Differences in food intake and nutritional habits between (PDF)

936 Nutr Hosp. 2015;31(2):936-943 ISSN 0212-1611 • CODEN NUHOEQ S.V.R. 318 Original/Valoración nutricional 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 Fatima Olea-Serrano1 1Department of Nutrition and Food Science, Research Group Nutrition, Diet and Risk Assessment (AGR-255), University of Granada. Spain. 2Department of Food Technology, Nutrition and Food Science, University of 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. (Nutr Hosp. 2015;31:936-943) DOI:10.3305/nh.2015.31.2.8267 Key words: Food intake. Nutritional habits. Adolescents. Physical activity. Sport. 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.2015.31.2.8267 Palabras clave: Ingesta de alimentos. Hábitos nutriciona- les. Adolescentes. Actividad física. Deporte. 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. 054_8267 Ingesta de alimentos y habitos nutricionales entre adolescentes españoles.indd 936 14/01/15 16:38  937 Nutr Hosp. 2015;31(2):936-943 Differences in food intake and nutritional habits between Spanish adolescents who engage in ski activity and those who do not 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 adolescents1. 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 their dietary 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)11,12. Research in adults has shown that elevated metabolism 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.11,12 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 of 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 054_8267 Ingesta de alimentos y habitos nutricionales entre adolescentes españoles.indd 937 14/01/15 16:38  938 Nutr Hosp. 2015;31(2):936-943 Miguel Mariscal-Arcas et al. study group comprised 288 students (93% of original enrolment). Questionnaires 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 group21,22. The PAQ gathered data on their physical acti- vities during the previous year and on the time devoted to each activity. Nutrient Intake Dietary intake of energy (kcal) and nutrients was as- sessed from responses to the 3x24 hour-recall. The 24-h recall was completed by all study subjects at the begin- ning of the ski season (December) and again at the end of the season (April/May). Questionnaires were excluded as unreliable following the criteria established by Goldberg et al23, taking account of the energy intake (EI) results, daily energy expenditure (from 3x 24-h recall), and ba- sal metabolism rate (BMR) FAO7. The food composition tables in the NOVARTIS software program24 used in this study were reviewed, checking the nutrient composition of each food against the data in the program and ensu- ring the inclusion of all nutrients of interest or in the usual diet of the study population25 The reference data were based on dietary recommendations for this population in Spain26 and those published by the FAO7 Division of population by physical activity level The study population was divided between skiing par- ticipants (SP) and non-ski participants (N-SP). Inclusion criteria for SP were membership of a Sports Training Center and participation in competitive ski training two or more days/week. Inclusion criterion for N-SP was par- ticipation in physical activities for less than two hours/ week. Anthropometrics Height, weight, and skin-fold measurements were always performed in a private room at the education centers by the same group of three trained researchers using the same equipment and procedure, following re- commendations of the Anthropometry Procedures Ma- nual (NHANES)27 Body mass index (BMI, Kg/m2) was categorized as follows: <15th percentile, underweight; 15th-85th percentile, normal weight; and >85th percentile, overweight7,28 Data Analysis 