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Adherence to the Mediterranean dietary pattern and BMI change among US adolescents



Among adults, the Mediterranean dietary pattern (MDP) is inversely related to body mass index (BMI). Data are lacking on adherence to the MDP among youth in the United States and whether the MDP is related to weight change in that group.


To assess whether adherence to the MDP was associated with BMI change among adolescents. To examine temporality, we studied the association between baseline and 2–3-year changes in adherence to the MDP with concurrent changes in BMI, as well as subsequent changes in BMI over a 7-year period.


We prospectively followed 6002 females and 4916 males in the Growing Up Today Study II, aged 8–15 years in 2004, living across United States. Data were collected by questionnaire in 2004, 2006, 2008 and 2011. Dietary intake was assessed by the Youth/Adolescent Questionnaire. The KidMed Index was derived to measure the adherence to the MDP. We used generalized estimating equations with repeated measures within subjects to assess the association between MDP and BMI change.


A two-point increment in the KidMed Index was independently associated with a lower gain in BMI (−0.04 kg m−2; P=0.001). A greater increase in adherence to the KidMed Index was independently related to a lower gain in BMI in both the concurrent (P-for-trend<0.001) and the subsequent period (P-for-trend=0.002).


Adherence to MDP was inversely associated with change in BMI among adolescents. Two-year improvement in adherence to MDP was independently associated with less steep gain in the BMI in both the concurrent and the subsequent period.

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  1. Kromhout D, Keys A, Aravanis C, Buzina R, Fidanza F, Giampaoli S et al. Food consumption patterns in the 1960s in seven countries. Am J Clin Nutr 1989; 49: 889–894.

    Article  CAS  Google Scholar 

  2. Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr 2011; 14: 2274–2284.

    Article  Google Scholar 

  3. Fundación Dieta Mediterránea. Pirámide de la diéta mediterránea: un estilo de vida actual. Guía para la población adulta, 2010; Available at (accessed 30 November 2014).

  4. Estruch R, Ros E, Salas-Salvado J, Covas M, Corella D, Aros F et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368: 1279–1290.

    Article  CAS  Google Scholar 

  5. Nordmann AJ, Suter-Zimmermann K, Bucher HC, Shai I, Tuttle KR, Estruch R et al. Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med 2011; 124: 841.e2–851.e2.

    Article  Google Scholar 

  6. Kastorini CM, Milionis HJ, Esposito K, Giugliano D, Goudevenos JA, Panagiotakos DB . The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol 2011; 57: 1299–1313.

    Article  CAS  Google Scholar 

  7. Moller K, Krogh-Madsen R . Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008; 359: 2170.

    CAS  PubMed  Google Scholar 

  8. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB . Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 2011; 364: 2392–2404.

    Article  CAS  Google Scholar 

  9. Salas-Salvado J, Bullo M, Estruch R, Ros E, Covas MI, Ibarrola-Jurado N et al. Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial. Ann Intern Med 2014; 160: 1–10.

    Article  Google Scholar 

  10. Benetou V, Trichopoulou A, Orfanos P, Naska A, Lagiou P, Boffetta P et al. Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort. Br J Cancer 2008; 99: 191–195.

    Article  CAS  Google Scholar 

  11. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D . Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003; 348: 2599–2608.

    Article  Google Scholar 

  12. Sofi F, Macchi C, Abbate R, Gensini GF, Casini A . Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr 2014; 17: 2769–2782.

    Article  Google Scholar 

  13. Serra-Majem L, Garcia-Closas R, Ribas L, Perez-Rodrigo C, Aranceta J . Food patterns of Spanish schoolchildren and adolescents: The enKid Study. Public Health Nutr 2001; 4: 1433–1438.

    CAS  PubMed  Google Scholar 

  14. Serra-Majem L, Ribas L, Ngo J, Ortega RM, Garcia A, Perez-Rodrigo C et al. 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.

    Article  Google Scholar 

  15. Papadaki S, Mavrikaki E . Greek adolescents and the Mediterranean diet: factors affecting quality and adherence. Nutrition 2015; 31: 345–349.

    Article  Google Scholar 

  16. Santomauro F, Lorini C, Tanini T, Indiani L, Lastrucci V, Comodo N et al. Adherence to Mediterranean diet in a sample of Tuscan adolescents. Nutrition 2014; 30: 1379–1383.

