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. 2025 Jan 11;184(2):130.
doi: 10.1007/s00431-024-05945-1.

Validity of the MED4CHILD tool for assessing adherence to the Mediterranean diet in preschool children

Alicia Larruy-García  1 , Pilar De Miguel-Etayo  1   2 , Nancy Babio  3   4   5 , Katherine Flores-Rojas  6 , Rosaura Picáns-Leis  7 , Carlos Gómez-Martínez  2   8   9 , María L Miguel-Berges  1   2 , J Alfredo Martínez  2   10 , Dolores Corella  2   11 , M José de la Torre-Aguilar  6 , Rocío Vázquez-Cobela  2   12   13 , Sangeetha Shyam  2   8   9 , Belén Pastor-Villaescusa  2   6 , Diana Paola Córdoba-Rodríguez  14 , Helmut Schröder  15   16 , María Fernández de la Puente  2   8   9 , José Manuel Jurado-Castro  2   6 , Jiaqi Ni  2   8   9 , Santiago Navas-Carretero  2   10   17   18 , Rosaura Leis  2   13   14 , Mercedes Gil-Campos  2   6 , Jordi Salas-Salvadó  2   8   9 , Luis A Moreno  1   2
Affiliations

Validity of the MED4CHILD tool for assessing adherence to the Mediterranean diet in preschool children

Alicia Larruy-García et al. Eur J Pediatr. .

Abstract

Most of the available tools to assess adherence to Mediterranean diet (MedDiet) were constructed for adults, having limited applicability to children and adolescents. The aim of this study is to validate a specific questionnaire to assess adherence to MedDiet in children aged 3 to 6 years (MED4CHILD questionnaire). The validation was performed in a baseline examination of a cohort of children who were recruited in schools in seven cities. Of the total sample of 1509 children, we included 858 children aged 3 to 6 years with complete information on adherence to the MedDiet, food consumption, anthropometry and cardiometabolic characteristics. Adherence to the MedDiet was assessed using an 18-item questionnaire, adapted from validated questionnaire for adults using the Delphi method. Food and beverage consumption was assessed using a validated COME-Kids Food and Beverage Frequency Questionnaire. Anthropometric measurements and cardiometabolic risk factors were assessed using standard methods. Statistical analyses included kappa agreement, ANOVA and linear regression models. Higher MED4CHILD scores were associated with higher intakes of food characteristic of the MedDiet. The MED4CHILD questionnaire showed moderate validity, especially for key items of the Mediterranean diet (kappa ranging from 0.333 to 0.665). Direct significant associations were found between MED4CHILD scores and cardiometabolic profile, including waist circumference (p), triglycerides and HOMA-IR (p < 0.05).

Conclusion: The 18-item MED4CHILD questionnaire showed moderate validity for assessing adherence to the MedDiet in children aged 3 to 6 years, in terms of agreement with food and beverage consumption and favourable cardiometabolic profile.

What is known: • The Mediterranean diet has been linked to a number of health benefits and the assessment of children's adherence to this diet is important for public health and research. • The tools available to assess MedDiet compliance are mainly for adults.

What is new: • The MED4CHILD questionnaire is a simple, inexpensive and rapid tool for assessing MedDiet compliance in children. • This tool showed moderate relative validity and a high score was associated with a favourable cardiometabolic profile.

Keywords: Childhood; Dietary intake; Mediterranean pattern; Short screener; Validation study.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Bland–Altman plot for the agreement between the administered MED4CHILD score and the MED4CHILD estimated from the COME-Kids Food and Beverage Frequency Questionnaire
See this image and copyright information in PMC

References

    1. Martínez-González MA, Salas-Salvadó J, Estruch R, Corella D, Fitó M, Ros E (2015) Benefits of the Mediterranean diet: insights from the PREDIMED study. Prog Cardiovasc Dis 58(1):50–60 - DOI - PubMed
    1. Velázquez-López L, Santiago-Díaz G, Nava-Hernández J, Muñoz-Torres AV, Medina-Bravo P, Torres-Tamayo M (2014) Mediterranean-style diet reduces metabolic syndrome components in obese children and adolescents with obesity. BMC Pediatr 14(1):175 - DOI - PMC - PubMed
    1. Zhao LG, Sun JW, Yang Y, Ma X, Wang YY, Xiang YB (2016) Fish consumption and all-cause mortality: a meta-analysis of cohort studies. Eur J Clin Nutr 70(2):155–61 - DOI - PubMed
    1. Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W et al (2014) Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 349:4490 - DOI - PMC - PubMed
    1. Schwingshackl L, Hoffmann G (2014) Monounsaturated fatty acids, olive oil and health status: a systematic review and meta-analysis of cohort studies. Lipids Health Dis 13:154 - DOI - PMC - PubMed

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