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Clustering of Mediterranean dietary patterns linked with health-related quality of life in adolescents: the EHDLA study

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Abstract

The aim of this cross-sectional study was to analyze the association between adherence to the Mediterranean diet (MedDiet) and its dietary components and health-related quality of life (HRQoL) in a sample of Spanish adolescents. A total sample of 634 adolescents was included (mean age: 13.96 ± 1.54 years; 56.9% girls). The Mediterranean Diet Quality Index in children and adolescents (KIDMED) and the KIDSCREEN-10 were used to assess adherence to the MedDiet and its components and HRQoL, respectively. Linear regression was applied to estimate the association between overall adherence to the MedDiet and HRQoL. Cluster analysis was used to establish subgroups according to different patterns of MedDiet component consumption. Higher overall adherence to the MedDiet was significantly associated with greater HRQoL (unstandardized beta coefficient [β] = 0.329; 95% CI: 0.108, 0.550; p = 0.004), even after adjustment for sociodemographic, physical and lifestyle covariates (β = 0.228; 95% CI: 0.007, 0.449; p = 0.043). When different clusters were established according to similar features of MedDiet component consumption, the cluster with a higher percentage of individuals who skipped breakfast had significantly lower scores on the HRQoL scale (p < 0.05)

  Conclusions: Our findings highlight the relevance of considering the specific patterns of food group consumption and MedDiet-related behaviors and not just the overall measure of MedDiet adherence for promoting HRQoL in adolescents.

What is Known:

• Previous studies have shown that some lifestyle behaviors, such as dietary habits, could be associated with health-related quality of life.

• According to our results, higher adherence to the Mediterranean diet pattern was associated with greater health-related quality of life in adolescents.

What is New:

• Skipping breakfast seems to have a crucial role in health-related quality of life among adolescents.

• These results could lead to the development of more specific dietary strategies for increasing health-related quality of life in adolescents.

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Abbreviations

β:

Unstandardized beta coefficient

CI:

Confidence interval

FAS-III:

Family Affluence Scale

FFQ:

Food frequency questionnaire

HRQoL:

Health-related quality of life

KIDMED:

Mediterranean Diet Quality Index in children and adolescents

MedDiet:

Mediterranean diet

YAP-S:

Spanish version of the Youth Activity Profile

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Acknowledgments

JFL-G is a Margarita Salas Fellow (Universidad Pública de Navarra—1225/2022). AEM is a Beatriz Galindo Fellow (Spanish Ministry of Education, Culture and Sport – BEAGAL 18/00093). 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. BB‐P is a Beatriz Galindo Fellow (University of Castilla-La Mancha co-financed by the European Social Fund – 2020‐ PREDUCLM-16746). RF‐R was supported by a grant from the Spanish Ministry of Education, Culture and Sport (FPU 19/00167).

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Authors and Affiliations

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

    Estela Jiménez-López, Arthur Eumann Mesas, Bruno Bizzozero-Peroni, Rubén Fernández-Rodríguez & Miriam Garrido-Miguel

  2. Department of Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain, CIBERSAM, ISCIII, Madrid, Spain

    Estela Jiménez-López

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

    Arthur Eumann Mesas

  4. Universidad de la República, Instituto Superior de Educación Física, Rivera, Uruguay

    Bruno Bizzozero-Peroni

  5. Faculty of Pharmacy and Nutrition, UCAM Universidad Católica San Antonio de Murcia, Murcia, Spain

    Desirée Victoria-Montesinos

  6. Department of Physical Medicine and Nursing, University of Zaragoza, Saragossa, Spain

    Rubén López-Bueno

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

    José Francisco López-Gil

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

    José Francisco López-Gil

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

    José Francisco López-Gil

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  1. Estela Jiménez-López
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  8. José Francisco López-Gil
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Contributions

EJ-L and JFL-G developed the methodological approach. EJ-L and JFL-G performed the data analyses and prepared the tables and figures, with inputs from AEM. BB-P, RF-R, DV-M, RL-B, and MG-M provided further data interpretation. EJ-L wrote the first draft of the manuscript with further input from all coauthors. All authors contributed to drafting the work or reviewing it critically and made substantial contributions. EJ-L had final responsibility for the decision to submit for publication. All authors had full access to all the data in the study and accept responsibility to submit for publication.

Corresponding author

Correspondence to Arthur Eumann Mesas.

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Competing interests and funding

The authors have declared that they have no competing or potential conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical statement

This study was performed in line with the principles of the Declaration of Helsinki. This obtained ethics approval from the Bioethics Committee of the University of Murcia (ID 2218/2018) and the Ethics Committee of the Albacete University Hospital Complex and the Albacete Integrated Care Management (ID 2021–85).

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Jiménez-López, E., Mesas, A.E., Bizzozero-Peroni, B. et al. Clustering of Mediterranean dietary patterns linked with health-related quality of life in adolescents: the EHDLA study. Eur J Pediatr 182, 4113–4121 (2023). https://doi.org/10.1007/s00431-023-05069-y

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