Mediterranean diets have gained interest as uniquely beneficial, with promising effects on cardiovascular disease. In the United States, most studies have focused on adult populations. We evaluated Mediterranean diet adherence in adolescents and examined factors such as race, ethnicity, income level, and food patterns.

Methods

We examined data from 4 two-year cycles (2007-2008 to 2013-2014) from the National Health and Nutrition Examination Survey (NHANES), identifying individuals ages 12-19 years. The KIDMED Index was calculated to quantify adequacy of the Mediterranean diet.

Results

A total of 4,223 adolescents were identified (average age 16y and 51% female). Overall, 19% had average adherence to the diet, 81% had poor adherence, and none had optimal adherence. Adherence was significantly associated with race and family income, with Mexican Americans most likely (23.9%) and Blacks least likely (10.1%) to have average adherence. For every one unit increase in income/poverty ratio, adolescents were 20% more likely to have average adherence (p<0.001). In terms of food patterns, Whites were almost twice as likely to consume nuts regularly as other races/ethnicities (15.9% vs. 8.7% and 8.5%), and 25% of Mexican Americans ate pulses more than once a week, compared to 7-8% of other races (p<0.001). More than half of Blacks (51.9%) reported skipping breakfast, compared to 35.8% of Whites and 36.9% of Mexican Americans.

Conclusions

With the rising prevalence of obesity and metabolic syndrome in adolescents, understanding cultural and social factors related to diets can help guide physician recommendations, health coaching, and policies for weight management and food programs.