Dietary sources of sugars in adolescents' diet: the HELENA study.

OBJECTIVE: To report dietary sugars consumption and their different types and food sources, in European adolescents. METHODS: Food consumption data of selected groups were obtained from 1630 adolescents (45.6% males, 12.5-17.5 years) from the HELENA study using two nonconsecutive 24-h recalls. Energy intake, total sugars and free sugars were assessed using the HELENA-DIAT software. Multiple regression analyses were performed adjusting for relevant confounders. RESULTS: Total sugars intake (137.5 g/day) represented 23.6% and free sugars (110.1 g/day), 19% of energy intake. Girls had significantly lower intakes of energy, carbohydrates, total sugars and free sugars. 94% of adolescents had a consumption of free sugars above 10% of total energy intake. The main food contributor to free sugars was 'carbonated, soft and isotonic drinks,' followed by 'non-chocolate confectionary' and 'sugar, honey, jam and syrup.' Older boys and girls had significantly higher intakes of free sugars from 'cakes, pies and biscuits.' Free sugars intake was negatively associated with low socioeconomic status for 'non-chocolate confectionary' and 'sugar, honey and jam' groups; with low maternal educational level for carbonated and 'soft drinks,' 'sugar, honey and jam,' 'cakes and pies' and 'breakfast cereals' groups; and with high paternal educational level for 'carbonated and soft drinks' and 'chocolates' group. CONCLUSIONS: The majority (94%) of studied adolescents consumed free sugars above 10% of daily energy intake. Our data indicate a broad variety in foods providing free sugars. Continued efforts are required at different levels to reduce the intake of free sugars, especially in families with a low educational level.

Reliability of anthropometric measurements in European preschool children: the ToyBox-study.

The ToyBox-study aims to develop and test an innovative and evidence-based obesity prevention programme for preschoolers in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. In multicentre studies, anthropometric measurements using standardized procedures that minimize errors in the data collection are essential to maximize reliability of measurements. The aim of this paper is to describe the standardization process and reliability (intra- and inter-observer) of height, weight and waist circumference (WC) measurements in preschoolers. All technical procedures and devices were standardized and centralized training was given to the fieldworkers. At least seven children per country participated in the intra- and inter-observer reliability testing. Intra-observer technical error ranged from 0.00 to 0.03 kg for weight and from 0.07 to 0.20 cm for height, with the overall reliability being above 99%. A second training was organized for WC due to low reliability observed in the first training. Intra-observer technical error for WC ranged from 0.12 to 0.71 cm during the first training and from 0.05 to 1.11 cm during the second training, and reliability above 92% was achieved. Epidemiological surveys need standardized procedures and training of researchers to reduce measurement error. In the ToyBox-study, very good intra- and-inter-observer agreement was achieved for all anthropometric measurements performed.

Validity of 24-h recalls in (pre-)school aged children: comparison of proxy-reported energy intakes with measured energy expenditure.

BACKGROUND & AIMS: Little is known about the validity of repeated 24-h dietary recalls (24-HDR) as a measure of total energy intake (EI) in young children. This study aimed to evaluate the validity of proxy-reported EI by comparison with total energy expenditure (TEE) measured by the doubly labeled water (DLW) technique. METHODS: The agreement between EI and TEE was investigated in 36 (47.2% boys) children aged 4-10 years from Belgium and Spain using subgroup analyses and Bland-Altman plots. Low-energy-reporters (LER), adequate-energy-reporters (AER) and high-energy-reporters (HER) were defined from the ratio of EI over TEE by application of age- and sex-specific cut-off values. RESULTS: There was good agreement between means of EI (1500 kcal/day) and TEE (1523 kcal/day) at group level though in single children, i.e. at the individual level, large differences were observed. Almost perfect agreement between EI and TEE was observed in thin/normal weight children (EI: 1511 kcal/day; TEE: 1513 kcal/day). Even in overweight/obese children the mean difference between EI and TEE was only -86 kcal/day. Among the participants, 28 (78%) were classified as AER, five (14%) as HER and three (8%) as LER. CONCLUSION: Two proxy-reported 24-HDRs were found to be a valid instrument to assess EI on group level but not on the individual level.

Validation of anthropometry and foot-to-foot bioelectrical resistance against a three-component model to assess total body fat in children: the IDEFICS study.

