Acknowledgements: The authors would like to thank the participants and their families for the collaboration. Financial support: The authors gratefully acknowledge the financial support of the European Community Sixth RTD Framework Programme (Contract FOOD-CT-2005-007034). C.J. received a grant from the Ministerio de Educación, Cultura y Deporte (grant number FPU13/00421). Additional support was received from the Spanish Instituto de Salud Carlos III (CIBERObn, grant number CB12/03/30038). The funders had no role in the design, analysis or writing of this article. Conflict of interest: The authors declare that they have no conflicts of interest that may affect the contents of this work. Authorship: L.A.M. coordinated the HELENA project at the international level. L.A.M., F.G., Y.M., K.W., D.M., A.K., M.S. and S.D.H. were involved in the design of the HELENA project and locally coordinated the HELENA projects. G.V.-R., L.G.-M., M.G.-G, J.V. and I.H. organized the fieldwork and performed the data collection locally. I.H. and M.K. were responsible for the database management. C.J., L.A.M. and I.H. worked on the conceptualization of the study. C.J., T.M. and I.H. were involved in manuscript drafting and statistical analysis. All authors reviewed the manuscript, gave input and made significant improvements. Ethics of human subject participation: The study was performed following the ethical guidelines of the Declaration of Helsinki 1964, the Good Clinical Practice rules and the legislation about clinical research in humans in each of the participating countries. All study participants and their parents provided a signed informed consent form. The protocol was approved by the Human Research Review Committees of the institutions involved.
HELENA Study Group. Co-ordinator: Luis A. Moreno. Core Group members: Luis A. Moreno, Fréderic Gottrand, Stefaan De Henauw, Marcela González-Gross, Chantal Gilbert. Steering Committee: Anthony Kafatos (President), Luis A. Moreno, Christian Libersa, Stefaan De Henauw, Sara Castelló, Fréderic Gottrand, Mathilde Kersting, Michael Sjöstrom, Dénes Molnár, Marcela González-Gross, Jean Dallongeville, Chantal Gilbert, Gunnar Hall, Lea Maes, Luca Scalfi. Project Manager: Pilar Meléndez. Universidad de Zaragoza (Spain): Luis A. Moreno, Jesús Fleta, José A. Casajús, Gerardo Rodríguez, Concepción Tomás, María I. Mesana, Germán Vicente-Rodríguez, Adoración Villarroya, Carlos M. Gil, Ignacio Ara, Juan Fernández Alvira, Gloria Bueno, Aurora Lázaro, Olga Bueno, Juan F. León, Jesús Mª Garagorri, Idoia Labayen, Iris Iglesia, Silvia Bel, Luis A. Gracia Marco, Theodora Mouratidou, Alba Santaliestra-Pasías, Iris Iglesia, Esther González-Gil, Pilar De Miguel-Etayo, Cristina Julian, Mary Miguel-Berges, Isabel Iguacel. Consejo Superior de Investigaciones Científicas (Spain): Ascensión Marcos, Julia Wärnberg, Esther Nova, Sonia Gómez, Ligia Esperanza Díaz, Javier Romeo, Ana Veses, Belén Zapatera, Tamara Pozo, David Martínez. Université de Lille 2 (France): Laurent Beghin, Christian Libersa, Frédéric Gottrand, Catalina Iliescu, Juliana Von Berlepsch. Research Institute of Child Nutrition Dortmund, Rheinische Friedrich-Wilhelms-Universität Bonn (Germany): Mathilde Kersting, Wolfgang Sichert-Hellert, Ellen Koeppen. Pécsi Tudományegyetem (University of Pécs) (Hungary): Dénes Molnar, Eva Erhardt, Katalin Csernus, Katalin Török, Szilvia Bokor, Mrs Angster, Enikö Nagy, Orsolya Kovács, Judit Répasi. University of Crete School of Medicine (Greece): Anthony Kafatos, Caroline Codrington, María Plada, Angeliki