.. Nutrición Hospitalaria
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Nutr Hosp. 2015;31(2):936-943 ISSN «212-1611 • CODEN NUHOEQ S.V.R. 318
Original / Valoración nutritional
Differences in food intake and nutritional habits between Spanish adolescents who engage in ski activity and those who do not Miguel Mariscal-Arcas1-2, Celia Monteagudo1, Jessenia Hernandez-Elizondo3, Samira Benhammou1, Ma Luisa Lorenzo1 and Latima Olea-Serrano1 'Department o f Nutrition and Food Science, Research Group Nutrition, Diet and Risk Assessment (AGR-255), University o f Granada. Spain. 2Department o f Food Technology, Nutrition and Food Science, University o f Murcia, Spain. 3Escuela de Educación Física y Deportes, Universidad de Costa Rica, San José, Costa Rica.
Abstract Background: Increasing obesity among adolescents in the industrialized world may result from poor nutritional habits and inadequate exercise. Aim: To determine differences in food intake, nutritio nal habits, and body mass index between Spanish ado lescents who engage in ski activity and those who do not. Methods: A socio-demographic survey, food frequency questionnaire, 24-hr dietary recall, and physical activity questionnaire were completed by 300 Spanish schoolchil dren aged 10 to 18 yrs. Results were compared (Student’s t, chi-square and Fisher’s exact test) between adolescents engaged (SP) and not engaged (N-SP) in skiing according to their sex. Results: SP adolescents devoted > 4 h/day to physical activity versus < 1 h for N-SP adolescents. No significant differences were found in nutrient intake or nutritional habits between SP and N-SP adolescents. Protein and fat intakes of both groups were above recommended levels. A higher proportion of N-SP than SP males were overwei ght. Logistic regression analysis showed that the main tenance of a normal weight was favored by the practice of skiing, the consumption of sugar-free drinks, and su pplementation with vitamins/mineral salts and was nega tively associated with body weight dissatisfaction, intake of nutritional supplements other than vitamins or mine rals, and the consumption of snacks. Conclusions: The diet of this adolescent population was poorly balanced. Engagement in physical activity appears to be a key factor in maintaining a healthy body mass index. (,NutrHosp. 2015;31:936-943)
DOI: 10.3305/nh.2015.31.2.8267 Key words: Food intake. Nutritional habits. Adolescents. Physical activity. Sport.
Correspondence: Fatima Olea-Serrano. Department of Nutrition and Food Science. University of Granada. Campus de Cartuja s/n. 18071 Granada, Spain. E-mail: [email protected] Recibido: 22-X-2014. Aceptado: 30-XI-2014.
936
INGESTA DE ALIMENTOS Y HÁBITOS NUTRICIONALES ENTRE ADOLESCENTES ESPAÑOLES QUE PRACTICAN Y NO PRACTICAN ESQUÍ Resumen Antecedentes: El aumento de la obesidad entre los ado lescentes en países desarrollados puede ser consecuencia de malos hábitos alimentarios y falta de actividad. Objetivo: Determinar las diferencias en la ingesta de alimentos, hábitos nutricionales e índice de masa corpo ral entre adolescentes españoles que practican esquí y los que no lo hacen. Métodos: Una muestra de 300 adolescentes españoles de 10 a 18 años completó una encuesta que incluyó va riables sociodemográficas, un cuestionario de frecuencia de consumo de alimentos, recordatorio de 24h y un cues tionario de actividad física. Se utilizaron test de compa ración paramétricos y no paramétricos para comparar los resultados entre adolescentes que practican (SP) y no practican (N-SP) esquí, en función al sexo. Resultados: Los adolescentes SP dedicaron más de 4h diarias a la realización de actividad física mientras que los adolescentes N-SP dedicaron menos de 1 hora diaria a la actividad física. No se encontraron diferencias signi ficativas en la ingesta de nutrientes o los hábitos nutri cionales entre adolescentes SP y N-SP. La ingesta de pro teínas y lípidos de ambos grupos estuvo por encima de los niveles recomendados. El sobrepeso fue más frecuente entre adolescentes N-SP. El análisis de regresión logística mostró que el mantenimiento de un peso normal se ve fa vorecido por la práctica del esquí, el consumo de bebidas sin azúcar y la suplementación con vitaminas/minerales y se asoció negativamente con la insatisfacción con el peso corporal, el consumo de suplementos nutricionales dis tintos a vitaminas o minerales y el consumo de aperitivos. Conclusiones: La dieta de esta población adolescente fue desequilibrada. La participación en la actividad físi ca parece ser un factor clave en el mantenimiento de un índice de masa corporal saludable. (Nutr Hosp. 2015;31:936-943)
DOI: 10.3305/nh.2«l 5.31.2.8267 Palabras clave: Ingesta de alimentos. Hábitos nutriciona les. Adolescentes. Actividad física. Deporte.
