Trend in Breakfast Consumption among Primary School Children in Italy.

Eating breakfast daily improves cognitive function, may contribute to learning and academic performance in children and can decrease the risk of childhood obesity. The aim of this study was to analyse how breakfast consumption changed in the period from 2008/9 to 2019 in Italy among children aged 8-9 years old participating in the OKkio alla SALUTE surveys and to explore the associations with some socio-demographic and lifestyle factors. Information about children's daily breakfast consumption (adequate, inadequate, and no breakfast) and the socio-demographic characteristics of the children and their mothers was collected through four questionnaires addressed to parents, children, teachers and head teachers. Data were analysed for the 272,781 children from 21 Italian regions from 2008/9 to 2019. The prevalence of adequate breakfast decreased from 60.7% in 2008/9 to 55.7% in 2019 and no breakfast from 10.9 to 8.7%; conversely, inadequate breakfast increased from 28.4 to 35.6%. Logistic regression models showed that the occurrence of inadequate or no breakfast consumption was significantly higher among girls, children living in the southern regions and children with less educated mothers. These findings highlight the need for effective interventions to increase daily breakfast consumption and its adequacy among children.

Exploring changes in children's well-being due to COVID-19 restrictions: the Italian EpaS-ISS study.

BACKGROUND: While existing research has explored changes in health behaviours among adults and adolescents due to the COVID-19 outbreak, the impact of quarantine on young children's well-being is still less clear. Moreover, most of the published studies were carried out on small and non-representative samples. The aim of the EpaS-ISS study was to describe the impact of the COVID-19 pandemic on the habits and behaviours of a representative sample of school children aged mainly 8-9 years and their families living in Italy, exploring the changes in children's well-being during the COVID-19 pandemic compared to the immediately preceding time period. METHODS: Data were collected using a web questionnaire. The target population was parents of children attending third-grade primary schools and living in Italy. A cluster sample design was adopted. A Well-Being Score (WBS) was calculated by summing the scores from 10 items concerning the children's well-being. Associations between WBS and socio-demographic variables and other variables were analysed. RESULTS: A total of 4863 families participated. The children's WBS decreased during COVID-19 (median value from 31 to 25; p = 0.000). The most statistically significant variables related to a worsening children's WBS were: time of school closure, female gender, living in a house with only a small and unliveable outdoor area, high parents' educational level and worsening financial situation. CONCLUSIONS: According to parents ' perception, changes in daily routine during COVID-19 negatively affected children's well-being. This study has identified some personal and contextual variables associated with the worsening of children's WBS, which should be considered in case of similar events.

Inequalities in Childhood Nutrition, Physical Activity, Sedentary Behaviour and Obesity in Italy.

Unhealthy diets, physical inactivity and high body mass index (BMI) are preventable risk factors for non-communicable diseases throughout a person's lifespan. The higher prevalence of these risk factors in children from lower socio-economic groups has been generally observed. The aim of this study is to explore the effect of parents' socio-economic conditions on children's consumption of fruit, vegetables and sugar-sweetened drinks, and inactivity, sedentary behaviour, overweight and obesity. This study used data from the sixth cross-sectional survey of the surveillance "OKkio alla Salute" (Italian COSI), involving 2467 schools and 53,275 children in 2019. All the information was collected through four questionnaires addressed to parents, children, teachers and head teachers. The weights and heights of the children were measured with standard techniques and equipment to classify overweight/obesity according to the WOF-IOTF cut-offs. The results showed a high percentage of children who do not adhere to health recommendations and a high prevalence of overweight and obesity. In particular, "less healthy" behaviours and higher BMI were more frequent in children from families with a lower socio-economic status and those residing in Southern Italy. These findings highlight the need for effective interventions that address the differences in these health-related behaviours.

Changes in Food Consumption and Eating Behaviours of Children and Their Families Living in Italy during the COVID-19 Pandemic: The EPaS-ISS Study.

The aim of the EPaS-ISS study was to describe the changes in food consumption and eating behaviours of children (mainly aged 8-9 years) and their families between the pre-COVID-19 period (before February/March 2020) and the COVID-19 period (from February/March 2020 to April 2022). A web questionnaire completed by parents was used to collect data. The sociodemographic characteristics of the children and their parents were also explored through the web questionnaire. Seventeen regions out of nineteen and the two autonomous provinces (PA) of Italy participated in the study. The survey was completed for 4863 children (47.9% females). The study showed that only small changes in children's food consumption happened between the pre-COVID-19 period and the COVID-19 period; in particular, about 25% of parents reported an increase in savoury snacks and sweet food. A decrease in fruit and vegetable (about 8%) and fish (14%) consumption was also found. However, the changes seem to have mainly affected children from most disadvantaged families. The results also indicate positive changes during the COVID-19 pandemic in some families' eating behaviours, such as eating more home-cooked meals (42%) and family meals (39%), as well as cooking more with children (42%).

