Background and Aims: To assess the compliance levels of adolescents in the Balearic Islands with the Mediterranean Diet Quality Index (KIDMED Index) and to assess its associations with socioeconomic, anthropometric and lifestyle characteristics. Methods: A cross-sectional survey (n = 1,231; 12-17 years) carried out in 2007-2008. The degree of adherence to the Mediterranean diet (MedDiet) was evaluated using the KIDMED Index. Body composition, body image, socioeconomic factors, and physical activity were also assessed. Results: Around 30% of adolescents showed high adherence to MedDiet and 15.7% showed poor adherence. More boys (32.0%) than girls (25.2%) showed high adherence to MedDiet. However, the proportion of adolescents who were reported to skip breakfast was higher among girls than boys (30.0 vs. 19.2%, respectively). The OR for poor adherence to MedDiet was higher in adolescents who usually attend mass media during mealtime, in boys eating ≤3 occasions/day, and in physically inactive girls. In boys, poor adherence to MedDiet was associated with lower OR in the age range 12-13 and in those who wished to have a thin body shape. In girls, high parental educational level, time spent on media <2 h/day and eating breakfast regularly were also associated with lower OR for poor adherence to MedDiet. Conclusions: A high percentage of adolescents in Balearic Islands showed poor adherence to MedDiet.

Keywords:
Adolescents, Dietary habits, Mediterranean diet, KIDMED, Balearic Islands
1.
Aranceta J, Pérez-Rodrigo C, Ribas L, Serra-Majem L: Sociodemographic and lifestyle determinants of food patterns in Spanish children and adolescents: the enKid study. Eur J Clin Nutr 2003;57(suppl 1):S40-S44.
2.
Neumark-Sztainer D, Hannan PJ, Story M, Croll J, Perry C: Family meal patterns: associations with sociodemographic characteristics and improved dietary intake among adolescents. J Am Diet Assoc 2003;103:317-322.
3.
Lake AA, Mathers JC, Rugg-Gunn AJ, Adamson AJ: Longitudinal change in food habits between adolescence (11-12 years) and adulthood (32-33 years): the ASH30 study. J Public Health (Oxf) 2006;28:10-16.
4.
Sofi F, Cesari F, Abbate R, Gensini GF, Casini A: Adherence to Mediterranean diet and health status: meta-analysis. BMJ 2008;337:a1344.
5.
Bach A, Serra-Majem L, Carrasco JL, Roman B, Ngo J, Bertomeu I, Obrador B: The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review. Public Health Nutr 2006;9:132-146.
6.
Serra-Majem L, Ribas L, Ngo J, Ortega RM, García A, Pérez-Rodrigo C, Aranceta J: Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean diet quality index in children and adolescents. Public Health Nutr 2004;7:931-935.
7.
Bibiloni Mdel M, Martinez E, Llull R, Juarez MD, Pons A, Tur JA: Prevalence and risk factors for obesity in Balearic Islands adolescents. Br J Nutr 2010;103:99-106.
8.
Bibiloni Mdel M, Martínez E, Llull R, Pons A, Tur JA: Western and Mediterranean dietary patterns among Balearic Islands' adolescents: socio-economic and lifestyle determinants. Public Health Nutr 2012;15:683-692.
9.
Bibiloni Mdel M, Pons A, Tur JA: Defining body fatness in adolescents: a proposal of the AFAD-A classification. PLoS One 2013;8:e55849.
10.
Bibiloni Mdel M, Pich J, Pons A, Tur JA: Body image and eating patterns among adolescents. BMC Public Health 2013;13:1104.
11.
Alvarez C, Alonso J, Domingo A, Regidor E: La medición de la clase social en ciencias de la salud. Barcelona: SG-Sociedad Española de Epidemiología, 1995.
12.
Slaughter MH, Lohman TG, Boileau RA, Horswill CA, Stillman RJ, van Loan MD, Bemben DA: Skinfold equations for estimation of body fatness in children and youth. Hum Biol 1988;60:709-723.
13.
Rodríguez G, Moreno LA, Blay MG, Blay VA, Fleta J, Sarría A, Bueno M; AVENA-Zaragoza Study Group: Body fat measurement in adolescents: comparison of skinfold thickness equations with dual-energy X-ray absorptiometry. Eur J Clin Nutr 2005;59:1158-1166.
14.
Bibiloni Mdel M, Pich J, Córdova A, Pons A, Tur JA: Association between sedentary behaviour and socioeconomic factors, diet and lifestyle among the Balearic Islands adolescents. BMC Public Health 2012;12:718.
15.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000;320:1240-1243.
16.
Alvero-Cruz JR, Alvarez Carnero E, Fernández-García JC, Barrera Expósito J, Carrillo de Albornoz Gil M, Sardinha LB: [Validity of body mass index and fat mass index as indicators of overweight status in Spanish adolescents: Esccola study]. Med Clin (Barc) 2010;135:8-14.
17.
IPAQ - International Physical Activity Questionnaire: Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ). www.ipaq.ki.es (accessed October 19, 2007).
18.
Hagströmer M, Bergman P, De Bourdeaudhuij I, Ortega FB, Ruiz JR, Manios Y, Rey-López JP, Phillipp K, von Berlepsch J, Sjöström M; HELENA Study Group: Concurrent validity of a modified version of the International Physical Activity Questionnaire (IPAQ-A) in European adolescents: the HELENA study. Int J Obes (Lond) 2008;32(suppl 5):S42-S48.
19.
