Inadequate eating habits in adolescence are an important risk factor for obesity and other chronic non-communicable diseases in adulthood. The school environment can have a relevant impact on adolescent behaviour, since many habits acquired in this phase affect the individual throughout life, with visible effects on health. In this study, we aimed to evaluate the association between food sales at Brazilian schools and ultra-processed food consumption among adolescents. The Study of Cardiovascular Risk Factors in Adolescents (ERICA) was a nationwide, school-based survey conducted from 2013 to 2014, including public and private schools in 121 Brazilian cities. Dietary intake was assessed via a 24-hour recall, and foods were divided according to the Nova Classification based on the degree of processing. Unadjusted and adjusted linear regression models were used to assess the association between exposure to school food sales and intake of ultra-processed food. The prevalence of exposure to food sales was 55.2% and the mean diet share of ultra-processed foods was 34.5%. Exposure to food sales in schools was associated with higher consumption of ultra-processed food (β=0.11; p=0.002). The results were similar when the analyses were stratified according to sex, usual intake of school meals, and public-school attendance (β=0.11; p=0.002). The association between exposure to food sales in schools and higher consumption of ultra-processed food suggests that school sales can influence adolescents’ food choices.

Regular physical activity for adults is associated with optimal appetite regulation, though little work has been performed in adolescents. To address this gap in the literature, we conducted a study examining appetite across a range of physical activity and adiposity levels in adolescent males. Healthy males (N=46, 14-18 years old) were recruited across four body weight and activity categories: normal weight/high active (n=11), normal weight/low active (n=13), overweight, obese/high active (n=14), overweight, obese/low active (n=8). Participants from each group completed a six-hour appetite assessment session on Day 0, followed immediately by a 14-day free-living physical activity and dietary assessment period on Days 1-14, and a fitness test session occurring between Days 15-18. Subjective and objective assessment of appetite, resting energy expenditure, body composition using dual energy absorptiometry‘, and thermic effect of feeding was conducted on Day 0. Physiological variables in the normal weight low active group that were different than their peers included lower fat-free mass, cardiorespiratory fitness, glucose/fullness response to a standardized meal, thermic effect of feeding in response to a standardized meal, lower self-rated fullness and satiety, and higher self-rated hunger to a standardized meal. Conversely, the overweight, obese high active group displayed better subjective appetite responses, but higher insulin responses to a standardized meal. Taken together, these results suggest that physical inactivity during adolescence has a negative impact on metabolic health and appetite control which may contribute to future weight gain.

Decreased gut microbial diversity is associated with greater depression symptoms in adults. Findings on the relationship between the gut microbiome and depression or anxiety in children and adolescents are mixed, and evidence syntheses are needed. Seven databases were searched for peer-reviewed studies on the gut microbiome and internalizing symptoms, depression, or anxiety, in children and adolescents (<19 years). Random-effects meta-analyses of alpha diversity indices were performed. Youth advisors validated the research findings’ relevance to their experiences and contributed to dissemination planning. Eight studies were included, representing 2,865 participants (mean age = 11.4 years, SD = 4.3). Study designs were cross-sectional (n = 5), longitudinal (n = 2), and interventional (n = 1). No association was found between alpha or beta diversity and internalizing problems, depression, or anxiety. Increased abundance of genera within phyla Bacillota (e.g., Fusicatenibacter) and Pseudomonadota (e.g., Escherichia), along with decreased abundance of other Bacillota genera (e.g., Faecalibacterium), were associated with depression and anxiety symptoms. This review identified preliminary associations between specific bacterial taxa and depression and anxiety in children and adolescents. Larger studies using comprehensive analytical approaches are needed to explore the role of the gut microbiome in the genesis and treatment of internalizing disorders.

For young people with eating disorders (EDs), family-based therapy (FBT) is generally recommended as first-line treatment. Although there is an abundance of evidence demonstrating the efficacy of FBT, less than half of young people achieve full remission with this treatment. Enhanced cognitive behaviour therapy (CBT-E) is an established alternative to FBT, demonstrating effectiveness in individuals who have not achieved full remission with FBT. It is also recommended when family therapy is unacceptable, contraindicated, or ineffective. Despite some overlap – particularly in addressing maintaining factors and prioritising weight normalisation – the two treatments diverge significantly in conceptualisation of the eating disorder, proposed mechanisms of action, role of both young people and parents, and strategies and processes of therapy. These differences may contribute to one treatment being effective where the other has not, but can present challenges and difficulties for the young person, family and clinician when transitioning from FBT to CBT-E. In this paper, we provide guidance for clinicians delivering CBT-E with young people who have a history of FBT treatment. We highlight common issues encountered among this cohort, discuss how they can present a barrier to successful implementation of CBT-E, and describe solutions.

Key learning aims

1. (1) To learn the commonly encountered barriers to treatment when implementing CBT-E for young people who have previously engaged in FBT.

2. (2) To learn strategies to overcome these barriers focusing on the young person, parents and multi-disciplinary team.

