 Good morning. Thank you very much, Andrew, for your kind presentation. First of all, I would like to thank the Gini Initiative for inviting me to participate in the second summit. And I would like to apologize because the change in the program was due to a technical problem I had with my presentation, and I hope it will work now. And the aim of this presentation is to address some results we obtained in a project that was supported by the European Union that is called the Helena Study. First of all, I would like to highlight that yogurt is one of the food items or food categories within the daily products food group. And I think, as the previous speakers already did, we should consider yogurt intake in the context of milk and daily products intake and also their relationship with human nutrition in general. And this is the portrait of a recent document published by FAO that I recommend you to read it because it's very relevant and very interesting. But going to the topic of my presentation, one of the main problems, public health problems and also a cardiometabolic risk factor is obesity in children and also in adolescents. And just to remind you that when we are talking about obesity, obesity is an excess of body fat. But in theory, it's very clear. But in practice, we don't have adequate methods in order to define or to measure this excess of body fat and even less, we don't have adequate cut-off values to define the excess of body weight. In any case, obesity in children and adolescents is a very relevant problem because this is not just an excess of this tissue. It is associated already in children and adolescents with complications affecting almost all the organs and systems in our body. Probably the most frequent complications are the psychosocial ones, but probably the most relevant in the long term are cardiovascular complications like hypertension or dyslipidemia and endocrine complications, especially the development of type 2 diabetes. In this context, very often we use to talk about the metabolic syndrome, even if this is discussed and even more discussed in children and adolescents, but in general, I recommend to include different complications, cardiovascular and endocrine complications of obesity like insulin resistance, hyperinsulinemia, dyslipidemia with elevated triglyceride levels and low HDL cholesterol concentrations, glucose intolerance and or type 2 diabetes and hypertension. In this regard, we can classify individuals, children and adolescents as having the metabolic syndrome or another strategy used mainly in epidemiological studies is to compute a quantitative score of the risk of complications related with the cardiovascular diseases. In relation with obesity, this was already commented in the previous presentations and in the case of obesity in children and adolescents and as a background, we had the opportunity of reviewing the role of different dietary factors and food habits in the development of obesity and one of the conclusions was that available evidence does not allow recommendations on the role of calcium or dairy products in the development of obesity. This was published in 2011, it's a position paper of the ESGAM Committee on Nutrition that was led at that time by Rana Shamir. This is also the conclusion of another very recent review on the role of the dairy products intake in children and adolescents and the relationship with some health outcomes and one of the conclusions was that despite concerns that energy provided by dairy may contribute to childhood obesity, that was an idea that was in the scientific literature, evidence presented in this review overwhelmingly supports a null or inverse association between milk or dairy product intake and indicators of adiposity. So this is the context of the study we perform or the analysis we perform in the frame of the Elena study and the objective was to investigate the relationship between dairy consumption in general and cardiovascular diseases risk factors in a sample of adolescents aged 12.5 to 17.5 years from eight European cities participating in the cross-sectional Elena study. Of course we will address the limitations that are always linked to the cross-sectional designs but you will see that we make some observations that can be useful mainly to design future studies. The Elena study as I already mentioned is a cross-sectional study that was performed in European cities from the north, Stockholm to the south, Eraklion for instance and from the east, Pech in Hungary to the west, Lille or Zaragoza in France and Spain. So we had nine countries, ten cities because in Greece we assess adolescents from Athens but also Eraklion where the Mediterranean diet was described in the 1960s and the aim was to recruit at least 350 adolescents per city and at the end in between 3,500 adolescents. And from the beginning because we were planning to make an extensive assessment of the nutritional status in the blood we decided to only obtain blood samples in one third of the total study sample so at the end in between 1,000 and 1,200 adolescents. So at the end in reality we were able to recruit 3,528 adolescents 1,845 females and 1,683 males and we obtained information in relation with different dimensions for example for diet, eating attitudes, nutrition knowledge, etc. but we obtained dietary intake using the Elena diet software for repeated 24-hour recalls and the aim was to obtain two 24-hour recalls, one from a weekday and one from a weekendday. So the adolescents were feeling the questionnaire in the computer room and we had also a lot of pictures, just a parenthesis to say that no one of the countries participating had English as the mother language all the materials were developed in English because it was the only common language but we don't have versions in English for example of the software and this is the version in Spanish as you can see. So we have different foods, we have also reminders for example in relation with water consumption, meal consumption, butter consumption, etc. and what was more important was that we had different portions so adolescents selected the portion they remember they ate the previous 24 hours to make the recall so this is for example a classic Spanish recipe and we did validation of the tool here in this paper we describe the development and evaluation of this 24-hour recall it is important to highlight that we consider 31 food groups that were the target for the analysis we did for this presentation and we also did a validation, I don't have time to go into the details comparing the food and nutrient intake and concentration biomarkers in these adolescents focusing on dairy products we consider four groups as you can see here milk including milk and butter milk the second group was yogurt, milk and yogurt based beverages including yogurt, yogurt and milk beverages like chocolate milk and probiotic beverages and also white cheese also cheese and milk based desserts and in our study no distinction was done on the fat content in any of these food groups of course we assess body composition using anthropometry, weight, height, skin folds also circumferences but also bioelectrical impedance and we did some methodological work using air displacement pathismography as it is a multi-center study it was important to assess the reliability of the measurements this is especially relevant for the skin folds and we can see here the intra-observer reliability was in all the cities higher than 95% and probably more difficult was to have a good inter-observer reliability and here again for all the skin fold thickness as an example we had a reliability that was higher than 90% we also assess cardiorespiratory fitness because as we will see later is one of the items that is included in one score we computed using the 20 meter shuttle run test and we did already some publications in this regard and we obtain an important set of biomarkers from the most