ORCID Profile
0000-0002-4303-4097
Current Organisation
Universidad de Zaragoza
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Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.JPEDS.2015.09.029
Abstract: To assess the relationships among physical activity, measured objectively, and attention capacity in European adolescents. The study included 273 adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Participants wore a uniaxial accelerometer for 7 days to measure physical activity. The d2 Test of Attention was administered to assess attention capacity. Multivariate analyses were used to study the association of attention capacity with each measure of physical activity. Receiver operating characteristic analysis was performed to determine thresholds that best discriminate between low and good attention capacity. After controlling for potential confounding variables (age, sex, body mass index, parental educational level, fat mass, aerobic fitness, and center), adolescents' attention capacity test performances were significantly and positively associated with longer time spent in moderate or moderate-to-vigorous physical activity (MVPA) in free-living conditions (P < .05). Receiver operating characteristic curve analyses revealed that the physical activity thresholds that best discriminated between low/good attention capacities were ≥41 min·day(-1) for moderate, ≥12 min·day(-1) for vigorous, and ≥58 min·day(-1) for MVPA. These findings suggest that promoting MVPA may be have a beneficial effect on attention capacity, an important component of cognition, in adolescents.
Publisher: Springer Science and Business Media LLC
Date: 04-11-2019
DOI: 10.1186/S12966-019-0864-8
Abstract: Most research on parenting and childhood obesity and obesity-related behaviours has focused on mothers while fathers have been underrepresented. Yet, recent literature has suggested that fathers uniquely influence their children’s lifestyle behaviours, and hence could also affect their weight status, but this has not yet been scientifically proven. Therefore, the present study aimed to determine whether the association between fathers’ weight status and their children’s weight status is mediated by fathers’ and children’s movement behaviours (i.e. physical activity (PA) and screen time (ST)). Cross-sectional data of 899 European fathers and their children were analyzed. Fathers/male caregivers ( mean age = 43.79 ± 5.92 years, mean BMI = 27.08 ± 3.95) completed a questionnaire assessing their own and their children’s ( mean age = 8.19 ± 0.99 years, 50.90% boys, mean BMI zscore = 0.44 ± 1.07) movement behaviours. Body Mass Index (BMI, in kg/m 2 ) was calculated based on self-reported (fathers) and objectively measured (children) height and weight. For children, BMI z-scores (SD scores) were calculated to obtain an optimal measure for their weight status. Serial mediation analyses were performed using IBM SPSS 25.0 Statistics for Windows to test whether the association between fathers’ BMI and children’s BMI is mediated by fathers’ PA and children’s PA (model 1) and fathers’ ST and children’s ST (model 2), respectively. The present study showed a (partial) mediation effect of fathers’ PA and children’s PA (but not father’s ST and children’s ST) on the association between fathers’ BMI and children’s BMI (model for PA coefficient: 0.001, 95% CI: [0.0001, 0.002] model for ST coefficient: 0.001, 95% CI: [0.000, 0.002]). Furthermore, fathers’ movement behaviours (PA and ST) were positively associated with their children’s movement behaviours (PA and ST) (model for PA, coefficient: 0.281, SE: 0.023, p 0.001 model for ST, coefficient: 0.345, SE: 0.025, p 0.001). These findings indicate that the influence of fathers on their children’s weight status partially occurs through the association between fathers’ PA and children’s PA (but not their ST). As such, intervening by focusing on PA of fathers but preferably of both members of the father-child dyad (e.g. engaging fathers and their children in co-PA) might be a novel and potentially effective strategy for interventions aiming to prevent childhood overweight and obesity. Longitudinal studies or intervention studies confirming these findings are however warranted to make meaningful recommendations for health intervention and policy. The Feel4Diabetes-study is registered with the clinical trials registry clinicaltrials.gov , ID: 643708 .
