days on two separate occasions (January-April 2008 and 2012). Wilcoxon signed-rank tests and Spearman's correlations were used to compare food group intake and changes in intake assessed using both methods. In 2008, the intake of eleven of the twenty-two food groups was overestimated and that of four food groups underestimated in the FFQ in comparison with the online tool; in 2012, the intake of four food groups was overestimated and that of seven food groups underestimated. Nevertheless, changes in intake did not differ significantly between the two methods for eighteen food groups. Correlations in 2008 and 2012 were, on average, 0.47; correlations between the changes in dietary intake were, on average, 0.26. The results suggest that despite the significant differences between the two methods for a number of food groups at both baseline and/or follow-up, the FFQ can be used to monitor changes in dietary intake for groups of young children.

Risk factors for childhood overweight: a 30-month longitudinal study of 3- to 6-year-old children.

OBJECTIVE: The increasing prevalence of childhood overweight is an important health issue. There is a need for longitudinal research among children in order to identify risk factors for childhood overweight. The objective of the present research was to identify potential sociodemographic and behavioural risk factors for development of childhood overweight among 3- to 6-year-old children. DESIGN: Longitudinal study. SETTING: Sixteen pre-primary and primary schools. SUBJECTS: BMI Z-scores at baseline and two follow-up measurements were calculated for 568 children. Sociodemographic, parental adiposity, familial composition, child's diet, physical activity and sedentary behavioural data were collected through questionnaires. RESULTS: Several risk factors for the development of childhood overweight were found. Being an only child, lower maternal educational level, maternal and paternal overweight, more than 1 h screen time on weekdays and high soft drinks consumption were shown to be positively associated with the development of childhood overweight. CONCLUSIONS: Although behavioural factors are important, our findings support the thesis that interventions on the prevention of childhood overweight should focus on high-risk groups, i.e. children from low socio-economic background or with high parental BMI. Interventions should address the whole family and take into account their lifestyle and structure.

Trends in thinness prevalence among adolescents in ten European countries and the USA (1998-2006): a cross-sectional survey.

OBJECTIVE: To describe the prevalence of 'graded thinness' in children aged 11, 13 and 15 years in eleven developed countries and to identify trends in the prevalence of 'thinness' (BMI < 17 kg/m2 at age 18 years) by age and gender. DESIGN: Cross-sectional study using data collected through self-reported questionnaires. SETTING: Data were taken from the 1997/1998, 2001/2002 and 2005/2006 surveys of the Health Behaviours in School-aged Children (HBSC) Study. SUBJECTS: Children and adolescents from ten European countries and the USA (n 158 000). RESULTS: Prevalence of grades 1, 2 and 3 of thinness was higher among 11-year-old students compared with the 13- and 15-year-olds in all countries. A higher prevalence of thinness was observed in girls than in boys. Since 1998 the prevalence of thinness decreased steadily in Czech boys and girls, while it increased for French girls. In the total European sample of females, thinness decreased from 1998 to 2006 (χ 2 for trend, P < 0·01). Age-adjusted logistic regression analysis showed that Czech boys and girls, and Flemish and American girls were less likely to be thin in 2006 than in 1998; while a noteworthy increment, even if borderline significant, was observed for French girls with a 41% increase in the likelihood to be thin. CONCLUSIONS: Our findings suggest that thinness is an important overlooked phenomenon with wide variation in prevalence and trends across developed countries. It deserves further longitudinal studies in a multinational context that could increase the understanding of the factors associated with thinness and contribute to developing preventive and nutritional programmes targeted at controlling obesity and chronic diseases, while monitoring thinness.

Children's food intake: a comparison of children's and parents' reports.

