Long-term trends in the consumption of sugary and diet soft drinks among adolescents: a cross-national survey in 21 European countries.

PURPOSE: To assess country-level trends in the prevalence of daily consumption of sugary (2002-2018) and diet (2006-2018) soft drinks among European adolescents, overall and by family material affluence. METHODS: We used 2002, 2006, 2010, 2014 and 2018 data from the 'Health Behaviour in School-aged Children' survey. Nationally representative samples of adolescents completed a standardised questionnaire at school, including a short food frequency questionnaire (n = 530,976 and 21 countries for sugary soft drinks; n = 61,487 and 4 countries for diet soft drinks). We classified adolescents into three socioeconomic categories for each country and survey year, using the Family Affluence Scale. Multilevel logistic models estimated time trends, by country. RESULTS: Sugary soft drinks: the prevalence of daily consumption (≥ 1×/day) declined in 21/21 countries (Plinear trends ≤ 0.002). Absolute [range - 31.7 to - 3.4% points] and relative [range - 84.8 to - 22.3%] reductions varied considerably across countries, with the largest declines in Ireland, England and Norway. In 3/21 countries, the prevalence of daily consumption decreased more strongly in the most affluent adolescents than in the least affluent ones (P ≤ 0.002). Daily consumption was more prevalent among the least affluent adolescents in 11/21 countries in 2018 (P ≤ 0.002). Diet soft drinks: overall, daily consumption decreased over time in 4/4 countries (Plinear trends ≤ 0.002), more largely among the most affluent adolescents in 1/4 country (P ≤ 0.002). CONCLUSIONS: Daily consumption of sugary and diet soft drinks in European adolescents decreased between 2002 (2006 for diet drinks) and 2018. Public health interventions should continue discouraging daily soft drink consumption, particularly among adolescents from lower socioeconomic groups.

Dietary disparities among adolescents according to individual and school socioeconomic status: a multilevel analysis.

This study aimed to estimate disparities in dietary habits according to the individual and contextual socioeconomic status (SES), while taking into account school nutrition-related characteristics. Data came from the 2018 cross-sectional "Health Behaviour in School-aged Children" (HBSC) survey. Multilevel multiple logistic regressions were performed. Over two-thirds of the observed variance was explained by individual and school characteristics, with SES being the main contributors. For example, 76.9% of the variance in daily sugar-sweetened beverage (SSB) intake was explained by individual and school characteristics. Adolescents of a secondary or lower parental education level were more likely to consume SSB daily than those of a post-secondary level (aOR = 1.46 (1.29-1.66)). Compared to those in a high SES school, the odds to consume SSB daily was higher for adolescents in low SES schools (aOR = 2.37(1.90-2.96)). These findings support the need for schools to pursue a consistent nutrition policy, with an increased support in low socioeconomic populations.

Perceived social support from teachers and classmates does not moderate the inverse association between body mass index and health-related quality of life in adolescents.

PURPOSE: The current study investigated the association between body mass index (BMI) and health-related quality of life (HRQoL) among a large and non-clinical sample of adolescents, and tested the possible moderating effect of perceived teacher and classmate support on this association. METHODS: French-speaking Belgian adolescents (n = 11,342) self-reported height and weight, HRQoL (KIDSCREEN-10), as well as their perception of teacher and classmate relationships. Adjusting for sociodemographics, linear regression analyses with HRQoL as the outcome variable were performed for boys and girls separately. Interactions between BMI and teacher support, and between BMI and classmate support were included to examine the effect of this support on the association between BMI and HRQoL. RESULTS: Obesity was associated with lower HRQoL for boys (ß = - 2.14, p = 0.002) and for girls (ß = - 2.96, p = 0.001), while only overweight girls showed a significant impaired HRQoL compared with normal-weight ones (ß = - 0.94, p = 0.01). In both sexes, lower perceived teacher and classmate support was associated with lower HRQoL. Interactions between BMI and perceived teacher relationships, and between BMI and perceived classmate relationships, were not significant for boys as for girls. CONCLUSIONS: Perceived school-related social support constitutes an important dimension of adolescent well-being, suggesting the relevance of considering it for promoting greater HRQoL in overweight and obese youth. Future studies are needed to confirm the absence of moderating effect of this support and explore its effect on other weight-related factors, like body image, weight misperception and bullying, associated with decreased HRQoL in adolescents.

