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Revista Andaluza de Medicina del Deporte

versión On-line ISSN 2172-5063versión impresa ISSN 1888-7546

Rev Andal Med Deporte vol.8 no.1 Sevilla mar. 2015 



SYMPOSIUM EXERNET. Investigación en Ejercicio y Salud: Presente y Futuro en España.
Granada, 7-8 de Noviembre de 2014


A Mediterranean diet is not enough for cardio-metabolic health: physical activity and physical fitness are major contributors in European adolescent



M. Cuenca-Garcíaa, J.R. Ruizb, F.B. Ortegab, I. Labayenc, I. Huybrechtsd, L. Morenoe, L. Libudaf, M. González-Grossg, J. Valtueñag, A. Santaliestra-Pasíase, A. Marcosh, S. Gómez-Martínezh, S. De Henauwd and M.J. Castilloa

aDepartment of Medical Physiology, School of Medicine, Granada University, Granada, Spain
bDepartment of Physical Education and Sport, School of Sport Sciences, Granada University, Granada, Spain
cDepartment of Nutrition and Food Sciences, University of the Basque Country, UPV/EHU, Vitoria, Spain
dDepartment of Public Health, Ghent University, Ghent, Belgium
eGENUD (Growth, Exercise, Nutrition and Development) research Group, Facultad de Ciencias de la Salud, Zaragoza University, Zaragoza, Spain
fResearch Institute of Child Nutrition (FKE) Dortmund, Rheinische Friedrich-Wilhelms-University Bonn, Dortmund, Germany
gImFINE Research Group. Department of Health and Human Performance. Faculty of Physical Activity and Sport Sciences-INEF. Technical University of Madrid, Spain
hImmunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition, Spanish National Research Council, Madrid, Spain
Correo electrónico: (M. Cuenca-García).


Key words: Mediterranean diet score. Moderate-to-vigorous physical activity. Body composition. lipid profile. Blood pressure. Insulin resistance. HELENA Study.


Aims. To examine the impact of adherence to the Mediterranean diet on body fatness and cardio-metabolic profile and the concomitant role of physical activity (PA) and cardiorespiratory fitness (CRF) in European adolescents (n = 2340; 12.5-17.5years) participating in the HELENA-study.
Method. A Mediterranean Diet Score (MDS) was calculated after assessing dietary intake by two non-consecutive24 h dietary recalls. PA was measured by accelerometry and CRF with the 20m shuttle run test. Cardio-metabolic risk (CMR) factor measurements included anthropometric parameters, blood lipid profile, blood pressure and insulin resistance. A CMR index and a fatness index were computed.
Results. MDS was inversely related to systolic blood pressure and PA with most CMR factors, after adjusted for energy intake and PA and for energy intake and MDS, respectively. However, associations between PA and fatness markers disappeared after adjusting for CRF. Overall, CRF was inversely related to all CMR factors also in the fully adjusted models which included MDS, energy intake and PA. Individuals with high MDS and being more physically active had the lowest score on fatness and the healthiest profile on most CMR factors (except systolic blood pressure and total cholesterol) regardless of sex, age, socioeconomic-status, parental education and centre. These associations were attenuated after adjustment for energy intake and disappeared when CRF was considered. Adolescents with high CRF had lower fatness, a healthier profile in most CMR factors and cardio-metabolic scores independently of their MDS (all P≤0.044). Results persisted after further adjusting for energy intake and PA (except for systolic blood pressure, total cholesterol and triglycerides).
Conclusion. Adherence to the Mediterranean diet alone is an insufficient fundament for lower adiposity and better cardio-metabolic health in adolescents. A combination of a Mediterranean diet with an active lifestyle and high cardiorespiratory fitness seems to be most effective with an active.

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