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Is chronotype linked with adherence to the Mediterranean diet among adolescents? The EHDLA study

Pediatric Research volume 94, pages 2070–2076 (2023)Cite this article

Abstract

Background

No previous study has evaluated the relationship between chronotype and adherence to the Mediterranean diet among adolescents. The aim of the present study was to assess the association between chronotype and adherence to the Mediterranean diet in a sample of Spanish adolescents aged 12–17 years.

Methods

This study examined secondary data from 820 adolescents (55.5% girls) from the Eating Healthy and Daily Life Activities (EHDLA) study, which included a representative sample of adolescents aged 12–17 years from the Valle de Ricote (Region of Murcia, Spain). Adolescents’ chronotype was evaluated with the Morningness/Eveningness Scale in Children. Adherence to the Mediterranean diet was determined through the Mediterranean Diet Quality Index for Children and Teenagers.

Results

The proportion of adolescents with an optimal Mediterranean diet was 37.6%. In relation to chronotype, we found that 24.5%, 69.4%, and 6.1% of the adolescents were classified as morning, intermediate, and evening types, respectively. After adjusting for several covariates, both evening- and intermediate-type adolescents showed lower odds of having optimal adherence to the Mediterranean diet (evening-type: odds ratio [OR] = 0.30, confidence interval [CI] 95% 0.12−0.72; intermediate-type: OR = 0.62, CI 95% 0.44−0.87) than morning-type adolescents.

Conclusions

Chronotype could affect adherence to the Mediterranean Diet in adolescents, so it should be a factor to be considered in future studies assessing eating habits.

Impact

  • No previous study has evaluated the relationship between chronotype and adherence to the Mediterranean diet among adolescents.

  • Both evening- and intermediate-type adolescents showed lower odds of having optimal Mediterranean diet adherence than morning-type adolescents.

  • These findings may indicate a need to promote eating healthy habits based on a more holistic approach, not only on the total energy expenditure or in specific food groups but also on the chronotype.

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Fig. 1: Mean differences in the Mediterranean Diet Quality Index for Children and Teenagers according to chronotype.
Fig. 2: Odds ratio of having an optimal Mediterranean diet according to the different chronotypes.

Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. World Health Organization. Healthy diet. https://www.who.int/news-room/fact-sheets/detail/healthy-diet (2020).

  2. Afshin, A. et al. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 393, 1958–1972 (2019).

    Article  Google Scholar 

  3. Serra-Majem, L. et al. Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr. 7, 931–935 (2004).

    Article  PubMed  Google Scholar 

  4. Willett, W. C. The Mediterranean diet: science and practice. Public Health Nutr. 9, 105–110 (2006).

    Article  PubMed  Google Scholar 

  5. Radd-Vagenas, S., Kouris-Blazos, A., Singh, M. F. & Flood, V. M. Evolution of Mediterranean diets and cuisine: concepts and definitions. Asia Pac. J. Clin. Nutr. 26, 749–763 (2017).

    PubMed  Google Scholar 

  6. Martínez-Lacoba, R., Pardo-Garcia, I., Amo-Saus, E. & Escribano-Sotos, F. Mediterranean diet and health outcomes: a systematic meta-review. Eur. J. Public Health 28, 955–961 (2018).

    Article  PubMed  Google Scholar 

  7. Bawaked, R. A. et al. Association of diet quality with dietary inflammatory potential in youth. Food Nutr. Res. 61, 1328961 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  8. López-Gil, J. F. et al. Mediterranean diet-based interventions to improve anthropometric and obesity indicators in children and adolescents: a systematic review with meta-analysis of randomized controlled trials. Adv. Nutr. 14, 858–869 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Koumpagioti, D., Boutopoulou, B., Moriki, D., Priftis, K. N. & Douros, K. Does adherence to the Mediterranean diet have a protective effect against asthma and allergies in children? A systematic review. Nutrients 14, 1618 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Cabrera, S. G. et al. KIDMED test; prevalence of low adherence to the Mediterranean Diet in children and young; a systematic review. Nutr. Hosp. 32, 2390–2399 (2015).