The Correlation between Adolescent Daily Breakfast Consumption and Socio-Demographic: Trends in 23 European Countries Participating in the Health Behaviour in School-Aged Children Study (2002-2018).

Breakfast is often considered the most important meal of the day and can benefit adolescent health in several ways. The aims of the present study were (1) to identify adolescents' socio-demographic (sex, family affluence and family structure) determinants of daily breakfast consumption (DBC) and (2) to describe trends in DBC among adolescents across 23 countries. Cross-sectional surveys of nationally representative samples of adolescents (aged 11, 13, and 15 years) (n = 589,737) participating in the Health Behaviour in School-aged Children (HBSC) survey from 2002 to 2018 were used. Multilevel logistic regression analyses modeled DBC over time, adjusted for family affluence, family structure and year of survey. Four countries showed an increased trend in DBC (the Netherlands, Macedonia, Slovenia, and England). A significant decrease in DBC was observed in 15 countries (Belgium-Fr, France, Germany, Croatia, Portugal, Spain, Hungary, Poland, Russian Federation, Ukraine, Denmark, Finland, Latvia, Lithuania and Sweden). In 4 countries no significant change was observed (Czech Republic, Scotland, Ireland and Norway). In most of the countries (n = 19), DBC was higher among the adolescents from high-affluence homes. In all the countries analysed, the adolescents living in two-parent households report higher DBC use than those in single-parent households. More than half of the countries showed a decrease in DBC. There is a need to implement key interventions by developing different strategies (education, incorporating educational curriculum and counselling programmes) to increase DBC. Comparing DBC patterns across HBSC countries is important for understanding regional and global trends, monitoring strategies, and developing health promotion programmes.

Problematic Social Media Use and Cyber Aggression in Italian Adolescents: The Remarkable Role of Social Support.

The recent increase in electronic and social media use among young people has highlighted the importance of focusing on problematic social media use (PSMU) and the concurrent phenomenon of cyber aggression, as well as the role of social support. As part of the 2018 Health Behavior in School-aged Children study in Italy, this study aims to explore the role of family, peer, and teacher support in the association between cyberbullying and PSMU. METHODS: Data were collected from 4183 school classes in Italy for a total of 58,976 adolescents aged 11, 13, and 15 years. The prevalence of cyber aggression (both cybervictimization and perpetration) and PSMU was estimated across subgroups of different age, gender, and geographical residence. A set of multivariable logistic regressions was then used to investigate the association between cyberbullying and PSMU, considering the effect of social support. RESULTS: Cybervictimization was more frequent among girls than in boys. PSMU was higher in 11-year-old boys and 13-year-old girls; 8.3% and 12.7%, respectively. Social support was highest in 11-year-olds, for both sexes, and then decreased with increasing age. The risk of cyberbullying, both suffered and perpetrated, was higher in girls and in the presence of PSMU. Social support showed to be highly protective against PSMU and cyberbullying in all ages and both genders. CONCLUSION: Although cyber aggression is less represented in Italy than in other European countries, it is likely to increase. PSMU appears to be an important contributor to the risk of cyber aggression; however, social support has been shown to be capable of reducing the risk of both phenomena. Public health policies fostering familiar and school support can help protect adolescents' mental health, reducing the risk of problematic media use and cyberbullying.

Physical Activity among Italian Adolescents: Association with Life Satisfaction, Self-Rated Health and Peer Relationships.

The aim of this study was to describe physical activity, both moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA), in a large nationally representative sample of Italian adolescents, aged 11, 13 and 15, and to evaluate if Italian adolescents were in line with the 2020 WHO recommendations. In order to assess the possible impact of physical activity on adolescent psychological and social wellbeing, the associations between MVPA and VPA with life satisfaction, self-rated health and peer relationships were also explored. Data from the 2018 Italian Health Behaviour in School-aged Children (HBSC) survey on 58,976 adolescents were analysed. Logistic regression analysis was used to investigate the association between physical activity and self-rated health, life satisfaction and peer relationships. The association of the Family Affluence Scale with self-rated health, life satisfaction and peer relationships was also studied. The results showed that the majority of Italian adolescents did not meet current physical activity WHO guidelines on MPVA. The prevalence of adolescents claiming to be involved "at least four or more times per week" in VPA was 29%. Overall, our findings highlighted a positive association between MVPA and VPA and life satisfaction, self-rated health and peer support. Data from this study underlined the need to encourage physical activity, especially among older adolescents and girls, who claimed lower levels of MPVA and VPA.

