Lifestyle patterns and endocrine, metabolic, and immunological biomarkers in European adolescents: The HELENA study

Pediatr Diabetes. 2019 Feb;20(1):23-31. doi: 10.1111/pedi.12802. Epub 2018 Dec 13.


Objective: To evaluate the association of lifestyle patterns related to physical activity (PA), sedentariness, and sleep with endocrine, metabolic, and immunological health biomarkers in European adolescents.

Methods: The present cross-sectional study comprised 3528 adolescents (1845 girls) (12.5-17.5 years) enrolled in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Cluster analysis was performed by including body composition, PA by accelerometry, self-reported sedentary behaviors, and sleep duration. We also measured endocrine, metabolic, and immunological biomarkers.

Results: Three-cluster solutions were identified: (a) light-PA time, moderate-vigorous-PA time and sedentary time, (b) light-PA time, moderate-vigorous-PA time, sedentary time and sleep time, (c) light-PA time, moderate-vigorous-PA time, sedentary time and body composition. In addition, each cluster solution was defined as: "healthy," "medium healthy," and "unhealthy" according to the presented rating. Analysis of variance showed that overall the healthiest groups from the three clusters analyzed presented a better metabolic profile. A decision tree analysis showed that leptin had a strong association with cluster 3 in both boys and girls, high-density lipoprotein cholesterol had the strongest association with clusters 1 and 3 in boys. Cortisol had the strongest association with cluster 1. HOMA index (homeostatic model assessment) and C3 showed a strong association with cluster 3 in girls.

Conclusions: Our results support the existence of different interactions between metabolic health and lifestyle patterns related to PA, sedentariness, and sleep, with some gender-specific findings. These results highlight the importance to consider multiple lifestyle-related health factors in the assessment of adolescents' health to plan favorable strategies.

Keywords: cardiometabolic biomarkers; physical activity; sedentary behavior; sleep time; youth.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accelerometry
  • Adolescent
  • Adolescent Behavior / physiology*
  • Adolescent Nutritional Physiological Phenomena
  • Biomarkers / analysis*
  • Biomarkers / metabolism
  • Body Composition / physiology
  • Child
  • Cross-Sectional Studies
  • Energy Metabolism / physiology*
  • Europe / epidemiology
  • Exercise / physiology
  • Female
  • Hormones / analysis*
  • Hormones / blood
  • Humans
  • Immune System / metabolism
  • Immune System / physiology*
  • Life Style*
  • Male
  • Sedentary Behavior
  • Sleep / physiology


  • Biomarkers
  • Hormones