Evaluation of the nutritional status, compliance with the Mediterranean diet, physical activity levels, and obesity prejudices of adolescents

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Gizem Aydın https://orcid.org/0000-0002-8016-291X
Hande Öngün Yılmaz https://orcid.org/0000-0002-3497-567X


Mediterranean diet, adolescent, nutrition, physical activity, obesity prejudice


Aim: This research was planned and conducted as a cross-sectional descriptive study in order to determine the nutritional status, compliance with the Mediterranean diet, physical activity levels, and obesity prejudices of adolescents, and to evaluate the relationship between them. Methods: The research was conducted with 233 adolescents aged between 13 and 18 years who studied at a high school in the Üsküdar district of Istanbul. A 3-day food consumption record and anthropometric measurements of the participants were made, and the KIDMED scale, IPAQ scale, and GAMS-27 scale were applied. Results: 50.2% of the adolescents participating in the study were girls and 49.8% were boys; the mean age was 15.57 ± 1.12 years. The mean BMI scores of the girls and boys were 22.55 ± 3.85 kg/m2 and 22.85 ± 3.52 kg/m2, respectively (p>0.05). The average waist/height ratio for girls was 0.45 ± 0.05, and for boys, it was 0.47±0.05 (p <0.05).  It was determined that girls consumed an average of 1673.28 ± 469.36 calories daily and boys consumed 1823.31 ± 576.70 calories (p<0.05). The mean KIDMED score of the participants was 4.31 ± 2.48, the mean IPAQ score was 3524.65 ± 2236.81 MET, and the mean GAMS-27 score was 82.56 ± 11.46. Discussion: As a result of the research, it was concluded that the participants complied with the Mediterranean diet at a low-moderate level, were minimally active, and prone to having obesity prejudices.

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1. Vanhelst J, Beghin L, Drumez E et al. Adolescents' diet quality in relation to their relatives' and peers' diet engagement and encouragement: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. Public Health Nutrition 2017; 21: 3192-3201.
2. Özdemir A. Macronutrients in Adolescence. International Journal of Caring Sciences 2016; 9: 1162-6.
3. Republic of Turkey Ministry of Health, Hacettepe University. Turkey Health Nutrition Survey (THNS) 2010. (2014). https://hsgm.saglik.gov.tr/depo/birimler/saglikli-beslenme-hareketli-hayat-db/Yayinlar/kitaplar/diger-kitaplar/TBSA-Beslenme-Yayini.pdf . (accessed February 2020).
4. United States Department of Agriculture (USDA), United States Department of Health and Human Services (USDHHS). Scientific report of the 2015 Dietary Guidelines Advisory Committee. (2015). https://ods.od.nih.gov/pubs/2015_dgac_scientific_report.pdf . (accessed February 2020).
5. Deka MK, Malhotra AK, Yadav R, Gupta S. Dietary pattern and nutritional deficiencies among urban adolescents. J Family Med Prim Care 2015; 4: 364-368.
6. Chien LY, Liou YM, Chang P. Low defecation frequency in Taiwanese adolescents: Association with dietary intake, physical activity and sedentary behavior. J Paediatr Child Health 2011; 47: 381-386.
7. Santaliestra-Pasias AM, Mouratidou T, Verbestel V, et al. Food Consumption and Screen-Based Sedentary Behaviors in European Adolescents: The HELENA Study. Arch Pediatr Adolesc Med 2012; 166: 1010-20.
8. American Diabetes Association. Standards of medical care in diabetes-2017. Diabetes Care 2017; 40: 11-24.
9. Dernini S, Berry EM. Mediterranean diet: from a healthy diet to a sustainable dietary pattern. Front Nutrition 2015; 2: 1-7.
10. Martinez-Gonzalez M, Garcia-Lopez M, Bes-Rastrollo M, et al. Mediterranean diet and the incidence of cardiovascular disease: A Spanish cohort. Nutr Metab Cardiovasc Dis 2011; 21: 237-44.
11. Akgüllü Ç, Sırıken F, Eryılmaz U, et al. The relation between compliance with the Mediterranean diet and the extensiveness of coronary artery disease. Türk Kardiyol Dern Arş 2015; 43: 340-9.
12. Casas R, Sacanella E, Urpi-Sarda M, et al. The effects of the Mediterranean Diet on Biomarkers of Vascular Wall Inflammation and Plaque Vulnerability in Subjects with High Risk for Cardiovascular Disease: A Randomized Trial. PLos ONE 2014; 9: 1-11.