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<0.05 was regarded as significant. SPSS version 19.0 statistical software was used for all statistical analyses. Results Eighty-six students (33 females and 53 males) were classified as SP; all participated in ski training at the Club Monachil de Sierra Nevada and High Performan- ce Centre (CAR) in Sierra Nevada. The remaining 202 students (87 females and 115 males) were considered as N-SP; only 15 students in this group performed some type of physical activity for up to 2 or 3 hrs wee- kly. Table I lists the demographic characteristics of the two groups. The age of the study population (range: 10-18 yrs) showed a non-normal distribution (p=0.0001). The- re was no significant age difference between the groups (SP and N-SP) in either sex. The weight of the population showed a normal distribution (p=0.200), whereas their height, BMI, and % fat values did not. Mean BMI and BMR values were significantly lower in SP females than in N-SP females. There were no differences in BMI or BMR between SP males and N-SP males. The physical activity was estimated as the number of hours dedicated to sports training (mean of 4.2 h/day for SP groups versus 0.95-1.05 h/day for N-SP groups), which significantly differed (p=0.001) between the SP and N-SP groups in both sexes. There was a significant difference (p=0.019) in wei- ght classification (underweight, normal weight, overwei- ght) between SP males and N-SP males, with 26% of N-SP males and 10.1% of SP males being categorized as overweight (Table I). Eating Behaviors The frequency of meals and other aspects of eating behavior were gathered from 15 questions in the FFQ survey. No difference in the number of daily meals on week days or at the weekend was observed among any of the four subgroups (N-SP males and females, NP males and females), being around four in all ca- 054_8267 Ingesta de alimentos y habitos nutricionales entre adolescentes españoles.indd 938 14/01/15 16:38  939 Nutr Hosp. 2015;31(2):936-943 Differences in food intake and nutritional habits between Spanish adolescents who engage in ski activity and those who do not ses (Table II). The SP group more frequently had lunch at their educational centre in comparison to the N-SP group (p<0.001). A very small percentage of both groups considered breakfast to be important, but 90% of all participants had breakfast, at a mean time of 07.45 h during the week and between 09.00 h and 10.30 h at weekends. Around half of the females spent 10-20 min on breakfast, with no difference between SP and N-SP females (p=0.116). Between 30 and 36% of males spent 10-20 min on breakfast, with no signifi- cant difference between SP and N-SP males (p=0.130). At the weekend, the percentage of males spending 10- 20 min on breakfast increased from 44.2 to 54.3%, with no significant difference between SP and N-SP males (p=0.381). Between 48.7 and 58.3% of all par- ticipants considered that they had good knowledge of nutrition, although there was a significant difference in this assessment between the two female sub-groups (Table II). The percentage of each group that was satisfied with their weight ranged from 48.7% (SP males) to 66.7% (SP females), with no significant differences among sub-groups. More than 80% of participants had never been on a diet to modify their weight. There was no significant difference in the con- sumption of sweets with sugar or artificial sweeteners between SP and N-SP groups. The consumption of snacks was slightly higher in N-SP groups but did not significantly difference among sub-groups (p<0.05). Nutrient Intake The equation proposed by Goldberg et al.23 was used to exclude questionnaires that deviated by more than double the mean for a study variable. We specifically applied this equation to the