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.

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.

Breakfast habits and factors influencing food choices at breakfast in relation to socio-demographic and family factors among European adolescents. The HELENA Study.

Breakfast consumption has been shown to be an important indicator of a healthy lifestyle. Little is known however about factors influencing breakfast consumption and food choices at breakfast in adolescents. The aim of the present study was therefore to describe breakfast habits, and factors influencing food choices at breakfast within the framework of the EU-funded HELENA Study, in 3528 adolescents from ten European cities. Additionally, socio-demographic differences in breakfast habits and in influencing factors were investigated. Half of the adolescents (and fewer girls than boys) indicated being regular breakfast consumers. Girls with mothers with a high level of education, boys from 'traditional' families and boys who perceived low family affluence were positively associated with breakfast consumption. Boys whose parents gave encouragement and girls whose peers ate healthily were more likely to be regular breakfast consumers. 'Hunger', 'taste', 'health concerns' and 'parents or guardian' were the most important influences on the adolescents' food choices at breakfast. Adolescents from southern Europe and girls reported to be more influenced by personal and socio-environmental factors. Socio-demographic differences, in particular regional and gender differences, need to be considered in discussions surrounding the development of nutritional intervention programs intended for adolescents.

Food-related family lifestyle associated with fruit and vegetable consumption among young adolescents in Belgium Flanders and the Veneto Region of Italy.

The present paper examined the relationship between fruit and vegetable consumption and food-related family lifestyle (dinner with parents, family food rules, and television viewing behaviors) in a sample of 14,407 adolescents from Belgium Flanders (N=7,904) and the Veneto Region of Italy (N=6,503) using multilevel binary logistic regression analyses. The data are part of the Health Behavior in School-aged Children cross-sectional survey. Daily dinner with parents, having more strict family food rules, and low television viewing behaviors were associated with daily fruit and vegetable intake. Watching television during meals was not associated with the outcome variables.

Soft drink consumption in adolescence: associations with food-related lifestyles and family rules in Belgium Flanders and the Veneto Region of Italy.

BACKGROUND: The number of studies among adolescents that focus on several lifestyle behaviours and family rules as determinant of soft drink consumption are limited. The aim of this study is to investigate the associations between daily soft drink consumption, food-related lifestyles and family rules in adolescence. METHODS: The data are part of the Health Behavior in School-aged Children (HBSC) cross-sectional survey. Adolescents between 11 and 16 years of age were included, resulting in a final sample of 14 407 adolescents representative of Belgium Flanders (N = 7904) and the Veneto Region of Italy (N = 6503). Binary logistic regression was used to test the association between soft drink consumption and food-related lifestyle (breakfast habits, family meals, snacking, meals in fast food restaurants and television viewing) and family rules (restriction and obligation rules) by region and gender. RESULTS: Each independent variable is significantly associated with daily soft drink consumption, despite some sub-groups exceptions. When we entered all the variables into the same statistical model, the positive association with daily soft drink consumption remained significant for frequent meals in fast food restaurants, television variables and low restriction rules. Breakfast during weekdays, evening meal with parents and obligation rules remained significant only in specific sub-groups and not the entire sample. Finally, the association with breakfast with parents and during the weekend disappeared. CONCLUSION: These findings suggest that considering gender and cultural differences, involving parents and limiting adolescents' exposure to television would increase the effectiveness of interventions aimed to reduce soft drink consumption in adolescence.

The role of behavioural factors in explaining socio-economic differences in adolescent health: a multilevel study in 33 countries.

