European Journal of Nutrition

, Volume 54, Issue 5, pp 771–782 | Cite as

Dietary fiber intake and its association with indicators of adiposity and serum biomarkers in European adolescents: the HELENA study

  • Yi Lin
  • Inge HuybrechtsEmail author
  • Carine Vereecken
  • Theodora Mouratidou
  • Jara Valtueña
  • Mathilde Kersting
  • Marcela González-Gross
  • Selin Bolca
  • Julia Wärnberg
  • Magdalena Cuenca-García
  • Frederic Gottrand
  • Elisabetta Toti
  • Sonia Gomez-Martínez
  • Evangelia Grammatikaki
  • Idoia Labayen
  • Luis A. Moreno
  • Michael Sjöström
  • John Van Camp
  • Romana Roccaldo
  • Emma Patterson
  • Yannis Manios
  • Denes Molnar
  • Anthony Kafatos
  • Kurt Widhalm
  • Stefaan De Henauw
Original Contribution



To evaluate total, energy-adjusted dietary fiber (DF), water-soluble fiber (WSF), and water-insoluble fiber (WIF) intakes in European adolescents and to investigate their association with indicators of adiposity and serum biomarkers.


This study, conducted from 2006 to 2007, included 1804 adolescents aged 12.5–17.5 years (47 % males) from eight European cities completing two non-consecutive computerized 24-h dietary recalls. GLM multivariate analysis was used to investigate associations.


Mean DF intake (20 g/day) of the sample met the European Food Safety Authority recommendation, but was below those of the World Health Organization and of the Institute of Medicine. Total DF, WSF and WIF intakes were higher in males (P < 0.001), but following energy-adjustments significantly higher intakes were observed among females (P < 0.001). Bread and cereals contributed most to total DF, WSF and WIF intakes, followed by potatoes and grains, energy-dense but low-nutritious foods, fruits and vegetables. Moreover, energy-adjusted WSF and WIF were positively associated with body fat percentage (BF%), waist to height ratio and low-density lipoprotein cholesterol, while energy-adjusted WSF was inversely associated with serum fasting glucose (β = −0. 010, P = 0.020).


Total DF intakes are rather low in European adolescents. An inverse association with serum fasting glucose might indicate a possible beneficial role of DF in preventing insulin resistance and its concomitant diseases, even though DF intakes were positively associated with adolescents’ BF%. Therefore, further longitudinal studies should elaborate on these potential beneficial effects of DF intake in the prevention of obesity and related chronic diseases.


Dietary fiber Adolescence Adiposity Biomarkers HELENA study 



The HELENA-study took place with the financial support of the European Community Sixth RTD Framework Programme. This work was also partially supported by the European Union, in the framework of the Public Health Programme, the Swedish Council for Working Life and Social Research, the Spanish Ministry of Education, Spanish Ministry of Science and Innovation (AGL2007-29784-E) and the Spanish Ministry of Health, Maternal, Child Health and Development Network. The content of this paper reflects only the authors’ views and the rest of HELENA-study members and the European Community is not liable for any use that may be made of the information contained therein. Yi Lin was responsible for the analyses and the drafting of the manuscript. Many thanks to Petra Pickert, Anke Carstensen, Rosa María Torres for their contribution to laboratory work. All authors contributed to the interpretation of the results and have evaluated and approved the manuscript as submitted.

Conflict of interest

The authors declare that there are no conflicts of interests.


  1. 1.
    Baur LA (2002) Child and adolescent obesity in the 21st century: an Australian perspective. Asia Pac J Clin Nutr 11(Suppl. 3):S524–S528CrossRefGoogle Scholar
  2. 2.
    Engeland A, Bjorge T, Sogaard AJ, Tverdal A (2003) Body mass index in adolescence in relation to total mortality: 32-year follow-up of 227,000 Norwegian boys and girls. Am J Epidemiol 157:517–523CrossRefGoogle Scholar
  3. 3.
    Lloyd LJ, Langley-Evans SC, McMullen S (2010) Childhood obesity and adult cardiovascular disease risk: a systematic review. Int J Obes (Lond) 34:18–28CrossRefGoogle Scholar
  4. 4.
    Lobstein T, Jackson-Leach R (2006) Estimated burden of paediatric obesity and co-morbidities in Europe. Part 2. Numbers of children with indicators of obesity-related disease. Int J Pediatr Obes 1:33–41CrossRefGoogle Scholar
  5. 5.
    Ogden CL, Flegal KM, Carroll MD, Johnson CL (2002) Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA 288:1728–1732CrossRefGoogle Scholar
  6. 6.
    Power C, Lake JK, Cole TJ (1997) Measurement and long-term health risks of child and adolescent fatness. Int J Obes Relat Metab Disord 21:507–526CrossRefGoogle Scholar
  7. 7.
    Ottova V, Erhart M, Rajmil L, Dettenborn-Betz L, Ravens-Sieberer U (2012) Overweight and its impact on the health-related quality of life in children and adolescents: results from the European KIDSCREEN survey. Qual Life Res 21(1):59–69CrossRefGoogle Scholar
  8. 8.
    Anderson JW, Smith BM, Gustafson NJ (1994) Health benefits and practical aspects of high-fiber diets. Am J Clin Nutr 59:1242S–1247SGoogle Scholar
  9. 9.
    Joint FAO/WHO expert consultation on diet NatPoCD (2003) Diet, nutrition, and the prevention of chronic diseases. WHO technical report series 91634-63Google Scholar
  10. 10.
    Tan KY, Seow-Choen F (2007) Fiber and colorectal diseases: separating fact from fiction. World J Gastroenterol 13:4161–4167CrossRefGoogle Scholar
  11. 11.
    Mathern JR, Raatz SK, Thomas W, Slavin JL (2009) Effect of fenugreek fiber on satiety, blood glucose and insulin response and energy intake in obese subjects. Phytother Res 23:1543–1548CrossRefGoogle Scholar
  12. 12.
    Nakaji S, Sugawara K, Saito D, Yoshioka Y, MacAuley D, Bradley T et al (2002) Trends in dietary fiber intake in Japan over the last century. Eur J Nutr 41:222–227CrossRefGoogle Scholar
  13. 13.
    Cruz JA (2000) Dietary habits and nutritional status in adolescents over Europe-Southern Europe. Eur J Clin Nutr 54(Suppl. 1):S29–S35CrossRefGoogle Scholar
  14. 14.
    Leclercq C, Piccinelli R, Arcella D, Le Donne C (2004) Food consumption and nutrient intake in a sample of Italian secondary school students: results from the INRAN-RM-2001 food survey. Int J Food Sci Nutr 55:265–277CrossRefGoogle Scholar
  15. 15.
    Lin Y, Huybrechts I, Vandevijvere S, Bolca S, De Keyzer W, De Vriese S et al (2011) Fibre intake among the Belgian population by sex-age and sex-education groups and its association with BMI and waist circumference. Br J Nutr 105:1692–1703CrossRefGoogle Scholar
  16. 16.
    Rolland-Cachera MF, Bellisle F, Deheeger M (2000) Nutritional status and food intake in adolescents living in Western Europe. Eur J Clin Nutr 54(Suppl. 1):S41–S46CrossRefGoogle Scholar
  17. 17.
    Serra-Majem L, Ribas-Barba L, Salvador G, Jover L, Raido B, Ngo J et al (2007) Trends in energy and nutrient intake and risk of inadequate intakes in Catalonia, Spain (1992–2003). Public Health Nutr 10:1354–1367Google Scholar
  18. 18.
