Skip to main content Accessibility help
×
Home

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

  • Raquel Aparicio-Ugarriza (a1) (a2), Magdalena Cuenca-García (a3) (a4), Marcela Gonzalez-Gross (a1) (a5), Cristina Julián (a6), Silvia Bel-Serrat (a7), Luis A Moreno (a5) (a6), Christina Breidenassel (a1) (a8), Mathilde Kersting (a9), Aline B Arouca (a10), Nathalie Michels (a10), Theodora Mouratidou (a6), Yannis Manios (a11), Jean Dallongeville (a12), Frédéric Gottrand (a13), Kurt Widhalm (a14), Anthony Kafatos (a15), Denes Molnár (a16), Stefaan De Henauw (a10) (a17), Marc J Gunter (a2) and Inge Huybrechts (a2)...

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.

Copyright

Corresponding author

*Corresponding author: Email HuybrechtsI@iarc.fr

References

Hide All
1.Iaccarino, P, Scalfi, L & Valerio, G (2017) Adherence to the Mediterranean diet in children and adolescents: a systematic review. Nutr Metab Cardiovasc Dis 27, 283299.
2.Waters, E, de Silva-Sanigorski, A, Hall, BJ et al. (2011) Interventions for preventing obesity in children. Cochrane Database Syst Rev issue 12, CD001871.
3.Garcia Cabrera, S, Herrera Fernandez, N, Rodriguez Hernandez, C et al. (2015) KIDMED test; prevalence of low adherence to the Mediterranean diet in children and young; a systematic review. Nutr Hosp 32, 23902399.
4.Peng, W, Berry, EM & Goldsmith, R (2019) Adherence to the Mediterranean diet was positively associated with micronutrient adequacy and negatively associated with dietary energy density among adolescents. J Hum Nutr 32, 41–52.
5.Vyncke, K, Cruz Fernandez, E, Fajo-Pascual, M et al. (2013) Validation of the Diet Quality Index for Adolescents by comparison with biomarkers, nutrient and food intakes: the HELENA study. Br J Nutr 109, 20672078.
6.Serra-Majem, L, Ribas, L, Ngo, J et al. (2004) Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr 7, 931935.
7.Feskanich, D, Rockett, HR & Colditz, GA (2004) Modifying the Healthy Eating Index to assess diet quality in children and adolescents. J Am Diet Assoc 104, 13751383.
8.Kranz, S, Findeis, JL & Shrestha, SS (2008) Use of the Revised Children’s Diet Quality Index to assess preschooler’s diet quality, its sociodemographic predictors, and its association with body weight status. J Pediatr (Rio J) 84, 2634.
9.Manios, Y, Kourlaba, G, Grammatikaki, E et al. (2010) Development of a diet–lifestyle quality index for young children and its relation to obesity: the Preschoolers Diet–Lifestyle Index. Public Health Nutr 13, 20002009.
10.Manios, Y, Kourlaba, G, Grammatikaki, E et al. (2010) Development of a lifestyle–diet quality index for primary schoolchildren and its relation to insulin resistance: the Healthy Lifestyle–Diet Index. Eur J Clin Nutr 64, 13991406.
11.Garcia-Marcos, L, Canflanca, IM, Garrido, JB et al. (2007) Relationship of asthma and rhinoconjunctivitis with obesity, exercise and Mediterranean diet in Spanish schoolchildren. Thorax 62, 503508.
12.Grosso, G & Galvano, F (2016) Mediterranean diet adherence in children and adolescents in southern European countries. NFS J 3, 1319.
13.Handeland, K, Kjellevold, M, Wik-Markhus, M et al. (2016) A diet score assessing Norwegian adolescents’ adherence to dietary recommendations – development and test–retest reproducibility of the score. Nutrients 29, 8.
14.Darnton-Hill, I, Nishida, C & James, WP (2004) A life course approach to diet, nutrition and the prevention of chronic diseases. Public Health Nutr 7, 101121.
15.Castro-Quezada, I, Roman-Vinas, B & Serra-Majem, L (2014) The Mediterranean diet and nutritional adequacy: a review. Nutrients 3, 231248.
16.Moreno, LA, González-Gross, M, Kersting, M et al. (2008) Assessing, understanding and modifying nutritional status, eating habits and physical activity in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Public Health Nutr 11, 288299.
17.Beghin, L, Castera, M, Manios, Y et al. (2008) Quality assurance of ethical issues and regulatory aspects relating to good clinical practices in the HELENA Cross-Sectional Study. Int J Obes (Lond) 32, Suppl. 5, 1218.
18.Black, AE (2000) Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations. Int J Obes Relat Metab Disord 24, 11191130.
19.Biró, G, Hulshof, KF, Ovesen, L et al. (2002) Selection of methodology to assess food intake. Eur J Clin Nutr 56, Suppl. 2, S25S32.