Introduction The diet of a population is determined by its life ha bits and environment, and numerous factors must be taken into account in evaluating the nutritional behavior of children and adolescents'. In Europe, depending on the country, 53-98% of children aged 6 to 11 yrs engage in sports activity, at least occasionally2, and similar per centages are reported for adolescents aged 12 to 16 yrs. In Spain, this proportion declines to 40% in the 15-19 yr age range3. This appears to be a low percentage, es pecially given current worldwide reports of an increase in childhood and adolescent obesity4,5, because the nu tritional habits of adolescent athletes have been shown to be healthier than those of their non-athletic peers6. In fact, nutrition is a major component of their training, aimed at optimizing performance and avoiding injuries or conditions related to nutritional deficiencies. Children and adolescents need an adequate energy intake to ensure their proper growth, development, and maturation. The athletic or very active child or adoles cent will generally need a greater intake to match their higher energy expenditure from physical activity. Ener gy intakes recommended by7 are based on equations that consider age, height, body weight, and physical ac tivity, classified as sedentary, moderately active, active, and very active. Although an adequate protein intake is important to provide essential amino acids to support growth, espe cially to maintain and develop lean body mass, an ade quate energy intake is also critical. Inadequate energy will cause protein to be used as an energy substrate rather than for synthesizing lean tissues. It is generally recommended that adults obtain at least 12-15% of thendietary energy from protein8, and this recommendation also appears reasonable for the child and adolescent athlete. The combination of heavy training and increa sed protein intake may also influence protein turnover and perpetuate the need for greater protein intake9. Gra in-based foods, vegetables, and fruit supply significant amounts of carbohydrate, fiber, minerals, and vitamins and contribute to restoring the muscle glycogen needed for training and competition. Because of the importance of carbohydrates as substrate for high-intensity training, it is recommended that young athletes consume at least 50% of their total daily energy intake as carbohydrates9 Dietary fat provides energy for the growth needs of children and adolescents and contributes essential fatty acids to their diet. In addition, a slightly higher fat intake might be recommended to young athletes in comparison with their sedentary counterparts, because of their in creased energy expenditure during training10. Minerals play key roles in the formation of body tis sues (e.g., calcium in bone), in the maintenance of fluid balance within specific compartments (sodium for extra cellular fluid space and potassium for intracellular fluid space), and in the excitation of tissues (action potentials and signal transmission in nerve and muscle tissue)"12. Research in adults has shown that elevated metabolism
Differences in food intake and nutritional habits between Spanish adolescents who engage in ski activity and those who do not
from exercise does not increase mineral requirements except when large amounts are lost in sweat13. Likewise, the need of children for minerals is not thought to be changed by sports."12 However, iron and calcium are two frequently deficient minerals in the diet of children and teenagers, which could affect health and physical performance, especially in female athletes9. In adequate intake of energy, protein, vitamin D, and cal cium may influence other factors (e.g., estrogen hormo ne levels) that negatively affect bone health. Increasing the consumption of iron in the diet could be assumed to alleviate iron deficit, although interactions with other nu trients should not be ignored. It was reported that plasma ferritin levels in athletes were not influenced by total iron or meat intake and that the best predictor of iron status was the proportion (not absolute intake) of total protein in the diet14. Carbohydrate and fat ingestion have been negatively correlated with plasma ferritin, and their high ingestion may inhibit iron absorption, whereas protein fa cilitates iron absorption15. At all stages of childhood and adolescence, it is ne cessary to promote not only a healthy diet that supplies all nutrients but also healthy life habits, primarily an appropriate level of physical activity.16 A good diet and physical activity are known to be related to weight con trol and a correct body composition in each age group. Intense physical activity is associated with maintenance of a stable weight17, and examples include running, fast cycling, aerobic exercises, and competitive team sports such as football, hockey and volleyball, etc. Lower body fat levels have been observed in children and adolescents who perform more intense physical activity18,19. One European study showed that body fat levels in children aged 9-10 yrs were lower in those performing an intense physical activity for more than 40 min/day than in those performing intense activity for 10-18 min/day. A physi cal activity level (PAL) of ~1.8, as defined by FAO7, is necessary to minimize weight gain17 and corresponds to moderate physical activity. The WHO recommends phy sical activity for 30 min on almost all days of the week20
Methods Description o f Sample and Study Design This study included 300 adolescents recruited from middle and high schools in Granada city (Southern Spain). Mean age (±SD) of the series was 12.8 (2.7) yrs (range: 10-18 yrs). All participants completed a so cio-demographic survey, food frequency questionnaire (FFQ), 24-hr x 3 times dietary recall, and physical ac tivity questionnaire (PAQ) during a physical education class or training session. The whole survey took 60-90 min. Anthropometric data were collected by trained research staff. Study procedures were approved by the Ethics Committee of Granada University, and informed consent was obtained from the participants or, when aged below 18 yrs, by their parent or guardian. The final
Nutr Hosp. 2015;31(2):936-943
937
study group comprised 288 students (93% of original enrolment).