    Google Scholar 

  11. Grosso, G. & Galvano, F. Mediterranean diet adherence in children and adolescents in southern European countries. NFS J. 3, 13–19 (2016).

    Article  Google Scholar 

  12. López-Gil, J. F., de Camargo, E. M. & Yuste Lucas, J. L. Adherencia a la dieta mediterránea en escolares de Educación Primaria partícipes en actividad física: una revisión sistemática. Cult. Cienc. Deporte 15, 267–275 (2020).

    Article  Google Scholar 

  13. Iaccarino Idelson, P., Scalfi, L. & Valerio, G. Adherence to the Mediterranean Diet in children and adolescents: a systematic review. Nutr. Metab. Cardiovasc. Dis. 27, 283–299 (2017).

    Article  CAS  PubMed  Google Scholar 

  14. Phoi, Y. Y., Rogers, M., Bonham, M. P., Dorrian, J. & Coates, A. M. A scoping review of chronotype and temporal patterns of eating of adults: tools used, findings, and future directions. Nutr. Res. Rev. 35, 112–135 (2022).

    Article  PubMed  Google Scholar 

  15. Adan, A. et al. Circadian typology: a comprehensive review. Chronobiol. Int. 29, 1153–1175 (2012).

    Article  PubMed  Google Scholar 

  16. Natale, V. & Cicogna, P. Morningness-eveningness dimension: is it really a continuum. Pers. Indiv. Differ. 32, 809–816 (2002).

    Article  Google Scholar 

  17. Roenneberg, T. et al. Epidemiology of the human circadian clock. Sleep. Med. Rev. 11, 429–438 (2007).

    Article  PubMed  Google Scholar 

  18. Randler, C., Faßl, C. & Kalb, N. From Lark to Owl: developmental changes in morningness-eveningness from new-borns to early adulthood. Sci. Rep. 7, 45874 (2017).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Fischer, D., Lombardi, D. A., Marucci-Wellman, H. & Roenneberg, T. Chronotypes in the US – influence of age and sex. PLoS ONE 12, e0178782 (2017).

  20. Karan, M. et al. Sleep–wake timings in adolescence: chronotype development and associations with adjustment. J. Youth Adolesc. 50, 628–640 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rodríguez-Cortés, F. J. et al. Individual circadian preference, eating disorders and obesity in children and adolescents: a dangerous liaison? A systematic review and a meta-analysis. Children 9, 167 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  22. Fabbian, F. et al. Chronotype, gender and general health. Chronobiol. Int. 33, 863–882 (2016).

    Article  CAS  PubMed  Google Scholar 

  23. López‐Soto, P. J. et al. Chronotype, nursing activity, and gender: a systematic review. J. Adv. Nurs. 75, 734–748 (2019).

    Article  PubMed  Google Scholar 

  24. Bhar, D., Bagepally, B. S. & Rakesh, B. Association between chronotype and cardio-vascular disease risk factors: a systematic review and meta-analysis. Clin. Epidemiol. Glob. Health 16, 101108 (2022).

    Article  CAS  Google Scholar 

  25. Ekiz Erim, S. & Sert, H. The relationship between chronotype and obesity: a systematic review. Chronobiol. Int. 20, 1–13 (2023).

    Google Scholar 

  26. Lotti, S. et al. Morning chronotype is associated with higher adherence to the Mediterranean diet in a sample of Italian adults. Nutr. Metab. Cardiovasc. Dis. 32, 2086–2092 (2022).

    Article  CAS  PubMed  Google Scholar 

  27. Vetrani, C. et al. Evening chronotype is associated with severe NAFLD in obesity. Int. J. Obes. 46, 1638–1643 (2022).