13. Romaguera D, Guevara M, Norat T, et al. Mediterranean diet and type 2 diabetes risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study: the InterAct project. Diabetes Care 2011; 34: 1913–8.
14. Perez-Martinez P, Garcia-Rios A, Delgado-Lista J, Perez-Jimenez F, Lopez-Miranda J. Mediterranean diet rich in olive oil and obesity, metabolic syndrome and diabetes mellitus. Curr Pharm Des 2011; 17: 769-77.
15. Sofi F, Macchi C, Abbate R, Gensini GF, Casini A. Mediterranean Diet and Health. Biofactors 2013; 39: 335-42.
16. Schwingshackl L, Hoffmann G. Adherence to Mediterranean diet and risk of cancer: A systematic review and meta-analysis of observational studies. Int J Cancer 2014; 135: 1884-97.
17. Buckland G, Agudo A, Travier N, et al. Adherence to the Mediterranean diet reduces mortality in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). Br J Nutr 2011; 106: 1581-91.
18. Landry BW, Driscoll SW. Physical activity in children and adolescents. PM&R 2012; 4:826-832.
19. Biddle SJH, Asare M. Physical activity and mental health in children and adolescents: a review of reviews. Br J Sports Med 2011; 45: 886-95.
20. Taşkın G, Şahin-Özdemir FN. The Importance of Exercise in Children. Gazi Journal of Physical Education and Sports Sciences 2018; 23: 131-41.
21. Ayhan D., Günaydın E, Gönlüaçık E, Arslan U, Çetinkaya F, Asimi H, Uncu Y. Nutritional Habits of Uludağ University Medical Faculty Students and Factors Affecting Them. Journal of Uludağ University Faculty of Medicine 2012; 38: 97-104.
22. Hills AP, Andersen LB, Byrne NM. Physical activity and obesity in children. Br J Sports Med 2011; 45: 866-70.
23. Can S, Arslan E, Ersöz G. Physical Activity with a Current Perspective. Ankara University Faculty of Sport Sciences 2014; 12: 1-10.
24. Welborn S. Comparison Of Obesity Bias, Attitudes, and Beliefs Among Under Graduate Dietetic Students, Dietetic Interns, and Practicing Registered Dietitians. PhD Thesis, University of East Tennessee State. 2013.
25. World Health Organization. Weight bias and obesity stigma: considerations for the WHO European Region. (2017). http://www.euro.who.int/__data/assets/pdf_file/0017/351026/WeightBias.pdf?ua=1. (accessed January 2020).
26. Ercan A, Ok MA, Kızıltan G, Altun S. Development of Obesity Bias Scale for Health Sciences Students: GAMS 27-Obesity Bias Scale. International Refereed Journal of Nutrition Research 2015; 3: 29-43.
27. Nutter S, Ireland A, Alberga AS, Brun I, Lefebvre D, Hayden A, Mayhew SR. Weight Bias in Educational Settings: a Systematic Review. Curr Obes Rep 2019; 8: 185-200.
28. Sutin AR, Terracciano A. Perceived Weight Discrimination and Obesity. PLos One 2013; 8: 1-4.
29. Serra-Majem L, Ribas L, Ngo J. Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutrition 2004; 7: 931–5.
30. Erol E, Ersoy G, Pulur A, Özdemir G, Bektaş Y. Evaluation of the Mediterranean Diet Quality Index (KIDMED) in adolescents in Turkey. International Journal of Human Sciences 2010; 7: 647-64.
31. Craig CL, Marshall LA, Sjöström M, et al. International Physical Activity Questionnaire: 12-Country Reliability and Validity. Med Sci Sports Exerc 2003; 35: 1381-95.
32. Öztürk M. Validity and reliability of the international physical activity survey and determination of the levels of physical activity among students studying at the university. PhD Thesis, University of Hacettepe Ankara. 2005.
33. International Physical Activity Questionnaire. IPAQ scoring protocol. (2005). https://sites.google.com/site/theipaq/scoring-protocol. (accessed March 2020).
34. World Health Organization. BMI-for-age (5-19 years). (2007) https://www.who.int/growthref/who2007_bmi_for_age/en/. (accessed February 2020).
35. Ashwell M. Waist to height ratio and the Ashwell shape chart could predict the health risks of obesity in adults and children in all ethnic groups.  Nutrition and Food Science 2005; 35: 359-64.
36. Gerber M, Hoffman R. The Mediterranean diet: health, science and society. British Journal of Nutrition 2015; 113: 4-10.
37. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. (2012) Impact of Physical Inactivity on the World's Major Non-Communicable Diseases. Lancet 2012; 380: 219-29.
38. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity and trends in body mass index among US children and adolescents 1999-2010. JAMA 2012; 307: 483-90.
39. Keast DR, Nicklas TA, O’Neil CE. Snacking is associated with reduced risk of overweight and reduced abdominal obesity in adolescents: National Health and Nutrition Examination Survey (NHANES). Am J Clin Nutr 2010; 92: 428-35.
40. Aktaş D, Öztürk FN, Kapan Y. Frequency of obesity in adolescents and risk factors affecting it, determination of nutritional habits. TAF Preventive Medicine Bulletin 2015; 14: 406-12.
41. Deshmukh-Taskar PR, Nicklas TA, Oneil CE, Keast DR, Radcliffe JD, Cho S. The relationship of breakfast skipping and type of breakfast consumption with nutrient intake and weight status in children and adolescents: The National Health and Nutrition Examination Survey 1999-2006. Journal of American Dietetic Association 2010; 110: 869-78.
42. Aksoydan E, Çakır N. Evaluation of nutritional habits, physical activity levels and body mass indexes of adolescents. Gülhane Medical Journal 2011; 53: 264-70.
43. Azadbakht L, Hajishafiee M, Golshahi J, Esmaillzadeh A. Snacking behavior and obesity among female adolescents in Isfahan, Iran. J Am Coll Nutr 2015; 35: 405-12.
44. World Health Organization. Obesity and overweight. (2020). https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. (accessed May 2020).
45. Ergül Ş, Kalkım A. An important chronic disease: obesity in childhood and adolescence. TAF Preventive Medicene Bulletin 2011; 10: 223-30.
46. Yabancı N, Pekcan G. The effect of nutritional status and physical activity level on body composition and bone mineral density in adolescents. Journal of Family, Community Education and Culture Research 2010; 6: 9-20.
47. Ramirez-Velez R, Moreno-Jimenez J, Correa-Bautista JE, et al. Using LMS tables to determine waist circumference and waist-to-height ratios in Colombian children and adolescents: the FUPRECOL study. BMC Pediatrics 2017; 17: 162-73.
48. Aslan NN, Yardımcı H, Özçelik AÖ. Relationship between macro-nutrient intakes and anthropometric measurements of students preparing for the university exam. Erciyes University Journal of Health Sciences Faculty 2017; 4: 39-48.
49. Gümüş H, Bulduk S, Akdevelioğlu Y. Determination of the relationship between the nutritional and physical activity status of adolescents staying in orphanages and their body composition. Journal of Human Science 2011; 8: 786-808.
50. Tüfekçi ME, Güleç GS. Mediterranean Diet. In: Tüfekçi ME (ed) Diets and Facts, 1st edn. Hatiboğlu, Ankara, 2016, pp 123-160.
51. Buscemi S, Marventano S, Castellano S, et al. Role of anthropometric factors, self-perception, and diet on weight misperception among young adolescents: a cross-sectional study. Eat Weight Disord 2018; 23: 107-15.
52. Kabaran S, Gezer C. Determination of Obesity by Compliance with the Mediterranean Diet in Children and Adolescents in the Turkish Republic of Northern Cyprus. Turkish Journal of Pediatric Disease 2013; 7: 11-20.
53. Kılınç FN, Çakır B, Durmaz SE. Are sports adolescents fed optimally? Obesity states and Mediterranean Diet compliance levels. Turkey Clinics Journal of Sports Science 2020; 12: 49-57.
54. Torun-Toktaş N, Yildiz Y. Assessment of nutritional status of 10-14 years old adolescents using Mediterranean diet quality index (KIDMED). Procedia Social and Behavioral Science 2013; 106: 512-8.
55. Mistretta A, Marventano S, Antoci M, et al. Mediterranean diet adherence and body composition among Southern Italian adolescents. Obes Res Clin Pract 2017; 11: 215-26.
56. Galan-Lopez P, Sanchez-Oliver A, Ries F, Gonzalez-Jurado JA. Mediterranean Diet, Physical Fitness and Body Composition in Sevillian Adolescents: A Healthy Lifestyle. Nutrients 2019; 11: 2009-23.
57. Devran BS, Saka M. The effect of nutrition education given to high school students on nutritional habits, nutritional knowledge level and physical activity. Journal of Nutrition and Dietetics 2019; 47: 5-14.
58. Alper Y, Pündük Z, Akçakoyun F, Göktaş Z. Investigation of nutrition and physical activity habits of students of Balıkesir Science High School. Sports View: Journal of Sports and Educational Sciences 2017; 4: 101-10.