Attempts to describe and explain socio-economic differences in health have mainly focused on adults. Little is known about the mechanisms of the relationship between socio-economic status (SES) and health in adolescence including inconsistent findings between SES and health among young people. Data were derived from representative samples of 13 and 15-year-old students in 33 European and North American countries (n=97,721) as part of the Health Behaviour in School-aged Children (HBSC) study 2001/2002. Multilevel logistic regression models were used to investigate socio-economic differences in self-rated health among adolescents and the contribution of health-related behaviours to the explanation of such differences. Odds ratios of self-rated health by family affluence were calculated before and after adjustment for behavioural factors (tobacco smoking, physical activity, television use, breakfast intake, consumption of fruits and vegetables). On average, adolescents from low affluent families had an odds ratio for low self-rated health of 1.84 for boys and 1.80 for girls, compared to those from high affluent families. The majority of behavioural factors were significantly associated with family affluence in all countries and explained part of the relationship between self-rated health and family affluence. Smoking, physical activity and breakfast consumption showed the largest independent effect on health. The present study suggests that behavioural factors in early adolescence partly account for the association between self-rated health and socio-economic status. Prevention programmes should target unhealthy behaviours of adolescents from lower socio-economic groups to help prevent future life-course disadvantages in terms of health and social inequalities.

Parental occupation, family affluence and adolescent health behaviour in 28 countries.

OBJECTIVES: We explored the association between socioeconomic position and four different aspects of adolescent health behavior in a wide range of European countries, the US, Canada and Israel. METHODS: Data were collected from the Health Behaviour in School-aged Children (HBSC) study in 2002. Representative samples of 13 and 15 year olds completed a standardised questionnaire during school hours in each country. Logistic regression analyses were used to investigate the independent effect of parental occupation and family affluence on tobacco and alcohol use, vegetable consumption and TV viewing. RESULTS: Family affluence showed no significant association with regular smoking in most countries, whereas an increase in smoking with decreasing occupational status was found in half of the countries. For alcohol consumption a positive association was found with family affluence in half of the countries, while no relationship with parental occupation was observed. Both measures of socioeconomic position were strong independent predictors for vegetable consumption and television viewing in almost all countries. CONCLUSIONS: The findings suggest that health behaviours that begin to develop in adolescence are less strongly influenced by parental socioeconomic position. Preventive intervention strategies should take the different socioeconomic patterns of health behaviour into account.

Body weight dissatisfaction and communication with parents among adolescents in 24 countries: international cross-sectional survey.

BACKGROUND: Parents have significant influence on behaviors and perceptions surrounding eating, body image and weight in adolescents. The aim of this study was to examine the prevalence of body weight dissatisfaction, difficulty in communication with the parents and the relationship between communication with parents and adolescents' dissatisfaction with their body weight (dieting or perceived need to diet). METHODS: Survey data were collected from adolescents in 24 countries and regions in Europe, Canada, and the USA who participated in the cross-sectional 2001/2002 Health Behaviour of School-Aged Children (HBSC) study. The association between communication with parents and body weight dissatisfaction was examined using binary logistic regression analysis. RESULTS: Body weight dissatisfaction was highly prevalent and more common among girls than boys, among overweight than non-overweight, and among older adolescents than younger adolescents. Difficulty in talking to father was more common than difficulty in talking to mother in all countries and it was greater among girls than among boys and increased with age. Difficulties in talking to father were associated with weight dissatisfaction among both boys and girls in most countries. Difficulties in talking to mother were rarely associated with body weight dissatisfaction among boys while among girls this association was found in most countries. CONCLUSION: The findings suggest that enhanced parent communication might contribute in most countries to less body dissatisfaction in girls and better communication with the father can help avoiding body weight dissatisfaction in boys. Professionals working with adolescents and their families should help adolescents to have a healthy weight and positive body image and promote effective parent-adolescent communication.

Television viewing behaviour and associations with food habits in different countries.

OBJECTIVE: Several environmental factors influence adolescents' food habits and television (TV) viewing is thought to be one of these factors. The purpose of the present study was to describe sociodemographic differences in TV viewing and to examine associations of TV viewing with the consumption of sweets, soft drinks, fruit and vegetables in different countries. METHODS: Data were collected from 162,305 young people completing the 2001/02 Health Behaviour in School-Aged Children survey, a World Health Organization cross-national study on health and health behaviours among 11-, 13- and 15-year-old school pupils. Analyses of variance were used to examine sociodemographic differences in TV viewing and logistic regression analyses to examine associations between TV viewing and food habits. RESULTS: Large differences were found between countries in reported daily TV viewing time, from an average of 2.0 h in Switzerland to 3.7 h in Ukraine. The results indicate that those most likely to watch TV are boys, 13-year-olds and pupils of lower socio-economic status. Those who watched more TV were more likely to consume sweets and soft drinks on a daily basis and less likely to consume fruit and vegetables daily, although the latter associations were not so apparent among Central and Eastern European countries. CONCLUSIONS: Given the high TV viewing rates among adolescents and the association with less healthy food options, many young people are at increased risk of overweight or obesity. Interventions to modify TV viewing behaviour are needed. The findings underscore the importance of tackling socio-economic differences.