    Article  CAS  Google Scholar 

  28. Muscogiuri, G. et al. Chronotype and adherence to the Mediterranean diet in obesity: results from the Opera Prevention Project. Nutrients 12, 1354 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  29. Rodríguez-Muñoz, P. M. et al. Associations between chronotype, adherence to the Mediterranean diet and sexual opinion among university students. Nutrients 12, 1900 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  30. Zerón-Rugerio, M. F., Cambras, T. & Izquierdo-Pulido, M. Social jet lag associates negatively with the adherence to the Mediterranean diet and body mass index among young adults. Nutrients 11, 1756 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  31. López-Gil, J. F. The Eating Healthy and Daily Life Activities (EHDLA) Study. Children 9, 370 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  32. Carskadon, M. A., Vieira, C. & Acebo, C. Association between puberty and delayed phase preference. Sleep 16, 258–262 (1993).

    Article  CAS  PubMed  Google Scholar 

  33. Díaz‐Morales, J. F., de León, M. C. D. & Sorroche, M. G. Validity of the Morningness‐Eveningness Scale for Children among Spanish adolescents. Chronobiol. Int. 24, 435–447 (2007).

    Article  PubMed  Google Scholar 

  34. Muñoz, J. S. G., Cañavate, R., Hernández, C. M., Cara-Salmerón, V. & Morante, J. J. H. The association among chronotype, timing of food intake and food preferences depends on body mass status. Eur. J. Clin. Nutr. 71, 736–742 (2017).

    Article  PubMed  Google Scholar 

  35. García-Hermoso, A. et al. Is adherence to the Mediterranean Diet associated with healthy habits and physical fitness? A systematic review and meta-analysis including 565,421 youths. Br. J. Nutr. 9, 1–32 (2020).

    Google Scholar 

  36. Merikanto, I., Kuula, L., Lahti, J., Räikkönen, K. & Pesonen, A. K. Eveningness associates with lower physical activity from pre- to late adolescence. Sleep. Med. 74, 189–198 (2020).

    Article  PubMed  Google Scholar 

  37. Van der Merwe, C., Münch, M. & Kruger, R. Chronotype differences in body composition, dietary intake and eating behavior outcomes – a scoping systematic review. Adv. Nutr. 30, nmac093 (2022).

    Google Scholar 

  38. Currie, C. et al. Researching health inequalities in adolescents: the development of the Health Behaviour in School-Aged Children (HBSC) Family Affluence Scale. Soc. Sci. Med. 66, 1429–1436 (2008).

    Article  Google Scholar 

  39. Saint-Maurice, P. F. & Welk, G. J. Validity and calibration of the Youth Activity Profile. PLoS ONE 10, e0143949 (2015).

  40. Segura-Díaz, J. M. et al. Feasibility and reliability of the Spanish version of the Youth Activity Profile questionnaire (YAP-Spain) in children and adolescents. J. Sports Sci. 39, 801–807 (2021).

    Article  PubMed  Google Scholar 

  41. Roenneberg, T., Allebrandt, K. V., Merrow, M. & Vetter, C. Social jetlag and obesity. Curr. Biol. 22, 939–943 (2012).

    Article  CAS  PubMed  Google Scholar 

  42. Rodríguez, I. T., Ballart, J. F., Pastor, G. C., Jordà, E. B. & Val, V. A. [Validation of a short questionnaire on frequency of dietary intake: reproducibility and validity]. Nutr. Hosp. 23, 242–252 (2008).

    PubMed  Google Scholar 

  43. Benjamini, Y. & Hochberg, Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J. R. Stat. Soc. 57, 289–300 (1995).

    Google Scholar 

  44. Yu, B. Y. M. et al. Associations between the chronotypes and eating habits of Hong Kong school-aged children. Int. J. Environ. Res. Public Health 17, 2583 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  45. Fleig, D. & Randler, C. Association between chronotype and diet in adolescents based on food logs. Eat. Behav. 10, 115–118 (2009).

    Article  PubMed  Google Scholar 

  46. Arora, T. & Taheri, S. Associations among late chronotype, body mass index and dietary behaviors in young adolescents. Int. J. Obes. 39, 39–44 (2015).

    Article  CAS  Google Scholar 

  47. Golley, R. K., Maher, C. A., Matricciani, L. & Olds, T. S. Sleep duration or bedtime? Exploring the association between sleep timing behaviour, diet and BMI in children and adolescents. Int. J. Obes. 37, 546–551 (2013).

