Aims. To examine the impact of adherence to the Mediterranean diet on body fatness and cardio-metabolic profile and the concomitant role of physical activity (PA) and cardiorespiratory fitness (CRF) in European adolescents (n = 2340; 12.5-17.5years) participating in the HELENA-study.
Method. A Mediterranean Diet Score (MDS) was calculated after assessing dietary intake by two non-consecutive24 h dietary recalls. PA was measured by accelerometry and CRF with the 20m shuttle run test. Cardio-metabolic risk (CMR) factor measurements included anthropometric parameters, blood lipid profile, blood pressure and insulin resistance. A CMR index and a fatness index were computed.
Results. MDS was inversely related to systolic blood pressure and PA with most CMR factors, after adjusted for energy intake and PA and for energy intake and MDS, respectively. However, associations between PA and fatness markers disappeared after adjusting for CRF. Overall, CRF was inversely related to all CMR factors also in the fully adjusted models which included MDS, energy intake and PA. Individuals with high MDS and being more physically active had the lowest score on fatness and the healthiest profile on most CMR factors (except systolic blood pressure and total cholesterol) regardless of sex, age, socioeconomic-status, parental education and centre. These associations were attenuated after adjustment for energy intake and disappeared when CRF was considered. Adolescents with high CRF had lower fatness, a healthier profile in most CMR factors and cardio-metabolic scores independently of their MDS (all P≤0.044). Results persisted after further adjusting for energy intake and PA (except for systolic blood pressure, total cholesterol and triglycerides).
Conclusion. Adherence to the Mediterranean diet alone is an insufficient fundament for lower adiposity and better cardio-metabolic health in adolescents. A combination of a Mediterranean diet with an active lifestyle and high cardiorespiratory fitness seems to be most effective with an active.
Corresponding author. mmcuenca@ugr.es
