Associations between the adherence to the Mediterranean diet and cardiorespiratory fitness with total and central obesity in preschool children: the PREFIT project



Early recognition of risk factors associated with overweight/obesity is an important step towards preventing long-term health consequences. The aim of the current study was to examine the associations of the adherence to the Mediterranean dietary pattern (MDP) and cardiorespiratory fitness (CRF) with adiposity in preschool children from the north of Spain.


The adherence to the MDP (KIDMED), CRF (20-m shuttle run test), total (BMI) and central (waist circumference) adiposity and socio-demographic factors were assessed in 619 children (48.6% girls) who were on average 4.7 years old.


Higher MDP index (P < 0.05) and CRF levels (P < 0.01) were significantly related to lower waist circumference. CRF was inversely associated with BMI (P ≤ 0.001), yet no significant association was observed between MDP and BMI. Children not having high CRF levels and high MDP (i.e., non-upper sex-specific tertile of CRF or MDP, respectively) had the highest waist circumference.


Our findings support that higher adherence to the MDP and higher CRF are associated with lower waist circumference in preschool children, pointing them as relevant modifiable factors to be targeted by educational strategies aiming to prevent central obesity and later obesity-related comorbidities.

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Fig. 1
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Cardiorespiratory fitness


Cardiovascular disease


Mediterranean Diet Quality Index for children and teenagers


Mediterranean dietary pattern


Assessing FITness in PREschoolers


World Obesity Federation


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Our special thanks go to the children who participated in the study and their parents and teachers for their collaboration. We also acknowledge the members involved in fieldwork for their efforts.

Author information




IL conceived the hypothesis, conducted the statistical analyses and drafted the manuscript, FOB designed the PREFIT study, NGC, LA, and MM collected the data, LA, MM, CCS, NGC and FOB critically revised the drafted manuscript. All authors were involved in writing the paper and had final approval of the submitted and published versions.

Corresponding author

Correspondence to Idoia Labayen Goñi.

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Funding support

The PREFIT study was supported by the University of the Basque Country (GIU14/21), MM is supported by a grant of the Spanish Ministry of Education, Culture and Sports (FPU14/03329), LA by a grant of Education, Linguistic Policy and Culture Department of the Governement of the Basque Country (PRE_2016_1_0057). CC-S by a grant from the Spanish Ministry of Economy and Competitiveness (BES-2014-068829) and FBO by a grant from the Spanish Ministry of Science and Innovation (RYC-2011-09011). Additional funding was obtained from the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES); the SAMID III network, RETICS, funded by the PN I + D + I 2017–2021 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion, the European Regional Development Fund (ERDF) (Ref. RD16/0022); and the EXERNET Research Network on Exercise and Health in Special Populations (DEP2005-00046/ACTI).

Conflict of interest

No competing financial interests exist.

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Labayen Goñi, I., Arenaza, L., Medrano, M. et al. Associations between the adherence to the Mediterranean diet and cardiorespiratory fitness with total and central obesity in preschool children: the PREFIT project. Eur J Nutr 57, 2975–2983 (2018).

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  • Preschool children
  • Obesity
  • Adherence to the Mediterranean diet
  • Cardiorespiratory fitness
  • Dietary habits