OBJECTIVE: To compare different field methods for estimating body fat mass with a reference value derived by a three-component (3C) model in pre-school and school children across Europe. DESIGN: Multicentre validation study. SUBJECTS: Seventy-eight preschool/school children aged 4-10 years from four different European countries. METHODS: A standard measurement protocol was carried out in all children by trained field workers. A 3C model was used as the reference method. The field methods included height and weight measurement, circumferences measured at four sites, skinfold measured at two-six sites and foot-to-foot bioelectrical resistance (BIA) via TANITA scales. RESULTS: With the exception of height and neck circumference, all single measurements were able to explain at least 74% of the fat-mass variance in the sample. In combination, circumference models were superior to skinfold models and height-weight models. The best predictions were given by trunk models (combining skinfold and circumference measurements) that explained 91% of the observed fat-mass variance. The optimal data-driven model for our sample includes hip circumference, triceps skinfold and total body mass minus resistance index, and explains 94% of the fat-mass variance with 2.44 kg fat mass limits of agreement. In all investigated models, prediction errors were associated with fat mass, although to a lesser degree in the investigated skinfold models, arm models and the data-driven models. CONCLUSION: When studying total body fat in childhood populations, anthropometric measurements will give biased estimations as compared to gold standard measurements. Nevertheless, our study shows that when combining circumference and skinfold measurements, estimations of fat mass can be obtained with a limit of agreement of 1.91 kg in normal weight children and of 2.94 kg in overweight or obese children.

Five year trends on total and abdominal adiposity in Spanish adolescents.

OBJECTIVE: To assess five years trends in total and abdominal fat in Spanish adolescents. DESIGN: Two cross-sectional studies: adolescents from the city of Zaragoza (Spain) assessed during 2001-2002 and 2006-2007. SUBJECTS: 399 adolescents in 2001-02 and 392 adolescents in 2006-07. MAIN OUTCOME MEASUREMENTS: Socio-economic status was assessed using the education level of both parents. A complete anthropometric assessment was performed in both surveys using the same methodology: weight, height, skinfold thickness (biceps, triceps, subscapular, suprailiac, thigh and calf) and circumferences (waist and hip). The body mass index (BMI) and the sum of 6 skinfold thicknesses were calculated. Body fat percentage (BF%) was also calculated by the formulas described by Slaughter et al. RESULTS: After adjusting for age and pubertal status, only females showed a significantly decrease in weight, BMI and waist circumference, and a significant increase in the sum of 6 skinfolds (all P < 0.05 and Cohen's d ≥ 0.25) in 2006-2007, when compared to values obtained in 2001-2002. Males did not show any significant change between the two surveys. Concerning centile values, a slight general reduction was observed in weight, BMI and waist circumference for both males and females. On the contrary, the sum of 6 skinfolds and the BF% were higher in 2006-2007 than in 2001-2002. CONCLUSION: According to these results, there might be a levelling-off in the trends of BMI, BF% and waist circumference in male adolescents from Zaragoza. In females, despite a trend towards higher body fat mass, there was a trend towards lower BMI and waist circumference values.

Assessment tools of energy balance-related behaviours used in European obesity prevention strategies: review of studies during preschool.

Valid and reliable measures of energy balance-related behaviours are required when evaluating the effectiveness of public health interventions aiming at prevention of childhood obesity. A structured descriptive review was performed to appraise food intake, physical activity and sedentary behaviour assessment tools used in obesity intervention strategies targeting mainly preschool children across Europe. In total, 25 papers are described, addressing energy balance-related behaviours as study outcomes and targeting individuals or clusters of individuals at school- or home-based environment. Parentally reported food records and 24-h recalls were commonly used to assess food intake. Subjective levels of physical activity and sedentary behaviour were commonly accessed via parentally reported questionnaires. Accelerometry was used to obtain objective measures of physical activity. Insufficient evidence of tool evaluation was provided. When feasible, food records and accelerometry are recommended as the most appropriate methods to assess food intake in young children. Sedentary behaviour could be assessed via questionnaires that include key indicators of sedentarism and are able to differentiate individual practices. The choice of methodology for the assessment of specific intervention effects should be equally balanced between required accuracy levels and feasibility, and be guided by the intervention targets.

Vitamin D status and physical activity interact to improve bone mass in adolescents. The HELENA Study.