20.Gilbert, C, Hegyi, A, Sanchez, MJ et al. (2008) Qualitative research exploring food choices and preferences of adolescents in Europe. HELENA Deliverable, 11. http://www.helenastudy.com/packages.php (accessed October 2018).
21.Gilbert, CC, Hall, G, Hegyi, A et al. (2013) Food choices and preferences. In HELENA Cross-Sectional Study Manual of Operations, pp. 101109 [Gonzalez-Gross, M, De Henauw, S, Gottrand, FF et al., editors]. Zaragoza: University of Zaragoza.
22.Vereecken, CA, Covents, M, Matthys, C et al. (2005) Young adolescents’ nutrition assessment on computer (YANA-C). Eur J Clin Nutr 59, 658667.
23.Vereecken, CA, Covents, M, Sichert-Hellert, W et al. (2008) Development and evaluation of a self-administered computerized 24-h dietary recall method for adolescents in Europe. Int J Obes (Lond) 32, Suppl. 5, 2634.
24.Dehne, LI, Klemm, C, Henseler, G et al. (1999) The German Food Code and Nutrient Data Base (BLS II.2). Eur J Epidemiol 15, 355359.
25.Julian-Almarcegui, C, Bel-Serrat, S, Kersting, M et al. (2016) Comparison of different approaches to calculate nutrient intakes based upon 24-h recall data derived from a multicenter study in European adolescents. Eur J Nutr 55, 537545.
26.Haubrock, J, Harttig, U, Souverein, O et al. (2010) An improved statistical tool for estimating usual intake distributions: the Multiple Source Method (MSM). Arch Public Health 68, Suppl. 1, S15S16.
27.Haubrock J, Harttig U, Souverein O et. al. (2010) An improved statistical tool for estimating usual intake distributions: the Multiple Source Method (MSM). Arch Public Health 68, Suppl. 1, S15–S16; available at https://www.wiv-isp.be/aph/pdf/APH68_S15-S16.pdf
28.Vereecken, C, Dohogne, S, Covents, M et al. (2010) How accurate are adolescents in portion-size estimation using the computer tool Young Adolescents’ Nutrition Assessment on Computer (YANA-C)? Br J Nutr 103, 18441850.
29.Vereecken, CA & Maes, L (2003) A Belgian study on the reliability and relative validity of the Health Behaviour in School-Aged Children food-frequency questionnaire. Public Health Nutr 6, 581–588.
30.Trichopoulou, A, Costacou, T, Bamia, C et al. (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348, 25992608.
31.Gonzalez-Gross, M, Breidenassel, C, Gomez-Martinez, S et al. (2008) Sampling and processing of fresh blood samples within a European multicenter nutritional study: evaluation of biomarker stability during transport and storage. Int J Obes (Lond) 32, Suppl. 5, S66S75.
32.Jacques, PF, Sulsky, SI, Sadowski, JA et al. (1993) Comparison of micronutrient intake measured by a dietary questionnaire and biochemical indicators of micronutrient status. Am J Clin Nutr 57, 182189.
33.Bates, CJ, Rutishauser, IH, Black, AE et al. (1979) Long-term vitamin status and dietary intake of healthy elderly subjects. 2. Vitamin C. Br J Nutr 42, 4356.
34.Jenab, M, Slimani, N, Bictash, M et al. (2009) Biomarkers in nutritional epidemiology: applications, needs and new horizons. Hum Genet 125, 507525.
35.Willett, WC, Stampfer, MJ, Underwood, BA et al. (1983) Vitamins A, E, and carotene: effects of supplementation on their plasma levels. Am J Clin Nutr 38, 559566.
36.Rock, CL, Swendseid, ME, Jacob, RA et al. (1992) Plasma carotenoid levels in human subjects fed a low carotenoid diet. J Nutr 122, 96100.
37.Andersen, LF, Solvoll, K & Drevon, CA (1996) Very-long-chain n-3 fatty acids as biomarkers for intake of fish and n-3 fatty acid concentrates. Am J Clin Nutr 64, 305311.
38.Hodge, AM, Simpson, JA, Gibson, RA et al. (2007) Plasma phospholipid fatty acid composition as a biomarker of habitual dietary fat intake in an ethnically diverse cohort. Nutr Metab Cardiovasc Dis 17, 415426.
39.Hodson, L, Skeaff, CM & Fielding, BA (2008) Fatty acid composition of adipose tissue and blood in humans and its use as a biomarker of dietary intake. Prog Lipid Res 47, 348380.
40.Baylin, A, Kim, MK, Donovan-Palmer, A et al. (2005) Fasting whole blood as a biomarker of essential fatty acid intake in epidemiologic studies: comparison with adipose tissue and plasma. Am J Epidemiol 162, 373381.
41.Sonnenberg, LM, Quatromoni, PA, Gagnon, DR et al. (1996) Diet and plasma lipids in women. II. Macronutrients and plasma triglycerides, high-density lipoprotein, and the ratio of total to high-density lipoprotein cholesterol in women: the Framingham nutrition studies. J Clin Epidemiol 49, 665672.
