Translation and cultural adaptation of the mediterranean diet quality index in children and adolescents / Tradução e adaptação cultural do mediterranean diet quality index in children and adolescents

ABSTRACT Objective: To translate and culturally adapt the Mediterranean Diet Quality Index in Children and Adolescent (KIDMED) for the Brazilian population. Methods: The processes of translation and cultural adaptation followed internationally standardized methodological norms. We used the intraclass correlation coefficient and the Bland-Altman dispersion analysis to assess the reproducibility and calculated the internal consistency with Cronbach's alpha coefficient. Results: A total of 102 children and adolescents participated in the cross-cultural adaptation, of whom 58 (56.9%) were females, with a mean age of 9.8±4.9 years. The mean overall scores of adherence to the Mediterranean diet in the test and retest were similar (8.00 and 3.80 versus 8.01 and 3.84) for children and adolescents, respectively. The intraclass correlation coefficient for children and adolescents was 0.893 and 0.998, respectively. The internal consistency was 0.72. The Bland-Altman plot analysis showed good agreement between the final scores of the test and retest questionnaires, with no statistically significant difference. Conclusions: The KIDMED questionnaire was translated into Brazilian Portuguese and culturally adapted, presenting high reproducibility. This questionnaire can, therefore, be included and used in Brazilian studies that aim at evaluating the adherence to the Mediterranean diet among children and adolescents.

RESUMO Objetivo: Traduzir e adaptar culturalmente a escala do Mediterranean Diet Quality Index in Children and Adolescent (KIDMED) para a população brasileira. Métodos: Os processos de tradução e adaptação cultural seguiram normas metodológicas padronizadas internacionalmente. A reprodutibilidade foi avaliada pelo coeficiente de correlação intraclasse e pela análise de dispersão de Bland-Altman, e a consistência interna foi calculada pelo coeficiente de Cronbach. Resultados: Participaram da etapa de adaptação transcultural 102 crianças e adolescentes, sendo 58 (56,9%) meninas com idade média de 9,8±4,9 anos. Os escores totais médio de aderência à dieta mediterrânea no teste e no reteste foram semelhantes (8,00 e 3,80 versus 8,01 e 3,84) para as crianças e os adolescentes, respectivamente. O coeficiente de correlação intraclasse para as crianças e os adolescentes foi de 0,893 e 0,998, respectivamente. A consistência interna obtida foi de 0,72. A análise do gráfico de Bland-Altman demonstrou boa concordância entre os escores finais dos questionários de teste e de reteste, sem diferença estatisticamente significativa. Conclusões: O questionário KIDMED foi traduzido e adaptado culturalmente para a língua portuguesa do Brasil, apresentando alta reprodutibilidade. Esse questionário pode ser, portanto, incluído e utilizado em estudos brasileiros que visem avaliar a aderência à dieta mediterrânea de crianças e adolescentes.

Efectos de un programa alternativo de promoción de la alimentación saludable en comedor escolar / Effects of an alternative program to promote healthy eating in school canteen

Resumen El objetivo del estudio fue determinar los efectos sobre los hábitos alimentarios de escolares en una intervención educativa alternativa al modelo convencional de promoción de alimentación a un centro con comedor y proyecto de huerto ecológico. Estudio observacional descriptivo de corte transversal y comparativo de 111 niños y niñas entre 9 y 12 años, en el periodo 2013-15. Se comparó un colegio con intervención alternativa con otro que únicamente incluía contenidos propios del currículo de Educación Infantil y Primaria, mediante evaluación de adherencia a la dieta mediterránea del alumnado con cuestionario validado Kidmed. El centro de intervención presentó mayor adherencia a la dieta mediterránea que el centro control. En el centro de intervención el porcentaje de alumnado con dieta óptima (64,52%) fue mayor que los que necesitaban mejorar su dieta (33,87%), mientras que en el centro fue inferior (42,86% y 51,02% respectivamente). Los escolares del centro de intervención presentaron mayor porcentaje de respuestas afirmativas en ítems Kidmed. El programa de promoción de alimentación saludable alternativo del centro de intervención podría ser efectivo para la adquisición de una dieta de mayor adherencia a la dieta mediterránea.

