Objective: To evaluate dietary habits in Spanish children and adolescents based on a Mediterranean Diet Quality Index tool, which considers certain principles sustaining and challenging traditional healthy Mediterranean dietary patterns. Design: Observational population-based cross-sectional study. A 16-item Mediterranean Diet Quality Index was included in data gathered for the EnKid study (in which two 24-hour recalls, a quantitative 169-item food-frequency questionnaire and a general questionnaire about socio-economic, demographic and lifestyle items were administered). Setting: Spain. Subjects: In total, 3850 children and youths aged 2-24 years residing in Spain.Results: Of the sample, 4.2% showed very low KIDMED index results, 49.4% had intermediate values and 46.4% had high index results. Important geographical differences were seen, with subjects from the Northeast showing the most favourable outcomes (52% with elevated scores vs. 37.5% of those from the North). Lower percentages of high diet quality were observed in low socio-economic groups, compared with middle and upper income cohorts (42.8%, 47.6% and 54.9%, respectively). Large cities had more positive results and only slight variations were seen for gender and age. Conclusions: The KIDMED index, the first to evaluate the adequacy of Mediterranean dietary patterns in children and youth, confirms that this collective is undergoing important changes, which makes them a priority target for nutrition interventions. Results challenge certain commonly perceived notions tied to income level, population size and diet quality.

Objective: To analyse prevailing food patterns among Spanish children and young people and their relationship to sociodemographic and lifestyle factors. Design: Cross-sectional population survey. Setting: Population study. Data were collected at participants' home addresses. Subjects: Random sample of the Spanish population aged 2-24 y (n ¼ 3534; 1629 boys and 1905 girls). Interventions: Food consumption was assessed by means of a 24-h recall and a food frequency questionnaire. Sociodemographic and lifestyle related data were collected by specially designed questionnaires, previously pretested and validated. All the information was collected during a personal interview by trained dietitians. Data collection: May 1998-April 2000.Results: Average consumption of fruit and vegetables was low. The youngest age group (2-5 y) showed the lowest proportions of inadequacy for the dairy group (Po0,001; w 2 ¼ 39.11 boys; w 2 ¼ 49.60 girls). Factor analysis identified five main components of dietary patterns. The 'Snacky' pattern was characterised by more frequent and higher consumption of bakery products (buns, cakes and biscuits), sweets, salted snacks and soft drinks. Higher intakes of fruit, vegetables and fish were associated to the 'Healthy' pattern. Children whose mother had a low level of education and those who spent more than 2 h daily watching TV were more likely to follow the 'Snacky' pattern. Girls were more likely to follow the 'Healthy' pattern, while children and young people whose mother had a lower level of education were less likely. Conclusion: Results from this study highlight the importance of enhancing school-based and community-based actions to promote healthy eating and physical activity addressed to children and young people.

Background: Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy, dietary guidelines and food security strategies need to evolve from the limited historical approach, mainly focused on nutrients and health, to a new one considering the environmental, socio-economic and cultural impact—and thus the sustainability—of diets. Objective: To present an updated version of the Mediterranean Diet Pyramid (MDP) to reflect multiple environmental concerns. Methods: We performed a revision and restructuring of the MDP to incorporate more recent findings on the sustainability and environmental impact of the Mediterranean Diet pattern, as well as its associations with nutrition and health. For each level of the MDP we provided a third dimension featuring the corresponding environmental aspects related to it. Conclusions: The new environmental dimension of the MDP enhances food intake recommendations addressing both health and environmental issues. Compared to the previous 2011 version, it emphasizes more strongly a lower consumption of red meat and bovine dairy products, and a higher consumption of legumes and locally grown eco-friendly plant foods as much as possible.