42.Grosso, G, Marventano, S, Buscemi, S et al. (2013) Factors associated with adherence to the Mediterranean diet among adolescents living in Sicily, Southern Italy. Nutrients 4, 49084923.
43.Vyncke, KE, Libuda, L, De Vriendt, T et al. (2012) Dietary fatty acid intake, its food sources and determinants in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Br J Nutr 108, 22612673.
44.Appel, LJ, Sacks, FM, Carey, VJ et al. (2005) Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA 16, 24552464.
45.Ruiz, E, Avila, JM, Valero, T et al. (2015) Energy intake, profile, and dietary sources in the Spanish population: findings of the ANIBES study. Nutrients 12, 47394762.
46.Edmonds, CJ & Burford, D (2009) Should children drink more water?: the effects of drinking water on cognition in children. Appetite 52, 776779.
47.Duffey, KJ, Huybrechts, I, Mouratidou, T et al. (2012) Beverage consumption among European adolescents in the HELENA study. Eur J Clin Nutr 66, 244252.
48.Serra-Majem, L, Ribas, L, Garcia, A et al. (2003) Nutrient adequacy and Mediterranean diet in Spanish school children and adolescents. Eur J Clin Nutr 57, Suppl. 1, 3539.
49.Gonzalez-Gross, M, Valtuena, J, Breidenassel, C et al. (2012) Vitamin D status among adolescents in Europe: the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Br J Nutr 107, 755764.
50.Amit, M (2010) Vegetarian diets in children and adolescents. Paediatr Child Health 15, 303314.
51.Yokota, RT, Miyazaki, ES & Ito, MK (2010) Applying the triads method in the validation of dietary intake using biomarkers. Cad Saude Publica 26, 20272037.
52.Bach-Faig, A, Geleva, D, Carrasco, J et al. (2006) Evaluating associations between Mediterranean diet adherence indexes and biomarkers of diet and disease. Public Health Nutr 9, 11101117.
53.Prentice, RL, Sugar, E, Wang, CY et al. (2002) Research strategies and the use of nutrient biomarkers in studies of diet and chronic disease. Public Health Nutr 5, 977984.
54.Selhub, J & Paul, L (2011) Folic acid fortification: why not vitamin B12 also? Biofactors 37, 269271.
55.Obeid, R, Munz, W, Jäger, M et al. (2005) Biochemical indexes of the B vitamins in cord serum are predicted by maternal B vitamin status. Am J Clin Nutr 82, 133139.
56.Bischoff-Ferrari, HA (2011) Vitamin D: role in pregnancy and early childhood. Ann Nutr Metab 59, 1721.
57.Zhang, R & Naughton, DP (2010) Vitamin D in health and disease: current perspectives. Nutr J 9, 65.
58.Holick, MF (2007) Vitamin D deficiency. N Engl J Med 19, 266281.
59.Elmadfa, I, Godina-Zarfl, B, Dichtl, M et al. (1994) The Austrian Study on Nutritional Status of 6- to 18-year-old pupils. Bibl Nutr Dieta 51, 6267.
60.Weinstein, SJ, Vogt, TM & Gerrior, SA (2004) Healthy Eating Index scores are associated with blood nutrient concentrations in the third National Health and Nutrition Examination Survey. J Am Diet Assoc 104, 576584.
61.Okuda, M, Sasaki, S, Bando, N et al. (2009) Carotenoid, tocopherol, and fatty acid biomarkers and dietary intake estimated by using a brief self-administered diet history questionnaire for older Japanese children and adolescents. J Nutr Sci Vitaminol (Tokyo) 55, 231241.
62.de Souza, RJ, Mente, A, Maroleanu, A et al. (2015) Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ 351, h3978.
63.EFSA/EU Menu Guidance (2013) Example of a protocol for identification of misreporting (under- and overreporting of energy intake based on the PILOT-PANEU project. http://www.efsa.europa.eu/sites/default/files/efsa_rep/blobserver_assets/3944A-8-2-1.pdf (accessed June 2016).

Keywords

Type Description Title
WORD
Supplementary materials

Aparicio-Ugarriza et al. supplementary material
Aparicio-Ugarriza et al. supplementary material 1

 Word (134 KB)
134 KB

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

  • Raquel Aparicio-Ugarriza (a1) (a2), Magdalena Cuenca-García (a3) (a4), Marcela Gonzalez-Gross (a1) (a5), Cristina Julián (a6), Silvia Bel-Serrat (a7), Luis A Moreno (a5) (a6), Christina Breidenassel (a1) (a8), Mathilde Kersting (a9), Aline B Arouca (a10), Nathalie Michels (a10), Theodora Mouratidou (a6), Yannis Manios (a11), Jean Dallongeville (a12), Frédéric Gottrand (a13), Kurt Widhalm (a14), Anthony Kafatos (a15), Denes Molnár (a16), Stefaan De Henauw (a10) (a17), Marc J Gunter (a2) and Inge Huybrechts (a2)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed