Determinants of Adherence to the Mediterranean Diet in Spanish Children and Adolescents: The PASOS Study

A progressive shift away from traditional healthy dietary patterns, such as the Mediterranean diet (MedDiet), has been observed in recent decades. The aim of this study was to assess determinants of optimal adherence to the MedDiet in Spanish children and adolescents. A cross-sectional analysis was included in the PASOS nationwide representative study in Spain. Participants were 3607 children and adolescents; 8-16 years old. Primary and secondary outcome measures of weight and height were measured. Adherence to the MedDiet, physical activity, and sedentary behavior in children and adolescents, as well as parental physical activity and dietary habits, were assessed. Optimal adherence to the MedDiet was observed in 45.5% of primary school students and 34.8% of secondary school students (OR: 0.65; 95%CI: 0.56-0.75). Optimal adherence to the MedDiet was higher in children/adolescents meeting daily recommended moderate and vigorous physical activity (OR: 2.39, 95%CI: 1.97-2.89) and in those meeting daily recommended screen time on weekdays (OR: 2.05, 95%CI: 1.77-2.38) and weekends (OR: 1.76, 95%CI: 1.48-2.10). Participants with optimal adherence to the MedDiet were more likely to have mothers with a high-level education and high-tercile of SDQS, mothers who never smoked or were former smokers, and mothers who met the recommended physical activity and screen time. It can be concluded that a low prevalence of optimal adherence to the MedDiet was found among current Spanish children and adolescents. Optimal adherence to the MedDiet was associated with reaching the recommendations on physical activity and screen time, with the highest maternal educational level, and healthier maternal lifestyles.

Citing Articles

Eating distractions as predictors of ultra-processed food consumption and Mediterranean diet adherence in adolescents.

Lopez-Gil J, Quiroz-Cardenas F, Montenegro-Espinosa J, Cisneros-Vasquez E, Mino C, Castillo-Minaca M Sci Rep. 2025; 15(1):7579.

PMID: 40038379 PMC: 11880373. DOI: 10.1038/s41598-025-91754-x.

Healthier Diet and Diet-Related Behaviors Are Associated with Increased Physical Activity and Reduced Sedentary Behavior Among Adolescents in Greece.

Chaireti E, Orfanos P, Fotiou A, Kanavou E, Stavrou M, Richardson C Nutrients. 2025; 17(3).

PMID: 39940239 PMC: 11820917. DOI: 10.3390/nu17030381.

Lifestyle Factors Associated with Children's and Adolescents' Adherence to the Mediterranean Diet Living in Mediterranean Countries: The DELICIOUS Project.

Rosi A, Scazzina F, Giampieri F, Alvarez-Cordova L, Abdelkarim O, Ammar A Nutrients. 2025; 17(1.

PMID: 39796460 PMC: 11722675. DOI: 10.3390/nu17010026.

Switching Mediterranean Consumers to Mediterranean Sustainable Healthy Dietary Patterns (SWITCHtoHEALTHY): Study Protocol of a Multicentric and Multi-Cultural Family-Based Nutritional Intervention Study.

Calderon-Perez L, Domingo A, Bas J, Gutierrez B, Crescenti A, Rahmani D Nutrients. 2024; 16(22).

PMID: 39599724 PMC: 11597679. DOI: 10.3390/nu16223938.

Cross-Sectional Assessment of Nutritional Status, Dietary Intake, and Physical Activity Levels in Children (6-9 Years) in Valencia (Spain) Using Nutrimetry.

Morales-Suarez-Varela M, Peraita-Costa I, Llopis-Morales A, Llopis-Gonzalez A Nutrients. 2024; 16(16).

PMID: 39203786 PMC: 11356814. DOI: 10.3390/nu16162649.

References

De Santi M, Callari F, Brandi G, Toscano R, Scarlata L, Amagliani G . Mediterranean diet adherence and weight status among Sicilian Middle school adolescents. Int J Food Sci Nutr. 2020; 71(8):1010-1018. DOI: 10.1080/09637486.2020.1751089. View

Grao-Cruces A, Nuviala A, Fernandez-Martinez A, Porcel-Galvez A, Moral-Garcia J, Martinez-Lopez E . [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(4):1129-35. DOI: 10.3305/nh.2013.28.4.6486. View

Rosa Guillamon A, Carrillo Lopez P, Garcia Canto E, Perez Soto J, Tarraga Marcos L, Tarraga Lopez P . Mediterranean diet, weight status and physical activity in schoolchildren of the Region of Murcia. Clin Investig Arterioscler. 2018; 31(1):1-7. DOI: 10.1016/j.arteri.2018.09.002. View

Bibiloni M, Pons A, Tur J . Compliance with the Mediterranean Diet Quality Index (KIDMED) among Balearic Islands' Adolescents and Its Association with Socioeconomic, Anthropometric and Lifestyle Factors. Ann Nutr Metab. 2015; 68(1):42-50. DOI: 10.1159/000442302. View

