European Pandemic Recovery: An Opportunity to Reboot.

Europe's failure to manage a bold, common response would further increase divergence, strengthen anti-European forces and fuel populism.

[Economic Implications of the Corona Crisis and Economic Policy Measures]. / Wirtschaftliche Implikationen der Corona-Krise und wirtschaftspolitische Maßnahmen.

The corona crisis started in China and had great consequences for public health and the economy. In the meantime, high and rapidly growing numbers of cases of infections with SARS-CoV-2 have also been recorded in Japan, Korea, Italy, Germany, Great Britain, France, Spain and above all in the USA. Forecasts of economic growth have been massively revised downwards and governments around the world are struggling to find the right economic policy response. This article describes basic short-term options for the German government to react to the corona shock and briefl y assesses the package of measures "Schutzschirm für Beschäftigte und Unternehmen" presented on 13 March 2020 by the German Finance Minister Olaf Scholz and the German Economics Minister Peter Altmaier.

Adolescents' diet quality in relation to their relatives' and peers' diet engagement and encouragement: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study.

OBJECTIVE: To examine the associations between adolescents' diet quality and their perceived relatives' and peers' diet engagement and encouragement. DESIGN: Cross-sectional study performed in European countries. Diet quality was scored using the Diet Quality Index for Adolescents (DQI-A) based on four components: quality, diversity, balance and meal frequency. Perceived diet quality engagement and perceived encouragement of the relatives/peers were assessed using the questions 'How healthy is each of the following persons' diet?' and 'How often does each of the following persons encourage you to eat a healthy diet?' SETTING: Vienna, Ghent, Lille, Athens, Heraklion, Pecs, Rome, Dortmund, Zaragoza and Stockholm. SUBJECTS: Healthy adolescents (n 2943). RESULTS: The perceived engagement level of the mother, father and sister was each positively associated with the DQI-A (P<0·05). A positive association was found for the perceived engagement level of siblings, father and mother with all specific components (P<0·05). DQI-A was negatively associated with the perceived encouragement level from a best friend and positively associated with the encouragement level of the mother and father (P<0·05). Diversity, balance and quality components were positively associated with the perceived encouragement level from the mother and father (P<0·05), whereas the best friend's perceived encouragement was negatively associated with the meal frequency component (P<0·01). CONCLUSIONS: These findings highlight the role of social engagement and encouragement of relatives and peers in adolescents' diet quality. Intervention or promotion programmes aimed at enhancing diet quality in adolescents should target both family and peers.

Physical activity awareness of European adolescents: The HELENA study.

The aim of this study was to assess physical activity (PA) awareness of adolescents and to identify anthropometric and psychosocial factors that can lead to under or overestimation of PA. This study included 2044 adolescents. Participants wore a uniaxial accelerometer for 7 days to measure PA and completed a self-rated questionnaire about PA. Adolescents were classified into four PA awareness subgroups (realistically active, overestimators, underestimators and realistically inactive) according to the self-rated and objective assessment of PA. Characteristics and psychosocial factors of the self-rated physically active groups were compared using bivariate and multivariate mixed logistic regression models. Forty-five percent of adolescents reported their PA levels correctly (34.8% realistically active and 10.1% realistically inactive). Among the 59.4% who were objectively inactive, 82.9% tended to overestimate their PA level. Adolescents who overestimated their PA level were older (P < .05), had more support from mother and a best friend (P < .05) and had higher cardiorespiratory fitness (P < .001) compared with those who were realistically active. A significant number of adolescents believe that they are physically active when they are not. Improving awareness, especially in the high-risk groups identified here, might help to bring about behavioural changes in physically inactive adolescents.

Impact of the choice of threshold on physical activity patterns in free living conditions among adolescents measured using a uniaxial accelerometer: the HELENA study.