Environmental correlates of physical activity among children 10 to 13 years old in Wallonia (Belgium).

BACKGROUND: In Belgium, as in many other countries, the juvenile practice of physical activity is insufficient. A growing attention has been paid to environmental factors that may influence physical activity but with inconsistent findings. This study aims to estimate the association between daily life environment characteristics and physical activity among children 10 to 13 years old in Wallonia (Belgium). METHODS: Data were collected using a self-administered questionnaire among 1940 children (HBSC survey). Associations between factors related to the children's living environment and physical activity (vigorous physical activity (VPA) ≥ twice a week; global physical activity (GPA) defined as VPA ≥ twice a week and moderate-to-vigorous physical activity ≥1 h/day) were estimated using logistic regressions adjusted for potential confounders. RESULTS: Nearly three-quarters of the children practiced VPA ≥ twice a week, but only one in five practiced GPA consistent with recommendations. After adjustment, children living in a neighborhood with playgrounds or parks were more likely to achieve a recommended level of GPA (OR: 1.34 [1.04-1.73]), as were children who reported that other youngsters were present in their neighborhood with whom they could play outside (OR: 1.50 [1.12-1.99]). The presence of neighborhood children was also positively associated with VPA (OR: 1.80 [1.42-2.29]); in stratified analyses, the association was significant only among boys (OR: 1.95 [1.34-2.82]). Moreover, and only in girls (OR: 1.66 [1.10-2.49]), a feeling of safety in one's neighborhood was positively associated with VPA. No association was found between VPA and the existence of a yard or a garden at home to go playing outside. CONCLUSION: Our results argue for developing actions aimed at creating living environments more favorable to children's daily physical activity. More specifically, they help better understand the environment of Belgian children and thus contribute to better identify their needs.

Feelings about the timing of first sexual intercourse and health-related quality of life among adolescents.

BACKGROUND: Early sexual intercourse (SI) may have long-lasting negative impacts on health-related quality of life (HRQoL). So far, these impacts have been studied using age for defining early SI instead of feelings about its timing. The present study examined the association between feelings about the timing of first SI and current HRQoL. METHODS: Data came from the 2014 cross-sectional Health Behaviour in School-aged Children (HBSC) study in French-speaking Belgium. Among participants aged 16-20 years who already had SI, 1778 were included in analyses. Univariate and multivariate logistic regressions were performed, including potential confounders. RESULTS: One quarter of adolescents (26.4%) had poor HRQoL, 19.8% expressed a negative feeling about the timing of first SI and 19.6% did not think about it. Compared with adolescents who thought first SI happened at the right time or wished it had happened sooner, adolescents who had a negative feeling about the timing and those who did not think about it were more likely to have a poor HRQoL (cOR = 1.67 (1.28-2.17) and cOR = 1.37 (1.05-1.80), respectively). After adjustment, associations were no more significant (aOR = 1.22 (0.91-1.63) and aOR = 1.22 (0.91-1.64)). Sex disparity in expressing a negative feeling mostly explained the difference between crude and adjusted analyses. CONCLUSION: Further research is needed to better understand such a complex relationship. The high proportion of adolescents having poor HRQoL and negative feeling about the timing of first SI shows how important it is to find out effective prevention for both domains.

Weekday sleep duration and morning tiredness are independent covariates of breakfast skipping in adolescents.

BACKGROUND/OBJECTIVES: Although regular breakfast consumption is associated with various health benefits, many adolescents skip this meal, particularly those with shorter sleep durations. In order to better understand the association between sleep duration and breakfast consumption among youth, we analyzed the association between weekday morning tiredness and daily breakfast consumption in adolescents, and explored the mediating role of morning tiredness in the association between sleep duration and daily breakfast consumption on weekdays. SUBJECTS/METHODS: The "Health Behaviour in School-aged Children" survey conducted in 2018 in French-speaking Belgian schools provided data (n = 8444 11-20-year-old adolescents) on bed- and wake-up times, and on the frequency of breakfast consumption and morning tiredness on weekdays. Multivariable logistic regressions and mediation analyses assessed the association, on weekdays, of morning tiredness (≥4 school mornings a week vs. less) and sleep duration (hours), with daily breakfast consumption, and the mediating role of morning tiredness. RESULTS: Feeling tired ≥4 school mornings a week was associated with lower odds of daily breakfast consumption on weekdays (aOR = 0.77 (95% CI 0.69-0.86)). In turn, on weekdays, sleep duration was positively associated with daily breakfast consumption (aOR = 1.29 (95% CI 1.23-1.36)), even after adjustment for morning tiredness (aOR = 1.28 (95% CI 1.21-1.35)). Morning tiredness only explained 4.9% of the association between sleep duration and daily breakfast consumption. CONCLUSION: Our findings suggest that in adolescents, sleep duration and morning tiredness are independent correlates of daily breakfast consumption on weekdays.

