Evidence suggests possible synergetic effects of multiple lifestyle behaviors on health risks like obesity and other health outcomes. A better insight in the clustering of those behaviors, could help to identify groups who are at risk in developing chronic diseases. This study examines the prevalence and clustering of physical activity, sedentary and dietary patterns among European adolescents and investigates if the identified clusters could be characterized by socio-demographic factors. The study comprised a total of 2084 adolescents (45.6% male), from eight European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Physical activity and sedentary behavior were measured using self-reported questionnaires and diet quality was assessed based on dietary recall. Based on the results of those three indices, cluster analyses were performed. To identify gender differences and associations with socio-demographic variables, chi-square tests were executed. Five stable and meaningful clusters were found. Only 18% of the adolescents showed healthy and 21% unhealthy scores on all three included indices. Males were highly presented in the cluster with high levels of moderate to vigorous physical activity (MVPA) and low quality diets. The clusters with low levels of MVPA and high quality diets comprised more female adolescents. Adolescents with low educated parents had diets of lower quality and spent more time in sedentary activities. In addition, the clusters with high levels of MVPA comprised more adolescents of the younger age category. In order to develop effective primary prevention strategies, it would be important to consider multiple health indices when identifying high risk groups.

BACKGROUND: In our previous study, the negative correlation found between plasma insulin levels and plasma α-tocopherol concentrations suggested that decreased antioxidant vitamin levels and reduced antioxidant capacity might be a characteristic feature of obese children with multimetabolic syndrome (MMS). OBJECTIVE: To investigate lipid-soluble antioxidant vitamin levels and total antioxidant status (TAS) in obese children with and without MMS and in controls. SUBJECTS: In total, 16 control children (age: 16.2±1.1 y, BMI: 20.7±1.9 kg/m², body fat (BF): 25.6±5.7%; mean±s.d.), 15 obese children (age: 13.4±2.1 y, BMI: 34.2±3.1 kg/m², BF: 36.9±5.8%,) and 17 obese children without MMS (age: 14.4±2.3 y, BMI: 30.4±6.2 kg/m², BF: 36.3±5.8%) were included in the study. METHODS: Body composition was determined by anthropometric methods. Vitamin analysis was carried out by high-performance liquid chromatography and TAS of the plasma was measured with commercially available kits. Plasma glucose, lipids and insulin were measured by standard laboratory methods. RESULTS: Plasma α-tocopherol and β-carotene levels corrected for plasma lipids (cholesterol + triglyceride) were significantly (P<0.05) lower in obese children with MMS (2.4 (3.1) μmol/mmol and 12.3 (24.0) pmol/mmol, respectively, median (range from the first to the third quartile)), than in the obese without MMS (3.7 (0.9) μmol/mmol and 48.2 (27.7) pmol/mmol) and in the control group (3.8 (0.7) μmol/mmol and 86.6 (44.5) pmol/mmol). Plasma TAS values of the MMS group (1.2 (0.4) mmol/l) were also significantly (P<0.05) reduced as compared to obese children without MMS (1.62 (0.14) mmol/l) and to controls (1.58 (0.21) mmol/l). CONCLUSION: Obese children with MMS are prone to oxidative stress. Further investigations are necessary to determine if these children may benefit from vitamin E and β-carotene supplementation.

Obesity treatment is by large ineffective long term, and more emphasis on the prevention of excessive weight gain in childhood and adolescence is warranted. To inform energy balance related behaviour (EBRB) change interventions, insight in the potential personal, family and school environmental correlates of these behaviours is needed. Studies on such multilevel correlates of EBRB among schoolchildren in Europe are lacking. The ENERGY survey aims to (1) provide up-to-date prevalence rates of measured overweight, obesity, self-reported engagement in EBRBs, and objective accelerometer-based assessment of physical activity and sedentary behaviour and blood-sample biomarkers of metabolic function in countries in different regions of Europe, (2) to identify personal, family and school environmental correlates of these EBRBs. This paper describes the design, methodology and protocol of the survey. A school-based cross-sectional survey was carried out in 2010 in seven different European countries; Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia, and Spain. The survey included measurements of anthropometrics, child, parent and school-staff questionnaires, and school observations to measure and assess outcomes (i.e. height, weight, and waist circumference), EBRBs and potential personal, family and school environmental correlates of these behaviours including the social-cultural, physical, political, and economic environmental factors. In addition, a selection of countries conducted accelerometer measurements to objectively assess physical activity and sedentary behaviour, and collected blood samples to assess several biomarkers of metabolic function. The ENERGY survey is a comprehensive cross-sectional study measuring anthropometrics and biomarkers as well as assessing a range of EBRBs and their potential correlates at the personal, family and school level, among 10-12 year old children in seven European countries. This study will result in a unique dataset, enabling cross country comparisons in overweight, obesity, risk behaviours for these conditions as well as the correlates of engagement in these risk behaviours.

OBJECTIVE: To review the prevalence of the metabolic syndrome and type 2 diabetes in children and adolescents. METHOD: Literature review. RESULTS: It is well demonstrated that cardiovascular risk factors are frequent in childhood obesity and they tend to cluster. However, the frequency of the metabolic syndrome in childhood and adolescence has been investigated only by few studies. In spite of the diverse criteria used for defining the metabolic syndrome, it is evident that the syndrome is already highly prevalent among obese children and adolescents. Population-based data suggest that the epidemic of pediatric obesity is being followed by an increase of type 2 diabetes mellitus, especially in the United States and in minorities. For the European countries, there are no population-based incidence and prevalence data concerning type 2 diabetes mellitus in children and adolescents. From the available data, the magnitude of the problem in the European Caucasian population seems to be much less than in North America. CONCLUSION: There is an urgent need to establish internationally acceptable criteria for the metabolic syndrome in children and adolescents and to commence screening for this syndrome. Although type 2 diabetes mellitus is still rare among European children, screening is recommended for type 2 diabetes mellitus or impaired glucose tolerance in children and especially in adolescents with substantial risk for the development of this disease.