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Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents

Published online by Cambridge University Press:  02 January 2007

Lluís Serra-Majem*
Department of Clinical Sciences, University of Las Palmas de Gran Canaria, PO Box 550, E-35080 Las Palmas de Gran Canaria, Spain Foundation for the Advancement of the Mediterranean Diet, Community Nutrition Research Centre, University of Barcelona Science Park, Barcelona, Spain
Lourdes Ribas
Foundation for the Advancement of the Mediterranean Diet, Community Nutrition Research Centre, University of Barcelona Science Park, Barcelona, Spain
Joy Ngo
Foundation for the Advancement of the Mediterranean Diet, Community Nutrition Research Centre, University of Barcelona Science Park, Barcelona, Spain
Rosa M Ortega
Department of Nutrition, University Complutense of Madrid, Madrid, Spain
Alicia García
Foundation for the Advancement of the Mediterranean Diet, Community Nutrition Research Centre, University of Barcelona Science Park, Barcelona, Spain
Carmen Pérez-Rodrigo
Community Nutrition Unit, Bilbao City Council, Bilbao, Spain
Javier Aranceta
Community Nutrition Unit, Bilbao City Council, Bilbao, Spain
*Corresponding author: Email
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To evaluate dietary habits in Spanish children and adolescents based on a Mediterranean Diet Quality Index tool, which considers certain principles sustaining and challenging traditional healthy Mediterranean dietary patterns.


Observational population-based cross-sectional study. A 16-item Mediterranean Diet Quality Index was included in data gathered for the EnKid study (in which two 24-hour recalls, a quantitative 169-item food-frequency questionnaire and a general questionnaire about socio-economic, demographic and lifestyle items were administered).




In total, 3850 children and youths aged 2–24 years residing in Spain.


Of the sample, 4.2% showed very low KIDMED index results, 49.4% had intermediate values and 46.4% had high index results. Important geographical differences were seen, with subjects from the Northeast showing the most favourable outcomes (52% with elevated scores vs. 37.5% of those from the North). Lower percentages of high diet quality were observed in low socio-economic groups, compared with middle and upper income cohorts (42.8%, 47.6% and 54.9%, respectively). Large cities had more positive results and only slight variations were seen for gender and age.


The KIDMED index, the first to evaluate the adequacy of Mediterranean dietary patterns in children and youth, confirms that this collective is undergoing important changes, which makes them a priority target for nutrition interventions. Results challenge certain commonly perceived notions tied to income level, population size and diet quality.