Abstract The objective of this study was to determine the effects on school feeding habits in an educational intervention alternative to the conventional model of feeding promotion to a center with school canteens and ecological garden project. Cross-sectional and comparative descriptive observational study of 111 boys and girls between 9 and 12 years old, in the 2013-15 period. A school with alternative intervention was compared with another one that only included contents of the Infant and Primary Education curriculum, by means of evaluation of adherence to the mediterranean diet of the students with a validated Kidmed questionnaire. The intervention center presented greater adherence to the mediterranean diet than the control center. In the intervention center, the percentage of students with optimal diet (64.52%) was higher than those who needed to improve their diet (33.87%), contrary to what occurs in control center (42.86% and 51.02% respectively). The students of the intervention center presented a higher percentage of affirmative answers in Kidmed test. The program of promotion of healthy alternative food of the intervention center could be effective for the acquisition of a diet of greater adherence to the mediterranean diet.

The association between healthy lifestyle behaviors and health-related quality of life among adolescents / Associação entre comportamentos de estilo de vida saudável e a qualidade de vida relacionada à saúde entre adolescentes

Abstract Objective: The aim of this research was to examine the association between body mass index, physical activity, adherence to the Mediterranean diet, and health-related quality of life in a sample of Spanish adolescents. Method: The study involved 456 adolescents aged between 11 and 14 years. They completed questionnaires on the Mediterranean diet (KIDMED), physical activity (Physical Activity Questionnaire for Older Children [PAQ-C]), and quality of life (KIDSCREEN-27). Body mass index was calculated. Hierarchical linear regression analyses were used to determine whether health-related quality of life could be predicted by the measured variables. The variables were analyzed in a stepwise manner, with Mediterranean diet entered in the first step, body mass index in the second, and physical activity in the third. Results: Mediterranean diet accounted for 4.6% of the variance in adolescent's health-related quality of life, with higher adherence to the Mediterranean diet predicting higher health-related quality of life-scores. Body mass index accounted for a further 4.1% of the variance, with a higher body mass index predicting lower health-related quality of life scores. Finally, physical activity explained an additional 11.3% of the variance, with a higher level of physical activity being associated with higher health-related quality of life scores. Together, these variables explained 20% of the variance in the adolescents' health-related quality of life. Conclusions: Physical activity, body mass index, and adherence to the Mediterranean diet are important components to consider when targeting improvements in the health-related quality of life of adolescents, with physical activity representing the component with the greatest influence.

Resumo Objetivo: O objetivo desta pesquisa foi examinar a associação entre o índice de massa corporal, a atividade física, a adesão à dieta mediterrânea e a qualidade de vida relacionada à saúde em uma mostra de adolescentes espanhóis. Método: O estudo envolveu 456 adolescentes entre 11 e 14 anos. Eles preencheram questionários sobre a dieta mediterrânea (Kidmed), atividade física (Questionário de Atividade Física para Crianças mais velhas, PAQ-C) e qualidade de vida (Kidscreen-27). Foi calculado o índice de massa corporal. Análises de regressão linear hierárquica foram usadas para determinar se a qualidade de vida relacionada à saúde pode ser prevista pelas variáveis medidas. As variáveis foram introduzidas de forma gradual com a dieta mediterrânea na primeira etapa, índice de massa corporal na segunda etapa e atividade física na terceira. Resultados: A dieta mediterrânea representou 4,6% da variância na qualidade de vida relacionada à saúde dos adolescentes e uma maior adesão à dieta mediterrânea foi preditiva de maiores escores de qualidade de vida relacionados à saúde. O índice de massa corporal representou um adicional de 4,1% de variância e um maior índice de massa corporal foi preditivo de menores escores de qualidade de vida relacionada à saúde. Por fim, a atividade física representou um adicional de 11,3% da variância e um maior nível de atividade física foi associado a maiores escores de qualidade de vida relacionada à saúde. Juntas, essas variáveis representam 20% da variância na qualidade de vida relacionada à saúde dos adolescentes. Conclusões: A atividade física, o índice de massa corporal e a adesão à dieta mediterrânea são importantes componentes para considerar ao visar melhorias na qualidade de vida relacionada à saúde dos adolescentes, a atividade física é o componente com maior influência.