UNLABELLED: The effects of vitamin D concentrations on bone mineral content in adolescents are still unclear. Vitamin D and physical activity (PA) may interact to determine bone mineral content (BMC) in two possible directions; 25(OH)D sufficiency levels improve BMC only in active adolescents, or PA increases BMC in individuals with replete vitamin D levels. INTRODUCTION: The effects of suboptimal 25-hydroxycholecalciferol (25(OH)D) concentrations on BMC in adolescents are still unclear. The main aim of this study was to evaluate the influence of 25(OH)D on BMC in adolescents, considering the effect of body composition, sex, age, Tanner stage, season, calcium and vitamin D intakes, physical fitness and PA. METHODS: Serum 25(OH)D concentrations, anthropometric measurements, dual energy X-ray absorptiometry measurements, calcium and vitamin D intakes, PA and physical fitness were obtained in 100 Spanish adolescents (47 males), aged 12.5-17.5 years, within the framework of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Relations were examined using ANCOVA and regression analyses including BMC as dependent variable. RESULTS: Linear regression of BMC suggested that 25(OH)D concentrations independently influenced total and leg BMC after controlling for age, sex, lean mass, seasonality and calcium intake (B = 0.328, p < 0.05, and B = 0.221, p < 0.05, respectively) in the physically active group. No significant influence of 25(OH)D concentrations on BMC was observed in the inactive group. Significant effect was shown between the interaction of 25(OH)D and PA on BMC for the total body and legs (both p < 0.05). CONCLUSIONS: Vitamin D and PA may interact to determine BMC. 25(OH)D sufficiency levels improve bone mass only in active adolescents, or PA has a positive influence on BMC in individuals with replete vitamin D levels.

Bone mass and bone metabolism markers during adolescence: The HELENA Study.

BACKGROUND/AIMS: The assessment of bone mineral content (BMC) and density (BMD) status in children and adolescents is important for health and the prevention of diseases. Bone metabolic activity could provide early information on bone mass development. Our aim was to describe bone mass and metabolism markers according to age and Tanner stage in adolescents. METHODS: Spanish adolescents (n = 345; 168 males and 177 females) aged 12.5-17.5 years participated in this cross-sectional study. Body composition variables were measured by dual-energy X-ray absorptiometry. Serum osteocalcin (n = 101), aminoterminal propeptide of type I procollagen (n = 92) and ß-isomerized C-telopeptides (ß-CTX, n = 65) and urine samples (ß-CTX; n = 237) were analyzed by electrochemiluminescence immunoassay. RESULTS: Analysis of covariance showed that females had higher values for BMC and BMD in most of the regions. Both males and females had a significant decrease in bone markers while sexual maturation increases (all p < 0.05). Males had an increased bone turnover compared to females (all p < 0.05, except for urine ß-CTX in Tanner ≤IV). CONCLUSION: Our results support the evidence of dimorphic site-specific bone accretion between sexes and show an increased bone turnover in males, suggesting higher metabolic activity.

Secular trends in health-related physical fitness in Spanish adolescents: the AVENA and HELENA studies.

We analysed the secular trends in health-related physical fitness in Spanish adolescents between 2001-2002 and 2006-2007. Two representative population studies were conducted 5 years apart in adolescents (12.5-17.5 years) from Zaragoza (Spain) that participated in the AVENA study in 2001-2002 and in the HELENA-CSS study in 2006-2007. Both studies used the same tests to assess physical fitness: the handgrip strength, bent arm hang, standing broad jump, 4×10m shuttle run and 20m shuttle run tests. Performance in 4×10m shuttle run and 20m shuttle run tests was higher in 2006-2007 (Cohen's d ranging from 0.2 to 0.4, p<0.05), whereas performance in handgrip strength and standing broad jump tests was lower in 2006-2007 (Cohen's d ranging from 0.3 to 1.1, p<0.001). Adjustment for age, pubertal status, fat mass, fat free mass and parental education did not alter the results. The odds ratio (OR) of meeting the FITNESSGRAM Standards for healthy cardiorespiratory fitness was higher in 2006-2007 in both boys (OR, 95% CI: 2.123, 1.157-3.908) and girls (OR, 95% CI: 2.420, 1.377-4.255). The results indicate that levels of both speed/agility and cardiorespiratory fitness were higher in 2006-2007 than in 2001-2002, whereas muscular strength components were lower in 2006-2007.