Comparison of a computer-administered and paper-and-pencil-administered questionnaire on health and lifestyle behaviors.

PURPOSE: The Health Behavior in School-aged Children (HBSC) study is a cross-national survey examining health and lifestyle behaviors of adolescents, traditionally administered by paper and pencil in a school setting. The purpose of the present study was to investigate if a computer format of the questionnaire would affect the responses of the adolescents in comparison with the paper and pencil format. METHODS: In 2000, the Belgian (Flemish) HBSC survey was administered in 81 secondary schools by paper and pencil (n = 4083) and in 19 schools by computer (n = 1008). Eight hundred four computer participants (aged 12-20 years) were matched with paper and pencil participants on the basis of gender, age, educational level, socioeconomic status, and type of school authority. The questionnaire included items on lifestyle behaviors (e.g., nutrition, substance use, physical inactivity, sexual behavior), psychosomatic health, and social relations. RESULTS: For the majority of lifestyle behaviors, we found that mode of administration had no significant effect on adolescents' responses, whereas for several questions about feelings/affective states, more socially desirable responses were found in the paper and pencil format than in the computer format. CONCLUSION: The present findings suggest a need for further exploration of potential mode effects on questions about feelings and affective states before transition from the paper and pencil HBSC-survey to the computer format.

Adolescents' food habits: results of the Health Behaviour in School-aged Children survey.

The present study describes food habits in adolescents in thirty-five countries and regions (European countries/regions, Israel, Canada and the USA), based on the food-frequency questions from the cross-sectional Health Behaviour in School-aged Children survey of the year 2001-2. A total of 162,305 pupils of 11, 13 or 15 years of age completed an anonymous standardised questionnaire on health and lifestyle factors during one school hour. Large differences in food habits between countries were found: the consumption frequency of fruit varied from on average 2.8 to 5 d/week, the consumption of vegetables varied from on average 2.4 to 5.5 d/week, the consumption of soft drinks varied from 2.1 to 5 d/week and sweet consumption from 2.6 to 5 d/week. Methodological problems in comparing between countries are discussed. Nonetheless, the results indicate a need for national and international health promotion programmes to improve adolescents' food habits.

The relative influence of individual and contextual socio-economic status on consumption of fruit and soft drinks among adolescents in Europe.

BACKGROUND: The number of studies among children and adolescents that focus on socio-economic differences in food habits is limited. Moreover, most are done in only one country and often include a non-representative sample. The present study examines whether socio-economic differences in the consumption of fruit and soft drinks can be found among young adolescents in a wide range of European countries. METHODS: Multilevel statistical analysis of 114 558 school-pupils aged 11, 13 and 15 from 28 countries participating in the WHO collaborative cross-national study of Health Behaviours among School-aged Children 2001-2002. The individual outcomes were daily fruit and soft drink consumption and the socio-economic predictors at the individual level were occupation of the head of household and family material wealth. Family material wealth was aggregated at the country level to operationalize country-level socio-economic status. RESULTS: In general, girls and younger pupils consumed fruit more often and soft drinks less often. Significant between-school, between-country and between-region differences were found. Fruit consumption increased with family material wealth and higher parental occupational status. Soft drink consumption was lower among pupils of higher parental occupational status in Northern, Southern and Western European countries, but not in Central and Eastern European countries. Only in Central and Eastern European countries was a significant increase in soft drink consumption with increasing family affluence found. The country level of family affluence did not seem to have an effect on either outcome variable. CONCLUSION: The findings underscore the importance of socio-economic factors in relation to the food habits of young adolescents.

Influence of mother's educational level on food parenting practices and food habits of young children.