PURPOSE: In longitudinal studies, parents are the most accurate source of information on young children's dietary intake; for older children, questioning children themselves may be more appropriate. However, if parental reports for young children and self-reports of older children are to be used in the same analyses, the measures must be comparable. METHODS: During school hours, fourth and sixth graders in 14 Flemish (Belgium) primary schools completed an online 15-item food frequency questionnaire with a retest questionnaire one to two weeks later; parents completed a paper-and-pencil or online questionnaire. Test-retest data were available for 286 children; children's tests could be matched to parents' reports for 275 children. RESULTS: On average, test-retest correlations were 0.68 (grade 4: 0.63; grade 6: 0.71) and correlations between children's and parents' reports were 0.44 (grade 4: 0.39; grade 6: 0.49). No systematic differences were found between the test and retest. Comparison of children's and parents' reports resulted in significant differences for six of the 15 items. CONCLUSIONS: Low consensus between parents' and children's reports for several items may impede comparisons at a group level. Additionally, the results indicate more optimal dietary assessment in sixth graders.

Validation of the Diet Quality Index for Adolescents by comparison with biomarkers, nutrient and food intakes: the HELENA study.

Food-based dietary guidelines (FBDG) aim to address the nutritional requirements at population level in order to prevent diseases and promote a healthy lifestyle. Diet quality indices can be used to assess the compliance with these FBDG. The present study aimed to investigate whether the newly developed Diet Quality Index for Adolescents (DQI-A) is a good surrogate measure for adherence to FBDG, and whether adherence to these FBDG effectively leads to better nutrient intakes and nutritional biomarkers in adolescents. Participants included 1804 European adolescents who were recruited in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study. Dietary intake was assessed by two, non-consecutive 24 h recalls. A DQI-A score, considering the components' dietary quality, diversity and equilibrium, was calculated. Associations between the DQI-A and food and nutrient intakes and blood concentration biomarkers were investigated using multilevel regression analysis corrected for centre, age and sex. DQI-A scores were associated with food intake in the expected direction: positive associations with nutrient-dense food items, such as fruits and vegetables, and inverse associations with energy-dense and low-nutritious foods. On the nutrient level, the DQI-A was positively related to the intake of water, fibre and most minerals and vitamins. No association was found between the DQI-A and total fat intake. Furthermore, a positive association was observed with 25-hydroxyvitamin D, holo-transcobalamin and n-3 fatty acid serum levels. The present study has shown good validity of the DQI-A by confirming the expected associations with food and nutrient intakes and some biomarkers in blood.

Test-retest reliability and agreement between children's and parents' reports of a computerized food preferences tool.

OBJECTIVE: To investigate test-retest reliability of primary-school children's reports of food preferences and to investigate agreement with parental reports. DESIGN: Children completed an online test and retest, one to two weeks later, during school hours; parents completed a paper-and-pencil or an online questionnaire at home. The children's preferences questionnaire contained 148 food items, reduced to twelve scales; the parental questionnaire contained seventy-eight items reduced to nine scales. SETTING: Children of fourteen primary schools in Belgium-Flanders. SUBJECTS: In total 572 children participated; test-retest data were available for 354 children, children's tests could be matched to 362 parental reports. RESULTS: Test-retest intraclass correlations were on average 0.73, ranging between 0.62 and 0.86; correlations between children's and parents' reports were on average 0.50, ranging between 0.32 and 0.62. Retest preferences were significantly higher for more than half of the scales. Children reported higher preferences than their parents for milk & milk products, fruit and soft drinks, while parents reported higher preferences for bread & breakfast cereals, meat, snacks and sauces. CONCLUSIONS: The results indicate that the test-retest stability was good; however, agreement between parents and children was rather low to moderate.

Formative evaluation of the feedback component of Children's and Adolescents' Nutrition Assessment and Advice on the Web (CANAA-W) among parents of schoolchildren.

OBJECTIVE: The aim of the paper is to describe the formative evaluation of the feedback component of an online nutrition tailoring instrument, the Children's and Adolescents' Nutrition Assessment and Advice on the Web (CANAA-W), among parents of schoolchildren. DESIGN: Parents of pre-primary and primary-school children recorded their child's food intake over 3 d with CANAA-W and completed the evaluation questionnaire online. A subsample participated in focus group discussions. SETTING: Parents completed CANAA-W at home. SUBJECTS: Forty-six parents completed the evaluation questionnaire. Seventeen parents participated in three focus group discussions. RESULTS: Parents were enthusiastic: the majority (81 % or more) found the advice comprehensible, interesting, logical, useful, believable, well formulated, correct, personal, relevant, complete, attractive, containing enough and not too much information; they indicated that it is helpful to improve their children's eating habits and that they intend to use it. The qualitative analyses revealed that the respondents appreciated the confrontation with their child's diet and the visualization (i.e. traffic light colours, pictograms, food models, diagrams). The length of the feedback was rather a drawback, but it was useful nevertheless. CONCLUSIONS: CANAA-W was well received by the parents; the scores on the feasibility questionnaire were high and the qualitative analyses showed that the confrontation with their child's diet, and attractive visualization of the most relevant feedback linked to more elaborated optional feedback, were well appreciated. The major challenge will be to convince parents who are less interested in food habits and less computer-literate to participate in this type of study.