The aim of this study was to assess the impact of the choice of threshold on physical activity patterns measured in adolescents under free living conditions (FLC) using a uniaxial accelerometer. The study comprised 2043 adolescents (12.5-17.5 years) participating in the HELENA Study. Participants wore a uniaxial accelerometer for 7 days. The PA patterns were assessed using thresholds determined from six different studies. For each of the thresholds used, the number of adolescents fulfilling the recommendation of 60 min of moderate to vigorous PA (MVPA) per day was also calculated. A significant difference was found between thresholds regardless of the activity level: differences of 38%, 207%, 136%, and 2780% for sedentary, light, moderate, and vigorous intensity PA, respectively (P < 0.001). Time of MVPA varied between methods from 25.3 to 55.2 min · day(-1). The number of adolescents fulfilling the recommendation varied from 5.9% to 37% according to the thresholds used. The kappa coefficient for concordance in the assessment of the number of adolescents achieving the PA recommendations was generally low. The definition of the threshold for PA intensity may considerably affect the PA patterns in FLC when assessed using a uniaxial accelerometer and the number of participants fulfilling the recommendations.

[Assessment of physical activity levels in a sample of the Italian adult population]. / Valutazione dell'attività fisica in un gruppo di popolazione adulta italiana.

A cross-sectional study was performed to evaluate, amongst a sample of the Italian adult population, physical activity levels and adherence to international recommendations. Overall, 220 subjects were recruited. Study participants completed a lifestyle questionnaire after seven consecutive days of monitoring by an accelerometer. The study population was found to devote most of their time to sedentary activities, but over half of the sample reached minimum levels of physical activity recommended by the World Health Organization.

A favorable built environment is associated with better physical fitness in European adolescents.

OBJECTIVE: To assess the association between the built environment and physical fitness and physical activity in adolescents. METHODS: The study included 3528 adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. The health-related physical fitness components were assessed using the physical fitness tests. Participants wore a uniaxial accelerometer (ActiGraph®) for 7 days to measure physical activity. A specific questionnaire addressing the built environment was used. Potential confounding factors including age, gender, body mass index, body composition, pubertal status, smoking, educational level of parents, and socioeconomic status were analyzed using backward stepwise linear regression analysis. RESULTS: Heavy traffic in the neighborhood was the strongest factor negatively associated with both physical fitness and physical activity (both P<0.05). Conversely, a secure bicycling or walking route from home to school was positively associated with various components of physical fitness and physical activity (P<0.01). Outdoor fields and gymnasiums near home were also associated with better physical fitness (P<0.01), but not with physical activity. CONCLUSIONS: A favorable built environment may contribute to health-related physical fitness and physical activity of adolescents and should be considered in future interventions and health promotion strategies.

Can differences in physical activity by socio-economic status in European adolescents be explained by differences in psychosocial correlates? A mediation analysis within the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study.

OBJECTIVE: Socio-economic status (SES) has been positively associated with physical activity (PA) levels in adolescents. In order to tackle these social inequalities, information is needed about the underlying mechanisms of this association. The present study aimed to investigate the potential mediating role of psychosocial correlates of PA on the relationship between SES and PA in European adolescents. DESIGN: Cross-sectional study testing the mediating role of psychosocial correlates in the SES-PA association using the product-of-coefficients test of MacKinnon. SETTING: Ten European cities in nine different countries, the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. SUBJECTS: Adolescents (n 2780) aged 12·5-17·49 years self-reported on PA (moderate-to-vigorous intensity PA and total PA), SES indicators (education of the mother and Family Affluence Scale) and psychosocial correlates of PA (stage of change, attitudes, awareness, modelling, social support, self-efficacy, benefits, barriers and environmental correlates). RESULTS: SES (Family Affluence Scale) was significantly associated with moderate-to-vigorous intensity PA. According to single-mediator models, this association was significantly mediated by stage of change (t = 3·6, P ≤ 0·001), awareness (t = 2·7, 0·001 < P ≤ 0·01), modelling (t = 4·8, P ≤ 0·001), self-efficacy (t = 2·5, 0·01

Objectively measured physical activity and sedentary time in European adolescents: the HELENA study.