15th-85th percentile, normal weight; and >85th percentile, overweight7,28
Questionnaires
Data Analysis
A 56-item socio-demographic questionnaire was used to explore socio-environmental, personal, and behavioral factors of relevance to adolescent food choices, weight status, and overall health. The self-administered FFQ in cluded 92 food items classified by food group. The 3x 24-h recall used an open format and served to validate the nutritional questionnaires.. The validity and reliability of the FFQ were previously established by our research group2122. The PAQ gathered data on their physical acti vities during the previous year and on the time devoted to each activity.
Analyses were stratified by sex across the two groups (SP and N-SP). Continuous variables were expressed as mean, maximum, minimum and standard deviation (SD), and categorical variables as frequencies and analyzed with the chi-square and Fisher’s exact tests. The Student’s t-test was used to compare means of variables. Logistic regression analysis was used to establish the likelihood of being normal- versus over-weight as a function of the study variables. P
0 ^ 0
Nutr Hosp. 2015;31(2):936-943 ISSN «212-1611 • CODEN NUHOEQ S.V.R. 318
Original / Valoración nutritional
Differences in food intake and nutritional habits between Spanish adolescents who engage in ski activity and those who do not Miguel Mariscal-Arcas1-2, Celia Monteagudo1, Jessenia Hernandez-Elizondo3, Samira Benhammou1, Ma Luisa Lorenzo1 and Latima Olea-Serrano1 'Department o f Nutrition and Food Science, Research Group Nutrition, Diet and Risk Assessment (AGR-255), University o f Granada. Spain. 2Department o f Food Technology, Nutrition and Food Science, University o f Murcia, Spain. 3Escuela de Educación Física y Deportes, Universidad de Costa Rica, San José, Costa Rica.
Abstract Background: Increasing obesity among adolescents in the industrialized world may result from poor nutritional habits and inadequate exercise. Aim: To determine differences in food intake, nutritio nal habits, and body mass index between Spanish ado lescents who engage in ski activity and those who do not. Methods: A socio-demographic survey, food frequency questionnaire, 24-hr dietary recall, and physical activity questionnaire were completed by 300 Spanish schoolchil dren aged 10 to 18 yrs. Results were compared (Student’s t, chi-square and Fisher’s exact test) between adolescents engaged (SP) and not engaged (N-SP) in skiing according to their sex. Results: SP adolescents devoted > 4 h/day to physical activity versus < 1 h for N-SP adolescents. No significant differences were found in nutrient intake or nutritional habits between SP and N-SP adolescents. Protein and fat intakes of both groups were above recommended levels. A higher proportion of N-SP than SP males were overwei ght. Logistic regression analysis showed that the main tenance of a normal weight was favored by the practice of skiing, the consumption of sugar-free drinks, and su pplementation with vitamins/mineral salts and was nega tively associated with body weight dissatisfaction, intake of nutritional supplements other than vitamins or mine rals, and the consumption of snacks. Conclusions: The diet of this adolescent population was poorly balanced. Engagement in physical activity appears to be a key factor in maintaining a healthy body mass index. (,NutrHosp. 2015;31:936-943)
DOI: 10.3305/nh.2015.31.2.8267 Key words: Food intake. Nutritional habits. Adolescents. Physical activity. Sport.
