Optimal Adherence to a Mediterranean Diet May Not Overcome the Deleterious Effects of Low Physical Fitness on Cardiovascular Disease Risk in Adolescents: A Cross-Sectional Pooled Analysis

Abstract

To examine the combined association of cardiorespiratory fitness (CRF), muscular fitness (MF), and adherence to a Mediterranean diet (MeDiet) on cardiovascular risk in adolescents, a pooled study, including cross-sectional data from two projects [2477 adolescents (1320 girls) aged 12–18 years], was completed. A shuttle run test was used to assess CRF. MF was assessed by the standing-long jump and handgrip tests. Adherence to a MeDiet was assessed by the Kidmed questionnaire. A cardiovascular risk score was computed from the following components: Age and sex, waist circumference, triglycerides, systolic blood pressure, high-density lipoprotein cholesterol (HDL), and glucose. Analysis of covariance showed that participants classified as having optimal (High) adherence to a MeDiet/HighMF/HighCRF, as well those classified as low adherence to a MeDiet/HighMF/HighCRF, had, on average, the lowest cardiovascular risk score (F = 15.6; p < 0.001). In addition, the high adherence to a MeDiet/LowMF/LowCRF group had the highest odds of having a high cardiovascular risk (OR = 7.1; 95% CI: 3.4–15.1; p < 0.001), followed by the low adherence to a MeDiet/LowMF/LowCRF group (OR = 3.7; 95% CI: 2.2–6.3; p < 0.001), high adherence to a MeDiet/HighMF/LowCRF group (OR = 3.1; 95% CI: 1.4–7.0; p = 0.006), and low adherence to a MeDiet/LowMF/HighCRF group (OR = 2.5; 95% CI: 1.5–4.4; p = 0.002) when compared to those with high adherence to a MeDiet/HighMF/HighCRF, after adjustments for potential confounders. In conclusion, our findings showed that, regardless of the MeDiet status, adolescents with low MF and low CRF cumulatively, presented the highest cardiovascular disease risk. Therefore, these findings suggest that the combination of these two fitness components may be beneficial to adolescents’ cardiometabolic profile, independent of MeDiet behaviour.

Adherence to Mediterranean Diet Related with Physical Fitness and Physical Activity in Schoolchildren Aged 6–13

“…On the other hand, we observed that a greater adherence to the MD is associated with a greater CRF, as also demonstrated other studies [18,23,24]. This fact could be explained to some degree by the above-mentioned relationship with PA, since a higher participation in PA (as a result of active lifestyle) could increase PF level [52].…”

“…Thus, the combination of an optimal adherence to MD, followed by appropriate levels of muscular fitness, seems to provide the highest protection against cardiometabolic risk [21]. Apart from that, it has been found that optimal adherence to the MD could not be enough to prevent some deleterious health effects if adequate levels of muscle strength are not available [24]. These relationships have also been found in the current sample, although it was not statistically significant.…”

“…Thus, some studies point out that a combination of high levels of muscle strength and an optimal adherence to MD are associated with healthier metabolic profile [20,21], as well as to a better health-related quality of life [23]. In addition to this, a positive association has been found between adherence to the MD and CRF [18,19,23,24], as well as speed-agility [25], but only in males. Likewise, some studies found positive associations between higher PA level (assessed by the Physical Activity Questionnaire for Older Children (PAQ-C) and greater adherence to the MD [18,19,22].…”

Adherence to Mediterranean Diet Related with Physical Fitness and Physical Activity in Schoolchildren Aged 6-13

“…On the other hand, we observed that a greater adherence to the MD is associated with a greater CRF, as also demonstrated other studies [18,23,24]. This fact could be explained to some degree by the abovementioned relationship with PA, since a higher participation in PA (as a result of active lifestyle) could increase PF level [47].…”

“…Thus, some studies point out that a combination of high levels of muscle strength and an optimal adherence to MD are associated with healthier metabolic profile [20,21], as well as to a better health-related quality of life [23]. In addition to this, a positive association has been found between adherence to the MD and CRF [18,19,23,24], as well as speed-agility [25], but only in males. Likewise, some studies found positive associations between higher PA level (assessed by the Physical Activity Questionnaire for Older Children [PAQ-C]) and greater adherence to the MD [18,19,22].…”