Breakfast consumption and CVD risk factors in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.

OBJECTIVE: To examine the association between breakfast consumption and CVD risk factors in European adolescents. DESIGN: Cross-sectional. Breakfast consumption was assessed by the statement 'I often skip breakfast' and categorized into 'consumer', 'occasional consumer' and 'skipper'. Blood pressure, weight, height, waist circumference, skinfold thickness, total cholesterol (TC), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), TAG, insulin and glucose were measured and BMI, TC:HDL-C, LDL-C:HDL-C and homeostasis model assessment­insulin resistance index (HOMA-IR) were calculated. SETTING: The European Union-funded HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. SUBJECTS: European adolescents, aged 12?50­17?49 years, from ten cities within the HELENA study (n 2929, n 925 with blood sample, 53% females). RESULTS: In males, significant differences across breakfast consumption category ('consumer', 'occasional consumer' and 'skipper') were seen for age, BMI, skinfold thickness, waist circumference, cardiorespiratory fitness, systolic and diastolic blood pressures, TC:HDL-C, LDL-C:HDL-C, glucose, insulin, HOMA-IR and LDL-C; in females, for cardiorespiratory fitness, skinfold thickness, BMI, insulin and HOMA-IR. In overweight/obese males significant differences were also seen for TC and LDL-C, whereas no differences were observed in non-overweight males or in females regardless of weight status. CONCLUSIONS: Our findings among European adolescents confirm previous data indicating that adolescents who regularly consume breakfast have lower body fat content. The results also show that regular breakfast consumption is associated with higher cardiorespiratory fitness in adolescents, and with a healthier cardiovascular profile, especially in males. Eating breakfast regularly may also negate somewhat the effect of excess adiposity on TC and LDL-C, especially in male adolescents.

Health promotion in individuals with mental disorders: a cluster preference randomized controlled trial.

BACKGROUND: The existing literature on weight management interventions targeting physical activity and healthy eating in mental health care appears to provide only limited evidence. The aim of the study was to examine the effectiveness of a 10-week health promotion intervention, followed by a 6-month follow-up period in individuals with mental disorders living in sheltered housing in the Flanders region (Belgium). METHODS: The study had a cluster preference randomized controlled design. Twenty-five sheltered housing organisations agreed to participate (16 in the intervention group, nine in the control group). In the intervention group, 225 individuals agreed to participate, while in the control group 99 individuals entered into the study. The main outcomes were changes in body weight, Body Mass Index, waist circumference and fat mass. Secondary outcomes consisted of changes in physical activity levels, eating habits, health-related quality of life and psychiatric symptom severity. RESULTS: A significant difference was found between the intervention group and the control group regarding body weight (-0.35 vs. +0.22 kg; p=0.04), Body Mass Index (-0.12 vs. +0.08 kg/m2; p=0.04), waist circumference (-0.29 vs. + 0.55 cm; p<0.01), and fat mass (-0.99 vs. -0.12%; p<0.01). The decrease in these outcomes in the intervention group disappeared during the follow up period, except for fat mass. Within the intervention group, a larger decrease in the primary outcomes was found in the participants who completed the intervention. No significant differences between the two groups in changes in the secondary outcomes were found, except for the pedometer-determined steps/day. In the intervention group, the mean number of daily steps increased, while it decreased in the control group. CONCLUSIONS: The study demonstrated that small significant improvements in the primary outcomes are possible in individuals with mental disorders. Integration of health promotion activities targeting physical activity and healthy eating into daily care are, however, necessary to maintain the promising results. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov NCT 01336946.