typical glucose for example cholesterol, total cholesterol, HDL cholesterol triglycerides but also as you can see insulin, different vitamins, etc with all these variables we measure at the end we compute a continuous score of cluster cardiovascular diseases risk factors as it was suggested in this publication in 2006 so the variables we consider were systolic blood pressure, the sum of four skin folds we measure also in our study triglycerides, serum concentrations the ratio of total cholesterol to HDL cholesterol the HOMA index and also cardiorespiratory fitness so we computed first sex-specific set of scores and then we added up all the results of the set of scores of the different variables for the statistical analysis we use first discriminant analysis to distinguish participants at high and low cardiovascular diseases risk according to the distribution of food consumption and when we started this analysis we used the stepwise method including all the food groups the 31 food groups that were entered simultaneously and we observed that in comparison to the rest of the food groups milk and the food group yogurt, milk and yogurt base Weber HS showed the highest standardized canonical discriminant coefficients and accounted for a very important variability for the majority of the cardiovascular diseases risk factors in both males and females for this reason we decided to focus in these two food groups milk and yogurt so we continue with the analysis I'm going to summarize we performed multiple linear regression also one way analysis of covariance and we consider as confounders something it's important in adolescence, pubertal maturity socioeconomic status of course and other lifestyles that could be also related with the risk of cardiovascular diseases as moderate vigorous physical activity sedentary behaviors in take at least so at the end because we needed to have adolescence with complete measurements of all these variables we were able to analyze 511 subjects 49.9 boys and we compare this specific sample with the complete sample in which we obtain blood and we didn't observe significant differences for example age, weight, height and body mass index so we are coming to the results here we can see the standardized regression coefficients examining the association of the food groups milk then yogurt and then we added up milk plus yogurt and yogurt base and we have a vivacious intake on or in relation with the cardiovascular diseases risk factors here and this is already published in pediatric obesity and we observe an inverse association between these food groups and some indicators of body composition if we focus on girls that especially the yogurt group was associated and the association was higher when we added up milk to yogurt and yogurt base beverages and this was for a set score of body mass index, weight circumference and the sum of skin force we also observe and this was also very interesting for us the negative association between especially the yogurt group but also the combination of the two food groups with cardiorespiratory fitness and in girls we observe a negative association with triglyceride serum concentrations and also but only in girls we observe a negative association between these food groups and the cardiovascular diseases risk score including all the variables I presented to you before we also perform an analysis classifying the adolescents according to their tiles of consumption of the different food groups here milk and you can see that for example for waist circumference there was not any significant difference but when we consider the group of yogurt adjusting for these variables we observe a significant difference in girls between adolescents being in the third tile one and those being in third tile two of yogurt consumption and when we consider the overall daily consumption we also observe or we observe a stronger association always in girls for waist circumference and also for the sum of skimful fitness and finally for the cardiovascular diseases risk score when we consider milk or yogurt as separate food groups we found some associations but this association was stronger when we consider the overall daily consumption because those being in the third tile one had a very or quite high cardiovascular diseases risk score and those in third tile three this score was lower but we had also the results of the complete sample of the study and this could be relevant to address the specific topic of obesity or body composition so taking it to account that we were planning to make this presentation we did a supplementary analysis that is not included in the paper so the requirement here was to have adolescents with complete measurements on body composition and also dietary intake at the end we had a sample of 1,422 adolescents close to 45 boys and again there was no difference between this specific sample and the complete sample in terms of age, weight, height and body massimics and here we obtained similar results for example for the set score of BMI there were clear differences in girls between those consuming the overall daily from third tile one to third tile three and this was also the case for waist circumference here both in boys and in girls and for the sum of skin faults here also in this case in boys so these are the results we obtained and as I already showed to you at the beginning of the presentation there was a recent review on the topic of the relationship with obesity and the summary of this review they described that there were 35 observational and intervention studies that were included in the review and 34 reported null or inverse associations between dating take and different indicators of body composition and energy balance there were five randomized control trials and four found no association between dating take and measures of a depositive always in children and adolescents and one found an inverse association and it is important also to highlight that 23 of the 35 studies the majority were obtained in the US so we need also to perform analysis in Europe and in other regions and of course it is important to consider the potential mechanisms to explain these results some of them were already commented by Professor Tremblay but the first one is the replacement of some foods by others the potential effect also of dietary calcium that is suppressing calcitriol and calcitriol stimulated influx of calcium into the adipocytes and potentially inhibiting lipogenesis and promoting lipolysis another potential mechanism is through the angiotensin converting enzyme inhibitory peptides in way protein that stimulates adipocyte lipogenesis dairy proteins they were already mentioned that potentially support better the synthesis of proteins in the muscles than plant foods and by this way could enhance anabolisms and potentially increase energy expenditures specific amino acids and also for example the presence of conjugated linoleic acid in dairy products so to conclude in this cross-sectional study with all the limitations of this design in European adolescence we observed an inverse association between yogurt, milk and yogurt-based beverages and some cardiovascular diseases risk factors especially excess total and abdominal body fat the association was stronger when we added up milk intake in my opinion there is a need of having observational studies considering yogurt as an individual food category what is very often missing and of course we need also randomized control trials to provide evidence supporting these findings and also trying to understand the specific mechanisms just to finish to acknowledge the support mainly of the European Commission for different projects specifically for Elena here you can see the website where you can find here the papers we are publishing of course this is the effort of a lot of people this was our last meeting in Granada in Spain and just to thank you very much for your attention