The dietary inflammatory index (DII) has emerged as a promising tool associated with the development of cardiovascular risk factors. This systematic review and meta-analysis, developed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines (the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under number CRD42022323267), aimed to synthesise observational studies that evaluated the association between the DII and indicators of body adiposity and blood pressure in children and adolescents. PubMed/MEDLINE, Embase, LILACS, CINAHL, Web of Science, Scopus and Google Scholar were searched, without time and language restrictions. The methodological quality of the studies and the certainty of the evidence were assessed using the Newcastle–Ottawa scale and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively. The meta-analysis revealed that a higher DII (pro-inflammatory diet) was significantly associated with increased odds of body adiposity, as indicated by body mass index (BMI) (odds ratio [OR] = 1·62; 95% confidence interval [CI] 1·38–1·86), waist circumference (OR = 1·45; 95% CI 1·10–1·81) and the waist-to-height ratio (OR = 1·76; 95% CI 1·38–2·14) in adolescents, compared with those with a lower DII (anti-inflammatory diet). In addition, for every unit increase in the DII, there was a small but significant rise in mean BMI (β = 0·06 kg/m2). The children’s dietary inflammatory index (CDII) showed no association with cardiometabolic risk factors. There were no consistent associations between the DII or CDII and blood pressure. In conclusion, while a pro-inflammatory diet (based on the DII) is linked to body adiposity, additional longitudinal studies are needed to explore these associations, particularly regarding the CDII and blood pressure.

Despite growing evidence of the benefits of delayed school start times in adolescents, only a fraction of high schools globally – including US, Europe and Asia – have adopted later starts. The disadvantages of earlier school times for adolescents elicit primary concerns of decreased academic performance and well-being with a potential for the development of mental health conditions. In this impact paper, we discuss the current evidence and contributing mechanisms regarding insufficient sleep and circadian misalignment related to adolescent school schedules. We conclude by summarizing the obstacles to implementing later school start times and provide recommendations for policy change and potential alternatives to better promote better sleep hygiene and well-being among adolescents.

The aim of this study was to evaluate the relative validity of food and nutrient intakes estimated by a brief-type diet history questionnaire for Japanese children and adolescents (BDHQ15y) designed to assess habitual dietary intake during the previous month. A total of 432 boys and 412 girls aged 6–17 years from thirty-two prefectures in Japan completed the BDHQ15y and subsequently provided 8-day weighed dietary records (DR) on two non-consecutive days over four seasons for comparison. Among the intakes of forty-four nutrients and thirty-one food groups adjusted for energy intake using the density model, the BDHQ15y showed percentage differences in median intake of less than 10 % compared with the DR for nineteen nutrients in both sexes, as well as for eleven and seven food groups in boys and girls, respectively, indicating good agreement for key nutrients and food groups, including protein, fat, carbohydrate, dietary fibre, grains, vegetables, dairy products and sugar-sweetened beverages (SSB). The median values (25th–75th percentiles) of Spearman’s correlation coefficients in boys and girls were 0·33 (0·28–0·38) and 0·28 (0·23–0·35) for nutrients, respectively, and 0·36 (0·29–0·42) and 0·29 (0·24–0·36) for food groups, respectively. Bland–Altman plots showed wide limits of agreement, with overestimation at higher intakes for most nutrients and food groups, except SSB. In conclusion, the BDHQ15y shows promise for large-scale dietary monitoring, particularly for estimating group-level intakes of key nutrients and food groups. However, its limited ability to rank individual intakes and the variability in individual-level assessments necessitate cautious interpretation and application.

Adolescents may not necessarily have a specific mental health challenge to seek information on mental health. They may be genuinely curious on how to better understand these issues, especially when mental health is being discussed in school, among peers and with parents. The purpose of this study was to examine the frequency and factors associated with online information seeking about mental health among adolescents. A total of 702 high school students from Belgrade, Serbia, participated in the study and filled in an anonymous questionnaire about sociodemographics, digital behaviors and the Electronic Health Literacy Scale (eHEALS). The prevalence of seeking information about mental health in our study sample was 23.5% (165/702). The multivariate model showed that having a lower school performance, lower eHEALS score and browsing health blogs, social media and websites run by physicians and health institutions were independently associated with online information seeking about mental health. Additionally, searching for online information about psychoactive substances, bullying and medications was independently associated with online information seeking about mental health among adolescents. Adolescents are familiar with a variety of sources of online health information, but choose specific online platforms to read about mental health. These platforms could be utilized to promote mental well-being in high schools.

This study investigates the epidemiology of adolescent suicide in India, addressing the limited research on the subject. Data on adolescent suicide (14–17 years) by sex and state were obtained from the National Crimes Records Bureau for 2014–2019, which included acquiring unpublished data from 2016 to 2019. Crude suicide rates for the period 2014–2019 were calculated by sex and state. Rate ratios (RRs) by sex and state were also calculated to assess changes over time, comparing suicide rates from 2017–2019 to 2014–2016. Female adolescent suicide rates, which ranged between 9.04 and 8.10 per 100,000 population, were consistently higher than male adolescent suicide rates, which ranged between 8.47 and 6.24 per 100,000 population. Compared to the first half of the study period (2014–2016), adolescent suicide rates significantly increased between 2017 and 2019 among less developed states (RRs = 1.06, 95% uncertainty interval [UI] = 1.03–1.09) and among females in these states (RRs = 1.09, 95% UI = 1.05–1.14). Male suicide rates aligned with global averages, while female rates were two to six times higher than in high-income and Southeast Asian countries. Findings highlight the urgent need for comprehensive surveillance and targeted suicide prevention strategies to address this critical public health issue.