Correspondence: Fatima Olea-Serrano. Department of Nutrition and Food Science. University of Granada. Campus de Cartuja s/n. 18071 Granada, Spain. E-mail: [email protected] Recibido: 22-X-2014. Aceptado: 30-XI-2014.
936
INGESTA DE ALIMENTOS Y HÁBITOS NUTRICIONALES ENTRE ADOLESCENTES ESPAÑOLES QUE PRACTICAN Y NO PRACTICAN ESQUÍ Resumen Antecedentes: El aumento de la obesidad entre los ado lescentes en países desarrollados puede ser consecuencia de malos hábitos alimentarios y falta de actividad. Objetivo: Determinar las diferencias en la ingesta de alimentos, hábitos nutricionales e índice de masa corpo ral entre adolescentes españoles que practican esquí y los que no lo hacen. Métodos: Una muestra de 300 adolescentes españoles de 10 a 18 años completó una encuesta que incluyó va riables sociodemográficas, un cuestionario de frecuencia de consumo de alimentos, recordatorio de 24h y un cues tionario de actividad física. Se utilizaron test de compa ración paramétricos y no paramétricos para comparar los resultados entre adolescentes que practican (SP) y no practican (N-SP) esquí, en función al sexo. Resultados: Los adolescentes SP dedicaron más de 4h diarias a la realización de actividad física mientras que los adolescentes N-SP dedicaron menos de 1 hora diaria a la actividad física. No se encontraron diferencias signi ficativas en la ingesta de nutrientes o los hábitos nutri cionales entre adolescentes SP y N-SP. La ingesta de pro teínas y lípidos de ambos grupos estuvo por encima de los niveles recomendados. El sobrepeso fue más frecuente entre adolescentes N-SP. El análisis de regresión logística mostró que el mantenimiento de un peso normal se ve fa vorecido por la práctica del esquí, el consumo de bebidas sin azúcar y la suplementación con vitaminas/minerales y se asoció negativamente con la insatisfacción con el peso corporal, el consumo de suplementos nutricionales dis tintos a vitaminas o minerales y el consumo de aperitivos. Conclusiones: La dieta de esta población adolescente fue desequilibrada. La participación en la actividad físi ca parece ser un factor clave en el mantenimiento de un índice de masa corporal saludable. (Nutr Hosp. 2015;31:936-943)
DOI: 10.3305/nh.2«l 5.31.2.8267 Palabras clave: Ingesta de alimentos. Hábitos nutriciona les. Adolescentes. Actividad física. Deporte.
Introduction The diet of a population is determined by its life ha bits and environment, and numerous factors must be taken into account in evaluating the nutritional behavior of children and adolescents'. In Europe, depending on the country, 53-98% of children aged 6 to 11 yrs engage in sports activity, at least occasionally2, and similar per centages are reported for adolescents aged 12 to 16 yrs. In Spain, this proportion declines to 40% in the 15-19 yr age range3. This appears to be a low percentage, es pecially given current worldwide reports of an increase in childhood and adolescent obesity4,5, because the nu tritional habits of adolescent athletes have been shown to be healthier than those of their non-athletic peers6. In fact, nutrition is a major component of their training, aimed at optimizing performance and avoiding injuries or conditions related to nutritional deficiencies. Children and adolescents need an adequate energy intake to ensure their proper growth, development, and maturation. The athletic or very active child or adoles cent will generally need a greater intake to match their higher energy expenditure from physical activity. Ener gy intakes recommended by7 are based on equations that consider age, height, body weight, and physical ac tivity, classified as sedentary, moderately active, active, and very active. Although an adequate protein intake is important to provide essential amino acids to support growth, espe cially to maintain and develop lean body mass, an ade quate energy intake is also critical. Inadequate energy will cause protein to be used as an energy substrate rather than for synthesizing lean tissues. It is generally recommended that adults obtain at least 12-15% of thendietary energy from protein8, and this recommendation also appears reasonable for the child and adolescent athlete. The combination of heavy training and increa sed protein intake may also influence protein turnover and perpetuate the need for greater protein intake9. Gra in-based foods, vegetables, and fruit supply significant amounts of carbohydrate, fiber, minerals, and vitamins and contribute to restoring the muscle glycogen needed for training and competition. Because of the importance of carbohydrates as substrate for high-intensity training, it is recommended that young athletes consume at least 50% of their total daily energy intake as carbohydrates9 Dietary fat provides energy for the growth needs of children and adolescents and contributes essential fatty acids to their diet. In addition, a slightly higher fat intake might be recommended to young athletes in comparison with their sedentary counterparts, because of their in creased energy expenditure during training10. Minerals play key roles in the formation of body tis sues (e.g., calcium in bone), in the maintenance of fluid balance within specific compartments (sodium for extra cellular fluid space and potassium for intracellular fluid space), and in the excitation of tissues (action potentials and signal transmission in nerve and muscle tissue)"12. Research in adults has shown that elevated metabolism