Papadaki, Katerina Sarri, Anna Viskadourou, Christos Hatzis, Michael Kiriakakis, George Tsibinos, Constantine Vardavas, Manolis Sbokos, Eva Protoyeraki, Maria Fasoulaki. Institut für Ernährungs- und Lebensmittelwissenschaften – Ernährungphysiologie, Rheinische Friedrich Wilhelms Universität (Germany): Peter Stehle, Klaus Pietrzik, Marcela González-Gross, Christina Breidenassel, Andre Spinneker, Jasmin Al-Tahan, Miriam Segoviano, Anke Berchtold, Christine Bierschbach, Erika Blatzheim, Adelheid Schuch, Petra Pickert. University of Granada (Spain): Manuel J. Castillo, Ángel Gutiérrez, Francisco B. Ortega, Jonatan R. Ruiz, Enrique G. Artero, Vanesa España, David Jiménez-Pavón, Palma Chillón, Cristóbal Sánchez-Muñoz, Magdalena Cuenca. Instituto Nazionalen di Ricerca per gli Alimenti e la Nutrizione (Italy): Davide Arcella, Elena Azzini, Emma Barrison, Noemi Bevilacqua, Pasquale Buonocore, Giovina Catasta, Laura Censi, Donatella Ciarapica, Paola D’Acapito, Marika Ferrari, Myriam Galfo, Cinzia Le Donne, Catherine Leclercq, Giuseppe Maiani, Beatrice Mauro, Lorenza Mistura, Antonella Pasquali, Raffaela Piccinelli, Angela Polito, Romana Roccaldo, Raffaella Spada, Stefania Sette, Maria Zaccaria. University of Napoli ‘Federico II’ Dept of Food Science (Italy): Luca Scalfi, Paola Vitaglione, Concetta Montagnese. Ghent University (Belgium): Ilse De Bourdeaudhuij, Stefaan De Henauw, Tineke De Vriendt, Lea Maes, Christophe Matthys, Carine Vereecken, Mieke de Maeyer, Charlene Ottevaere, Inge Huybrechts. Medical University of Vienna (Austria): Kurt Widhalm, Katharina Phillipp, Sabine Dietrich, Birgit Kubelka, Marion Boriss-Riedl. Harokopio University (Greece): Yannis Manios, Eva Grammatikaki, Zoi Bouloubasi, Tina Louisa Cook, Sofia Eleutheriou, Orsalia Consta, George Moschonis, Ioanna Katsaroli, George Kraniou, Stalo Papoutsou, Despoina Keke, Ioanna Petraki, Elena Bellou, Sofia Tanagra, Kostalenia Kallianoti, Dionysia Argyropoulou, Stamatoula Tsikrika, Christos Karaiskos. Institut Pasteur de Lille (France): Jean Dallongeville, Aline Meirhaeghe. Karolinska Institutet (Sweden): Michael Sjöstrom, Jonatan R. Ruiz, Francisco B. Ortega, María Hagströmer, Anita Hurtig Wennlöf, Lena Hallström, Emma Patterson, Lydia Kwak, Julia Wärnberg, Nico Rizzo. Asociación de Investigación de la Industria Agroalimentaria (Spain): Jackie Sánchez-Molero, Sara Castelló, Elena Picó, Maite Navarro, Blanca Viadel, José Enrique Carreres, Gema Merino, Rosa Sanjuán, María Lorente, María José Sánchez. Campden BRI (UK): Chantal Gilbert, Sarah Thomas, Elaine Allchurch, Peter Burgess. SIK – Institutet foer Livsmedel och Bioteknik (Sweden): Gunnar Hall, Annika Astrom, Anna Sverkén, Agneta Broberg. Meurice Recherche & Development asbl (Belgium): Annick Masson, Claire Lehoux, Pascal Brabant, Philippe Pate, Laurence Fontaine. Campden & Chorleywood Food Development Institute (Hungary): Andras Sebok, Tunde Kuti, Adrienn Hegyi. Productos Aditivos SA (Spain): Cristina Maldonado, Ana Llorente. Cárnicas Serrano SL (Spain): Emilio García. Cederroth International AB (Sweden): Holger von Fircks, Marianne Lilja Hallberg, Maria Messerer. Lantmännen Food R&D (Sweden): Mats Larsson, Helena Fredriksson, Viola Adamsson, Ingmar Börjesson. European Food Information Council (Belgium): Laura Fernández, Laura Smillie, Josephine Wills. Universidad Politécnica de Madrid (Spain): Marcela González-Gross, Jara Valtueña, David Jiménez-Pavón, Ulrike Albers, Raquel Pedrero, Agustín Meléndez, Pedro J. Benito, Juan José Gómez Lorente, David Cañada, Alejandro Urzanqui, Rosa María Torres, Paloma Navarro.
