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Gonzalez Gross, Maria MarcelaAuthorZapico A.g.Author

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June 5, 2023
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Article

Trends in Adherence to the Mediterranean Diet in Spanish Children and Adolescents across Two Decades

Publicated to: Nutrients. 15 (10): 2348- - 2023-05-17 15(10), DOI: 10.3390/nu15102348

Authors:

Herrera-Ramos, Estefania; Tomaino, Laura; Sanchez-Villegas, Almudena; Ribas-Barba, Lourdes; Gomez, Santiago F; Warnberg, Julia; Oses, Maddi; Gonzalez-Gross, Marcela; Gusi, Narcis; Aznar, Susana; Marin-Cascales, Elena; Gonzalez-Valeiro, Miguel Angel; Terrados, Nicolas; Tur, Josep A; Segu, Marta; Fito, Montserrat; Homs, Clara; Benavente-Marin, Juan Carlos; Labayen, Idoia; Zapico, Augusto G; Sanchez-Gomez, Jesus; Jimenez-Zazo, Fabio; Alcaraz-Ramon, Pedro Emilio; Sevilla-Sanchez, Marta; Pulgar-Munoz, Susana; Bouzas, Cristina; Sistac-Sorigue, Clara; Schroder, Helmut; Serra-Majem, Lluis
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Affiliations

Biomed Res Networking Ctr Frailty & Hlth Aging CI, Madrid 28029, Spain - Author
Blanquerna Ramon Llull Univ, Fac Hlth Sci, Global Res Wellbeing GroW, Barcelona 08025, Spain - Author
Carlos III Hlth Inst, CIBER Epidemiol & Publ Hlth CIBERESP, Madrid 28029, Spain - Author
Catholic Univ Murcia, Res Ctr High Performance Sport, Murcia 30107, Spain - Author
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública , Hospital del Mar - Author
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública , Universitat de Lleida , Hospital del Mar , Gasol Foundation - Author
Centro de Investigación Biomédica en Red Sobre Fragilidad y Envejecimiento Saludable , Faculty of Sports Sciences - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Complejo Hospitalario Universitario Insular Materno-Infantil , Universidad de Las Palmas de Gran Canaria - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Fundación para la Investigación Nutricional (FIN) - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Hospital del Mar - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Universidad Politécnica de Madrid - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Universidad Pública de Navarra - Author
Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Universidad Pública de Navarra , Universidad de Las Palmas de Gran Canaria - Author
Ctr Hosp Univ Insular Materno Infantil CHUIMI, Canarian Hlth Serv, Prevent Med Serv, Las Palmas Gran Canaria 35016, Spain - Author
Faculty of Sports Sciences - Author
Fdn Invest Nutr FIN, Barcelona Sci Pk, Barcelona 08028, Spain - Author
Fundació Institut d'Investigació Sanitaria Illes Balears , Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición , Universitat de les Illes Balears - Author
Gasol Fdn, St Boi de Llobregat 08830, Barcelona, Spain - Author
Hlth Res Inst Balear Isl IDISBA, Palma de Mallorca 07122, Spain - Author
Hlth Res Inst Principal Asturias ISPA, Oviedo 33011, Spain - Author
Hosp Mar Med Res Inst IMIM, Barcelona 08003, Spain - Author
Inst Hlth Carlos III, Ctr Invest Biomed Red Fisiopatol Obes & Nutr CIBE, Madrid 28029, Spain - Author
Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina , Centro de Investigación Biomédica en Red-Fisiopatología de la Obesidad y Nutrición - Author
Instituto de Investigación Sanitaria del Principado de Asturias , Regional Unit of Sports Medicine-Municipal Sports Foundation of Avilés - Author
Probitas Fdn, Barcelona 08022, Spain - Author
Probitas Foundation - Author
Reg Unit Sports Med Municipal Sports Fdn Aviles, Aviles 33402, Spain - Author
UCAM Univ Catolica Murcia, Fac Deporte, Murcia 30107, Spain - Author
Univ A Coruna, Fac Sports Sci & Phys Educ, La Coruna 15001, Spain - Author
Univ Balear Isl, Res Grp Community Nutr & Oxidat Stress, IUNICS, Palma de Mallorca 07122, Spain - Author
Univ Castilla La Mancha Toledo Campus, Fac Sports Sci, PAFS Res Grp, Toledo 45071, Spain - Author
Univ Computense Madrid, Dept Language Arts & Phys Educ, Madrid 28040, Spain - Author
Univ Extremadura, Fac Sport Sci, Phys Act & Qual Life Res Grp AFYCAV, Caceres 10003, Spain - Author
Univ Lleida, Nursing & Physiotherapy Dept, GREpS, Hlth Educ Res Grp, Lleida 25008, Spain - Author
Univ Malaga, Sch Hlth Sci, EpiPHAAN Res Grp, Inst Invest Biomed Malaga IBIMA, Malaga 29590, Spain - Author
Univ Palmas Gran Canaria, Res Inst Biomed & Hlth Sci IUIBS, Las Palmas Gran Canaria 35016, Spain - Author
Univ Politecn Madrid, Dept Hlth & Human Performance, ImFINE Res Grp, Madrid 28003, Spain - Author
Univ Publ Navarra UPNA, IS FOOD Inst Sustainabil & Food Chain Innovat, IDISNA, Pamplona 31006, Spain - Author
Universidad Católica de Murcia - Author
Universidad de Extremadura - Author
Universidad de Las Palmas de Gran Canaria - Author
Universidad Politécnica de Madrid , Universidad Complutense de Madrid - Author
Universidad Pública de Navarra - Author
Universidade da Coruña - Author
Universitat Ramon Llull , Gasol Foundation - Author
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Abstract