Mental Well-Being: 2010-2018 Trends among Italian Adolescents.

(1) Aims: To explore temporal trends 2010-2018 of well-being among Italian adolescents and to evaluate potential explanatory factors. (2) Methods: Italian nationality representative samples of students aged 11, 13, and 15 years were recruited in 2010, 2014, and 2018; Health Behaviour in School-aged Children (HBSC), for an overall number of 165,000 teenagers. Multivariable logistic regression models were performed to fit the trends over time of life satisfaction (LS), psychological (PSY-HC) and somatic health complaints (SOM-HC) considering the contextual factors: school work pressure, social support (family, school, peers), socioeconomic status, geographic area, and immigration background; (3) Results: From 2010 to 2018 while LS was steady, health complaints increased, mainly for PSY-HC, in all age and gender groups. Trend of PSY-HC affected mainly 15-years-olds: rates among boys varied from 29.6% to 35.9% (OR: 1.13, 95%CI: 1.02-1.25); among girls from 49.1% to 63.3% (OR: 1.56, 95%CI: 1.42-1.72). High school work pressure and poor social support play a central role in worsening well-being outcomes; (4) Conclusions: Our findings pictured a remarkable worsening trend of teenagers' well-being, especially among 15-year-old girls. Further research will be required to investigate this breaking up of the connection between psychophysical symptomatology and cognitive perception of life satisfaction.

The methodology of the Italian Health Behaviour in School-aged Children (HBSC) 2018 study and its development for the next round.

Introduction: The Italian "Health Behaviour in School-aged Children" (HBSC) is a national surveillance system that collects data on health and well-being among adolescents aged 11, 13 and 15 years attending school. It is part of the HBSC Research Network, an international alliance of researchers from 45 European and North American countries and regions started in 1982. Methods: All countries and regions participating in HBSC must adhere to a common international standard protocol developed and systematically updated by the entire HBSC Network. Data collection occurs every four years. Italy joined the international Network in 2000 and, to date, five waves (in 2002, 2006, 2010, 2014 and 2018) have been carried out. From 2010 the Italian HBSC is representative at regional level and in 2017 the base of the "Surveillance system for risk behaviours in 11-17 year-olds" became part of the Prime Ministerial Decree "Identification of surveillance systems and registries of mortality, tumours and other diseases". Cluster sampling is used, with school class as primary sampling unit, and two validated questionnaires are used to collect the information. Results: In 2018, the Italian HBSC involved 3,608 classes and 58,976 students. The average response rates were 86% of sampled classes and 97% of students achieving a national and regional representative sample for youths of all age groups (19,504 eleven-year-old, 20,554 thirteen-year-old and 18,918 fifteen-year-old). The national coordination group prepared a standardized format for disseminating the results locally and indicating areas for intervention A national report and some articles have been published. The next round, which will take place in the 2021-2022 school year, will also involve a representative sample of students of grade four of secondary schools (adolescents aged 17 years) and use on line questionnaires. Conclusions: Over 3 decades at international and 2 decades at national level 35 years have demonstrated that HBSC methodology and its results are useful for monitoring and deepening the knowledge on the most critical issues of adolescents' well-being.

Alcohol use and misuse: a profile of adolescents from 2018 Italian HBSC data.

OBJECTIVE: Alcohol remains the most commonly substance used by adolescents.The aim of the study was to draw a comprehensive picture of the behavioural patterns that characterize alcohol use and abuse among 15-year-olds. MATERIALS AND METHODS: The study sample included 18,918 15-year-olds participating in the 2018 Italian Health Behaviour in School-aged Children (HBSC) survey. A Bayesian approach was adopted for selecting the manifest variables associated with alcohol consumption; a latent class regression model was employed to identify health-related risk patterns associated with alcohol use. RESULTS: 21% of our sample represented the cluster of heavy drinkers who shared other risk behaviours: heavy smoking habits (29%), cannabis (68%), gambling (52%) and drunkenness (76%) experience, binge drinking (96%) and sexual intercourse (51%). CONCLUSIONS: Our results confirm multiple risk-taking behaviours among adolescents tending to cluster in behavioural patterns. This has implications for public health policies and must be considered when planning interventions and prevention strategies.

Dietary habits among Italian adolescents and their relation to socio-demographic characteristics.