    Article  Google Scholar 

  17. Schroder 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.

    Article  Google Scholar 

  18. Mar Bibiloni M, Martinez E, Llull R, Maffiotte E, Riesco M, Llompart I et al. Metabolic syndrome in adolescents in the Balearic Islands, a Mediterranean region. Nutr Metab Cardiovasc Dis 2011; 21: 446–454.

    Article  CAS  Google Scholar 

  19. Grao-Cruces A, Nuviala A, Fernandez-Martinez A, Porcel-Galvez AM, Moral-Garcia JE, Martinez-Lopez 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.

    PubMed  Google Scholar 

  20. Costarelli V, Koretsi E, Georgitsogianni E . Health-related quality of life of Greek adolescents: the role of the Mediterranean diet. Qual Life Res 2013; 22: 951–956.

    Article  CAS  Google Scholar 

  21. Strauss RS . Comparison of measured and self-reported weight and height in a cross-sectional sample of young adolescents. Int J Obes Relat Metab Disord 1999; 23: 904–908.

    Article  CAS  Google Scholar 

  22. Goodman E, Hinden BR, Khandelwal S . Accuracy of teen and parental reports of obesity and body mass index. Pediatrics 2000; 106: 52–58.

    Article  CAS  Google Scholar 

  23. Shannon B, Smiciklas-Wright H, Wang MQ . Inaccuracies in self-reported weights and heights of a sample of sixth-grade children. J Am Diet Assoc 1991; 91: 675–678.

    CAS  PubMed  Google Scholar 

  24. Field AE, Aneja P, Rosner B . The validity of self-reported weight change among adolescents and young adults. Obesity (Silver Spring) 2007; 15: 2357–2364.

    Article  Google Scholar 

  25. Rockett HR, Breitenbach M, Frazier AL, Witschi J, Wolf AM, Field AE et al. Validation of a youth/adolescent food frequency questionnaire. Prev Med 1997; 26: 808–816.

    Article  CAS  Google Scholar 

  26. Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act 2011; 8: 98.

    Article  Google Scholar 

  27. 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.

    Article  Google Scholar 

  28. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32: S498–S504.

    Article  CAS  Google Scholar 

  29. Jette M, Sidney K, Blumchen G . Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity. Clin Cardiol 1990; 13: 555–565.

    Article  CAS  Google Scholar 

  30. Trichopoulou A, Bamia C, Trichopoulos D . Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ 2009; 338: b2337.

    Article  Google Scholar 

  31. 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.

    Article  Google Scholar 

  32. Velazquez-Lopez L, Santiago-Diaz G, Nava-Hernandez J, Munoz-Torres AV, Medina-Bravo P, Torres-Tamayo M . Mediterranean-style diet reduces metabolic syndrome components in obese children and adolescents with obesity. BMC Pediatr 2014; 14: 175.

    Article  Google Scholar 

  33. Ebbeling CB, Swain JF, Feldman HA, Wong WW, Hachey DL, Garcia-Lago E et al. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA 2012; 307: 2627–2634.

    Article  CAS  Google Scholar 

  34. Mozaffarian D, Appel LJ, Van Horn L . Components of a cardioprotective diet: new insights. Circulation 2011; 123: 2870–2891.

    Article  Google Scholar 

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We thank the thousands of participants in the Growing Up Today Study II and their mothers. The Growing up Today Study II is supported by the Breast Cancer Research Foundation and the grants R01-DK084001 and R01-HL096905 from the National Institute of Health.

Author contributions

NM-C, JEC and AEF designed the research and developed the statistical methods; JEC and JF assisted with the statistical analysis. NM-C performed statistical analysis and drafted the paper; JEC, JF, FBH and AEF provided critical feedback on drafts of the manuscript. AEF had primary responsibility for final content. All authors read and approved the final manuscript.

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Correspondence to A E Field.

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Supplementary Information accompanies this paper on International Journal of Obesity website

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Martin-Calvo, N., Chavarro, J., Falbe, J. et al. Adherence to the Mediterranean dietary pattern and BMI change among US adolescents. Int J Obes 40, 1103–1108 (2016).

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