Vicente-Rodríguez G, Rey-López JP, Martín-Matillas M, Moreno LA, Wärnberg J, Redondo C, Tercedor P, Delgado M, Marcos A, Castillo M, Bueno M; AVENA Study Group: Television watching, videogames, and excess of body fat in Spanish adolescents: the AVENA study. Nutrition 2008;24:654-662.
20.
Moraes AC, Fernandes CA, Elias RG, Nakashima AT, Reichert FF, Falcão MC: [Prevalence of physical inactivity and associated factors in adolescents]. Rev Assoc Med Bras 2009;55:523-528.
21.
Strong WB, Malina RM, Blimkie CJ, et al: Evidence based physical activity for school-age youth. J Pediatr 2005;146:732-737.
22.
Stunkard AJ, Sorensen T, Schulsinger F: Use of the Danish adoption register for the study of obesity and thinness. Res Publ Assoc Res Nerv Ment Dis 1983;60:115-120.
23.
Mariscal-Arcas M, Rivas A, Velasco J, Ortega M, Caballero AM, Olea-Serrano F: Evaluation of the Mediterranean Diet Quality Index (KIDMED) in children and adolescents in Southern Spain. Public Health Nutr 2009;12:1408-1412.
24.
Ayechu Díaz A, Durá Travé T: Dieta mediterránea y adolescentes. Nutr Hosp 2009;24:759-760.
25.
Kontogianni MD, Vidra N, Farmaki AE, Koinaki S, Belogianni K, Sofrona S, Magkanari F, Yannakoulia M: Adherence rates to the Mediterranean diet are low in a representative sample of Greek children and adolescents. J Nutr 2008;138:1951-1956.
26.
Lazarou C, Panagiotakos DB, Matalas AL: Level of adherence to the Mediterranean diet among children from Cyprus: the CYKIDS study. Public Health Nutr 2009;12:991-1000.
27.
Papadaki S, Mavrikaki E: Greek adolescents and the Mediterranean diet: factors affecting quality and adherence. Nutrition 2015;31:345-349.
28.
Martínez E, Llull R, Del Mar Bibiloni M, Pons A, Tur JA: Adherence to the Mediterranean dietary pattern among Balearic Islands adolescents. Br J Nutr 2010;103:1657-1664.
29.
Sweeting HN: Gendered dimensions of obesity in childhood and adolescence. Nutr J 2008;7:1.
30.
Fernández San Juan PM: Dietary habits and nutritional status of school aged children in Spain. Nutr Hosp 2006;21:374-378.
31.
Lazarou C, Matalas AL: Breakfast intake is associated with nutritional status, Mediterranean diet adherence, serum iron and fasting glucose: the CYFamilies study. Public Health Nutr 2015;18:1308-1316.
32.
Hu FB: Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 2002;13:3-9.
33.
Tur JA, Puig MS, Benito E, Pons A: Associations between sociodemographic and lifestyle factors and dietary quality among adolescents in Palma de Mallorca. Nutrition 2004;20:502-508.
34.
Yannakoulia M, Lykou A, Kastorini CM, Saranti Papasaranti E, Petralias A, Veloudaki A, Linos A; DIATROFI Program Research Team: Socio-economic and lifestyle parameters associated with diet quality of children and adolescents using classification and regression tree analysis: the DIATROFI study. Public Health Nutr 2015; Epub ahead of print. DOI: 10.1017/S136898001500110X1-9.
35.
Kontogianni MD, Farmaki AE, Vidra N, Sofrona S, Magkanari F, Yannakoulia M: Associations between lifestyle patterns and body mass index in a sample of Greek children and adolescents. J Am Diet Assoc 2010;110:215-221.
36.
Fernández San Juan PM: Dietary habits and nutritional status of school aged children in Spain. Nutr Hosp 2006;21:374-378.
37.
Ebbeling CB, Pawlak DB, Ludwig DS: Childhood obesity: public-health crisis, common sense cure. Lancet 2002;360:473-482.
38.
Rey-López JP, Vicente-Rodríguez G, Répásy J, Mesana MI, Ruiz JR, Ortega FB, Kafatos A, Huybrechts I, Cuenca-García M, León JF, González-Gross M, Sjöström M, de Bourdeaudhuij I, Moreno LA: Food and drink intake during television viewing in adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Public Health Nutr 2011;14:1563-1569.
39.
Lazarou C, Panagiotakos DB, Matalas AL: Physical activity mediates the protective effect of the Mediterranean diet on children's obesity status: the CYKIDS study. Nutrition 2010;26:61-67.
40.
Schröder H, Mendez MA, Ribas-Barba L, Covas MI, Serra-Majem L: Mediterranean diet and waist circumference in a representative national sample of young Spaniards. Int J Pediatr Obes 2010;5:516-519.
41.
Grao-Cruces A, Nuviala A, Fernández-Martínez A, Porcel-Gálvez AM, Moral-García JE, Martínez-López EJ: [Adherence to the Mediterranean diet in rural and urban adolescents of southern Spain, life satisfaction, anthropometry, and physical and sedentary activities]. Nutr Hosp 2013;28:1129-1135.
42.
Middleman AB, Vazquez I, Durant RH: Eating patterns, physical activity, and attempts to change weight among adolescents. J Adolesc Health 1998;22:37-42.
43.
Alió-Sanz J, Iglesias-Conde C, Pernía JL, Iglesias-Linares A, Mendoza-Mendoza A, Solano-Reina E: Retrospective study of maxilla growth in a Spanish population sample. Med Oral Patol Oral Cir Bucal 2011;16:e271-e277.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.