    WHO (2009) Population nutrient intake goals for preventing diet-related chronic diseases. (Accessed 18 Dec 2011)
  19. 19.
    Albertson AM, Affenito SG, Bauserman R, Holschuh NM, Eldridge AL, Barton BA (2009) The relationship of ready-to-eat cereal consumption to nutrient intake, blood lipids, and body mass index of children as they age through adolescence. J Am Diet Assoc 109:1557–1565CrossRefGoogle Scholar
  20. 20.
    Buyken AE, Cheng G, Gunther AL, Liese AD, Remer T, Karaolis-Danckert N (2008) Relation of dietary glycemic index, glycemic load, added sugar intake, or fiber intake to the development of body composition between ages 2 and 7 y. Am J Clin Nutr 88:755–762Google Scholar
  21. 21.
    Davis JN, Alexander KE, Ventura EE, Toledo-Corral CM, Goran MI (2009) Inverse relation between dietary fiber intake and visceral adiposity in overweight Latino youth. Am J Clin Nutr 90:1160–1166CrossRefGoogle Scholar
  22. 22.
    Rampersaud GC, Pereira MA, Girard BL, Adams J, Metzl JD (2005) Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc 105:743–760CrossRefGoogle Scholar
  23. 23.
    Hodgson JM, Lee YP, Puddey IB, Sipsas S, Ackland TR, Beilin LJ et al (2010) Effects of increasing dietary protein and fibre intake with lupin on body weight and composition and blood lipids in overweight men and women. Int J Obes (Lond) 34:1086–1094CrossRefGoogle Scholar
  24. 24.
    Affenito SG, Thompson DR, Barton BA, Franko DL, Daniels SR, Obarzanek E et al (2005) Breakfast consumption by African-American and white adolescent girls correlates positively with calcium and fiber intake and negatively with body mass index. J Am Diet Assoc 105:938–945CrossRefGoogle Scholar
  25. 25.
    Ma Y, Griffith JA, Chasan-Taber L, Olendzki BC, Jackson E, Stanek EJIII et al (2006) Association between dietary fiber and serum C-reactive protein. Am J Clin Nutr 83:760–766Google Scholar
  26. 26.
    Pal S, Khossousi A, Binns C, Dhaliwal S, Ellis V (2011) The effect of a fibre supplement compared to a healthy diet on body composition, lipids, glucose, insulin and other metabolic syndrome risk factors in overweight and obese individuals. Br J Nutr 105:90–100CrossRefGoogle Scholar
  27. 27.
    Beghin L, Huybrechts I, Vicente-Rodriguez G, De Henauw S, Gottrand F, Gonzalez-Gross M et al (2012) Mains characteristics and participation rate of European adolescents included in the HELENA study. Arch Public Health 70:14CrossRefGoogle Scholar
  28. 28.
    Moreno LA, Gonzalez-Gross M, Kersting M, Molnar D, De Henauw S, Beghin L et al (2008) Assessing, understanding and modifying nutritional status, eating habits and physical activity in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Public Health Nutr 11:288–299CrossRefGoogle Scholar
  29. 29.
    Moreno LA, De Henauw S, Gonzalez-Gross M, Kersting M, Molnar D, Gottrand F, Barrios L et al (2008) Design and implementation of the healthy lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study. Int J Obes (Lond) 32(Suppl. 5):S4–S11CrossRefGoogle Scholar
  30. 30.
    Beghin L, Castera M, Manios Y, Gilbert CC, Kersting M, De Henauw S et al (2008) Quality assurance of ethical issues and regulatory aspects relating to good clinical practices in the HELENA Cross-Sectional study. Int J Obes (Lond) 32(Suppl. 5):S12–S18CrossRefGoogle Scholar
  31. 31.
    Vereecken CA, Covents M, Matthys C, Maes L (2005) Young adolescents’ nutrition assessment on computer (YANA-C). Eur J Clin Nutr 59:658–667CrossRefGoogle Scholar
  32. 32.
