Epidemiological evidences suggest that dietary patterns in the Mediterranean countries are changing rapidly. Objective: To assess the diet quality of Mediterranean adolescents by means of the Mediterranean adaptation of the DQI-I, and its association with socioeconomic, anthropometric, lifestyle and body image characteristics. Cross-sectional survey (n=1231; 12−17 years old) carried out in the Balearic Islands, a Mediterranean region. Diet quality was assessed by means of the DQI-I’s Mediterranean adaptation. Body composition, body image, socioeconomic factors, and physical activity were also assessed. The mean total modified DQI score was around 47.0% (standard deviation: 9.8%) of the possible score (100%). The univariate linear regression analysis showed that age and media screen time were inversely correlated with the DQI score; whereas a direct correlation with parental educational level was found. The DQI score also decreased in physically inactive adolescents and in those adolescents who wish a thicker body shape; whereas increased in those adolescents who wish a thinner body shape. The multivariate linear regression showed that age group, parental educational level, media screen time and body image dissatisfaction were the main associated variables with the DQI score. The assessed Mediterranean adolescents showed a poor-quality diet. Programs to promote the traditional Mediterranean dietary pattern among adolescents and their relatives, combined with active lifestyle, would likely result in a more favorable future health profile.

The Mediterranean diet (MedDiet) includes high amount and frequency consumption of vegetables, fruits, cereals (preferably as whole grain), legumes, nuts and olive oil; moderate consumption of fish and shellfish, white meat, eggs and dairy products; small quantity and frequency consumption of red meat, processed meats, and foods rich in sugars and in fats; and a regular but moderate intake of wine, generally during meals. However, epidemiological evidences suggest that dietary patterns in the Mediterranean countries are changing rapidly, with an increased consumption of animal products and saturated fat and a decline of intake of basic foodstuffs based on vegetables.

The MedDiet has been quantified in diet indices that attempt to make a global evaluation of the quality of the diet based on a traditional MedDiet reference pattern. Diet indexes are known as ‘a priori’, as they are built based on dietary guidelines or recommendations, and ‘a posteriori’, as they consists in defining food patterns once the dietary data are collected and using specific statistical analysis. Referring to the ‘a priori’ defined diet indices, a Mediterranean adaptation of the Diet Quality Index-International (DQI-I) was previously stated assessing the diet of young people in southern Spain, following the Tur et al. modification of the method developed by Kim et al. The Mediterranean DQI adaptation focuses on four aspects of high-quality diet (i.e. variety, adequacy, moderation and overall balance). Specific diet components are assessed under each category. Variety is evaluated as overall variety and as variety of protein; adequacy evaluates the intake of those dietary elements that are required to protect against under-nutrition and deficiency disorders; moderation evaluates the intake of food and nutrients related to chronic diseases, which may need restriction; and overall balance examines diet in terms of proportions of energy sources and fatty acid composition. These categories help users to identify aspects of their diet that may need improvement.

The assessed Mediterranean adolescents showed a poor-quality diet. While parental educational level and physical activity level were directly associated with diet quality, age and media screen time were inversely associated with diet quality. Body image is also a powerful determinant of adolescent diet quality. Adolescents constitute priority targets for action and should be more aware about the diet quality and its health benefits. Programs to promote the traditional Mediterranean dietary pattern among adolescents and their relatives, combined with active lifestyle, would likely result in a more favorable future health profile.

With Regards,
Joseph Kent
Journal Manager
Journal of Clinical Nutrition & Dietetics