Alcohol consumption in early adolescence: Associations with sociodemographic and psychosocial factors according to gender.

INTRODUCTION: Early alcohol consumption can irreversible damage the adolescents' brain and may affect their quality of life. In order to better prevent such a deleterious behaviour, knowing its determinants is needed. So far, only few studies among adolescents aged <15 years exist, of which the majority failed to include gender differences. Therefore, the aim of this study was to investigate whether gender differences in the association between alcohol use and sociodemographic and psychosocial characteristics among 10-14-year olds exist. METHODS: Data came from the 2018 Health Behaviour in School-Aged Children (HBSC) study conducted in French-speaking schools of Belgium. The sample analysed here comprised 4,364 10-14-year olds from the Walloon Region. Associations of the recent alcohol consumption (at least one glass during the past month) with sociodemographic and psychosocial characteristics were estimated using gender-stratified multivariable logistic regression modelling. RESULTS: Prevalence of early alcohol consumption was 14% (boys: 16%; girls: 12%). Migration status and family affluence scale (FAS) were associated with early alcohol consumption only in boys. Second-generation immigrant boys (vs. natives: OR = 0.66 [0.47-0.92]) and boys from "low" FAS families (vs. "high": OR = 0.56 [0.32-0.98]) or "medium" FAS (vs. "high": OR = 0.63 [0.43-0.92]) were less likely to have consumed alcohol in the past month. In both genders, alcohol consumption was positively associated with age and inversely associated with school satisfaction and family support. No association was observed with family structure, peer support and life satisfaction in the multivariable models. CONCLUSION: Our findings showed that gender differences may exist in the determinants of alcohol consumption among young adolescents. They will contribute to the development of public health policies and actions for the most vulnerable adolescents, which should take gender differences into account.

Twenty-Four-Year Trends in Family and Regional Disparities in Fruit, Vegetable and Sugar-Sweetened Beverage Consumption among Adolescents in Belgium.

Dietary habits are influenced by various determinants that may evolve over time. This study aimed to examine, among adolescents in Belgium, trends in the dietary habits between 1990 and 2014 and to determine changes in family and regional disparities related to diet during this time period. In the 1990, 2002 and 2014 cross-sectional "Health Behaviour in School-aged Children" (HBSC) surveys, food consumption was estimated using a short Food Frequency Questionnaire. The Relative Index of Inequality (RII) enabled quantification of the gradients of inequality related to the family structure and to the region for non-daily fruit and vegetable and daily sugar-sweetened beverage (SSB) consumption. Between 1990 and 2014, the prevalence of non-daily fruit consumption increased from 27.7% to 60.6%, whereas the daily SSB consumption decreased from 58.9% to 34.8%. Over time, a downward trend in family disparities (p = 0.007) was observed for daily fruit consumption (RII: 1.58 (1.33-1.88) to 1.18 (1.13-1.23)). An upward trend in region-related disparities (p < 0.001) for SSB was found (RII: 1.15 (1.07-1.23) to 1.37 (1.28-1.47)). The overall trend of increasing disparities when dietary habits improved and decreasing disparities when dietary habits worsened highlights the need to implement actions that improve overall dietary habits while ensuring that disparities do not increase.

Time trends in consumption of sugar-sweetened beverages and related socioeconomic differences among adolescents in Eastern Europe: signs of a nutrition transition?