    Article  CAS  Google Scholar 

  48. Sato-Mito, N., Shibata, S., Sasaki, S. & Sato, K. Dietary intake is associated with human chronotype as assessed by both morningness–eveningness score and preferred midpoint of sleep in young Japanese women. Int. J. Food Sci. Nutr. 62, 525–532 (2011).

    Article  CAS  PubMed  Google Scholar 

  49. Mazri, F. H., Manaf, Z. A., Shahar, S. & Mat Ludin, A. F. The association between chronotype and dietary pattern among adults: a scoping review. Int. J. Environ. Res. Public Health 17, 68 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  50. Kanerva, N. et al. Tendency toward eveningness is associated with unhealthy dietary habits. Chronobiol. Int. 29, 920–927 (2012).

    Article  CAS  PubMed  Google Scholar 

  51. Dashti, H. S., Scheer, F. A., Jacques, P. F., Lamon-Fava, S. & Ordovás, J. M. Short sleep duration and dietary intake: epidemiologic evidence, mechanisms, and health implications. Adv. Nutr. 6, 648–659 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Ogata, H. et al. Skipping breakfast for 6 days delayed the circadian rhythm of the body temperature without altering clock gene expression in human leukocytes. Nutrients 12, 2797 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Jakubowicz, D. et al. Influences of breakfast on clock gene expression and postprandial glycemia in healthy individuals and individuals with diabetes: a randomized clinical trial. Diabetes Care 40, 1573–1579 (2017).

    Article  CAS  PubMed  Google Scholar 

  54. Wittmann, M., Dinich, J., Merrow, M. & Roenneberg, T. Social jetlag: misalignment of biological and social time. Chronobiol. Int. 23, 497–509 (2006).

    Article  PubMed  Google Scholar 

  55. Touitou, Y. Adolescent sleep misalignment: a chronic jet lag and a matter of public health. J. Physiol. 107, 323–326 (2013).

    Google Scholar 

  56. Roenneberg, T. et al. A marker for the end of adolescence. Curr. Biol. 14, R1038–R1039 (2004).

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to express their gratitude to Ayuntamiento de Archena, as well as the participation of all the adolescents, parents/legal guardians, physical education teachers, schools, and staff implicated, and wish to thank them for the information provided. J.F.L.-G. is a Margarita Salas Fellow (Universidad Pública de Navarra—1225/2022).

Funding

J.M.G. is supported by the US NIH/NIEHS (Grant number: R01ES030100).

Author information

Authors and Affiliations

  1. Navarrabiomed, Hospital Universitario de Navarra, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain

    José Francisco López-Gil

  2. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA

    José Francisco López-Gil

  3. One Health Research Group, Universidad de Las Américas, Quito, Ecuador

    José Francisco López-Gil

  4. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain

    Laura Moreno-Galarraga

  5. Department of Pediatrics, Complejo Hospitalario de Navarra, Servicio Navarro de Salud, Pamplona, Spain

    Laura Moreno-Galarraga

  6. Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain

    Arthur Eumann Mesas

  7. Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Brazil

    Arthur Eumann Mesas

  8. Escuela de Fisioterapia, Universidad de las Américas, Quito, 170504, Ecuador

    Héctor Gutiérrez-Espinoza

  9. Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain

    Rubén López-Bueno

  10. Division of Pulmonary Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    Jonathan M. Gaffin

Authors
  1. José Francisco López-Gil
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  2. Laura Moreno-Galarraga
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Contributions

Conceptualization, methodology, software, validation, analysis, data curation, writing—original draft preparation, supervision, J.F.L.-G; writing—review and editing, L.M.-G., A.E.M., H.G.-E., R.L.-B., and J.M.G. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to José Francisco López-Gil or Héctor Gutiérrez-Espinoza.

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López-Gil, J.F., Moreno-Galarraga, L., Mesas, A.E. et al. Is chronotype linked with adherence to the Mediterranean diet among adolescents? The EHDLA study. Pediatr Res 94, 2070–2076 (2023). https://doi.org/10.1038/s41390-023-02703-1

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