OBJECTIVE: The aim is to describe dietary habits and their association with socio-demographic characteristics in a large nationally representative sample of Italian adolescents aged 11, 13 and 15 years. MATERIALS AND METHODS: Data from the 2018 Italian Health Behaviour in School-aged Children (HBSC) survey on 58,976 adolescents were analysed to determine eating habits. Logistic regression was used to investigate the association between incorrect dietary habits and potential predictors. RESULTS: 38.3% of boys and 48.1% of girls skipped breakfast and 54.1% did not consume fruit and/or vegetables daily. 15.9% of boys and 11.3% of girls drank carbonated-sugary beverages at least once a day. Incorrect dietary habits were more common among boys, adolescents with lower socio-economic conditions, residents in Southern Italy and those spending more time watching TV. Italian adolescents were more likely to have incorrect dietary habits compared with those from most other countries involved in 2018 HBSC. CONCLUSIONS: Action is needed to improve dietary habits among adolescents.

Cadmium bioaccumulation in Mediterranean spider crab (Maya squinado): human consumption and health implications for exposure in Italian population.

Cd bioaccumulation pattern was investigated in Mediterranean spider crab (Maya squinado, Herbst, 1788) collected from the northern Adriatic Sea. Specimens were caught in the framework of a monitoring plan in order to quantify the Cd distribution into different organs and tissues of crab. For this purpose, Cd level was studied in appendages, cephalothorax, abdomen as well as gonads. Cd concentrations were found largely below the Maximum Level (ML) established at the European Union (EU) level for muscle from crab appendages (found mean 0.011 mg kg(-1)) and approximately amounted to 2% of the EU ML (0.50 mg kg(-1)). The higher Cd concentrations were found in organs and tissues included in crab body such as abdomen, chephalotorax and gonads with respect to appendages. Chephalotorax showed the highest metal concentration (mean value of 1.19 mg kg(-1)). The possible differences in Cd bioaccumulation rate among crab organs and tissues were also investigated applying a parametric linear regression. A major Cd bioaccumulation rate was revealed in chephalotorax with respect to other analyzed organs and tissues. Furthermore, the evaluation of health risk related to human consumption of the Mediterranean spider crab has been studied for median of total population, median and 95th percentile of consumers of Italy. The observed results highlighted that the consumption of organs and tissues included in crab body such as abdomen, gonads and, in particular, chephalotorax substantially increased the Cd intake reaching also alarming Estimated Weekly Intake (EWI) values especially for median and 95th percentile of Italian consumers.

Arsenic contamination of the environment-food chain: a survey on wheat as a test plant to investigate phytoavailable arsenic in Italian agricultural soils and as a source of inorganic arsenic in the diet.

Seven hundred and twenty-six samples of wheat grains from the majority of Italian agricultural areas were pooled into 141 composite samples, homogeneous with respect to geographical origin and wheat variety. The average arsenic concentration of the pooled samples was 9 ng g(-1), with a range of 2-55 ng g(-1) (dry weight basis). The spread of arsenic concentrations (coefficient of variation of 91%) was related to spatial variability associated with geochemical and environmental factors. Temporal variability was investigated by a 3-year longitudinal study on 7 wheat cultivars grown in 22 areas of central and northern Italy. Average year-to-year variation in arsenic levels was low, and the average of the coefficients of variation was 23%. These results show that mapping of phytoavailable arsenic in agricultural soils can be done by measuring arsenic concentration in representative samples of wheat grains. Arsenic speciation in the grain showed that As(III) and As(V) were the major As compounds, highlighting the importance of wheat as a source of inorganic arsenic in the diet.

Arsenic speciation in freshwater fish: focus on extraction and mass balance.