estimation of energy as a multiple of the BMR from 24h-recall questionnaires. As a result, 15 questionnaires were excluded from the analysis and their data are not included in table III. No significant differences in macronutrient or energy intake were found between the SP and non-SP groups. Comparison between the two male groups showed no significant difference in their nutrient intake, regardless of their physical activity level (Table III). The mean energy intake of the males was significantly (p=0.003) lower than Spanish recommendations while their pro- tein intake was significantly (p=0.006) higher, with a range of 74.7-75.8 g/day versus the recommended 43- 56 g/day. SP females reported significantly higher intakes, abo- ve recommended values, of vitamin C (p=0.011) and riboflavin (p=0.029) intakes in comparison to non-SP females (Table III). The mean energy intake of the fe- males in both groups was lower than Spanish recom- mendations, significantly (p=0.036) in the 10- to 15-yr age group and non-significantly in the 16-to 18-yr age group (p=0.593) (Table IV). As in the males, protein intake was significantly (p<0.05) above recommenda- tions in both female groups. Table I Demographic characteristics of Sporting (SP) and Non-Sporting (N-SP) groups Female skiers Female non- skiers p Male skiers Male non-skiers p Age (yrs) 13.4 (1.8) 13.7 (1.4) 0.399 14.20 (2.4) 13.8 (1.5) 0.454 Weight (Kg) 48.92 (10.62) 57.68 (11.89) 0.140 53.52 (16.48) 54.93 (14.85) 0.039 Height (cm) 154.75 (8.95) 160.04 (6.99) 160.00 (14.65) 162.07 (10.98) Waist/Hip ratio 0.77 (0.05) 0.74 (03) 0.81 (0.03) 0.79 (0.10) BMI (Kg/m2) 19.92 (3.01) 22.36 (3.54) 0.030 20.61 (3.41) 20.65 (3.84 0.487 BMR (Kcal/day) 1332.91 (123.84) 1429.06 (124.91) 0.007 1577.40 (258.91) 1626.39 (251.56) 0.155 TEE (Kcal/day) 2322.43 (223.32) 2457.58 (147.51) 2875.10 (572.44) 2936.83 (447.22) PAL 1.74 (.04) 1.72 (0.06) 1.81 (0.08) 1.80 (0.04) % Body fat 22.4 (4.3) 23.73 (4.00) 0.090 16.49 (2.72) 18.14 (4.31) 0.046 Body fat weight 12.99 (3.70) 14.04 (4.98) 0.155 8.77 (3.68) 10.20 (4.93 0.064 Training (hours/day) 4.0 (2.0) 0.9 (1.4) 0.001 4.2 (2.1) 1.0 (1.0) 0.001 Frequency (%) pb Frequency (%) pb Underweight 4.3 4.0 8.1 2.0 Normal weight 78.3 70.7 0.478 81.1 72.0 0.019 Overweight 17.4 25.3 10.1 26.0 (a) T-Test. (b) Chi-square test. * (SP): Ski People. ** (N-SP): Non-Ski People BMR: Basal metabolic rate; PAL: physical activity level (TEE/BMR) TEE Total energy expenditure7. Male TEE = 310.2 + 63.3 weight - 0.263 weight2 ; Female TEE = 263.4 + 65.3 weight - 0.454 weight2 Male % Body fat = 18.70 (LG10 (Biceps+Triceps+Subscapula+Suprailiac)) -11.91 Female % Body fat = 23.94 (LG10 (Bíceps+Triceps+Subscapula+Suprailiac))-18.89 054_8267 Ingesta de alimentos y habitos nutricionales entre adolescentes españoles.indd 939 14/01/15 16:38  940 Nutr Hosp. 2015;31(2):936-943 Miguel Mariscal-Arcas et al. Analysis of the influence of the different study varia- bles on normal-weight/overweight showed that the main- tenance of a normal weight was favored (with statistically significant ORs) by the practice of skiing, the consump- tion of sugar-free drinks, supplementation with vitamins and mineral salts, and a restrictive diet designed to lose weight. Conversely, maintenance of normal weight was negatively associated with dissatisfaction with current body weight, intake in the previous year of nutritional su- pplements other than vitamins or minerals, and the con- sumption of snacks (Table IV). Discussion This study compared eating habits and nutrient adequacy between adolescents who were engaged in sports training and those who were not. They all came from a single city, limiting extrapolation of the results to other populations. Moreover, being a cross-sectional study, it was only possible to