Publisher: Springer Science and Business Media LLC
Date: 26-10-2010
DOI: 10.1038/IJO.2010.221
Abstract: To review child and adolescent obesity prevention programmes to determine whether they have included the Social Marketing Benchmark Criteria (BC). In addition, we analysed whether there was a relationship between the presence of the criteria and the effectiveness of the programme. Interventions had to be aimed at preventing obesity through behaviour changes relating to diet, physical activity, lifestyle and social support, separately or in combination. A total of 41 interventions were identified in PubMed and Embase that fulfilled the inclusion criteria. The more recent the studies, the greater the number of the BC that seem to have been used. However, regarding behaviour changes, we found the most effective period to be 1997-2002, with 100% of the interventions resulting in behaviour changes (9/9). In addition, almost all interventions resulted in improvements in body composition variables: 5 of 6 for body mass index or overweight/obesity prevalence and 6 of 6 for skin-folds. The presence of a higher number of BC does not assure higher effectiveness. Further research is required in this field. At the moment, studies aimed at preventing obesity in children and adolescents have not included social marketing aspects in their interventions in a comprehensive manner.
Publisher: Springer Science and Business Media LLC
Date: 04-12-2018
DOI: 10.1007/S00038-018-1178-3
Abstract: To delineate the clustering of energy balance-related behaviors in adolescents and investigate whether these behaviors are associated with the household socioeconomic status and parental education level. Two cross-sectional studies assessed information on sedentary behavior, physical activity, sugar-sweetened beverages and fruit and vegetable consumption, and sleep duration by self-reported questionnaires in adolescents (12.5-17.5 years old) from Maringá/Brazil (BRACAH Study n = 682) and ten European cities (HELENA Study n = 1252) from nine different countries. Gender-specific cluster analyses were performed separately for each study, applying a combination of hierarchical and non-hierarchical methods. Girls showed equivalent behaviors: Sedentary Active Unhealthy Eating Healthy Eating while boys differed (Brazilian: Sedentary Active Healthy Eating European: Sedentary Healthy Unhealthy Eating). In Brazil, we found no association between socioeconomic status and parental education. In European girls, the high socioeconomic status and both parents' university degree were associated with Healthy Eating. In European boys, the high socioeconomic status was associated with Unhealthy Eating, and the mothers' university degree was associated with the Healthy cluster. Adolescents show Sedentary behavior, regardless of their sex, country of origin, or socioeconomic condition.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.BONE.2018.10.019
Abstract: Vigorous physical activity (VPA) has been proven to promote osteogenesis in adolescents however the specifics of the optimal pattern of frequency and duration of VPA are unknown. The main goal of the present study was to analyze the associations of different length of VPA bouts with bone health. 180 healthy male adolescents (11-13 years) had their bone mineral content and density assessed by dual-energy X-ray absorptiometry scans at the whole body, femoral neck (FN) and lumbar spine and their physical activity measured by an accelerometer during one week. VPA was the intensity with the strongest associations with bone mineral parameters especially at the FN. Subjects whose longest VPA bout was 5 min or above had higher FN bone mineral density (BMD) than those who did not complete any 5-min bout and these differences were greater with participants who reached 15 consecutive minutes of VPA (>15': 0.977 ± 0.020 g/cm2 5'-15': 0.907 ± 0.009 g/cm2 <5': 0.876 ± 0.009 g/cm2 all p < 0.05). When comparing the relevance of VPA bouts and volume of physical activity, the group with low volume and having a VPA bout had better FN BMD compared to the group with high volume but no VPA bout. Additionally, the group with both high volume and VPA bout showed better FN BMD than the rest of the groups. VPA may be the most effective activity intensity to improve bone mineral density and content of adolescent boys, with greater benefits if VPA periods either long or frequent.
Publisher: Informa UK Limited
Date: 12-2013
DOI: 10.1080/02640414.2013.803595
Abstract: This report aims (1) to examine the association between seasonality and physical activity (PA) and sedentary time in European adolescents and (2) to investigate whether this association was influenced by geographical location (Central-North versus South of Europe), which implies more or less extreme weather and daylight hours. Valid data on PA, sedentary time and seasonality were obtained in 2173 adolescents (1175 females 12.5-17.5 years) included in this study. Physical activity and sedentary time were measured by accelerometers. ANCOVA was conducted to analyse the differences in PA and sedentary time across seasons. Results showed that girls had lower levels of moderate to vigorous PA (MVPA) and average PA, and spent more time in sedentary activities in winter compared with spring (all P < 0.05). Stratified analyses showed differences in PA and sedentary time between winter and spring in European girls from Central-North of Europe (P < 0.05 for sedentary time). There were no differences between PA and sedentary time across seasonality in boys. In conclusion, winter is related with less time spent in MVPA, lower average PA and higher time spent in sedentary activities in European adolescent girls, compared with spring. These differences seem to mainly occur in Central-North Europe.
