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Adherence to the Mediterranean diet in metabolically healthy and unhealthy overweight and obese European adolescents: the HELENA study

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Abstract

Purpose

To examine the adherence to the Mediterranean dietary pattern (MDP) in metabolically healthy overweight or obese (MHO) and metabolically unhealthy obese (MUO) European adolescents.

Methods

In this cross-sectional study, 137 overweight/obese adolescents aged 12–17 years old from the HELENA study were included. Height, weight, waist circumference and skinfold thickness were measured and body mass index and body fat percent were calculated. Systolic and diastolic blood pressure, glucose, HDL cholesterol, triglycerides and cardiorespiratory fitness (20 m shuttle run test) were measured. MHO and MUO phenotypes were categorized following the Jolliffe and Janssen criteria. Two non-consecutive 24 h recalls were used for dietary intake assessment and the adherence to the MDP was calculated using the Mediterranean dietary pattern score (MDP score) (range 0–9).

Results

A total of 45 (22 girls) adolescents (32.8%) were categorized as MHO. The adherence to the MDP was significantly higher in MHO than in MUO adolescents regardless of age, sex, body fat percentage, energy intake and center (MDP score: 4.6 ± 1.6 vs. 3.9 ± 1.5, p = 0.036), but this difference became non-significant after further adjustment for cardiorespiratory fitness. Participants who had a low adherence to the MDP (MDP score ≤ 4) had a higher likelihood of having MUO phenotype regardless of sex, age, energy intake, center and body fat percentage (OR 2.2; 95% CI 1.01–4.81, p = 0.048).

Conclusions

Adherence to the MDP might be beneficial to maintain metabolic health in overweight/obese adolescents, yet cardiorespiratory fitness seems to play a key role on the metabolic phenotype.

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Abbreviations

MHO:

Metabolically healthy overweight or obesity

MUO:

Metabolically unhealthy overweight/obese

MDP:

Mediterranean dietary pattern

MDP score:

Mediterranean dietary pattern score

BMI:

Body mass index

HDL:

High-density lipoprotein

LDL:

Low-density lipoprotein

TG:

Triglycerides

HELENA-DIAT:

HELENA-dietary assessment tool

References

  1. Katzmarzyk PT, Barreira TV, Broyles ST et al (2015) Relationship between lifestyle behaviors and obesity in children ages 9–11: results from a 12-country study. Obesity 23(8):1696–1702

    Article  Google Scholar 

  2. Raghuveer G (2010) Lifetime cardiovascular risk of childhood obesity. Am J Clin Nutr 91(5):1514S–1519S

    Article  Google Scholar 

  3. Zamrazilova H, Weiss R, Hainer V et al (2016) Cardiometabolic health in obese adolescents is related to length of obesity exposure: a pilot study. J Clin Endocrinol Metab 101(8):3088–3095

    Article  CAS  Google Scholar 

  4. Prince RL, Kuk JL, Ambler KA et al (2014) Predictors of metabolically healthy obesity in children. Diabetes Care 37(5):1462–1468

    Article  CAS  Google Scholar 

  5. Wilkie HJ, Standage M, Gillison FB et al (2016) Multiple lifestyle behaviours and overweight and obesity among children aged 9–11 years: results from the UK site of the International Study of Childhood Obesity, Lifestyle and the Environment. BMJ Open 6(2):e010677

    Article  Google Scholar 

  6. Struijk EA, May AM, Wezenbeek NLW et al (2014) Adherence to dietary guidelines and cardiovascular disease risk in the EPIC-NL cohort. Int J Cardiol 176(2):354–359

    Article  Google Scholar 

  7. Trichopoulos A, Costacou T, Bamia et al (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J 348(26):2599–2608

    Article  Google Scholar 

  8. The InterAct Consortium (2011) Mediterranean diet and type 2 diabetes risk in the European Prospective Investigation Into Cancer an Nutrition (EPIC) study. Diabetes Care 34:1913–1918

    Article  Google Scholar 

  9. Sofi F, Cesari F, Abbate R et al (2008) Adherence to Mediterranean diet and health status: meta-analysis. BMJ 337(a1344):1–7

    Google Scholar 

  10. Moreno LA, De Henauw S, González-Gross M et al (2008) Design and implementation of the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional study. Int J Obes 32(Suppl 5):S4–S11

    Article  Google Scholar 

  11. Iliescu C, Censi L, Dietrich S et al (2008) Harmonization process and reliability assessment of anthropometric measurements in a multicenter study in adolescents. Int J Obesity 32:S58–S65

    Article  Google Scholar 

  12. Cole TJ, Lobstein T (2012) Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes 7(4):284–294

    Article  CAS  Google Scholar 

  13. Slaughter MH, Lohman TG, Boileau RA et al (1988) Skinfold equations for estimation of body fatness in children and youth. Hum Biol 5:709–723