The authors' aim in this cross-sectional study was to characterize levels of objectively measured physical activity and sedentary time in adolescents from 9 European countries. The study comprised 2,200 European adolescents (1,184 girls) participating in the HELENA cross-sectional study (2006-2008). Physical activity was measured by accelerometry and was expressed as average intensity (counts/minute) and amount of time (minutes/day) spent engaging in moderate- to vigorous-intensity physical activity (MVPA). Time spent in sedentary behaviors was also objectively measured. Cardiorespiratory fitness was measured by means of the 20-m shuttle run test. Level of maternal education was reported by the adolescents. A higher proportion of boys (56.8% of boys vs. 27.5% of girls) met the physical activity recommendations of at least 60 minutes/day of MVPA. Adolescents spent most of the registered time in sedentary behaviors (9 hours/day, or 71% of the registered time). Both average intensity and MVPA were higher in adolescents with high cardiorespiratory fitness, and sedentary time was lower in the high-fitness group. There were no physical activity or sedentary time differences between maternal education categories. These data provide an objective measure of physical activity and amount of time spent in sedentary behaviors in a relatively large number of European adolescents.

Mediterranean Diet Effect: an Italian picture.

BACKGROUND: The purpose of this study was to evaluate the overall diet quality effects, mainly on antioxidant nutritional status and some cytokines related to the cellular immune response as well as oxidative stress in a healthy Italian population group. METHODS: An observational study was conducted on 131 healthy free-living subjects. Dietary intake was assessed by dietary diary. Standardised procedures were used to make anthropometric measurements. On blood samples (serum, plasma and whole blood) were evaluated: antioxidant status by vitamin A, vitamin E, carotenoids, vitamin C, uric acid, SH groups, SOD and GPx activities; lipid blood profile by total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides; total antioxidant capacity by FRAP and TRAP; the immune status by TNF-α, and IL-10 cytokines; the levels of malondialdehyde in the erythrocytes as marker of lipid peroxidation. RESULTS: The daily macronutrients intake (g/day) have shown a high lipids consumption and significant differences between the sexes with regard to daily micronutrients intake. On total sample mean Mediterranean Diet Score (MDS) was 4.5 ± 1.6 and no significant differences between the sexes were present. A greater adherence to a Mediterranean dietary pattern increases the circulating plasma levels of carotenoids (lutein plus zeaxanthin, cryptoxanthin, α and ß-carotene), vitamin A and vitamin E. The levels of endogenous antioxidants were also improved. We observed higher levels in anti-inflammatory effect cytokines (IL-10) in subjects with MDS ≥ 6, by contrast, subjects with MDS ≤ 3 show higher levels in sense of proinflammatory (TNF α P < 0.05). Lower levels of MDA were associated with MDS > 4. Our data suggest a protective role of vitamin A against chronic inflammatory conditions especially in subjects with the highest adherence to the Mediterranean-type dietary pattern. CONCLUSIONS: Mediterranean dietary pattern is associated with significant amelioration of multiple risk factors, including a better cardiovascular risk profile, reduced oxidative stress and modulation of inflammation.

Self-reported physical activity in European adolescents: results from the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study.

OBJECTIVE: To describe self-reported physical activity (PA) patterns in the various domains (school, home, transport, leisure time) and intensity categories (walking, moderate PA, vigorous PA) in European adolescents. Furthermore, self-reported PA patterns were evaluated in relation to gender, age category, weight status category and socio-economic status (SES). DESIGN: Cross-sectional study. SETTING: Ten European cities. SUBJECTS: In total, 3051 adolescents (47·6 % boys, mean age 14·8 (sd 1·2) years) completed an adolescent-adapted version of the validated International Physical Activity Questionnaire. RESULTS: The total sample reported most PA during leisure time (485 min/week) and least PA at home (140 min/week). Boys reported significantly more school-based PA (P < 0·001), leisure-time PA (P = 0·003), vigorous PA (P < 0·001) and total PA (P = 0·002) than girls, while girls reported more home-based PA (P < 0·001) and walking (P = 0·002) than boys. Self-reported PA at school (P < 0·001), moderate PA (P < 0·001), vigorous PA (P < 0·001) and total PA (P < 0·001) were significantly higher in younger age groups than in older groups. Groups based on weight status differed significantly only in leisure-time PA (P = 0·004) and total PA (P = 0·003), while groups based on SES differed in all PA domains and intensities except transport-related PA and total PA. CONCLUSIONS: The total sample of adolescents reported different scores for the different PA domains and intensity categories. Furthermore, patterns were different according the adolescents' gender, age, weight status and SES.