Differences in food intake and nutritional habits between Spanish adolescents who engage in ski activity and those who do not
from exercise does not increase mineral requirements except when large amounts are lost in sweat13. Likewise, the need of children for minerals is not thought to be changed by sports."12 However, iron and calcium are two frequently deficient minerals in the diet of children and teenagers, which could affect health and physical performance, especially in female athletes9. In adequate intake of energy, protein, vitamin D, and cal cium may influence other factors (e.g., estrogen hormo ne levels) that negatively affect bone health. Increasing the consumption of iron in the diet could be assumed to alleviate iron deficit, although interactions with other nu trients should not be ignored. It was reported that plasma ferritin levels in athletes were not influenced by total iron or meat intake and that the best predictor of iron status was the proportion (not absolute intake) of total protein in the diet14. Carbohydrate and fat ingestion have been negatively correlated with plasma ferritin, and their high ingestion may inhibit iron absorption, whereas protein fa cilitates iron absorption15. At all stages of childhood and adolescence, it is ne cessary to promote not only a healthy diet that supplies all nutrients but also healthy life habits, primarily an appropriate level of physical activity.16 A good diet and physical activity are known to be related to weight con trol and a correct body composition in each age group. Intense physical activity is associated with maintenance of a stable weight17, and examples include running, fast cycling, aerobic exercises, and competitive team sports such as football, hockey and volleyball, etc. Lower body fat levels have been observed in children and adolescents who perform more intense physical activity18,19. One European study showed that body fat levels in children aged 9-10 yrs were lower in those performing an intense physical activity for more than 40 min/day than in those performing intense activity for 10-18 min/day. A physi cal activity level (PAL) of ~1.8, as defined by FAO7, is necessary to minimize weight gain17 and corresponds to moderate physical activity. The WHO recommends phy sical activity for 30 min on almost all days of the week20
Methods Description o f Sample and Study Design This study included 300 adolescents recruited from middle and high schools in Granada city (Southern Spain). Mean age (±SD) of the series was 12.8 (2.7) yrs (range: 10-18 yrs). All participants completed a so cio-demographic survey, food frequency questionnaire (FFQ), 24-hr x 3 times dietary recall, and physical ac tivity questionnaire (PAQ) during a physical education class or training session. The whole survey took 60-90 min. Anthropometric data were collected by trained research staff. Study procedures were approved by the Ethics Committee of Granada University, and informed consent was obtained from the participants or, when aged below 18 yrs, by their parent or guardian. The final
Nutr Hosp. 2015;31(2):936-943
937
study group comprised 288 students (93% of original enrolment).
15th-85th percentile, normal weight; and >85th percentile, overweight7,28
Questionnaires
Data Analysis
A 56-item socio-demographic questionnaire was used to explore socio-environmental, personal, and behavioral factors of relevance to adolescent food choices, weight status, and overall health. The self-administered FFQ in cluded 92 food items classified by food group. The 3x 24-h recall used an open format and served to validate the nutritional questionnaires.. The validity and reliability of the FFQ were previously established by our research group2122. The PAQ gathered data on their physical acti vities during the previous year and on the time devoted to each activity.
Analyses were stratified by sex across the two groups (SP and N-SP). Continuous variables were expressed as mean, maximum, minimum and standard deviation (SD), and categorical variables as frequencies and analyzed with the chi-square and Fisher’s exact tests. The Student’s t-test was used to compare means of variables. Logistic regression analysis was used to establish the likelihood of being normal- versus over-weight as a function of the study variables. P