Physical activity and beverage consumption in preschoolers: focus groups with parents and teachers.

BACKGROUND: Qualitative research is a method in which new ideas and strategies can be discovered. This qualitative study aimed to investigate parents' and teachers' opinions on physical activity and beverage consumption of preschool children. Through separate, independent focus groups, they expressed their perceptions on children's current physical activity and beverage consumption levels, factors that influence and enhance these behaviours, and anticipated barriers to making changes. METHODS: Multi-cultural and multi-geographical focus groups were carried out in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain). In total, twenty-four focus groups with 122 parents and eighteen focus groups with 87 teachers were conducted between October 2010 and January 2011. Based on a semi-structured interview guide, questions on preschoolers' physical activity (opinions on preschoolers' physical activity, how to increase physical activity, facilitators and barriers of physical activity) and beverage consumption (rules and policies, factors influencing promotion of healthy drinking, recommendations for future intervention development) were asked. The information was analyzed using qualitative data analysis software (NVivo8). RESULTS: The focus group results indicated misperceptions of caregivers on preschoolers' physical activity and beverage consumption levels. Caregivers perceived preschoolers as sufficiently active; they argue that children need to learn to sit still in preparation for primary school. At most preschools, children can drink only water. In some preschools sugar-sweetened beverages like chocolate milk or fruit juices, are also allowed. It was mentioned that sugar-sweetened beverages can be healthy due to mineral and vitamin content, although according to parents their daily intake is limited. These opinions resulted in low perceived needs to change behaviours. CONCLUSIONS: Although previous research shows need of change in obesity-related behaviours, the participants in the current study didn't perceive such. The awareness of parents and teachers needs to be raised concerning their shared responsibility about healthy behaviours in preschoolers. Providing preschool teachers with ready-to-use classroom material will encourage them to change physical activity and beverage consumption, and to implement related activities in the classroom. Involvement in activities that their children perform at preschool will motivate parents to extend these behaviours to the home environment.

Development and test-retest reliability of a nutrition knowledge questionnaire for primary-school children.

OBJECTIVE: To evaluate a web-based nutritional knowledge questionnaire for primary-school children. DESIGN: Children's nutritional knowledge was assessed in five domains: healthy choices (twenty-seven items), estimated recommended portions/servings (eight items), nutrient content (five items), main food function (five items) and categorization of food items (eight items). SETTING: The questionnaires were completed in school. SUBJECTS: A convenience sample of 576 Belgian children (aged 7-12 years) from fourteen primary schools completed the questionnaire once, 386 completed the questionnaire twice. RESULTS: Healthy choices could be answered correctly by 73 % of the children, nutrients by 59 %, food categorization by 49 %, main function by 38 % and portion estimation by 36 %. Children's test-retest intra-class correlations were 0·75 for healthy choices, 0·33 for nutrients, 0·61 for food categorization, 0·44 for main function, 0·47 for portion estimation and 0·76 for the total scale. The intra-class correlation was lower in the youngest age group (grade 2: 0·51, grade 4: 0·65, grade 6: 0·66). The total score was significantly lower in the retest. The instrument was in general positively evaluated by the children. CONCLUSIONS: The instrument is a promising, practical, inexpensive tool with acceptable test-retest reliability in fourth and sixth graders.

Effects of a 2-year healthy eating and physical activity intervention for 3-6-year-olds in communities of high and low socio-economic status: the POP (Prevention of Overweight among Pre-school and school children) project.

OBJECTIVE: The purpose of the present study was to evaluate the effects of a school-based, 2-year, multi-component intervention on BMI, eating and physical activity behaviour in Flanders, Belgium, targeting children aged 3-6 years in communities of high and low socio-economic status (SES). DESIGN: Cluster-randomized controlled trial. SETTING: Thirty-one pre-primary and primary schools in three different intervention communities and three paired-matched (on SES profile) control communities in Flanders, Belgium. SUBJECTS: BMI Z-scores at baseline and follow-up were calculated for 1102 children. Questionnaires with sociodemographic data and FFQ were available from 694 of these 1102 children. RESULTS: No significant effects were found on BMI Z-scores for the total sample. However, there was a significant decrease in BMI Z-score of 0·11 in the low-SES intervention community compared with the low-SES control community, where the BMI Z-score increased by 0·04 (F = 6·26, P = 0·01). No significant intervention effects could be found for eating behaviour, physical activity or screen-time. There were no significant interaction effects of age and gender of the children on the outcome variables. CONCLUSIONS: Although no significant effects were found for BMI Z-scores in the total sample, this intervention had a promising effect in the low-SES community of reducing excess weight gain among young children.

