Trends in the adherence to the Mediterranean diet in Israeli adolescents: results from two national health and nutrition surveys, 2003 and 2016

Purpose: To compare the adherence to the Mediterranean diet (MD) in Israeli adolescents in 2003–4 and in 2015–6, and associated factors. Methods: Adolescents (aged 11–19 years) from two cross-sectional, school-based, nationally representative surveys, Mabat Youth I (2003–4, n 5005) and II (2015–6, n 3906), completed self-administered questionnaires on food frequency, eating behaviors and lifestyle. The Mediterranean Diet Quality Index for Children and Adolescents (KIDMED index), derived from these questionnaires, was used; higher scores indicate better diet quality. The samples comprised eight subgroups, according to population group (Jews/Arabs), school level (middle/high) and sex. Results: The percentages with poor, average and good KIDMED scores were 11.6, 45.3 and 43.1% in 2015–6, compared to 25.5, 55.2 and 19.3%, respectively, in 2003–4. Significant improvement was seen in all subgroups (all p < 0.001), and was attributed to increased consumption of fruits, vegetables, cereals, dairy products, and decreased negative eating behaviors. In Mabat Youth II, physical activity at least 1 h/day was positively associated with good KIDMED scores among Jewish adolescents; dieting and sleeping at least 7 h/day were associated with good MD adherence in Jewish boys; always/often reading food labels predicted good MD adherence among Jewish boys and Arab girls. Overweight and obesity were negatively associated with better KIDMED scores in Jewish boys. Conclusion: MD adherence in Israeli adolescents has improved overall. The changes in MD components and the associated behavioral factors indicate the initiatives, relevant to the different subgroups, that are necessary to promote healthier nutrition and lifestyles.