Marcadores del metabolismo óseo en adolescentes españoles. Estudio HELENA / Bone metabolism markers in Spanish adolescents. The HELENA Study

Objetivo del trabajo: Describir el metabolismo óseo a lo largo de la adolescencia, según la edad y el desarrollo puberal en adolescentes. Material (pacientes) y método: El análisis de los marcadores de metabolismo óseo se realizó a partir de muestras de suero con osteocalcina (OC; n=95), propeptido aminoterminal del procolágeno de tipo 1 (P1NP; n=87) y C-telopépidos Beta-isomerizados (Beta-CTX; n=65)] y de orina [Beta-CTX (n=209)] que se analizaron mediante inmunoensayo de electroquimioluminiscencia. Resultados: La concentración de los marcadores de formación y resorción ósea eran más altos en los chicos y las chicas menos desarrollados comparado con los grupos de mayor desarrollo puberal (p < 0.05), excepto ‚-CTX (en orina) en chicos (p = 0,105). Sin embargo, la osteocalcina no mostró una tendencia significativa en chicos (p = 0.264) al agrupar por edades. Los chicos adolescentes presentaron un remodelado óseo superior al de las chicas. Conclusiones: Los chicos adolescentes presentaron un remodelado óseo superior al de las chicas, lo que sugiere una mayor actividad metabólica de éstos durante la adolescencia (AU)

Objetives: To describe bone metabolism throughout adolescence, according to age and pubertal development. Material and methods: Bone metabolism markers were analysed on serum [Osteocalcin (n=95), aminoterminal propeptide of type I procollagen (PINP, n=87) and ‚-isomerised C-telopeptides (Beta-CTX, n=65)] and urine samples [Beta-CTX (n=209)] by electrochemiluminescence immunoassay. Results: bone formation and resorption biomarkers concentration were higher in males and females with lower pubertal development compared with those groups with higher development (p < 0.05), except urine ‚- CTX in males (p = 0,105). Osteocalcin did not show a significant trend in males (p = 0.264) when grouping by age. Males had an increased bone turnover compared to females. Conclusions: Males showed an increased bone turnover compared to females, suggesting higher metabolic activity during adolescence (AU)

Quality assurance of ethical issues and regulatory aspects relating to good clinical practices in the HELENA Cross-Sectional Study.

RATIONALE: Research involving humans is regulated by regulatory authorities through their specific requirements and controls. The Healthy Life Style in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS) is a multicenter biomedical research study of adolescents in several representative European cities, which requires satisfying medico-regulatory requirements including Independent Ethics Committee (IEC) approval and agreement by the national or local regulatory authorities. To achieve a high level of quality assurance relating to ethical issues, we followed the good clinical practices (GCP) described at the International Conference on Harmonisation (ICH), which we adapted to the national and local situations of each of the 11 participating cities in 10 European countries. OBJECTIVE: The main objective of the HELENA-CSS is to evaluate reliable and comparable data of nutritional habits and lifestyle in a representative sample of European adolescents. The aim of this paper is to present the methods relating to the ethical and regulatory issues of this study and to describe the current state of the medico-regulatory requirements involved in conducting this kind of study in each country. MATERIALS AND METHODS: Following the GCP-ICH guidelines, a protocol describing the HELENA-CSS was written and approved by all partners. In the pilot study, a case report form adapted to the study objectives and its manual of operation was constructed and used by all partners. All information letters to adolescents and their parents and consent forms were first written in English, then translated into the local language, and adapted to each local situation. All documents were then checked centrally for any deviation and corrected if required. An operation manual relating to ethical issues and other medico-regulatory requirements was also developed. This paper presents the current status of the medico-regulatory requirements from each HELENA-CSS participant country. RESULTS: Before the beginning of the study, most centers had satisfied the medico-regulatory requirements of IEC approval and agreement with other national or local regulatory authorities/organizations. For a few centers, some problems were detected and corrective actions were taken to improve missing information to reach a high level of quality assurance of ethical issues. CONCLUSION: The GCP-ICH guidelines about nontherapeutic biomedical research are interpreted and applied differently across Europe. This study shows that high-quality nontherapeutic biomedical research can address the ethical issues included in the GCP-ICH regulations and can be harmonized among the HELENA European partners.