Longer breastfeeding is associated with increased lower body explosive strength during adolescence.

Our aim in this study was to examine the association between breastfeeding duration and cardiorespiratory fitness, isometric strength, and explosive strength during adolescence. A total of 2567 adolescents (1426 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) cross-sectional study aged 12.5-17.5 y were included. Information about duration of any and exclusive breastfeeding was obtained retrospectively by means of a parental questionnaire. The 20-m shuttle run, handgrip strength, and standing long jump tests were used to assess physical fitness. Significant differences among the categories of breastfeeding duration were tested using ANCOVA after adjusting for a set of potential confounders: gestational and current age, birth weight, sexual maturation, fat mass, fat-free mass, maternal education, parental weight status, country, smoking behavior, and days of vigorous physical activity. Longer breastfeeding (either any or exclusive) was associated with a higher performance in the standing long jump test in both boys and girls (P < 0.001), regardless of fat mass, fat-free mass, and the rest of potential confounders. In adolescents who were breastfed for 3-5 mo or ≥6 mo, the risk of having a standing long jump performance below the 5th percentile was reduced by half compared with those who were never breastfed [odds ratio (OR) = 0.54, 95% CI = 0.30-0.96, P < 0.05; and OR = 0.40, 95% CI = 0.22-0.74, P < 0.01, respectively). These findings suggest a role of breastfeeding in determining lower body explosive strength during adolescence.

Do adolescents accurately evaluate their diet quality? The HELENA study.

BACKGROUND & AIMS: The aim of this study was to assess the diet quality awareness and associated factors in a large sample of European adolescents. METHODS: The study included 3389 healthy adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study. The adolescents' diet quality was based on repeated 24 h recalls and scored into a Diet Quality Index for Adolescents (DQI-A) considering four components: meal, equilibrium, diversity and quality. A self-rated diet quality questionnaire was administered to adolescents to assess their dietary awareness. The association of DQI-A with dietary awareness was studied using a linear mixed model including the center as the random effect and dietary awareness as the fixed effect. RESULTS: There was a positive association between DQI-A scores and diet quality perception levels (p < 0.0001). The mean DQI-A was 59.0 (SD = 14.8) in adolescents with a low dietary awareness compared with 65.4 (SD = 12.6) in adolescents with high dietary awareness (p < 0.0001). Similar results were found for all the DQI components. When analyses were stratified, we found a significant heterogeneity across the nutritional status, with no significant association between DQI-A and dietary awareness level in obese adolescents, but a positive association in overweight, normal and undernourished groups. We found also a significant heterogeneity associated with the lunch location (school or home). No other factor affected dietary awareness (gender, pubertal status and maternal educational level). CONCLUSION: European adolescents evaluate well their food quality whatever their pubertal status, gender and parental educational level, except for the obese who are not able to assess their diet quality. Improving the dietary awareness in obese adolescents might help to induce behavioral changes.

Single-nucleotide polymorphism of CD36 locus and obesity in European adolescents.