Arsenic (As) speciation in muscle tissues of freshwater fish was investigated with special emphasis on extraction yields and mass balances. For the quantification of water-soluble As compounds, samples were extracted using a 1:1 (v/v) methanol/water mixture. Various extraction parameters, such as extraction volume, number of additional extractions, intermediate and final volume in sample preconcentration were optimized so as to improve the extraction efficiency. Arsenic compounds were determined by HPLC with online ICP-MS, using both cation and anion exchange separation. The species studied were eel (Anguilla anguilla L.), flathead grey mullet (Mugil cephalus L.), chub (Leuciscus cephalus L.), and carp (Cyprinus carpio L.). Mean total As concentrations ranged from 354 microg kg(-1) dry weight (carp) to 1804 microg kg(-1) dry weight (mullet). Under optimized conditions, the percentage of total As extracted ranged from 64% for carp, to 82%, 84%, and 89% for grey mullet, eel and chub, respectively. Extraction of lipid-rich eel with n-hexane recovered some additional 3% of total As. The sizeable effect of sample matrix on HPLC retention time of some organoarsenicals in gradient elution cation exchange chromatography was exploited to achieve separation of coeluting compounds by analysing the same sample at different dilutions. The recovery of As from chromatographic columns was 101%, 102%, 103% and 104% for carp, chub, mullet and eel, respectively, indicating that no As was retained during chromatography. Arsenobetaine (AB) was the dominating As compound, but several other arsenicals, including arsenous acid (Asiii), arsenic acid (Asv), methylarsonic acid (MMA), dimethylarsinic acid (DMA), trimethylarsine oxide (TMAO), arsenocholine ion (AC), tetramethylarsonium ion (TETRA), oxo-arsenosugar-glycerol (AS1), oxo-arsenosugar-phosphate (AS2), oxo-arsenosugar-sulfate (AS4), thio-arsenosugar-phosphate (ThioAS2), and three unknown As compounds, were found. Arsenic speciation in carp was different compared to the other fish species, and a lower proportion of AB along with a high contribution of AS2 and ThioAS2 was found. DMA and TMAO were noteworthy minor compounds in eel and carp, respectively. Arsenic speciation and the chemical composition of fish muscle both appeared to affect the extraction yield.

Changes in selenium speciation associated with increasing tissue concentrations of selenium in wheat grain.

Wheat (Triticum aestivum) collected in the Nawanshahr-Hoshiarpur Region (Punjab, India) showed the highest selenium concentrations ever recorded in cereal grains (29-185 microg g(-1)). There was a strong positive relationship between the selenium content in shoots and that in kernels, showing that grain selenium concentration can be predicted from that in the vegetative tissues of the plant. The identity and content of the selenocompounds in the grain samples and in wheat-based reference materials were investigated by HPLC-ICP-dynamic reaction cell-MS. Reversed-phase, cation exchange, and anion exchange HPLC were used to separate the selenium species after ultrasound-assisted enzymatic extraction with an ultrasonic probe. Selenomethionine and selenate accounted for 72-85% and 2-6% of the sum of the selenium species, respectively. The proportion of organic Se species varied with increasing Se content; namely, SeMet showed a relative reduction whereas the other organoselenium compounds increased up to 18-22% of the total chromatographed selenium. Se-methyl-selenocysteine was detected as a minor compound (0.2-0.5%) in high-Se wheat by both reversed-phase and cation exchange HPLC using retention time matching with the standard substance spiked to the sample extracts. Regular consumption of locally produced wheat-based food items may lead the population of the study area to an excessive intake of selenium. On the other hand, the large predominance of selenomethionine shows that local wheat can be a promising raw material for naturally enriched products to be used to supplement human and animal diets in low selenium areas.

Bioaccumulation potential of dietary arsenic, cadmium, lead, mercury, and selenium in organs and tissues of rainbow trout (Oncorhyncus mykiss) as a function of fish growth.

The distribution and potential bioaccumulation of dietary arsenic, cadmium, lead, mercury, and selenium in organs and tissues of rainbow trout (Oncorhyncus mykiss Walbaum, 1792), a major aquaculture species, was studied in relation to fish growth over a period of >3 years. Fish were reared under normal farming conditions, that is, fed a standard fish food and exposed to negligible levels of waterborne trace elements. The age-related variations in the content of each trace element in gills, kidney, liver, muscle, and skin were studied through nonparametric regression analysis. A buildup of all elements in all tissues and organs was observed, but due to dilution with growth, the concentrations did not increase, except in a few cases such as cadmium and mercury in liver and kidney. In muscle tissue, the concentrations of mercury, lead, and selenium did not alter significantly with growth, whereas cadmium increased but remained at exceedingly low levels. The concentration of arsenic in muscle tissue peaked at 14 months and then decreased in adult specimens. Arsenic speciation by high-performance liquid chromatography--inductively coupled plasma mass spectrometry revealed that arsenic in muscle was almost exclusively present in the form of nontoxic arsenobetaine. Application of a mercury mass balance model gave predicted concentrations in agreement with measured ones and showed that in farmed rainbow trout the ratio of mercury concentrations in feed and in fish is about 1:1. Therefore, rainbow trout does not approach the limits established for human consumption even when reared with feed at the maximum permitted levels. These findings highlight the low bioaccumulation potential of toxic trace elements such as cadmium, lead, and mercury in rainbow trout following dietary exposure. On the other hand, selenium concentrations in muscle (about 0.2 microg g (-1) of fresh weight) show that rainbow trout may be a good source of this essential element.