    Vereecken C, Dohogne S, Covents M, Maes L (2010) How accurate are adolescents in portion-size estimation using the computer tool young adolescents’ nutrition assessment on computer (YANA-C)? Br J Nutr 103:1844–1850CrossRefGoogle Scholar
  33. 33.
    Vereecken CA, Covents M, Sichert-Hellert W, Alvira JM, Le Donne C, De Henauw S et al (2008) Development and evaluation of a self-administered computerized 24-h dietary recall method for adolescents in Europe. Int J Obes (Lond) 32(Suppl. 5):S26–S34CrossRefGoogle Scholar
  34. 34.
    Federal Research Centre for Nutrition and Food (2011) Bundeslebensmittelschlüssel (BLS)—German nutrient data base. Karlsruhe. (Accessed 2010)
  35. 35.
    Division of Nutrition, Physical Activity and Obesity National Center for Chronic Disease Prevention and Health Promotion (2008) Research to practice series, no. 5. Low-energy-dense foods and weight management: cutting calories while controlling hunger. Centers for Disease Control and Prevention, AtlantaGoogle Scholar
  36. 36.
    Black AE (2000) Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations. Int J Obes Relat Metab Disord 24:1119–1130CrossRefGoogle Scholar
  37. 37.
    Cole TJ, Flegal KM, Nicholls D, Jackson AA (2007) Body mass index cut offs to define thinness in children and adolescents: international survey. BMJ 335:194CrossRefGoogle Scholar
  38. 38.
    Slaughter MH, Lohman TG, Boileau RA, Horswill CA, Stillman RJ, Van Loan MD et al (1988) Skinfold equations for estimation of body fatness in children and youth. Hum Biol 60:709–723Google Scholar
  39. 39.
    Tanner JM, Whitehouse RH (1976) Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 51:170–179CrossRefGoogle Scholar
  40. 40.
    Nagy E, Vicente-Rodriguez G, Manios Y, Beghin L, Iliescu C, Censi L et al (2008) Harmonization process and reliability assessment of anthropometric measurements in a multicenter study in adolescents. Int J Obes (Lond) 32(Suppl. 5):S58–S65CrossRefGoogle Scholar
  41. 41.
    Gonzalez-Gross M, Breidenassel C, Gomez-Martinez S, Ferrari M, Beghin L, Spinneker A et al (2008) Sampling and processing of fresh blood samples within a European multicenter nutritional study: evaluation of biomarker stability during transport and storage. Int J Obes (Lond) 32(Suppl. 5):S66–S75CrossRefGoogle Scholar
  42. 42.
    Department of Epidemiology of the German Institute of Human Nutrition Potsdam-Rehbrücke (2009) Multiple source method (MSM). (Accessed Apr 2010)
  43. 43.
  44. 44.
    European food safety authority (2010) Scientific Opinion on Dietary Reference Values for carbohydrates and dietary fibre. EFSA J 8:1462Google Scholar
  45. 45.
    Aeberli I, Kaspar M, Zimmermann MB (2007) Dietary intake and physical activity of normal weight and overweight 6 to 14 year old Swiss children. Swiss Med Wkly 137:424–430Google Scholar
  46. 46.
    Ortega RM, Requejo AM, Andres P, Lopez-Sobaler AM, Redondo R, Gonzalez-Fernandez M (1995) Relationship between diet composition and body mass index in a group of Spanish adolescents. Br J Nutr 74:765–773Google Scholar
  47. 47.
    O’Neil CE, Zanovec M, Keast DR, Fulgoni VL III, Nicklas TA (2011) Nutrient contribution of total and lean beef in diets of US children and adolescents: National Health and Nutrition Examination Survey 1999–2004. Meat Sci 87:250–256CrossRefGoogle Scholar
  48. 48.
    Murakami K, Miyake Y, Sasaki S, Tanaka K, Arakawa M (2011) Dietary glycemic index and glycemic load in relation to risk of overweight in Japanese children and adolescents: the Ryukyus Child Health Study. Int J Obes (Lond) 35(7):925–936CrossRefGoogle Scholar