Validación de cuestionario autoaplicable para un índice de alimentación mediterránea en Chile / Validation of self-applicable questionnaire for a Mediterranean dietary index in Chile

Background: Availability of brief dietary indexes that can effectively evaluate dietary patterns and their association with health is critical for prevention and management of several chronic disease conditions. Aim: To adapt a self-applicable Mediterranean Dietary Index in Chile (Chilean-MDI). Material and Methods: The Chilean-MDI was developed based on a previous Mediterranean eating score that was adapted to Chilean dietary habits. This index was further validated in a sample of 153 adults by comparing the concordance between the results obtained by self-application of the Chilean-MDI with those obtained by a trained nutritionist. Additionally, the index was applied in a sample of 53,366 Chilean adults in order to describe the diet quality of our population. Results: There was an adequate concordance between findings obtained by self-application of the Chilean-MDI and those achieved by the nutritionist. The application of the index in Chilean adult population showed a better diet quality (high Mediterranean diet adherence) among women, with advanced age and among people with higher educational levels. Conclusions: The Chilean-MDI can be successfully self-applied to portray the overall diet quality in the Chilean adult population. Additionally, this dietary index describes overall food intake in Chilean adults, showing demographic trends that are comparable to those obtained with similar indexes applied in other populations.

Health-related fitness in school children: compliance with physical activity recommendations and its relationship with body mass index and diet quality / Condición física relacionada con la salud en escolares: observancia de las recomendaciones de práctica de actividad física y su relación con el índice de masa corporal y la calidad de la dieta

This study establishes the relationship between the compliance with the governmental physical activity guidelines (at least a minimum of one hour of moderate to vigorous physical activity, MVPA, five times a week), health-related physical fitness and different health related lifestyle variables in a representative sample of Spanish children. Subjects were a representative group of scholars from five schools randomly selected in Extremadura, a mainly rural region with a very low population density. Statistical analysis comprises a t-test to calculate physical fitness differences between groups, according to the compliance with the mentioned physical activity guidelines. A multinomial logistic regression coefficient is established to determine the differences between the better physical fitness status group (= percentile 75) and the poorer physical fitness status group (= percentile 25) for each fitness test and gender, body mass index, physical activity, Mediterranean diet index and population size. Main findings show that the compliance with physical activity guidelines result in a better handgrip strength in left hand (p<0.05), leg strength (p<0.000), speed-agility run (p<0.000) and 20 m endurance shuttle run (p<0.000). Being a girl, being overweighed and living in an urban setting are associated with a lower physical fitness (= percentile 25), whereas there is no relationship between diet quality and subjects’ performance in all physical fitness test evaluated. As a conclusion, this study emphasizes the need to promote an active lifestyle in which physical activity suppose a minimum of one hour of regular MVPA, at least five times a week, to achieve a healthy fitness status.

Este estudio establece la relación entre el cumplimiento de las directrices gubernamentales de actividad física (una hora de actividad física moderada o vigorosa, MVPA, cinco veces a la semana), la condición física saludable, la calidad de la dieta y otras variables en una muestra de escolares de Extremadura (España). Se ha utilizado un t-test para calcular las diferencias de condición física entre los grupos, de acuerdo con el cumplimiento de las mencionadas directrices de actividad física. Se ha establecido un coeficiente de regresión logística multinomial para determinar las diferencias entre el grupo con mejor condición física (= percentil 75) y el grupo con peor condición física (= percentil 25), en función del sexo, índice de masa corporal, actividad física, índice mediterráneo de calidad de la dieta y tamaño de la población. El cumplimiento de las directrices de actividad física se relaciona con mejor fuerza de prensión en la mano izquierda (p <0,05), mayor potencia de las piernas (p <0,000), mejor agilidad (p <0,000) y mayor aptitud cardiorrespiratoria (p <0,000). Ser niña, tener exceso de peso y vivir en un entorno urbano se asocia con peor condición física (= percentil 25), mientras que no existe relación entre calidad de la dieta y la actuación de los sujetos en las pruebas de condición física realizadas. Este estudio enfatiza la necesidad de promover un estilo de vida activo en el que exista al menos una hora de actividad física (MVPA) durante cinco días a la semana, para alcanzar un estado físico saludable.

Comparison of mediterranean, Western and Japanese diets and some recommendations.

During the past thousands of years, food systems, and thus human diets, have been and are shaped by climate, terrain, seasons, location, culture, and technology. In this context, many types of diet patterns have emerged. Nowadays, numerous epidemiological studies are being conducted in many countries in order to find relationships between empirically identified dietary factors and the occurrence of illnesses. Today, some dietary patterns are described as healthy eating models while others are generally qualified as unhealthy.