Gallardo-Alfaro L, Bibiloni M, Mateos D, Ugarriza L, Tur J . Leisure-Time Physical Activity and Metabolic Syndrome in Older Adults. Int J Environ Res Public Health. 2019; 16(18). PMC: 6765775. DOI: 10.3390/ijerph16183358. View

Costarelli V, Koretsi E, Georgitsogianni E . Health-related quality of life of Greek adolescents: the role of the Mediterranean diet. Qual Life Res. 2012; 22(5):951-6. DOI: 10.1007/s11136-012-0219-2. View

Molina L, Sarmiento M, Penafiel J, Donaire D, Garcia-Aymerich J, Gomez M . Validation of the Regicor Short Physical Activity Questionnaire for the Adult Population. PLoS One. 2017; 12(1):e0168148. PMC: 5234797. DOI: 10.1371/journal.pone.0168148. View

Esteban-Cornejo I, Izquierdo-Gomez R, Gomez-Martinez S, Padilla-Moledo C, Castro-Pinero J, Marcos A . Adherence to the Mediterranean diet and academic performance in youth: the UP&DOWN study. Eur J Nutr. 2015; 55(3):1133-40. DOI: 10.1007/s00394-015-0927-9. View

Schroder H, Subirana I, Warnberg J, Medrano M, Gonzalez-Gross M, Gusi N . Validity, reliability, and calibration of the physical activity unit 7 item screener (PAU-7S) at population scale. Int J Behav Nutr Phys Act. 2021; 18(1):98. PMC: 8285783. DOI: 10.1186/s12966-021-01169-w. View

10.

Barja-Fernandez S, Pino Juste M, Portela Pino I, Leis Trabazo R . [Evaluation of food habits and physical activity in Galician students]. Nutr Hosp. 2019; 37(1):93-100. DOI: 10.20960/nh.02668. View

11.

Gasser C, Mensah F, Russell M, Dunn S, Wake M . Confectionery consumption and overweight, obesity, and related outcomes in children and adolescents: a systematic review and meta-analysis. Am J Clin Nutr. 2016; 103(5):1344-56. DOI: 10.3945/ajcn.115.119883. View

12.

Gomez S, Homs C, Warnberg J, Medrano M, Gonzalez-Gross M, Gusi N . Study protocol of a population-based cohort investigating Physical Activity, Sedentarism, lifestyles and Obesity in Spanish youth: the PASOS study. BMJ Open. 2020; 10(9):e036210. PMC: 7513598. DOI: 10.1136/bmjopen-2019-036210. View

13.

Naska A, Trichopoulou A . Back to the future: the Mediterranean diet paradigm. Nutr Metab Cardiovasc Dis. 2014; 24(3):216-9. DOI: 10.1016/j.numecd.2013.11.007. View

14.

Sobejano Tornos I, Moreno Iribas C, Vines Rueda J, Grijalba Uche A, Amezqueta Goni C, Serrano Martinez M . [Population-based study of leisure time physical activity]. Gac Sanit. 2009; 23(2):127-32. DOI: 10.1016/j.gaceta.2008.04.007. View

15.

Chacon-Cuberos R, Zurita-Ortega F, Martinez-Martinez A, Olmedo-Moreno E, Castro-Sanchez M . Adherence to the Mediterranean Diet Is Related to Healthy Habits, Learning Processes, and Academic Achievement in Adolescents: A Cross-Sectional Study. Nutrients. 2018; 10(11). PMC: 6267280. DOI: 10.3390/nu10111566. View

16.

Manzano-Carrasco S, Felipe J, Sanchez-Sanchez J, Hernandez-Martin A, Gallardo L, Garcia-Unanue J . Weight Status, Adherence to the Mediterranean Diet, and Physical Fitness in Spanish Children and Adolescents: The Active Health Study. Nutrients. 2020; 12(6). PMC: 7352616. DOI: 10.3390/nu12061680. View

17.

Korkmaz G, Kabaran S . Protective effects of a Mediterranean-like dietary pattern on obesity, abdominal obesity and large neck circumference in a cohort of Turkish children aged 6-9 years. Asia Pac J Clin Nutr. 2020; 29(2):363-371. DOI: 10.6133/apjcn.202007_29(2).0019. View

18.

Arenaza L, Huybrechts I, Ortega F, Ruiz J, de Henauw S, Manios Y . Adherence to the Mediterranean diet in metabolically healthy and unhealthy overweight and obese European adolescents: the HELENA study. Eur J Nutr. 2018; 58(7):2615-2623. DOI: 10.1007/s00394-018-1809-8. View

19.

Iaccarino Idelson P, Scalfi L, Valerio G . Adherence to the Mediterranean Diet in children and adolescents: A systematic review. Nutr Metab Cardiovasc Dis. 2017; 27(4):283-299. DOI: 10.1016/j.numecd.2017.01.002. View

20.

Bonaccorsi G, Furlan F, Scocuzza M, Lorini C . Adherence to Mediterranean Diet among Students from Primary and Middle School in the Province of Taranto, 2016-2018. Int J Environ Res Public Health. 2020; 17(15). PMC: 7432470. DOI: 10.3390/ijerph17155437. View