Food and nutrient intake, nutritional knowledge and diet-related attitudes in European adolescents.

BACKGROUND AND OBJECTIVE: To provide an overview of methods used to assess food and nutrient intake, nutritional knowledge and diet-related attitudes in the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS), with selected results from the feasibility study. MATERIAL AND METHODS: To assess food intake in 13- to 16-year-old adolescents, a previously developed computer-assisted and self-administered 24-h recall was adapted for international use. Food consumption data were linked to national food composition databases to calculate energy and nutrient intakes. To assess nutritional knowledge in pupils not having any special (trained) education concerning 'nutrition', a 23-item validated multiple choice questionnaire was adapted. To assess eating attitudes, behaviour and/or putative problems with body weight in adolescents, a validated inventory covering 60 questions or statements was adapted for the study. In a feasibility study, instruments, data collection and processing were tested in one school class in each of the 10 participating European cities. RESULTS AND CONCLUSIONS: The feasibility study provided plausible results, quite consistent between countries. Against this background and for the first time, standardized and uniform methodology was made available for the main study to assess and characterize dietary intake, nutritional knowledge and eating attitudes.

Body fat distribution reference standards in Spanish adolescents: the AVENA Study.

OBJECTIVE: To present body fat patterning reference standards to identify children with a predominant distribution of body fat in the abdominal or truncal region of the body. DESIGN: Cross-sectional study in a representative sample of Spanish adolescents aged 13-18 years. SUBJECTS: A total of 2160 adolescents with a complete set of anthropometric measurements (1109 males and 1051 females). MEASUREMENTS: Weight, height, body mass index, skinfold thickness (biceps, triceps, subscapular, suprailiac, thigh, calf) and waist and hip circumferences. RESULTS: In the majority of the age groups, subscapular/triceps skinfolds ratio, trunk-to-total skinfolds percent (TTS%)and waist circumference values were significantly higher in males than in females; hip circumference was higher in females than in males, except at 15.5 years. In males, age showed a significant effect for all the body fat distribution indices; however, in females, the effect was only significant for triceps skinfold, waist and hip circumferences and waist-to-hip ratio. Smoothed age- and sex-specific triceps skinfold, subscapular skinfold, subscapular/triceps skinfolds ratio, TTS%, waist circumference and hip circumference, waist-to-hip and waist-to-height ratio percentile values for male and female adolescents have been established. CONCLUSION: These reference data for waist circumference and the other fat patterning indices, together with data from other countries, will help to establish international central obesity criteria for adolescents. The presented percentile values will give the possibility to estimate the proportion of adolescents with high or low regional adiposity amounts.

Anthropometric body fat composition reference values in Spanish adolescents. The AVENA Study.

OBJECTIVE: To determine reference values for body mass index (BMI), sum of six skinfolds (sigma6 skinfolds) and body fat percentage (BF%) in Spanish adolescents aged 13-18 years, included in the AVENA Study (Alimentación y Valoración del Estado Nutricional en Adolescentes: Food and Assessment of the Nutritional Status of Adolescents). DESIGN: Multicentre cross-sectional study. SETTING: Representative sample of Spanish adolescents. SUBJECTS: The population was selected by means of a multiplestep, simple random sampling. The final number of subjects included in the AVENA Study was 2859 adolescents; 2160 adolescents had a complete set of anthropometric measurements and were then included in this study (1109 males and 1051 females). INTERVENTIONS: Weight, height and six skinfold thicknesses were measured. As indices of total adiposity, we calculated BMI, summation sigma6 skinfolds and BF% with the formulas described by Slaughter et al. RESULTS: Sigma6 skinfolds and BF% in each age group were significantly higher in females than in males. In males, age showed a significant effect for BMI, sigma6 skinfolds and BF%; however, in females, the effect was only significant for BF%. The percentile distribution was more disperse towards higher sigma6 skinfolds and BF% values in males when compared with females. CONCLUSIONS: The presented percentile values will help us to classify adolescents in comparison with a well-established reference population, and to estimate the proportion of adolescents with high or low adiposity amounts. SPONSORSHIP: The AVENA-Study was supported by the Spanish Ministry of Health (FIS 00/0015), and grants from Panrico SA, Madaus SA and Procter and Gamble SA. This study was also supported by Instituto de Salud Carlos III (Spain), RCESP (C03/09) and Spanish Ministry of Education (AP2003-2128).