Research Article
Copyright © The Authors 2004


1Trichopoulou, A, Lagiou, P. Healthy traditional Mediterranean diet: an expression of culture, history, and lifestyle. Nutrition Reviews 1997; 55: 383–9.Google Scholar
2Willett, WC, Sacks, F, Trichopoulou, A, Drescher, G, Ferro-Luzzi, A, Helsing, E, et al. Mediterranean diet pyramid: a cultural model for healthy eating. American Journal of Clinical Nutrition 1995; 61(Suppl. 6): 1402S–6S.Google Scholar
3Serra Majem, L. ¿Más beneficios de la dieta mediterránea? Nutrición y Obesidad 2001; 4: 43–6.Google Scholar
4Keys, A. Mediterranean diet and public health: personal reflections. American Journal of Clinical Nutrition 1995; 61(Suppl. 6): 1321S–3S.Google Scholar
5Serra-Majem, L, Santana, JF, Salmona, E. Dietary habits and nutrient status in Spain. World Review of Nutrition and Dietetics 2000; 87: 127–59.Google Scholar
6Serra-Majem, L, Ferro-Luzzi, A, Bellizzi, M, Salleras, L. Nutrition policies in Mediterranean Europe. Nutrition Reviews 1997; 55(Suppl. 2): S42–57.Google Scholar
7Serra Majem, L, Ribas, L. Hábitos alimentarios y consumo de alimentos en España. Dieta mediterránea. In: Serra-Majem, L, Aranceta, J, Mataix, J, eds. Nutrición y Salud Pública. Métodos, Bases Científicas y Aplicaciones. Barcelona: Masson, 1995; 303–10.Google Scholar
8Serra Majem, L, Ngo de la Cruz, J, eds. ¿Qué es la Dieta Mediterránea? Barcelona: Nexus Ediciones, 2002; 1221.Google Scholar
9Serra Majem, L, Aranceta Bartrina, J, Ribas Barba, L, Pérez Rodrigo, C, García Closas, R. Estudio enKid: objetivos y metodología. In: Serra-Majem, L, Aranceta, J, eds. Desayuno y Equilibrio Alimentario. Estudio enKid. Barcelona: Masson, 2000; 18.Google Scholar
10Serra-Majem, L, García-Closas, R, Ribas, L, Pérez-Rodrigo, C, Aranceta, J. Food patterns of Spanish schoolchildren and adolescents: The enKid Study. Public Health Nutrition 2001; 4: 1433–8.Google Scholar
11García Closas, R, Serra Majem, LI. Encuestas alimentarias en la infancia y adolescencia. Archivos de Pediatría 2000; 51(3): 146–56.Google Scholar
12Serra Majem, L, Ribas, L, García Closas, R, Ramon, JM, Salvador, G, Farran, A, et al. Llibre Blanc: Avaluació de l'Estat Nutricional de la Població Catalana (1992–93). Barcelona: Department de Sanitat i Seguretat Social, Generalitat de Catalunya, 1996; 1252.Google Scholar
13Serra-Majem, L, Ribas Barba, L, Armas Navarro, A. Equipo investigador de ENCA 1997–98. Encuesta Nutricional de Canarias 1997–98. Ingesta de Energía y Nutrientes y Riesgo de Ingestas Inadecuadas. Archiros Latino-americanos de Nutrición 2002; 50(Suppl. 1): 75225.Google Scholar
14Hercberg, S, Preziosi, P, Galan, P, Deheeger, M, Papoz, L, Dupin, H. Apports nutritionnels d'un échantillon représentatif de la population du Val-de-Marne: III. Les apports en minéraux et vitamines. Revue d'Epidémiologie et de Santé Publique 1991; 39: 245–61.Google Scholar
15Guerra, A, Feldl, F, Koletzko, B. Fatty acid composition of plasma lipids in healthy Portuguese children: is the Mediterranean diet disappearing? Annals of Nutrition & Metabolism 2001; 45: 7881.Google Scholar
16Greco, L, Musmarra, F, Franzese, C, Auricchio, S. Early childhood feeding practices in southern Italy: is the Mediterranean diet becoming obsolete? Study of 450 children aged 6–32 months in Campania, Italy. Cultural Paediatric Association. Acta Paediatrica 1998; 87: 250–6.Google Scholar
17Cruz, JA. Dietary habits and nutritional status in adolescents over Europe–Southern Europe. European Journal of Clinical Nutrition 2000; 54(Suppl. 1): S29–35.Google Scholar
18Avellone, G, Di Garbo, V, Panno, AV, Cordova, R, Abruzzese, G, Rotolo, G, et al. Cardiovascular risk factors and dietary habits in secondary school children in southern Italy. International Angiology 1994; 13: 148–53.Google Scholar
19Serra-Majem, L, Helsing, E, eds. Changing patterns of fat intake in Mediterranean countries. European Journal of Clinical Nutrition 1993; 47(Suppl. 1): S1–100.Google Scholar
20Alberti-Fidanza, A, Fidanza, F. Mediterranean Adequacy Index of Italian diets. Public Health Nutrition 2004; 7: 937–41.Google Scholar
21Trichopoulou, A, Kouris-Blazos, A, Wahlqvist, ML, Gnardellis, C, Lagiou, P, Polychronopoulos, E, et al. Diet and overall survival in elderly people. British Medical Journal 1995; 311(7018): 1457–60.Google Scholar
22Aranceta Bartrina, J, Pérez Rodrigo, C. Consumo de Alimentos y Estado Nutricional de la Población de Bilbao. Guías Nutricionales para la Población Escolar. Bilbao: Área de Salud y Consumo, Excmo, Ayuntamiento de Bilbao. 1996.Google Scholar
23Petridou, E, Malamou, H, Doxiadis, S, Pantelakis, S, Kanellopoulou, G, Toupadaki, N, et al. Blood lipids in Greek adolescents and their relation to diet, obesity, and socioeconomic factors. Annals of Epidemiology 1995; 5: 286–91.Google Scholar
24De Lorgeril, M, Salen, P. Wine ethanol, platelets, and Mediterranean diet. Lancet 1999; 353: 1067.Google Scholar
25De la Torre-Boronat, MC. Scientific basis for the health benefits of the Mediterranean diet. Drugs under Experimental and Clinical Research 1999; 25: 155–61.Google Scholar
26Birch, LL, Fisher, JO. Development of eating behaviours among children and adolescents. Pediatrics 1998; 101: 539–49.Google Scholar