CD36 is a membrane receptor with a wide variety of functions, including the regulation of energy metabolism, fat storage, and adipocyte differentiation. To assess the relationship between CD36 gene single-nucleotide polymorphisms (SNPs) and obesity in adolescents, we evaluated the relationship between CD36 SNPs and the risk of obesity in a case-control study composed of 307 obese (age = 15.0 +/- 1.1 years) and 339 normal-weight adolescents (age = 14.6 +/- 1.1 years). To validate the results, we assessed the relation between the same SNPs and percentage of body fat (BF%) and BMI in 1,151 European adolescents (age = 14.8 +/- 1.4 years). SNPs with a minor allele frequency >0.10 were selected to tag CD36. Genotyping was performed on an Illumina system. Four SNPs (rs3211867, rs3211883, rs3211908, and rs1527483) were associated with increased risk of obesity in the case-control study (odds ratio (OR) (95% confidence interval)): 1.96 (1.26-3.04], P = 0.003; 1.73 (1.16-2.59), P = 0.007; 2.42 (1.47-4.01), P = 0.0005 and 1.95 (1.25-3.05), P = 0.003, respectively). The same four SNPs were associated with higher BMI (P < 0.05) and BF% (P < 0.04) in the validation study. Further analyses identified a haplotype (frequency: 0.05) carrying the minor allele of these SNPs as being associated with obesity (OR: 2.28; P = 0.0008) in the case-control study and with excess adiposity (i.e., higher BF% (P = 0.03) and BMI (P = 0.04)) in the validation study. Our data suggest that genetic variability at the CD36 gene locus could be associated with body weight variability in European adolescents but these findings require replication.

Recommended levels of physical activity to avoid an excess of body fat in European adolescents: the HELENA Study.

BACKGROUND: It is unclear how much physical activity is necessary to prevent obesity during adolescence. PURPOSE: The purpose of this study was to examine whether the current physical activity guidelines for youth are associated with a lower risk of excess of body fat in European adolescents. METHODS: A sample of 2094 adolescents from the HELENA cross-sectional study was selected. Levels of moderate, vigorous, and moderate to vigorous physical activity (MVPA) were assessed using accelerometers. BMI and percentage of body fat (skinfolds) were calculated and used to categorize the adolescents as normal-weight/normal-fat, overweight/overfat, and obese. Data were collected during 2006-2007. Receiver operating characteristic (ROC) analysis, performed in 2009, was used to determine thresholds that best discriminate between weight and body fat categories. RESULTS: ROC analysis showed that >/=18 minutes/day in vigorous physical activity and >/=55 minutes/day in MVPA significantly discriminated between normal-weight and overweight+obesity categories. Moreover, >/=9 minutes/day of vigorous physical activity and >/=49 minutes/day of MVPA discriminated between normal-fat and overfat/obese adolescents. Adolescents who did not meet the current physical activity guidelines for youth of 60 minutes/day in MVPA increased the risk of having overweight+obesity (OR=1.24, 95% CI=1.01, 1.534) and overfat+obesity (OR=1.79, 95% CI=1.33, 2.42). ORs increased when adolescents did not meet the guidelines of at least 15 minutes/day in vigorous physical activity. CONCLUSIONS: Current physical activity guidelines seem to be appropriate to prevent excess of body fat in European adolescents. However, participation in vigorous physical activity might have additional importance in preventing obesity.

Distinctive modulation of inflammatory and metabolic parameters in relation to zinc nutritional status in adult overweight/obese subjects.

Overweight and obesity are associated with low grade of inflammation and chronic inflammatory response characterized by abnormal production and activation of some pro-inflammatory signalling pathways. Taking into account that obesity is the direct result of an imbalance between energy intake and energy expenditure, the nutritional factors in the diet, with particular focus on zinc, may play a pivotal role in the development of obesity-associated comorbidities. Considering the potential interactions among zinc nutritional status, inflammation, overweight/obesity and insulin secretion, the aim of the present work was to clarify the influence of zinc dietary intake on some metabolic, inflammatory and zinc status parameters in adult overweight/obese subjects. We found a close interrelationship between nutritional zinc and obesity. In particular, subjects with a lower zinc dietary intake display a deeper inflammatory status, general impairment of the zinc status, an altered lipid profile and increased insulin production with respect to obese subjects with normal zinc dietary intake. Moreover, in the presence of low dietary zinc intake, the obese subjects are less capable to respond to oxidative stress and to inflammation leading to the development of obesity or to a worsening of already preexisting obesity status. In conclusion, a possible zinc supplementation in obese subjects with a deeper inflammatory status and more altered zinc profile may be suggested in order to limit or reduce the inflammation, taking also into account that zinc supplementation normalizes "inflammaging" as well as zinc profile leading to a correct intra- and extracellular zinc homeostasis.