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Mediterranean diet, diet quality, and bone mineral content in adolescents: the HELENA study



Dietary scores, rather than individual nutrients, allow exploring associations between overall diet and bone health. The aim of the present study was to assess the associations between the Mediterranean Diet Score for Adolescents (MDS-A) and the Diet Quality Index for Adolescents (DQI-A) and bone mineral content (BMC) among Spanish adolescents. Our results do not support an association between dietary scores or indices and BMC in adolescents.


To assess the associations between the MDS-A and a DQI-A with the BMC measured with dual-energy X-ray absorptiometry.


The MDS-A and the DQI-A were calculated in 179 Spanish adolescents, based on two 24-h dietary recalls from the HELENA cross-sectional study. The associations between the diet scores and the BMC outcomes [total body less head (TBLH), femoral neck (FN), lumbar spine (LS), and hip] were analyzed using logistic regression models adjusting for several confounders.


Four hundred ninety-two models were included and only fruits and nuts and cereal and roots were found to provide significant ORs with regard to BMC. The risk of having low BMC reduced by 32% (OR 0.684; CI 0.473–0.988) for FN when following the ideal MDS-A, but this association lost significance when adjusting for lean mass and physical activity. For every 1-point increase in the cereal and root and the fruit and nut components, the risk of having low FN diminished by 56% (OR 0.442; CI 0.216–0.901) and by 67% (OR 0.332; CI 0.146–0.755), respectively.


An overall dietary score or index is not associated with BMC in our adolescent Spanish sample.

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This work was performed as part of the HELENA study. We gratefully acknowledge the financial support of the European Community sixth RTD Framework Programme (contact FOOD-CT-2005-007034). CJ received a Grant FPU13/00421 from the “Ministerio de Educación, Cultura y Deporte.”

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Julián, C., Huybrechts, I., Gracia-Marco, L. et al. Mediterranean diet, diet quality, and bone mineral content in adolescents: the HELENA study. Osteoporos Int 29, 1329–1340 (2018).

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  • Diet scores
  • Dietary patterns
  • Diet quality index
  • Fruits
  • Osteoporosis