examine associations be- tween involvement in sports and nutritional adequacy. There was no significant age difference among the study groups, but a significantly higher proportion of the parents of SP groups had a university education in comparison to the parents of N-SP groups. In agree- ment with other reports29, the BMI of SP females was significantly lower than that of N-SP females. Althou- gh the percentage with normal weight did not differ between the female groups, 17.4% of SP females were overweight versus 25.3% of N-SP females, using the classification of Cole et al,28 corrected for the % fat of subjects. The BMI was also lower in SP versus N-SP males, but the difference was not significant, while 26.0% of N-SP males were overweight versus 10.1% of the SP males, a significant difference (p= 0.019). The time devoted to sports practice significantly (p<0.001) differed between SP and N-SP groups (4.03h/day for SP females versus <1 h for N-SP females; 4.21 h/day for SP males versus 1.05 h/day (p<0.001). There were few significant differences in eating behaviors between sport-involved youths and their non-sport involved peers. Sport-involved youths more frequently ate at school and a higher percentage con- sidered that they had a good knowledge of nutrition compared with N-SP males. The female groups did not differ in the percentage that had been on a diet to lose weight. More than 56% of study participants were satisfied with their weight, and more than 59% ate everything on the plate at each meal, with no signi- ficant differences among sub-groups. It is difficult to establish the energy requirements of this adolescent population, because of the large in- ter-individual variability and the unpredictability of the onset of the growth spurt, a major impetus for in- creased energy requirements. It has been reported that children require more energy per kilogram of body weight during physical activity compared with adults9 .The combination of inadequate energy intake and high energy expenditure can create a negative energy balance that may lead to a delay in puberty onset and nutrient deficiencies30. Energy intake values did not table II Eating Behaviors Females Mean(SD) Males Mean(SD) SP* N-SP** aP SP* N-SP** aP How many times a day do you eat on weekdays? 4.3 (0.6) 4.3 (0.7) 0.761 3.9 (2.6) 4.1 (0.8) 0.354 How many times a day do you eat at the weekend? 3.8 (0.9) 4.0 (0.6) 0.299 3.7 (0.7) 3.9 (0.9) 0.188 Frequency (%) bP Frequency (%) bP Have lunch at school/college during term-time 40.0 1.8 0.001 46.2 2.0 0.001 Watch TV and talk while eating lunch 28.0 53.2 0.308 46.2 37.6 0.002 Believe breakfast to be important 4.0 3.3 0.626 2.6 4.4 0.306 Consider yourself to have good knowledge of nutrition 58.3 51.6 0.186 48.7 54.5 0.025 Appetite for food: eat everything presented without repeating 75.0 61.3 0.328 59.0 60.4 0.154 Consumed supplements (vitamins, minerals) in past year 32.0 16.1 0.298 20.5 16.8 0.526 Habitually consume specific sports preparations 8.7 1.3 0.040 2.6 5.0 0.351 Habitually consume sweets, chewing gum, etc. 72.7 79.3 0.441 73.6 75.7 0.774 Habitually consume sugar-free sweets and chewing gum, etc. 78.8 81.6 0.726 64.2 73.0 0.241 Habitually consume snacks (crisps, popcorn, etc.) 81.8 81.6 0.979 77.4 84.3 0.272 Are satisfied with your weight 66.7 53.3 0.294 48.7 64.4 0.101 Have been on some type of low-calorie (slimming) diet in past year 8.3 8.2 0.543 2.6 4.0 0.067 (a) T-Test. (b) Chi-square test. *(SP): Ski People. **(N-SP): Non-Skiing People 054_8267 Ingesta de alimentos y habitos nutricionales entre adolescentes españoles.indd 940 14/01/15 16:38  941 Nutr Hosp. 2015;31(2):936-943 Differences in food intake and nutritional habits between Spanish adolescents who engage in ski activity and those who do not Table III Comparison of nutrient and energy intakes (Kcal/day) among skiing (SP)* and non-skiing (N-SP)** groups Nutrient Sport Female Male Mean (SD) %DRI Pa Mean (SD) %DRI Pa Energy (Kcal/day) SP 2096.7 (771.4) 90.4 0.383 2117.6 (689.8) 77.1 0.630 N-SP 1963.7 (683.5) 78.5 2060.1 (664.5) 75.1 Protein (g) SP 75.8 (29.5) 135.5 0.377 80.2 (30.0) 146.7 0.402 N-SP 70.5 (27.4) 126.0 76.0 (27.1) 139.0 Fats (g) SP 99.6 (47.8) - 0.413 98.2 (41.3) - 0.833 N-SP 92.5 (40.6) - 96.8 (35.6) - Carbohydrate (g) SP 224.0 (78.4) - 0.495 228.0 (85.3) - 0.737 N-SP 212.6 (77.9) - 222.9 (84.7) - Phosphorus (mg) SP 1105.4 (488.4) 92.1 0.786 1233.6 (459.7) 102.7 0.199 N-SP 1079.1 (438.5) 89.9 1137.3 (400.5) 94.7 Magnesium (mg) SP 197.0 (72.7) 56.3 0.656 217.2 (78.8) 62.5 0.337 N-SP 190.4 (68.5) 54.4 204.3 (74.7) 58.4 Calcium (mg) SP 1048.1 (550.4) 104.8 0.220 1031.8 (461.0) 103.2 0.625 N-SP 917.2 (471.4) 91.7 996.9 (370.8) 99.7 Iron (mg) SP 11.7 (4.6) 61.1 0.194 10.7 (4.8) 71.3 0.601 N-SP 10.5 (3.9) 58.3 11.2 (4.0) 74.6 Zinc (mg) SP 11.4 (5.0) 76.0 0.627 12.1 (5.7) 80.6 0.740 N-SP 10.9 (5.9) 72.6 11.8 (5.8) 78.6 Selenium (µg) SP 63.76 (39.10) 123.1 0.143 73.12 (31.87) 144.3 0.465 N-SP 67.63 (51.4) 133.2 71.90 ( 35.36) 143.8 Ascorbic acid (mg) SP 130.7 (92.1) 217.8 0.011 107.6 (81.2) 179.3 0.16 N-SP 82.6 (70.5) 137.6 88.4 (74.4) 147.3 Thiamin (mg) SP 1.5 (0.6) 150.0 0.535 1.5 (0.8) 125.0 0.434 N-SP 1.6 (1.5) 160.0 1.6 (0.8) 133.3 Riboflavin (mg) SP 1.4 (0.5) 100.0 0.029 1.4 (0.6) 100.0 0.292 N-SP 1.1 (0.5) 78.5 1.3 (0.5) 92.8 Nicotinic acid (mg) SP 17.4 (8.3) 102.3 0.178 17.0 (9.8) 100.0 0.151 N-SP 14.8 (9.3) 87.0 14.8 (7.7) 87.0 Pyridoxine (mg) SP 1.3 (0.6) 61.9 0.540 1.4 (0.8) 66.6 0.027 N-SP 1.2 (0.7) 57.2 1.1 (0.6) 52.4 Vit. A (µg) SP 1750.1 (1597.1) 218.7 0.821 2017.3 (1811.3) 201.7 0.152 N-SP 1824.0 (1497.0) 228.0 1600.8 (1200.8) 160.0 Vit. D (µg) SP 4.9 (9.7) 98.0 0.766 5.6 (10.6) 112.0 0.292 N-SP 5.5 (10.4) 110.0 3.8 (6.6) 76.0 Vit. E (mg) SP 7.4 (5.4) 61.6 0.795 7.3 (5.1) 60.1 0.334 N-SP 7.1 (4.7) 59.2 6.5 (4.8) 54.2 Folic acid (µg) SP 166.2 (76.9) 41.5 0.172 155.9 (72.6) 38.9 0.289 N-SP 143.4 (78.0) 35.8 143.0 (66.5) 35.7 Cholesterol (mg) SP 365.7 (245.8) 121.9 0.435 338.7 (192.8) 112.9 0.433 N-SP 328.6 (210.4) 109.0 367.5 (214.5) 122.5 Fiber (g) SP 11.2 (4.7) 44.8 0.553 12.0 (5.2) 48.0 0.603 N-SP 11.9 (5.5) 47.6 11.5 (5.0) 46.0 (a) T-Test. *(SP): Ski People. **(N-SP): Non-Ski People. 054_8267 Ingesta de alimentos y habitos nutricionales entre adolescentes españoles.indd 941 14/01/15 16:38  942 Nutr Hosp. 2015;31(2):936-943 Miguel Mariscal-Arcas et al. differ between ski and non-ski groups, either between SP and N-SP females or between SP and N-SP males. For all study groups, the energy intake was highly sig- nificantly below Spanish recommendations26 for these age groups. The degree to which protein requirements are in- creased in children undertaking endurance training is not yet established. Based on research conducted on endurance and strength in adult athletes, many sports nutritionists and exercise physiologists recommend protein intakes for these groups that exceed recom- mended values (1.2-1.6 g/Kg/day and 1.2-1.7 g/Kg/ day) respectively9. They also recommend 1.5 g/Kg/ day of protein for adolescents undergoing growth spurt, which was around the mean intake found for the present study population, significantly higher than Spanish recommendations and also considered ade- quate for situations of high physical activity. In adults performing prolonged or repeated high-inten- sity exercise, carbohydrate is considered the limiting fuel for maintaining the work rate13. Children are thought to lack the full development of glycolytic capacity11; there- fore, fats may play a role as important as that of carbohy- drates in supporting performance. The