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.APPET.2013.09.002
Abstract: Considering the lack of uniformity regarding school meals in Europe, information on adolescents' school lunch patterns is of public health importance. Thus, the aim of this analysis was to describe and evaluate lunchtime energy and food intake of European adolescents at different lunch locations. Data on nutritional and health-related parameters were derived from the HEalthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS). A sub-s le of 891 adolescents (47% male) with plausible data on total and lunchtime energy intake (2 × 24 h recall) as well as usual lunch location was considered. Food intake was compared to lunch of the Optimized Mixed Diet (OMD) for children and adolescents. Although energy intake was nearly in line with the recommendations, food intake was suboptimal compared to the OMD regardless of usual lunch location. Adolescents had more potatoes and less sweets at school, and more drinks (water, coffee and tea) and vegetables at home when each compared with the other locations. Food intake of adolescents getting their lunch elsewhere was characterized by the smallest amounts of potatoes and the highest amounts of sweets. Although lunch patterns may differ among countries, schools in Europe do not seem to reveal all their potential to offer access to a healthy lunch for adolescents yet.
Publisher: Elsevier BV
Date: 09-2014
Abstract: Adolescence is a critical period, because major physical and psychologic changes occur during a very short period of time. Changes in dietary habits may induce different types of nutritional disorders and are likely to track into adulthood. The aim of this review is to describe the key findings related to nutritional status in European adolescents participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. We performed a cross-sectional study in 3528 (1845 females) adolescents aged 12.5–17.5 y. Birth weight was negatively associated with abdominal fat mass in adolescents and serum leptin concentrations (in female adolescents), providing additional evidence for a programming effect of birth weight on energy homeostasis control. Breakfast consumption was associated with lower body fat content and healthier cardiovascular profile. Adolescents eat half of the recommended amount of fruit and vegetables and less than two-thirds of the recommended amount of milk and milk products but consume more meat and meat products, fats, and sweets than recommended. For beverage consumption, sugar-sweetened beverages, sweetened milk, low-fat milk, and fruit juice provided the highest amount of energy. Although the intakes of saturated fatty acids (FAs) and salt were high, the intake of polyunsaturated FAs was low. Adolescents spent, on average, 9 h/d of their waking time (66–71% and 70–73% of the registered time in boys and girls, respectively) in sedentary activities. Factors associated with adolescents’ sedentary behavior included the following: 1) age 2) media availability in the bedroom 3) sleeping time 4) breakfast consumption and 5) season. Sedentary time was also associated with cardiovascular risk factors and bone mineral content. In European adolescents, deficient concentrations were identified for plasma folate (15%), vitamin D (15%), pyridoxal 5′-phosphate (5%), β-carotene (25%), and vitamin E (5%). Scientists and public health authorities should raise awareness of the importance of a healthy and sustainable lifestyle as a foundation of the health of the European population, now and in the future.
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.NUMECD.2016.12.003
Abstract: Inflammation plays a key role in atherosclerosis and this process seems to appear in childhood. The ideal cardiovascular health index (ICHI) has been inversely related to atherosclerotic plaque in adults. However, evidence regarding inflammation and ICHI in adolescents is scarce. The aim is to assess the association between ICHI and inflammation in European adolescents. As many as 543 adolescents (251 boys and 292 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional multi-center study including 9 European countries, were measured. C-reactive protein (CRP), complement factors C3 and C4, leptin and white blood cell counts were used to compute an inflammatory score. Multilevel linear models and multilevel logistic regression were used to assess the association between ICHI and inflammation controlling by covariates. Higher ICHI was associated with a lower inflammatory score, as well as with several in idual components, both in boys and girls (p < 0.01). In addition, adolescents with at least 4 ideal components of the ICHI had significantly lower inflammatory score and lower levels of the study biomarkers, except CRP. Finally, the multilevel logistic regression showed that for every unit increase in the ICHI, the probability of having an inflammatory profile decreased by 28.1% in girls. Results from this study suggest that a better ICHI is associated with a lower inflammatory profile already in adolescence. Improving these health behaviors, and health factors included in the ICHI, could play an important role in CVD prevention.