    Google Scholar 

  14. Breidenassel C, Go S, Ferrari M 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 32:66–75

    Article  Google Scholar 

  15. Ortega FB, Artero EG, Ruiz JR et al (2008) Reliability of health-related physical fitness tests in European adolescents. The HELENA Study. Int J Obes (Lond) 32:49–57

    Article  Google Scholar 

  16. Leger LA, Gadoury DM C LJ (1988) The multistage 20 metre shuttle run test for aerobic fitness. J Sport Sci 2:92–101

    Google Scholar 

  17. Ortega FB, Lavie CJ, Blair SN (2016) Obesity and cardiovascular disease. Circ Res 118(11):1752–1770

    Article  CAS  Google Scholar 

  18. Jolliffe CJ, Janssen I (2007) Development of age-specific adolescent metabolic syndrome criteria that are linked to the Adult Treatment Panel III and International Diabetes Federation criteria. J Am Coll Cardiol 49(8):891–898

    Article  Google Scholar 

  19. Vereecken CA, Covents M, Sichert-Hellert W 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–S34

    Article  Google Scholar 

  20. Heinzle S, Ball GDC, Kuk JL (2016) Variations in the prevalence and predictors of prevalent metabolically healthy obesity in adolescents. Pediatr Obes 11(5):425–433

    Article  CAS  Google Scholar 

  21. Phillips CM (2017) Metabolically healthy obesity across the life course: epidemiology, determinants, and implications. Ann NY Acad Sci 1391:85–100

    Article  Google Scholar 

  22. Camhi SM, Whitney Evans E, Hayman LL et al (2015) Healthy eating index and metabolically healthy obesity in U.S. adolescents and adults. Prev Med (Baltim) 77:23–27

    Article  Google Scholar 

  23. Hankinson AL, Daviglus ML, Horn L, Van et al (2013) Diet composition and activity level of at risk and metabolically healthy obese American adults. Obesity 21(3):637–643

    Article  CAS  Google Scholar 

  24. Kimokoti RW, Judd SE, Shikany JM et al (2014) Food intake does not differ between obese women who are metabolically healthy or abnormal. J Nutr 144:2018–2026

    Article  CAS  Google Scholar 

  25. Velázquez-lópez L, Santiago-díaz G, Nava-hernández J et al (2014) Mediterranean-style diet reduces metabolic syndrome components in obese children and adolescents with obesity. BMC Pediatr 14:175

    Article  Google Scholar 

  26. Zhong VW, Lamichhane AP, Crandell JL et al (2016) Association of adherence to a Mediterranean diet with glycemic control and cardiovascular risk factors in youth with type 1 diabetes: the SEARCH Nutrition Ancillary Study. Eur J Clin Nutr 70(7):802–807

    Article  CAS  Google Scholar 

  27. Giannini C, Diesse L, Adamo ED et al (2014) Influence of the Mediterranean diet on carotid intima e media thickness in hypercholesterolaemic children: a 12-month intervention study. Nutr Metab Cardiovasc Dis 24(1):75–82

    Article  CAS  Google Scholar 

  28. Lydakis C, Stefanaki E (2012) Correlation of blood pressure, obesity, and adherence to the Mediterranean diet with indices of arterial stiffness in children. Eur J Pediatr 171:1373–1382

    Article  CAS  Google Scholar 

  29. Torris C, Molin M, Cvancarova Smastuen M (2014) Fish consumption and its possible preventive role on the development and prevalence of metabolic syndrome—a systematic review. Diabetol Metab Syndr 6(1):112

    Article  Google Scholar 

  30. Melanson EL, Donahoo WT (2009) The relationship between dietary fat and fatty acid intake and body weight, diabetes, and the metabolic syndrome. Ann Nutr Metab 55:229–243

    Article  CAS  Google Scholar 

  31. Lai YHL, Petrone AB, Pankow JS et al (2013) Association of dietary omega-3 fatty acids with prevalence of metabolic syndrome: the National Heart, Lung, and Blood Institute Family Heart Study. Clin Nutr 32(6):966–969

    Article  CAS  Google Scholar 

  32. Baik I, Abbott RD, Curb JD et al (2010) Intake of fish and n-3 fatty acids and future risk of metabolic syndrome. J Am Diet Assoc 110(7):1018–1026

    Article  CAS  Google Scholar 

  33. Lauritzen L, Harsløf L, Hellgren L et al (2012) Fish intake, erythrocyte n-3 fatty acid status and metabolic health in Danish adolescent girls and boys. Br J Nutr 107:697–704

    Article  CAS  Google Scholar 

  34. Liao W, Xiao D, Huang Y et al (2016) Combined association of diet and cardiorespiratory fitness with metabolic syndrome in chinese schoolchildren. Matern Child Health J 20(9):1904–1910

    Article  Google Scholar 

  35. Ruiz JR, Rizzo NS, Hurtig-wennlöf A et al (2006) Relations of total physical activity and intensity to fitness and fatness in children: the European Youth Heart Study. Am J Clin Nutr 84:299–303