  49. 49.
    Li Y, Zhai F, Yang X, Schouten EG, Hu X, He Y et al (2007) Determinants of childhood overweight and obesity in China. Br J Nutr 97:210–215CrossRefGoogle Scholar
  50. 50.
    Keast DR, Fulgoni VL III, Nicklas TA, O’Neil CE (2013) Food sources of energy and nutrients among children in the United States: National Health and Nutrition Examination Survey 2003–2006. Nutrients 5:283–301CrossRefGoogle Scholar
  51. 51.
    Wanders AJ, van den Borne JJ, de Graaf C, Hulshof T, Jonathan MC, Kristensen M et al (2011) Effects of dietary fibre on subjective appetite, energy intake and body weight: a systematic review of randomized controlled trials. Obes Rev 12:724–739Google Scholar
  52. 52.
    Parikh S, Pollock NK, Bhagatwala J, Guo DH, Gutin B, Zhu H et al (2012) Adolescent fiber consumption is associated with visceral fat and inflammatory markers. J Clin Endocrinol Metab 97:E1451–E1457CrossRefGoogle Scholar
  53. 53.
    Berkey CS, Rockett HR, Field AE, Gillman MW, Frazier AL, Camargo CA Jr et al (2000) Activity, dietary intake, and weight changes in a longitudinal study of preadolescent and adolescent boys and girls. Pediatrics 105:E56CrossRefGoogle Scholar
  54. 54.
    Cheng G, Karaolis-Danckert N, Libuda L, Bolzenius K, Remer T, Buyken AE (2009) Relation of dietary glycemic index, glycemic load, and fiber and whole-grain intakes during puberty to the concurrent development of percent body fat and body mass index. Am J Epidemiol 169:667–677CrossRefGoogle Scholar
  55. 55.
    Murakami K, Sasaki S, Takahashi Y, Uenishi K, Yamasaki M, Hayabuchi H et al (2007) Nutrient and food intake in relation to serum leptin concentration among young Japanese women. Nutrition 23:461–468CrossRefGoogle Scholar
  56. 56.
    Sartorelli DS, Franco LJ, Cardoso MA (2008) High intake of fruits and vegetables predicts weight loss in Brazilian overweight adults. Nutr Res 28:233–238CrossRefGoogle Scholar
  57. 57.
    Fung TT, Hu FB, Pereira MA, Liu S, Stampfer MJ, Colditz GA et al (2002) Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. Am J Clin Nutr 76:535–540Google Scholar
  58. 58.
    Samra RA, Anderson GH (2007) Insoluble cereal fiber reduces appetite and short-term food intake and glycemic response to food consumed 75 min later by healthy men. Am J Clin Nutr 86:972–979Google Scholar
  59. 59.
    Zanovec M, O’Neil CE, Cho SS, Kleinman RE, Nicklas TA (2010) Relationship between whole grain and fiber consumption and body weight measures among 6- to 18-year-olds. J Pediatr 157:578–583CrossRefGoogle Scholar
  60. 60.
    Mumford SL, Schisterman EF, Siega-Riz AM, Gaskins AJ, Wactawski-Wende J, VanderWeele TJ (2011) Effect of dietary fiber intake on lipoprotein cholesterol levels independent of estradiol in healthy premenopausal women. Am J Epidemiol 173:145–156CrossRefGoogle Scholar
  61. 61.
    Kynde I, Johnsen NF, Wedderkopp N, Bygbjerg IB, Helge JW, Heitmann BL (2010) Intake of total dietary sugar and fibre is associated with insulin resistance among Danish 8-10- and 14-16-year-old girls but not boys. European Youth Heart Studies I and II. Public Health Nutr 13:1669–1674CrossRefGoogle Scholar
  62. 62.
    Dennison BA, Levine DM (1993) Randomized, double-blind, placebo-controlled, two-period crossover clinical trial of psyllium fiber in children with hypercholesterolemia. J Pediatr 123:24–29CrossRefGoogle Scholar
  63. 63.