Publisher: Springer Science and Business Media LLC
Date: 21-12-2016
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.NUT.2017.10.017
Abstract: To determine dietary patterns (DPs) and explain the highest variance of vitamin B A total of 2173 adolescents who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence study met the eligibility criteria for the vitamin B intake analysis (46% boys) and 586 adolescents for the biomarkers analysis (47% boys). Two non-consecutive, 24-h, dietary recalls were used to assess the mean intakes. Concentrations were measured by chromatography and immunoassay testing. A reduced rank regression was applied to elucidate the combined effect of food intake of vitamin B and related concentrations. The identified DPs (one per vitamin B intake and biomarker and by sex) explained a variability between 34.2% and 23.7% of the vitamin B intake and between 17.2% and 7% of the biomarkers. In the reduced rank regression models, fish, eggs, cheese, whole milk and buttermilk intakes were loaded positively for vitamin B intake in both sexes however, soft drinks and chocolate were loaded negatively. For the biomarkers, a higher variability was observed in the patterns in terms of food loads such as alcoholic drinks, sugars, and soft drinks. Some food items were loaded differently between intakes and biomarkers such as fish products, which was loaded positively for intakes but negatively for plasma folate in girls. The identified DPs explained up to 34.2% and 17.2% of the variability of the vitamin B intake and plasma concentrations, respectively, in European adolescents. Further studies are needed to elucidate the factors that determine such patterns.
Publisher: Springer Science and Business Media LLC
Date: 21-01-2015
Publisher: Hogrefe Publishing Group
Date: 07-2011
DOI: 10.1024/0300-9831/A000070
Abstract: Background: An adequate nutritional status of antioxidant vitamins (vitamins A, C, E) and b-carotene is essential especially during childhood and adolescence, because of their important roles in cell growth and development. Currently, there are no physiological reference values for blood concentration of these vitamins and b-carotene in apparently healthy European adolescents. The aim of the current study was to obtain reliable and comparable data of antioxidant vitamins and b-carotene in a cross-sectional study, within HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence), which was conducted in a representative s le of adolescents from ten European cities. Material and Methods: From a subs le of 1,054 adolescents (males= 501) of the HELENA Cross Sectional Study with an age range of 12.5 to 17.49 years, fasting blood s les were taken and analyzed for vitamins A, E, C, and b-carotene status. As specific reference values for adolescents are missing, percentile distribution by age and sex is given. Results: Mean concentrations were the following: Retinol: 356.4 ± 107.9 cm/mL alpha-tocopherol: 9.9 ± 2.1 microg/mL vitamin C: 10.3 ± 3.3 mg/L and b-carotene: 245.6 ± 169.6 cm/mL. Females showed higher alpha-tocopherol and vitamin C values compared with males and 17-year-old boys had higher retinol levels than the same-aged girls (p = 0.018). Retinol serum concentrations increased significantly according to age in both gender, but girls had also significantly increasing b-carotene levels by age. Conclusions: For the first time, concentrations of antioxidant vitamins and pro-vitamin beta-carotene have been obtained in a representative s le of apparently healthy European adolescents. These data can contribute to the establishment of reference ranges in adolescents.