The main purpose of the present study is to examine whether differences in mothers' food parenting practices by educational level could explain differences in food consumption in Flemish preschool children. Three hundred and sixteen mothers of children aged 2.5-7 years, completed a self-administered questionnaire. Differences by educational level were found in children's and mothers' consumption frequencies of fruit, vegetables and soft drinks, and in the use of restrictions, verbal praise, negotiation, discouragement of sweets and restraining from negative modelling behaviour. Multiple logistic regression analyses revealed that mothers' consumption was an independent predictor for all four outcome variables; verbal praise was a significant predictor for children's vegetable consumption, permissiveness for regular consumption of soft drinks and sweets, and, using food as a reward for regular sweet consumption. Differences in children's food consumption by mothers' educational level were completely explained by mother's consumption and other food parenting practices for fruit and vegetables but not for soft drinks.

The influence of parental occupation and the pupils' educational level on lifestyle behaviors among adolescents in Belgium.

PURPOSE: To analyze the associations of lifestyle behaviors with educational level and social background based on parental occupation in adolescence. METHODS: Data from secondary school pupils participating in the Belgian (Flemish) Health Behavior in School-aged Children (HBSC) survey of the year 2002 (N = 12,490) were analyzed. Multiple logistic regressions adjusting for age and gender were used to assess the effects of parental occupation and pupil educational level on the selected lifestyle behaviors. RESULTS: Pupils of lower educational level reported less healthy food habits, less teeth brushing, less seatbelt use, more TV watching, more smoking, more drunkenness, more use of hashish, and more lifetime use of Ecstasy. Pupils of parents with lower socioeconomic status (SES) (based on the occupation of the head of the household) reported less healthy food habits, less teeth brushing, more TV watching, and less seatbelt use. Daily smoking and the lifetime use of Ecstasy varied among pupils of different parental occupation, although the effect disappeared when the pupils' educational level was introduced into the models. Regular drunkenness and regular use of hashish did not vary among pupils of different SES backgrounds. However, after controlling for educational level, an effect of parental occupation on regular hashish use became visible, with a higher percentage of regular users among the pupils of higher parental occupation. CONCLUSION: A lower educational level is associated with higher prevalence of indicators of an unhealthy lifestyle. The results are less straightforward for the relationship between SES and lifestyle behaviors.

A Belgian study on the reliability and relative validity of the Health Behaviour in School-Aged Children food-frequency questionnaire.

OBJECTIVE: In the Health Behaviour in School-Aged Children (HBSC) survey, the frequency of consumption of a limited number of food items--focusing on fibre, calcium and less healthy items--is queried using a 15-item food-frequency questionnaire (FFQ). The present study was conducted to assess the reliability and relative validity of the HBSC FFQ among school pupils in Belgium. DESIGN AND SUBJECTS: To assess the reliability of the FFQ, 207 pupils aged 11-12 years and 560 pupils aged 13-14 years completed the questionnaire twice, with a test-retest interval of 6 to 15 days. To assess the relative validity of the FFQ, in a first study data were collected as part of the Flemish HBSC 2000 survey: 7072 pupils (11-18 years) completed the FFQ and a 24-hour food behaviour checklist (FBC). In a second study, 101 pupils (11-12 years) completed the FFQ and a 7-day food diary (FD). RESULTS: Reliability--weighted kappa values between test and retest ranged from 0.43 to 0.70, percentage agreement from 37 to 87%, and Spearman correlations from 0.52 to 0.82. Relative validity--comparison of the FBC with the percentage of respondents who should have consumed the food items on a random day, computed from the FFQ, showed good agreement between the FFQ and the FBC for most items. Only for cereals, diet soft drinks and other milk products were considerably higher food frequencies than expected found from the FBC. Comparison of the FFQ with the FD showed overestimation for all but three food items (cheese, soft drinks and chips). Spearman correlations ranged between 0.10 for crisps and 0.65 for semi-skimmed milk. CONCLUSION: The HBSC FFQ is a reliable questionnaire that can be used for ranking subjects for most food items, although one must consider the overestimation when the FFQ is used for estimating prevalences.