Unhealthy dietary habits determined during childhood may represent a risk factor to many of the chronic non-communicable diseases (NCDs) in adulthood. Mediterranean Diet (MD) adherence in children and adolescents (8–16 years) living in Spain was investigated using the KIDMED questionnaire in a comparative analysis of two cross-sectional nationwide representative studies: enKid (1998–2000, n = 1001) and PASOS (2019–2020, n = 3540). Taking into account the educational level of pupils, as well as the characteristics of the place of living, a significant association was found between a KIDMED score ≥ 8 (optimal MD adherence) and primary education as well as residency in an area of <50,000 inhabitants, while living in the southern regions was associated with non-optimal MD adherence (p < 0.001). Participants of the 2019–2020 study showed an increase in the consumption of dairy products (31.1% increase), pasta/rice (15.4% increase), olive oil (16.9% increase), and nuts (9.7% increase), as well as a decreased sweets and candies intake (12.6% reduction). In contrast, a significantly lower MD adherence was found when comparing the 2019–2020 (mean ± SE: 6.9 ± 0.04) and the 1998–2000 study (7.37 ± 0.08); p < 0.001), due to less consumption of fish (20.3% reduction), pulse (19.4% reduction), and fruits (14.9% reduction), and an increased intake of commercial goods/pastries or fast-food intake (both 19.4% increase). The lowest adherence was recorded for adolescents also in the most recent study, where 10.9% of them presented a KIDMED score ≤ 3. This study shows that eating habits are deteriorating among Spanish children and adolescents. Such findings point out the urgency of undertaking strong measures to promote the consumption of healthy, sustainable, and non-ultra-processed food, such as those available in an MD, not only at a scientific and academic level, but also at a governmental one.
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Keywords

adolescentschildrenfitnessfoodhabitsnutrition surveyspainAdolescentsChildrenCross-sectional studiesDiet, mediterraneanEducational statusFeeding behaviorMediterranean dietNutrition surveyQuality indexSpainSurveys and questionnaires

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Nutrients due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2023, it was in position 18/114, thus managing to position itself as a Q1 (Primer Cuartil), in the category Nutrition & Dietetics.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 5.89. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 13, 2025)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 4.51 (source consulted: FECYT Mar 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2026-04-24, the following number of citations:

  • WoS: 34
  • Scopus: 32
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Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2026-04-24:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 101.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 96 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 26.
  • The number of mentions on the social network X (formerly Twitter): 18 (Altmetric).
  • The number of mentions in news outlets: 1 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
  • Assignment of a Handle/URN as an identifier within the deposit in the Institutional Repository: https://oa.upm.es/84937/

As a result of the publication of the work in the institutional repository, statistical usage data has been obtained that reflects its impact. In terms of dissemination, we can state that, as of

  • Views: 155
  • Downloads: 51
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