    Anderson JW, Riddell-Mason S, Gustafson NJ, Smith SF, Mackey M (1992) Cholesterol-lowering effects of psyllium-enriched cereal as an adjunct to a prudent diet in the treatment of mild to moderate hypercholesterolemia. Am J Clin Nutr 56:93–98Google Scholar
  64. 64.
    Kaline K, Bornstein SR, Bergmann A, Hauner H, Schwarz PE (2007) The importance and effect of dietary fiber in diabetes prevention with particular consideration of whole grain products. Horm Metab Res 39:687–693CrossRefGoogle Scholar
  65. 65.
    Dorgan JF, Liu L, Barton BA, Deshmukh S, Snetselaar LG, Van Horn L et al (2011) Adolescent diet and metabolic syndrome in young women: results of the Dietary Intervention Study in Children (DISC) follow-up study. J Clin Endocrinol Metab 96:E1999–E2008CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Yi Lin
    • 1
  • Inge Huybrechts
    • 1
    • 2
    Email author
  • Carine Vereecken
    • 1
    • 3
  • Theodora Mouratidou
    • 4
  • Jara Valtueña
    • 5
  • Mathilde Kersting
    • 6
  • Marcela González-Gross
    • 5
  • Selin Bolca
    • 7
  • Julia Wärnberg
    • 8
  • Magdalena Cuenca-García
    • 9
  • Frederic Gottrand
    • 10
  • Elisabetta Toti
    • 11
  • Sonia Gomez-Martínez
    • 8
  • Evangelia Grammatikaki
    • 1
    • 12
  • Idoia Labayen
    • 13
  • Luis A. Moreno
    • 4
  • Michael Sjöström
    • 14
  • John Van Camp
    • 15
  • Romana Roccaldo
    • 11
  • Emma Patterson
    • 16
  • Yannis Manios
    • 12
  • Denes Molnar
    • 17
  • Anthony Kafatos
    • 18
  • Kurt Widhalm
    • 19
  • Stefaan De Henauw
    • 1
  1. 1.Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
  2. 2.International Agency for Research on Cancer, Dietary Exposure Assessment GroupLyonFrance
  3. 3.Research Foundation – Flanders (FWO)BrusselsBelgium
  4. 4.Growth, Exercise, Nutrition and Development (GENUD) Research Group, Faculty of Health SciencesUniversity of ZaragozaSaragossaSpain
  5. 5.ImFine Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Sciences (INEF)Universidad Politécnica de MadridMadridSpain
  6. 6.Research Institute of Child Nutrition, DortmundRheinische Friedich-Wilhelms-Universität BonnDortmundGermany
  7. 7.Laboratory for Bioinformatics and Computational Genomics (Biobix), Faculty of Bioscience EngineeringGhent UniversityGhentBelgium
  8. 8.Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN)Spanish National Research Council (CSIC)MadridSpain
  9. 9.Department of Medical Physiology, School of MedicineGranada UniversityGranadaSpain
  10. 10.Inserm U995, IFR114, Faculté de MédecineUniversité LilleLilleFrance
  11. 11.Food and Nutrition Research CentreAgricultural Research Council (CRA-NUT)RomeItaly
  12. 12.Department of Nutrition and DieteticsHarokopio UniversityKallithea, AthensGreece
  13. 13.Department of Nutrition and Food ScienceUniversity of the Basque Country, Paseo de la UniversidadBiscaySpain
  14. 14.Unit for Preventive Nutrition, Department of Biosciences and NutritionKarolinska InstituteStockholmSweden
  15. 15.Department of Food Safety and Food QualityGhent UniversityGhentBelgium
  16. 16.Samhällsnutrition och fysisk aktivitetKarolinska Institutet, Centrum för epidemiologi och samhällsmedicinStockholmSweden
  17. 17.Department of PediatricsUniversity of PécsPécsHungary
  18. 18.Preventive Medicine and Nutrition Unit, School of MedicineUniversity of Crete, HeraklionCreteGreece
  19. 19.Department of PediatricsPrivate Medical UniversitySalzburgAustria

Personalised recommendations