How to measure dietary intake and food habits in adolescence: the European perspective.

AIM: This paper deals with some methodological aspects of data collection in the context of measuring dietary intake in individuals in their adolescence life stage. METHOD: Experiences from three partners of the HELENA project in dietary intake measurement in children and adolescents are presented in this paper with emphasis on characteristics of under-reporting, long-term diet measurement and food patterns (Dortmund DONALD group), influences of survey duration on under-reporting (Ghent group) and meal habits (Spanish AVENA group). RESULTS: Under-reporters in the DONALD Study, particularly female adolescents, had a significantly higher body mass index (BMI) than non-under-reporters; BMI could not be explained by different long-term dietary patterns during childhood and adolescence clustered according to fat consumption; consumers of fast food had higher BMI values than nonconsumers. In the Ghent experience, the decline in population mean energy intake as calculated over selected clusters of days is 184 kcal (6.5%) in boys and 116 (5.6%) in girls; the cluster of 1 recording day and the cluster of 3 recording days were not significantly different but they were both significantly different from the 7-day cluster; no significant interaction was observed between the effect of time and BMI. In the AVENA Study, the percentage of adolescents skipping breakfast was higher in females (8.6%) than in males (3.5%, P<0.001); higher BMI values were observed in those skipping breakfast than in those notskipping breakfast, but differences were statistically significant in males at 15 y and in females at 14 and 17 y; adolescents avoiding some food groups for breakfast had higher BMI values (carbohydrates, fruits and pastries in males and milk, fruits and pastries in females). CONCLUSION: Dietary and nutrient intake data in the HELENA project will be obtained by means of repeated 24-h dietary recalls. Data from HELENA might be a basis for developing complex approaches like Healthy Eating Indices.

Inflammatory mediators in overweight and obese Spanish adolescents. The AVENA Study.

OBJECTIVE: The aim of this study was to clarify if there is an association between overweight and a state of chronic, low-grade inflammation in adolescents. DESIGN: The study is a part of the cross-sectional multicenter study AVENA, designed to evaluate the nutritional status of a representative sample of Spanish adolescents. The adolescents were divided into two groups: (1) nonoverweight and (2) overweight/obesity using the International Obesity Task Force (IOTF) standards. SUBJECTS: A geographically representative subsample of the AVENA study including 493 Spanish adolescents, aged 13-18 y (236 females/257 males), participated in this study. MEASUREMENTS: Serum C-reactive protein (CRP) and in vitro production of interleukin 6 and tumor necrosis factor alpha were measured, together with a detailed anthropometry. RESULTS: The inflammatory markers showed generally higher values in subjects with overweight/obesity than in those with nonoverweight, with only CRP showing significant differences (the means were 0.83 and 1.27 mg/l in the nonoverweight and overweight/obesity groups, respectively). CONCLUSION: Although we have not studied if adolescent overweight and obesity play an initiating role in the development of future diseases, we suggest it may induce a chronic low-grade inflammatory state, which points out the importance of maintaining an appropriate body weight, to avoid obesity-related diseases in adulthood.

Body composition and physical performance of Spanish adolescents: the AVENA pilot study.

In order to validate the physical fitness tests and anthropometric parameters of the AVENA multicenter study, a pilot study was carried out in 101 adolescents (48 girls and 53 boys) aged 15-18 years. Body composition was established by the sum of skinfolds (SS) in millimeters (biceps, triceps, subscapular, suprailiac) and body mass index (BMI, weight/height(2)) in kilograms per meters squared. Physical fitness was measured by means of the Course-Navette test (CNT). Median BMI was 22.5 and 20.3 for boys and girls, respectively, while their median SS was 32.5 and 47.47, respectively. The median CNT score was 8 and 4 for boys and girls, respectively. For both groups, there was a negative correlation between body fat and physical fitness, the correlation being stronger in boys ( r=-0.65) than in girls ( r=-0.43; p<0.01). SS appears to be more suitable than BMI in expressing body composition in this context. The CNT indicates physical fitness in adolescents satisfactorily. This subject will be explored in more depth during the final phase of the multicenter study.