    Article  CAS  Google Scholar 

  36. Neto AS, Sasaki JE, Mascarenhas LPG et al (2011) Physical activity, cardiorespiratory fitness, and metabolic syndrome in adolescents: a cross-sectional study. BMC Public Health 11(1):674

    Article  Google Scholar 

  37. Ortega FB, Cadenas-sánchez C, Sui X et al (2015) Role of fitness in the metabolically healthy but obese phenotype: a review and update. Prog Cardiovasc Dis 58(1):76–86

    Article  Google Scholar 

  38. Sénéchal M, Wicklow B, Wittmeier K et al (2013) Cardiorespiratory fitness and adiposity in metabolically healthy overweight and obese youth. Pediatrics 132(1):e85–e92

    Article  Google Scholar 

  39. Vereecken C, Dohogne S, Covents M et al (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(12):1844–1850

    Article  CAS  Google Scholar 

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Acknowledgements

First, we would like to thank the adolescents who participated in the study as well as their parents and teachers for their collaboration. We also recognize the members involved in fieldwork for their efforts. Our special thanks to Anke Carstensen for laboratory work.

Funding

The HELENA project was supported by the European Community Sixth RTD Framework Programme (contract FOOD-CT-2005-007034), by the Education Department of the Government of the Basque Country (PRE_2016_1_0057, PRE_2017_2_0224), by the Spanish Ministry of Science and Innovation (RYC-2011-09011), by the University of the Basque Country (GIU14/21), and by the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES). Furthermore, the current study was supported by the Spanish Ministry of Health (CIBERobn CB12/03/30038). This paper and its content contemplates the authors’ views alone and the European Community is not responsible for any use of the information contained herein.

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Authors and Affiliations

  1. Institute for Innovation and Sustainable Development in Food Chain (IS-FOOD), Public University of Navarra, 31006, Pamplona, Navarra, Spain

    Lide Arenaza & Idoia Labayen

  2. Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France

    Inge Huybrechts

  3. PROmoting FITness and Health through physical activity research group (PROFITH), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain

    Francisco B. Ortega & Jonatan R. Ruiz

  4. Department of Public Health, Ghent University, Ghent, Belgium

    Stefaan De Henauw

  5. Department of Nutrition and Dietetics, Harokopio University, Athens, Greece

    Yannis Manios

  6. Immunonutrition Research Group, Department of Metabolism and Nutrition, Instituto del Frio, Institute of Food Science, Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC), Madrid, Spain

    Ascensión Marcos

  7. GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain

    Cristina Julián, Gloria Bueno & Luis A. Moreno

  8. Division of Nutrition and Metabolism, Department of Pediatrics, Medical University of Vienna, Vienna, Austria

    Kurt Widhalm

  9. Research Institute of Child Nutrition, Dortmund, Germany

    Mathilde Kersting

  10. School of Medicine, University of Crete, Crete, Greece

    Anthony Kafatos

  11. Department of Nutrition and Food Science, University of Bonn, Bonn, Germany

    Christina Breidenassel

  12. Faculty of Physical Activity and Sport Sciences (INEF), Universidad Politécnica de Madrid, Madrid, Spain

    Raquel Pedrero-Chamizo & Marcela González-Gross

  13. Department of Pediatrics, Jeanne de Flandre Children’s University Hospital, Lille, France

    Frédéric Gottrand

  14. Department of Preventive Medicine, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil

    Luis A. Moreno

Authors
  1. Lide Arenaza
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  2. Inge Huybrechts
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  3. Francisco B. Ortega
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  4. Jonatan R. Ruiz
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  5. Stefaan De Henauw
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  8. Cristina Julián
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  9. Kurt Widhalm
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  10. Gloria Bueno
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  11. Mathilde Kersting
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  12. Anthony Kafatos
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  13. Christina Breidenassel
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  15. Frédéric Gottrand
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  16. Marcela González-Gross
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  17. Luis A. Moreno
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  18. Idoia Labayen
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Contributions

IL conceived the hypothesis, LA drafted the manuscript and performed the statistical analysis; IH, FBO, JRR, SDH, YM, AM, CJ, KW, GB, MK, AK, CB, RPC, FG, MGG, LAM and IL contributed to the interpretation and discussion of the results. All authors contributed to the interpretation and discussion of the results, and critically revised the drafted manuscript and made the final approval of the version to be submitted.

Corresponding author

Correspondence to Lide Arenaza.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Arenaza, L., Huybrechts, I., Ortega, F.B. et al. Adherence to the Mediterranean diet in metabolically healthy and unhealthy overweight and obese European adolescents: the HELENA study. Eur J Nutr 58, 2615–2623 (2019). https://doi.org/10.1007/s00394-018-1809-8

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  • DOI: https://doi.org/10.1007/s00394-018-1809-8

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