BACKGROUND: High intake of sugar-sweetened beverages (SSBs) contributes to detrimental cardio-metabolic indicators in youth. Monitoring of SSB consumption is lacking in Eastern Europe. OBJECTIVES: We assessed trends in the prevalence of adolescent daily consumption of SSBs in 14 Eastern European countries between 2002 and 2018, both overall and according to family material affluence. METHODS: We used 2002, 2006, 2010, 2014, and 2018 data of the Health Behaviour in School-Aged Children school-based study (repeated cross-sectional). Nationally representative samples of adolescents aged 11, 13, and 15 years were included (n = 325,184; 51.2% girls). Adolescents completed a standardized questionnaire, including a question on SSB consumption frequency. We categorized adolescents into 3 socioeconomic groups based on the relative Family Affluence Scale (FAS). Adjusted prevalences of daily SSB consumption by survey year, as well as country-level time trends between 2002 and 2018, were computed using multilevel logistic models (overall and by FAS groups). RESULTS: In 2018, the prevalence of adolescents consuming SSBs every day varied considerably between countries (range, 5.1%-28.1%). Between 2002 and 2018, the prevalence of daily SSB consumption declined in 10/14 countries (P for linear trends ≤ 0.004). The largest reductions were observed in Slovenia (OR, 0.48; 95% CI: 0.45-0.50) and the Russian Federation (OR, 0.67; 95% CI: 0.64-0.70). Daily SSB consumption was reduced at faster rates among the most affluent adolescents (who were larger consumers in 2002) than in the least affluent adolescents in 11/14 countries (P for linear trends ≤ 0.004). Thus, differences between FAS groups narrowed over time or even reversed, leading to larger proportions of daily consumers in the least affluent adolescents in 2018 in 5/14 countries (P ≤ 0.05). CONCLUSIONS: Adolescent daily consumption of SSBs decreased between 2002 and 2018 in most Eastern European countries. Declines were larger among higher-affluence adolescents. These results are useful to evaluate and plan interventions promoting healthy childhood diets.

Socioeconomic Disparities in Diet Vary According to Migration Status among Adolescents in Belgium.

Little information concerning social disparities in adolescent dietary habits is currently available, especially regarding migration status. The aim of the present study was to estimate socioeconomic disparities in dietary habits of school adolescents from different migration backgrounds. In the 2014 cross-sectional "Health Behavior in School-Aged Children" survey in Belgium, food consumption was estimated using a self-administrated short food frequency questionnaire. In total, 19,172 school adolescents aged 10-19 years were included in analyses. Multilevel multiple binary and multinomial logistic regressions were performed, stratified by migration status (natives, 2nd- and 1st-generation immigrants). Overall, immigrants more frequently consumed both healthy and unhealthy foods. Indeed, 32.4% of 1st-generation immigrants, 26.5% of 2nd-generation immigrants, and 16.7% of natives consumed fish ≥two days a week. Compared to those having a high family affluence scale (FAS), adolescents with a low FAS were more likely to consume chips and fries ≥once a day (vs.

Habitual food consumption of the Belgian population in 2014-2015 and adherence to food-based dietary guidelines.

BACKGROUND: Between 2014 and 2015 a second National Food Consumption Survey was conducted in Belgium in order to evaluate the habitual food consumption in the general Belgian population and to compare it with food-based dietary guidelines (FBDG) and results of the 2004 Food Consumption Survey. METHODS: A representative sample of the Belgian population was randomly selected from the National Population Register following a multistage stratified sampling procedure. Information on dietary intake was collected from 3146 subjects between 3 and 64 year old through two non-consecutive 24-hour dietary recalls using GloboDiet®. In addition, a self-administered food frequency questionnaire was completed. The distribution of habitual food consumptions and proportion of persons who did not meet the recommendations were estimated with SPADE. RESULTS: For most of food groups analysed, the habitual consumption did not comply with FBDG. The consumption of nutrient-poor and energy-dense foods (e.g. alcohol, soft drinks and snacks) was excessive (35% of total energy intake), while the consumption of most other food groups was below the minimum recommended. A large majority of the population had an inadequate consumption of dairy products (98%), vegetables (95%), fruit (91%), potatoes, rice and pasta (88%) bread and cereals (83%) and water and sugar-free drinks (73%). Males had higher consumption of most food groups than females, thereby complying more often with FBDG. For all food groups, except dairy products and fruit, the consumption increased with age. The proportion of individuals meeting FBDG was the highest among young children (3-5 years) and the worst among adolescents aged 14-17 years old. Habitual consumption remained stable between 2004 and 2014 in the population aged 15-64 years old for all food groups except for increased consumption of water and sugar-free drinks (1180 to 1289 g/d) and decreased consumption of spreadable and cooking fat (27 to 19 g/d), red meat (34 to 25 g/d) and bread and cereals (173 to 142 g/d). CONCLUSIONS: The habitual food consumption of the Belgian population (3-64 years) in 2014-2015 deviates largely from FBDG, particularly among adolescents aged between 14 and 17 years old. Few improvements were observed between 2004 and 2014 in the population between 15 and 64 years old. Further efforts are therefore necessary to improve dietary habits in Belgium, in order to prevent and reduce diet-related diseases.