59. Bebiş H, Akpunar D, Özdemir S, Kılıç S. Investigation of Health Promotion Behaviors of Adolescents in a Secondary School. Gülhane Medical Journal 2015; 57: 129-35.
60. Christofaro DGD, De-Andrade SM, Mesas AE, Fernandes RA, Junior JCF. Higher Screen Time Is Associated With Overweight, Poor Dietary Habits and Physical Inactivity in Brazilian Adolescents Mainly among Girls. Eur J Sport Sci 2016; 16: 498-506.
61. Sanal E, Ardıç F, Kıraç S. Effects of aerobic or combined aerobic resistance exercise on body composition in overweight and obese adults: gender differences: A randomized intervention study. Eur J Phys Rehabil Med 2013; 49: 1-11.
62. Keskin K, Alpkaya U, Çubuk A, Öztürk Y. Examining the relationship between the physical activity levels of children 12-14 years old and their nutritional behaviors. IU Journal of Sports Sciences 2017; 7: 34-43.
63. Farajian P, Risvas G, Karasouli K, et al. Very high childhood obesity prevalence and low adherence rates to the Mediterranean diet in Greek children: The GRECO study. Atherosclerosis 2011; 217: 525-30.
64. Santi MD, Callari F, Brandi G et al. Mediterranean diet adherence and weight status among Sicilian Middle school adolescents. International Journal of Food Sciences and Nutrition; 2020.
65. Peng W, Goldsmith R, Berry EM. Demographic and lifestyle factors associated with adherence to the Mediterranean diet in relation to overweight / obesity among Israeli adolescents: findings from the Mabat Israeli national youth health and nutrition survey. Public Health Nutrition 2016; 20: 883–92.
66. Papadaki S, Mavrikaki E. Greek adolescents and the Mediterranean diet: factors affecting quality and adherence. Nutrition 2015; 31: 345–9.
67. Santomauro F, Lorini C, Tanini T, et al. Adherence to Mediterranean diet in a sample of Tuscan adolescents. Nutrition 2014; 30: 1379–83.
68. Arriscado D, Muros JJ, Zabala M, Dalmau JM. Factors associated with low adherence to a Mediterranean diet in healthy children in Northern Spain. Appetite 2014; 80: 28–34.
69. Bayram S, Köseler-Beyaz E, Türker PF, Saka M. The evaluation of obesity prejudices among adolescents. Acta scientific nutritional health 2019; 3: 166-71.
70. Puhl RM, Luedicke J. Weight-Based Victimization Among Adolescents in the School Setting: Emotional Reactions and Coping Behaviors. J Youth Adolescence 2012; 41: 27-40.
71. Gaspar MJM, Amaral TF, Oliveira BMPM, Borges N. Protective effect of physical activity on dissatisfaction with body image in children: A cross-sectional study. Psychology of Sport and Exercise 2011; 12: 563–9.
72. Coelho CG, Giatti L, Molina MDCB, Nunes MAA, Barreto SM. Body Image and Nutritional Status Are Associated with Physical Activity in Men and Women: The ELSA-Brasil Study. Int J Environ Res Public Health 2015; 12: 6179-96.
73. Bibiloni MDM, Pons A, Tur JA. Compliance with the Mediterranean Diet Quality Index (KIDMED) among Balearic Islands' Adolescents and Its Association with Socioeconomic, Anthropometric and Lifestyle Factors. Ann Nutr Metab 2016; 68: 42-50.
74. Albaladejo-Blázquez N, Ferrer-Cascales R, Riziz-Robledill N, Sapa-Sansegundo M, Clement-Carbonell V, Zaragoza-Martí A. Poor Dietary Habits in Bullied Adolescents: The Moderating Effects of Diet on Depression. Int J Environ Res Public Health 2018; 15: 1569-79.
75. De-Vriendt T, Clays E, Huybrecht I, et al. European adolescents' level of perceived stress is inversely related to their diet quality: The healthy lifestyle in Europe by Nutrition in Adolescence study. British Journal of Nutrition 2012; 108: 371-80.
76. Hou F, Xu S, Zhao Y, Lu Q, Zhang S, Zu P, Sun Y et al. Effects of emotional symptoms and life stress on eating behaviors among adolescents. Appetite 2013; 68: 63-8.
77. Michels N, Sioen I, Braet C, et al. Stress, emotional eating behavior and dietary patterns in children. Appetite 2012; 59: 762–9.