Davies, JH, Evans, BA & Gregory, JW (2005) Bone mass acquisition in healthy children. Arch Dis Child
Heaney, RP, Abrams, S, Dawson-Hughes, B
et al. (2000) Peak bone mass. Osteoporos Int
Julian-Almarcegui, C, Gomez-Cabello, A, Huybrechts, I
et al. (2015) Combined effects of interaction between physical activity and nutrition on bone health in children and adolescents: a systematic review. Nutr Rev
Julian, C, Gonzalez-Gross, M, Breidenassel, C
et al. (2017) 25-Hydroxyvitamin D is differently associated with calcium intakes of Northern, Central and Southern European adolescents: results from the HELENA study. Nutrition
Golden, NH & Abrams, SA (2014) Optimizing bone health in children and adolescents. Pediatrics
Handel, MN, Heitmann, BL & Abrahamsen, B (2015) Nutrient and food intakes in early life and risk of childhood fractures: a systematic review and meta-analysis. Am J Clin Nutr
Huybrechts, I, Lin, Y, De Keyzer, W
et al. (2011) Dietary sources and sociodemographic and economic factors affecting vitamin D and calcium intakes in Flemish preschoolers. Eur J Clin Nutr
Mouratidou, T, Vicente-Rodriguez, G, Gracia-Marco, L
et al. (2013) Associations of dietary calcium, vitamin D, milk intakes, and 25-hydroxyvitamin D with bone mass in Spanish adolescents: the HELENA study. J Clin Densitom
Uusitalo, U, Kronberg-Kippila, C, Aronsson, CA
et al. (2011) Food composition database harmonization for between-country comparisons of nutrient data in the TEDDY Study. J Food Compost Anal
Manios, Y, Moschonis, G, Mavrogianni, C
et al. (2014) Micronutrient intakes among children and adults in Greece: the role of age, sex and socio-economic status. Nutrients
Martini, LA, Verly, E Jr, Marchioni, DM
et al. (2013) Prevalence and correlates of calcium and vitamin D status adequacy in adolescents, adults, and elderly from the Health Survey–Sao Paulo. Nutrition
Ramos, E, Costa, A, Araujo, J
et al. (2013) Effect of television viewing on food and nutrient intake among adolescents. Nutrition
Barr-Anderson, DJ, Larson, NI, Nelson, MC
et al. (2009) Does television viewing predict dietary intake five years later in high school students and young adults?
Int J Behav Nutr Phys Act
Moreno, LA, De Henauw, S, Gonzalez-Gross, M
et al. (2008) Design and implementation of the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study. Int J Obes (Lond)
32, Suppl. 5, S4–S11.
Black, AE (2000) Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations. Int J Obes Relat Metab Disord
Tanner, JM & Whitehouse, RH (1976) Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child
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.
Julian-Almarcegui, C, Bel-Serrat, S, Kersting, M
et al. (2016) Comparison of different approaches to calculate nutrient intakes based upon 24-h recall data derived from a multicenter study in European adolescents. Eur J Nutr
Vyncke, K, Cruz Fernandez, E, Fajo-Pascual, M
et al. (2013) Validation of the Diet Quality Index for Adolescents by comparison with biomarkers, nutrient and food intakes: the HELENA study. Br J Nutr
Iliescu, C, Beghin, L, Maes, L
et al. (2008) Socioeconomic questionnaire and clinical assessment in the HELENA Cross-Sectional Study: methodology. Int J Obes (Lond)
32, Suppl. 5, S19–S25.
