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Public Health Nutr. 2019 Sep;22(13):2381-2397. doi: 10.1017/S1368980019001022. Epub 2019 Jun 17.

Relative validation of the adapted Mediterranean Diet Score for Adolescents by comparison with nutritional biomarkers and nutrient and food intakes: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study.

Author information

1
ImFINE Research Group, Department of Health and Human Performance, Facultad de Ciencias de la Actividad Física y del Deporte (INEF), Universidad Politécnica de Madrid, Madrid, Spain.
2
International Agency for Research on Cancer (IARC), 150 cours Albert Thomas, 69372Lyon Cedex 08, France.
3
Department of Medical Physiology, School of Medicine, Granada University, Granada, Spain.
4
Department of Physical Education, School of Education, University of Cadiz, Puerto Real, Spain.
5
Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.
6
GENUD (Growth, Exercise, Nutrition and Development) Research Group. Faculty of Health Sciences (FCS). Instituto Agroalimentario de Aragón (IA2). Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Spain.
7
National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland.
8
Institut für Ernährungs- und Lebensmittelwissenschaften-Humanernährung, Rheinische Friedrich-Wilhelms Universität, Bonn, Germany.
9
Research Institute of Child Nutrition Dortmund, Dortmund, Germany.
10
Department of Public Health, Ghent University, Ghent, Belgium.
11
Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece.
12
Inserm U744, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France.
13
Université Lille, Inserm U995, CHU Lille, France.
14
Division of Clinical Nutrition and Prevention, Department of Pediatrics, Medical University of Vienna, Vienna, Austria.
15
Preventive Medicine and Nutrition Clinic, University of Crete, Heraklion, Crete, Greece.
16
Department of Pediatrics, University of Pécs, Pécs, Hungary.
17
Department of Health Sciences, Vesalius, Hogeschool Gent, Ghent, Belgium.

Abstract

OBJECTIVE:

To investigate whether adherence to the adapted Mediterranean Diet Score for Adolescents (MDS_A) and the adapted Mediterranean Diet Quality Index for Adolescents (KIDMED_A) is associated with better food/nutrient intakes and nutritional biomarkers.

DESIGN:

The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study is a cross-sectional study aiming to obtain comparable data on a variety of nutritional and health-related parameters in European adolescents aged 12·5-17·5 years.

SETTING:

Nine European countries.

PARTICIPANTS:

European adolescents (n 2330) recruited to the HELENA study. Dietary intake was obtained with 24 h dietary recalls, an FFQ and a Food Choices and Preferences questionnaire. MDS_A was calculated as a categorical variable using cut-offs (MDS_A), as a continuous variable (zMDS_A) and with energy adjustments (zEnMDS_A). The KIDMED_A score was also calculated.

RESULTS:

Multilevel linear regression analysis showed positive associations for zMDS_A and KIDMED_A with serum levels of vitamin D, vitamin C, plasma folate, holo-transcobalamin, β-carotene and n-3 fatty acids, while negative associations were observed with trans-fatty acid serum levels. For categorical indices, blood biomarkers showed few significant results. zMDS_A and KIDMED_A showed positive associations with vegetables and fruits intake, and negative associations with energy-dense and low-nutritious foods. zMDS_A and KIDMED_A were positively associated with all macronutrients, vitamins and minerals (all P < 0·0001), except with monosaccharides and PUFA for KIDMED_A and cholesterol for both indices (P < 0·05).

CONCLUSIONS:

zMDS_A and KIDMED_A have shown the strongest associations with the dietary indicators and biomarkers that have been associated with the Mediterranean diet before, and are therefore considered the most appropriate and valid Mediterranean diet scores for European adolescents.

KEYWORDS:

Adolescents; Indices; Mediterranean diet; Nutrition assessment; Validation studies

PMID:
31204628
DOI:
10.1017/S1368980019001022

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