Publisher: Springer Science and Business Media LLC
Date: 04-07-2018
DOI: 10.1007/S00394-018-1764-4
Abstract: To assess if a healthy diet might attenuate the positive sedentary-inflammation relation, whereas an unhealthy diet may increase the effect of sedentary behaviors on inflammatory biomarkers. In 618 adolescents (13-17 years) of the European HELENA study, data were available on body composition, a set of inflammation markers, and food intake assessed by a self-administered computerized 24 h dietary recall for 2 days. A 9-point Mediterranean diet score and an antioxidant-rich diet z-score were used as dietary indices and tested as moderators. A set of low-grade inflammatory characteristics was used as outcome: several cytokines in an inflammatory ratio (IL-6, IL-10, TNF-α, TGFβ-1), C-reactive protein, three cell-adhesion molecules (sVCAM-1, sICAM-1, sE-selectin), three cardiovascular risk markers (GGT, ALT, homocysteine) and three immune cell types (white blood cells, lymphocytes, CD3). Sedentary behaviors were self-reported and analyzed as total screen time. Multiple linear regression analyses tested moderation by diet in the sedentary behaviors-inflammation association adjusted for age, sex, country, adiposity (sum of six skinfolds), parental education, and socio-economic status. Both diet scores, Mediterranean and antioxidant-rich diet, were significant protective moderators in the effect of sedentary behaviors on alanine-transaminase enzyme (P = 0.014 P = 0.027), and on the pro/anti-inflammatory cytokine ratio (P = 0.001 P = 0.004), but not on other inflammatory parameters. A higher adherence to the Mediterranean diet or an antioxidant-rich diet may attenuate the onset of oxidative stress signs associated by sedentary behaviors, whereas a poor diet seems to increase inflammation.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.NUMECD.2017.10.018
Abstract: The ideal cardiovascular health (iCVH) construct consists of 4 health behaviors (smoking status, body mass index, physical activity and diet) and 3 health factors (total cholesterol, blood pressure and fasting glucose). A greater number of iCVH components in adolescence are related to better cardiovascular health, but little is known about the correlates of iCVH in adolescents. Thus, the aim of the study was to examine correlates of iCVH in European adolescents. The study comprised 637 European adolescents with complete iCVH data. Participants were part of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional, multicenter study conducted in 9 different European countries. Correlates investigated were sex and age, family affluence scale, maternal education, geographic location, sleep time, television viewing, duration of pregnancy, birth weight and breastfeeding. Younger adolescents, those whose mothers had medium/high education or those who watched television less than 2 h per day had a greater number of iCVH components compared to those who were older, had a mother with low education or watched television 2 h or more daily (P ≤ 0.01). Since in our study older adolescents had worse iCVH than younger adolescents, early promotion of cardiovascular health may be important. Future studies may also investigate the usefulness of limiting television viewing to promote iCVH. Finally, since adolescents of mothers with low education had poorer iCVH, it may be of special interest to tailor public health promotion to adolescents from families with low socioeconomic status.
Publisher: Springer Science and Business Media LLC
Date: 17-10-2018
DOI: 10.1007/S00198-018-4731-2
Abstract: This study aims to analyze the impact of participation in vigorous physical activity as it can promote a healthy bone development. Adolescents who increased their participation in vigorous physical activity showed higher improvements in bone parameters compared to those who did not, which highlights the relevance of vigorous physical activity engagement. The main purpose of the study was to analyze the effects of different patterns of vigorous physical activity (VPA) on bone development. One-week accelerometry registers and dual-energy X-ray absorptiometry scans at the whole body, hip, and lumbar spine of 140 healthy male adolescents (11-13 years, at baseline) were performed twice with a 1-year interval between measurements. Four patterns of VPA evolution ("low-low," "low-high," "high-low," and "high-high") and three patterns of bone growth ("optimal," "mean," and "reduced") were defined according to the median participation in VPA and a cluster analysis of the longitudinal changes in BMC and BMD in all sites measured, respectively. Bone mineral parameters were adjusted for skeletal age and body weight prior to statistical comparison among groups. Participants in the "low-high" group had greater adjusted BMD increases at both the femoral neck and lumbar spine when compared to the "low-low" group (estimated mean (95% CI) 0.066 (0.047-0.085) vs. 0.034 (0.021-0.047) g/cm Engaging in VPA as well as maintaining high levels of VPA during puberty is associated with greater gains in bone mass, which can have an impact in future bone health.
