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J Am Coll Nutr. 2019 Nov-Dec;38(8):703-713. doi: 10.1080/07315724.2019.1598900. Epub 2019 Jul 9.

Dietary Patterns and Their Relationship With the Perceptions of Healthy Eating in European Adolescents: The HELENA Study.

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GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain.
Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.
Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn) Universidad de Zaragoza, Zaragoza, Spain.
University Lille, CHU Lille, Lille Inflammation Research International Center LIRIC-UMR 995 Inserm, Lille, France.
University Lille, CHU Lille, Clinical Investigation Center, Lille, France.
Institut Pasteur de Lille, Lille, France.
Department of Medical Physiology School of Medicine, University of Granada, Granada, Spain.
Department of Consumer & Sensory Sciences, Campden BRI, Gloucestershire, UK.
ImFine Research Group, Department of Health and Human Performance, Technical University of Madrid, Madrid, Spain.
Department of Nutrition and Food Sciences-Nutritional Physiology, University of Bonn, Bonn, Germany.
CIBER: CB12/03/30038 Fisiopatología de la Obesidad y la Nutrición, CIBERobn, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
Department of Public Health, Ghent University, Ghent, Belgium.
School of Medicine, University of Crete, Heraklion, Greece.
Ilioupolis, Athens, Greece.
Pediatric University Clinic Research Institute of Child Nutrition Ruhr University Bochum, Germany.
Centre for Research on Food and Nutrition, CREA Council for Agricultural Research and Analysis of Agricultural Economics, Rome, Italy.
Department of Nutrition and Dietetics School of Health Science and Education, Harokopio University, Athens, Greece.
Department of Pediatrics Medical Faculty, University of Pécs, Pécs, Hungary.
Unit for Preventive Nutrition, Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden.
Department of Pediatrics, Medical University of Vienna, Vienna, Austria.
Department of Pediatrics, Private Medical University, Salzburg, Austria.
See Appendix.


Objective: The aim of this study was to identify dietary patterns (DPs) in European adolescents and to examine the association between perceptions of healthy eating and the obtained DPs.Method: A multinational cross-sectional study was carried out in adolescents aged 12.5 to 17.5 years and 2,027 (44.9% males) were considered for analysis. A self-reported questionnaire with information on food choices and preferences, including perceptions of healthy eating, and two 24-hour dietary recalls were used. Principal component analysis was used to obtain sex-specific DPs, and linear analyses of covariance were used to compare DPs according to perceptions of healthy eating.Results: Three and four DPs for boys and girls were obtained. In boys and girls, there were significant associations between some perceptions about healthy food and the Breakfast-DP (p < 0.05). In boys, Breakfast-DP and Healthy Beverage-DP were associated with the perception of the own diet as healthy (p < 0.05). Healthy Beverage-DP was associated with those disliking fruits and vegetables (p < 0.05). Girls considering the own diet as healthy were associated with Mediterranean-DP, Breakfast-DP, and Unhealthy Beverage and Meat-DP (p < 0.05). The perception of snacking as a necessary part of a healthy diet was associated with Breakfast-DP in both genders (p < 0.05).Conclusions: In European adolescents, perceptions of healthy eating were mainly associated with a DP characterized by foods consumed at breakfast. Future studies should further explore these findings in order to implement health promotion programs to improve healthy eating habits in adolescents.


Dietary patterns; adolescents; food choices; food preferences; perceptions

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