difference between childhood and adulthood in muscle enzymatic capacity for glycogenolysis may disappear during the adolescent period, given that little or no difference from adult values has been observed in muscle glycolytic enzymes among adolescents aged 13 to 15 yrs31. When glycogen stores are depleted during exercise, athletes can obtain as much as 5% to 10% of energy needs from the oxidation of body protein. This is an undesirable response in growing young athletes, supporting the recommendation for an adequate carbohydrate intake to maintain adequate muscle and li- ver glycogen concentrations32. A deficit in the daily ener- gy from carbohydrates is commonly observed in contem- porary populations, and these adolescents only received 43% of their energy from carbohydrates comparison to the recommended 60%33. This low daily contribution of carbohydrates is compensated with an excess of energy from fats, which represented 42% of the energy intake of the present study population, in comparison to the re- commended 25% to 30%9. Dietary fat also facilitates ab- sorption of essential fat-soluble vitamins and carotenoids, which are all required in a healthy diet. A chronic inadequate intake of iron-rich food can re- duce body iron stores, impairing muscle metabolism and affecting cognitive function34,35, and iron intake appeared to be low in the present study population. Calcium is well known to interfere with the absorption of heme and non-heme forms of iron11, but the intake of the present sports and non-sports groups remained within Spanish recommendations (1000mg/day), with no significant di- fferences among the study groups. Results of the logistic regression analysis showed that the maintenance of a normal weight was favored by the practice of skiing, the consumption of sugar-free drinks, and supplementation with vitamins/mineral salts and was negatively associated with body weight dissatisfaction, intake of nutritional supplements other than vitamins or minerals, and the consumption of snacks. To summarize, no significant differences were found in nutrient intake or eating behavior between ski and non-ski groups. However, the sports-involved adolescent group showed lower BMI values and a smaller percen- tage of overweight individuals in comparison to their non-sporting peers, reflecting the significantly higher number of hours per day that the former devoted to phy- sical activity. These findings confirm the major impact of physical activity on the control of obesity in young people. Finally, the information gathered on supplement consumption was limited. A more detailed exploration of supplement use could yield important information on its impact on overall nutrient adequacy. Competing interests All authors revised and approved the manuscript. None of the authors had a conflict of interest. This Table IV Logistic regression analysis of influence of study variables on normal-weight/overweight B p OR 95.0% C I Lower Upper Skiing 1.222 0.006 3.393 1.411 8.161 Sugar-free soft drinks 0.745 0.052 2.107 0.995 4.462 Vit.-mineral supplements* 1.467 0.025 4.334 1.201 15.643 Other supplements* -1.420 0.078 0.242 0.050 1.175 Satisfied with weight -0.828 0.044 0.437 0.196 0.976 Tried to lose weight* 0.635 0.140 1.887 0.812 4.386 Snack -1.416 0.001 0.243 0.111 0.531 Constant -3.175 0.084 0.042 *In the previous 12 months 054_8267 Ingesta de alimentos y habitos nutricionales entre adolescentes españoles.indd 942 14/01/15 16:38  943 Nutr Hosp. 2015;31(2):936-943 Differences in food intake and nutritional habits between Spanish adolescents who engage in ski activity and those who do not work was supported by grants from the Spanish Mi- nistry of Education and Science (FPU program). 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