ObjectivesTo identify the main knowledge gaps and to propose research lines that will be developed within the European Union-funded ‘Healthy Lifestyle in Europe by Nutrition in Adolescence’ (HELENA) project, concerning the nutritional status, physical fitness and physical activity of adolescents in Europe.DesignReview of the currently existing literature.ResultsThe main gaps identified were: lack of harmonised and comparable data on food intake; lack of understanding regarding the role of eating attitudes, food choices and food preferences; lack of harmonised and comparable data on levels and patterns of physical activity and physical fitness; lack of comparable data about obesity prevalence and body composition; lack of comparable data about micronutrient and immunological status; and lack of effective intervention methodologies for healthier lifestyles.ConclusionsThe HELENA Study Group should develop, test and describe harmonised and state-of-the-art methods to assess the nutritional status and lifestyle of adolescents across Europe; develop and evaluate an intervention on eating habits and physical activity; and develop and test new healthy food products attractive for European adolescents.

The authors determined the association between metabolic syndrome in early pregnancy (mean, 11.96 weeks) and the risk of preterm birth in the mother-child cohort study ("Rhea" Study) in Crete, Greece, 2007-2009. Maternal fasting serum samples were collected, and blood pressure was measured at the time of the first major ultrasound examination (n = 625). Multivariable log-binomial regression models were used. Women with metabolic syndrome were at high risk for preterm birth (relative risk (RR) = 2.93, 95% confidence interval (CI): 1.53, 5.58), with the highest risk observed for medically indicated preterm births (RR = 5.13, 95% CI: 1.97, 13.38). Among the components of metabolic syndrome, the most significant risk factor was hypertension (RR = 2.32, 95% CI: 1.28, 4.20). An elevation of 10 mm Hg in diastolic blood pressure increased the relative risk for preterm birth by 29% (RR = 1.29, 95% CI: 1.08, 1.53), while a per unit increase in the low density lipoprotein/high density lipoprotein cholesterol ratio increased this risk by 19% (RR = 1.19, 95% CI: 1.02, 1.39). Fetal weight growth restriction was associated with elevated levels of insulin (RR = 1.14, 95% CI: 1.08, 1.20) and diastolic blood pressure (RR = 1.27, 95% CI: 1.00, 1.61) in early pregnancy. These findings suggest that women with metabolic syndrome in early pregnancy had higher risk for preterm birth.

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Summary What is already known about this subject Metabolic and cardiovascular diseases involve an inflammatory process that begins early in life. Muscular fitness has been inversely associated with cardiometabolic risk factors in adolescents, including inflammatory biomarkers. More research is needed to evaluate whether the influence of muscular fitness on chronic inflammation is independent of cardiorespiratory fitness and fatness. What this study adds Muscular fitness is inversely related with inflammatory biomarkers during adolescence, independently of cardiorespiratory fitness and insulin resistance. The lower inflammatory status in adolescents with higher levels of muscular fitness seems to be explained by lower levels of fatness. Overweight and obese adolescents present an exacerbated inflammatory status, but this may be counteracted – to some extent – by maintaining appropriate levels of muscular fitness. Background Muscular fitness, cardiorespiratory fitness (CRF) and fatness are mutually related with chronic inflammation. Purpose To examine the independent association of muscular fitness with inflammatory biomarkers in adolescents from nine European countries. Methods A total of 639 adolescents (296 boys) aged from 12.5 to 17.5 year were included in this report. Data collection took place in 2006–2007 and analyses in 2012. A muscular fitness score was computed from handgrip strength and standing long jump. CRF was measured using the 20 m shuttle run test. Z‐scores of C‐reactive protein, complement factors C3 and C4, leptin and white blood cell counts were summed to create a cluster of inflammatory biomarkers. Sex, age, pubertal stage and centre were used as main confounders. Additional models were further adjusted for insulin resistance (HOMA‐IR) and sum of four skinfolds. Results Muscular fitness was negatively associated with single and clustered inflammatory biomarkers (standardized β from −0.399 to −0.100, all P‐values < 0.05). Additional adjustments for CRF and HOMA‐IR weakened the associations, but they still remained significant. The association was no longer significant when adjusting for skinfolds. Decreasing values of inflammatory score were observed across incremental levels of muscular fitness in both non‐overweight and overweight adolescents (P ≤ 0.05). Conclusions Adolescents with higher levels of muscular fitness present a lower chronic inflammation, and this seems to be explained by lower levels of fatness. Yet, overweight and obese adolescents may exhibit a less adverse profile if they maintain appropriate levels of muscular fitness.

Some specific food-inflammation associations were found, suggesting that diet is to a certain extent already related to inflammation in adolescents and can be used in disease prevention. Also some counterintuitive results were found, which might be due to grouping very different foods into a single group, besides considering that the human body may respond differently depending on the interaction between diet, lifestyle, genetics, biochemical individuality, age and sex.