Craig, CL, Marshall, AL, Sjostrom, M
et al. (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc
De Cocker, K, Ottevaere, C, Sjostrom, M
et al. (2011) Self-reported physical activity in European adolescents: results from the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Public Health Nutr
Rey-Lopez, JP, Vicente-Rodriguez, G, Ortega, FB
et al. (2010) Sedentary patterns and media availability in European adolescents: the HELENA study. Prev Med
Rey-Lopez, JP, Ruiz, JR, Ortega, FB
et al. (2012) Reliability and validity of a screen time-based sedentary behaviour questionnaire for adolescents: the HELENA study. Eur J Public Health
Haubrock, J, Nothlings, U, Volatier, JL
et al. (2011) Estimating usual food intake distributions by using the multiple source method in the EPIC-Potsdam Calibration Study. J Nutr
Royo-Bordonada, MA, Gorgojo, L, de Oya, M
et al. (2003) Food sources of nutrients in the diet of Spanish children: the Four Provinces Study. Br J Nutr
Keast, DR, Fulgoni, VL 3rd, Nicklas, TA
et al. (2013) Food sources of energy and nutrients among children in the United States: National Health and Nutrition Examination Survey 2003–2006. Nutrients
Vatanparast, H, Calvo, MS, Green, TJ
et al. (2010) Despite mandatory fortification of staple foods, vitamin D intakes of Canadian children and adults are inadequate. J Steroid Biochem Mol Biol
Food and Agriculute Organization of the United Nations (2006) The State of World Fisheries and Aquaculture. Rome: FAO.
Spiro, A & Buttriss, JL (2014) Vitamin D: an overview of vitamin D status and intake in Europe. Nutr Bull
Lopes, TS, Sichieri, R, Salles-Costa, R
et al. (2013) Family food insecurity and nutritional risk in adolescents from a low-income area of Rio de Janeiro, Brazil. J Biosoc Sci
Rodriguez-Ramirez, S, Mundo-Rosas, V, Shamah-Levy, T
et al. (2009) Energy and nutrient intake in Mexican adolescents: analysis of the Mexican National Health and Nutrition Survey 2006. Salud Publica Mex
51, Suppl. 4, S551–S561.
Richter, A, Heidemann, C, Schulze, MB
et al. (2012) Dietary patterns of adolescents in Germany – associations with nutrient intake and other health related lifestyle characteristics. BMC Pediatr
Absoud, M, Cummins, C, Lim, MJ
et al. (2011) Prevalence and predictors of vitamin D insufficiency in children: a Great Britain population based study. PLoS One
Thompson, FE & Subar, AF (2008) Dietary assessment methodology. In Nutrition in the Prevention and Treatment of Disease, pp. 3–40 [AM Coulston and CJ Boushey, editors]. Burlington, MA: Elsevier Academic Press.
Moore, LL, Bradlee, ML, Gao, D
et al. (2008) Effects of average childhood dairy intake on adolescent bone health. J Pediatr
Bel-Serrat, S, Julián-Almárcegui, C, González-Gross, M
et al. (2016) Correlates of dietary energy misreporting among European adolescents: the Healthy Lifestlyle in Europe by Nutrition in Adolescence (HELENA) study. Br J Nutr
Ovesen, L, Brot, C & Jakobsen, J (2003) Food contents and biological activity of 25-hydroxyvitamin D: a vitamin D metabolite to be reckoned with?
Ann Nutr Metab
Hartmann, BM, Heuer, T & Hoffmann, I (2015) The German Nutrient Database: effect of different versions on the calculated energy and nutrient intake of the German population. J Food Compost Anal
Gonzalez-Gross, M, Valtuena, J, Breidenassel, C
et al. (2012) Vitamin D status among adolescents in Europe: the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Br J Nutr