Publisher: Oxford University Press (OUP)
Date: 15-04-2011
Abstract: Although there is a growing interest in the epidemiology of sedentary behaviours, it is unknown whether sedentary behaviour questionnaires are broad markers of sedentary time. The aims of this study were to determine the: (i) reliability of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) screen time-based sedentary behaviour questionnaire and (ii) its validity, i.e. the ability of the questionnaire to correctly rank adolescents according to the objectively measured sedentary time. A total of 183 adolescents (104 females aged 12.5-17.5 years) were involved in the reliability study. Participants completed the HELENA sedentary questionnaire twice (1 week apart). The validity study comprised 2048 (1212 females) adolescents (12.5-17.5 years of age) included in the HELENA cross-sectional study. Questions included television viewing, computer games, console games, Internet for study and non-study reasons and study during week and weekend days. We compared median values of sedentary time, using accelerometers, by tertiles of self-reported sedentary behaviours and their sum (composite sedentary score). Reliability study: κ-values showed a good agreement (>0.7), except for Internet for study reasons (0.46 weekdays, 0.33 weekend). The questionnaire correctly classified boys' sedentary time when analysed by specific behaviours and by a composite sedentary score. In girls, median values of objectively measured sedentary time were not different across tertiles of self-reported sedentary behaviours or the composite sedentary score. The HELENA sedentary questionnaire is reliable, yet only correctly classifies objectively measured sedentary time in boys.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.NUMECD.2017.10.004
Abstract: Inflammation may influence the cardio-metabolic profile which relates with the risk of chronic diseases. This study aimed to assess the inflammatory status by metabolic health (MH)/body mass index (BMI) category and to assess how inflammatory markers can predict the cardio-metabolic profile in European adolescents, considering BMI. A total of 659 adolescents (295 boys) from a cross-sectional European study were included. Adolescents were classified by metabolic health based on age- and sex-specific cut-off points for glucose, blood pressure, triglycerides, high density cholesterol and BMI. C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin (IL-6), complement factors (C3, C4) and cell adhesion molecules were assessed. Metabolically abnormal (MA) adolescents had higher values of C3 (p < 0.001) and C4 (p = 0.032) compared to those metabolically healthy (MHy). C3 concentrations significantly increased with the deterioration of the metabolic health and BMI (p < 0.001). Adolescents with higher values of CRP had higher probability of being in the overweight/obese-MH group than those allocated in other categories. Finally, high C3 and C4 concentrations increased the probability of having an unfavorable metabolic/BMI status. Metabolic/BMI status and inflammatory biomarkers are associated, being the CRP, C3 and C4 the most related inflammatory markers with this condition. C3 and C4 were associated with the cardio-metabolic health consistently.
Publisher: Cambridge University Press (CUP)
Date: 13-12-2013
DOI: 10.1017/S0007114513003796
Abstract: Diet quality is influenced by socio-economic and geographical factors. The present study sought to assess whether adolescents' diet quality is affected by their parents' socio-economic status and whether the relationship between these factors is similar in northern and southern Europe. Data collected in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study in eight European countries were analysed. Dietary intake data were recorded via repeated 24 h recalls (using specifically developed HELENA Dietary Intake Assessment Tool software) and converted into an adolescent-specific Diet Quality Index (DQI-AM). Socio-economic status was estimated through parental educational level (Par-Educ-Lev) and parental occupation level (Par-Occ-Lev) as reported by the adolescents in a specific questionnaire. The DQI-AM data were then analysed as a function of Par-Educ-Lev and Par-Occ-Lev in northern European countries (Austria, Belgium, France, Germany and Sweden) and southern European countries (Greece, Italy and Spain). We studied a total of 1768 adolescents (age 14·7 ( sd 1·3) years percentage of girls: 52·8 % 1135 and 633 subjects from northern and southern Europe, respectively). On average, the DQI-AM score was higher in southern Europe than in northern Europe (69·1 ( sd 0·1) v . 60·4 ( sd 2·8), respectively P 0·001 Δ = 12·6 %). The DQI was positively correlated with both paternal and maternal Par-Educ-Lev. However, this association was more pronounced in northern Europe than in southern Europe ( P interaction = 0·004 for the mother and 0·06 for the father). The DQI was also positively correlated with Par-Occ-Lev (all P trends 0·01), but this correlation was independent of the geographical area ( P interaction = 0·51 for the mother and 0·50 for the father). In conclusion, Par-Educ-Lev and Par-Occ-Lev are associated with diet quality in adolescents in Europe. However, this association differs between northern Europe and southern Europe.
No related grants have been discovered for Germán Vicente Rodríguez.