The Role of Food Security in Mediterranean Diet Adherence Among Adolescents: Findings from the EHDLA Study

Abstract

Food insecurity is a growing public health concern, particularly among vulnerable groups such as adolescents, and it has been linked to poor nutritional outcomes and increased risk of chronic diseases. The Mediterranean diet (MedDiet) is recognized for its numerous health benefits, yet few studies have explored the association between food insecurity and adherence to the MedDiet among adolescents, especially in Mediterranean regions.

Objective: This study aimed to investigate the association between food insecurity and adherence to the MedDiet in a sample of adolescents from Spain.

Methods: Data were acquired from 2021-2022 school years from adolescents aged 12-17 years enrolled in different secondary schools in Valle de Ricote, Region of Murcia, Spain. Food security was assessed via the Spanish Child Food Security Survey Module (CFSSM-S), and adherence to the MedDiet was assessed via the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED). A total of 836 participants were involved, and statistical analyses were conducted via linear regression models adjusted for lifestyle, anthropometric, and sociodemographic covariates.

Results: After adjusting for potential confounders, the mean KIDMED score was 7.0 (95% confidence interval [CI] 6.7 to 7.2) in the food-security group, 6.8 (95% CI 6.3 to 7.3) in the low-security group, and 5.9 (95% CI 4.9 to 6.9) in the very-low-security group. Notable differences were observed between participants with food security and their counterparts with very low food security (p = 0.040). Compared with those with food security (57.2%, 95% CI 51.5% to 62.8%), a significantly greater likelihood of having nonoptimal adherence to the MedDiet was identified in adolescents with low food security (61.6%, 95% CI 50.4% to 71.8%) and in those with very low food security (77.4%, 95% CI 54.5% to 90.7%). We identified a significant difference only between adolescents with food security and their peers with very low food security (p = 0.036).

Conclusions: The findings suggest that very low food security negatively impacts MedDiet adherence in adolescents. Compared with their food-secure peers, adolescents with very low food security showed significantly poorer diet quality. These results highlight the importance of addressing food insecurity through low-cost, high-nutrition programs aimed at improving healthy eating habits, particularly for children and adolescents living in low-food-security households.

Keywords: diet quality; eating healthy; food insecurity; lifestyle; socioeconomic status; teenagers.

Figure 1

Estimated marginal means and 95% confidence intervals of the Mediterranean Diet Quality Index in children and adolescents corresponding to food security status. Socioeconomic status, energy intake, age, sex, physical activity, sleep duration, sedentary behavior, and body mass index were adjusted for. CFSSM-S, Spanish Child Food Security Survey Module. KIDMED, Mediterranean Diet Quality Index in children and adolescents.

Figure 2

Predictive probabilities of having nonoptimal adherence to the Mediterranean diet by food security status. Socioeconomic status, energy intake, age, sex, physical activity, sleep duration, sedentary behavior, and body mass index were adjusted for. CFSSM-S, Spanish Child Food Security Survey Module.