Food sources and correlates of sodium and potassium intakes in Flemish pre-school children.

OBJECTIVE: The aim of the present study was to investigate dietary sources of Na and K intakes among Flemish pre-school children using multiple linear regression analyses. DESIGN: Three-day estimated diet records were used to assess dietary intakes. The contribution to Na and K intakes of fifty-seven food groups was computed by summing the amount provided by the food group for all individuals divided by the total intake for all individuals. SETTING: A random cluster sampling design at the level of schools, stratified by province and age, was used. SUBJECTS: A representative sample of 696 Flemish pre-school children aged 2·5-6·5 years was recruited. RESULTS: Mean Na intake was above and mean K intake was largely below the recommendation for children. Bread (22 %) and soup (13 %) were main contributors to Na intake followed by cold meat cuts and other meat products (12 % and 11 %, respectively). Sugared milk drinks, fried potatoes, milk and fruit juices were the main K sources (13 %, 12 %, 11 % and 11 %, respectively). Although Na and K intakes were positively correlated, several food categories showed Na:K intake ratio well above one (water, cheeses, soup, butter/margarine, fast foods and light beverages) whereas others presented a ratio well below one (oil & fat, fruits & juices, potatoes, vegetables and hot beverages). CONCLUSIONS: Flemish pre-school children had too high Na and too low K intakes. The finding that main dietary sources of Na and K are clearly different indicates the feasibility of simultaneously decreasing Na and increasing K intake among children.

Breakfast habits among European adolescents and their association with sociodemographic factors: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study.

OBJECTIVE: To describe breakfast habits at food group level in European adolescents and to investigate the associations between these habits and sociodemographic factors. DESIGN: Cross-sectional study. SETTING: Secondary schools from nine European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Breakfast habits were assessed twice using a computer-based 24 h dietary recall. Adolescents who consumed breakfast on at least one recall day were classified as 'breakfast consumers' and adolescents who did not have anything for breakfast on either of the two recall days were considered 'breakfast skippers'. A 'breakfast quality index' to describe breakfast quality was created based on the consumption or non-consumption of cereals/cereal products, dairy products and fruits/vegetables. The sociodemographic factors studied were sex, age, region of Europe, maternal and paternal education, family structure and family affluence. SUBJECTS: Adolescents (n 2672, 53 % girls) aged 12-17 years. RESULTS: The majority of the adolescents reported a breakfast that scored poorly on the breakfast quality index. Older adolescents, adolescents from the southern part of Europe and adolescents from families with low socio-economic status were more likely to consume a low-quality breakfast. CONCLUSIONS: The study highlights the need to promote the consumption of a high-quality breakfast among adolescents, particularly in older adolescents, adolescents from southern Europe and adolescents from families with low socio-economic status, in order to improve public health.

Parental socioeconomic status and soft drink consumption of the child. The mediating proportion of parenting practices.

The hypothesis of this study is twofold and states that parental socioeconomic status has an effect on the soft drink consumption of the child, and that this effect is mediated by the soft drink related parenting practices. One thousand six hundred and thirty-nine parents of 2.5-7 year old children from 34 Flemish pre-primary and primary schools, completed a self-administered questionnaire on sociodemographic characteristics, soft drink consumption and soft drink related parenting practices. Causal mediation analyses showed an effect of socioeconomic status on soft drink consumption of the child: children from high socioeconomic status consume 0.42 times the amount of soft drinks of children from lower socioeconomic status. Interestingly, this effect is almost entirely mediated by three soft drink parenting practices: soft drinks served at meals, the child can take soft drink whenever he or she wants and having soft drinks at home.