Protocol of the Belgian food consumption survey 2014: objectives, design and methods.

BACKGROUND: Dietary patterns are one of the major determinants as far as health and burden of disease is concerned. Food consumption data are essential to evaluate and develop nutrition and food safety policies. The last national food consumption survey in Belgium took place in 2004 among the Belgian population aged 15 years and older. Since dietary habits are prone to change over time a new Belgian National Food Consumption Survey (BNFCS2014) was conducted in 2014-2015. METHODS: The BNFCS2014 is a cross-sectional study. A representative sample (n = 3200) of the Belgian population aged 3 to 64 years old was randomly selected from the National Population Register following a multistage stratified sampling procedure. Data collection was divided equally over the four seasons and days of the week in order to incorporate seasonal effects and day-to-day variation in food intake. Information on food intake was collected in adults with two non-consecutive 24-h dietary recalls (using the GloboDiet® software). In children food intake was collected with two non-consecutive one-day food diaries followed by a completion interview with GloboDiet. Additional data on socio-demographic characteristics, eating habits, lifestyle, food safety (at household level), physical activity and sedentary behaviour were collected with a face-to-face questionnaire using a computer-assisted personal interviewing technique. In the time between the two visits, participants were asked to complete a self-administered food frequency questionnaire and health questionnaire. Height, weight and waist circumference were measured. In addition, children and adolescents were asked to wear an accelerometer and keep a logbook for seven consecutive days to objectively measure physical activity and sedentary behaviour. CONCLUSION: The main objective of the BNFCS2014 is to evaluate the habitual food, energy and nutrient intake in the Belgian population and to compare these with recommendations from the national dietary guidelines. A second objective is to monitor eating habits and food safety aspects of the food consumption in Belgium. The results of this dietary monitoring survey, together with the information on the level of physical activity, may underpin future nutrition, food safety and physical activity policies at national and European level.

Physical activity and sedentary behavior in Belgium (BNFCS2014): design, methods and expected outcomes.

BACKGROUND: There is strong evidence to indicate that regular moderate intensity physical activity is associated with health benefits. Furthermore, sedentary behavior has been related with an increased risk for all-cause mortality. The accurate measurement of physical activity and sedentary behavior is therefore vital to evaluate their health impact and provide evidence for the development of public health recommendations. This paper describes the methodology used for assessing physical activity and sedentary behavior in the Belgian population in the context of the Belgian National Food Consumption Survey 2014 (BNFCS2014). RESULTS: Data about physical activity and sedentary behavior were collected as part of the cross-sectional BNFCS2014 between February 2014 and May 2015. A nationally-representative sample of children (3-9 years) and adolescents (10-17 years) were asked to wear an accelerometer (Actigraph® GT3X) during their waking hours for 7 consecutive days. Data were recorded in 15-second epochs and respondents with at least 2 valid week days (i.e., 10 h of wear-time) and 1 valid week-end day (i.e., 8 h of wear-time) were retained for the analyses. The Evenson cut points were used to assess the time spent in each physical activity intensity level: sedentary, low, moderate and vigorous. Complementary, diaries were provided to register the activities performed when the accelerometer was removed; these activities were added to the measures provided by the accelerometers. In addition, age-specific self-reported questionnaires (ToyBox and FPAQ) were completed to provide contextual information about the type of activities performed. Due to financial constraints, physical activity in adults (18-64 years) was assessed and described through the self-reported International Physical Activity Questionnaire (IPAQ long version) only. CONCLUSION: Data were collected in the context of the BNFCS2014 to provide a comprehensive picture of the physical activity and sedentary behavior in the Belgian population, with a special focus on children (3-9 years) and adolescents (10-17 years). Levels of physical activity and sedentary behavior can be compared to international guidelines and analyzed according to several background variables, such as age, gender, Body Mass Index, education level and region. Such results are aimed to underpin future policies in the field of physical activity.