Breakfast Intake and Factors Associated with Adherence to the Mediterranean Diet among Lebanese High School Adolescents

Abstract

The Mediterranean diet has shown to have positive health impacts on metabolic diseases and cognitive performance. However, Mediterranean countries have witnessed a decreased adherence during the past years and the adoption of a more westernized dietary pattern. The aim of this study was to evaluate the association of Mediterranean diet adherence with sociodemographic, lifestyle, and anthropometric factors among Lebanese high school adolescents. Specifically, we aimed to analyse in this group the association between low adherence and breakfast intake. A cross-sectional survey was carried out on randomly selected students (268 boys and 332 girls), aged between 15 and 18 years old, from private and public schools in Beirut and Mount Lebanon. Data were obtained from self-administered questionnaires and anthropometric measurements. The Mediterranean Diet Quality Index for children and adolescents was used to assess the adherence to the Mediterranean diet. The results showed a high percentage of adolescents having a low adherence (43%), with girls (64.2%) having a significant (p<0.001) higher adherence than boys (35.8%). Furthermore, the study proved that a lower adherence to the Mediterranean diet was significantly associated with a higher risk of obesity (15.5%), breakfast skipping (69.4%), and an unhealthy breakfast options (17.4%). Younger adolescents (47.4%), students from public schools (92.6%), and students with the highest grades (25.3%) had a significantly higher adherence to the Mediterranean diet than those from private schools (7.4%) and older adolescents (18.9%). In conclusion, results should plead for an increased awareness in Lebanese schools, supporting students to be more adherent to the Mediterranean diet, in order to prevent a further increase in metabolic diseases later in adulthood.

Increased Adherence to the Mediterranean Diet and Higher Efficacy Beliefs Are Associated with Better Academic Achievement: A Longitudinal Study of High School Adolescents in Lebanon

“…In past research, favorable dietary intake characterized by consumption of fruits and vegetables, home-made meals, nuts, and adequate vitamin intake was found to predict greater academic performance [ 59 , 60 , 61 ], while a Western dietary pattern and consumption of nutrient-poor and refined food were predictive of poorer performance [ 62 , 63 , 64 , 65 ]. Our results are also in accordance with findings of previous studies that have explored adherence to the Mediterranean diet and academic achievement among Lebanese high school adolescents [ 43 , 66 ] and university students [ 67 ] showing that higher adherence was related to higher academic scores. The Mediterranean diet is considered one of the healthiest eating patterns and higher adherence has consistently been linked with better overall health and cognitive functioning [ 68 , 69 , 70 , 71 ].…”

Factors Associated with Adherence to the Mediterranean Diet and Dietary Habits among University Students in Lebanon

“…When comparing the results to studies done abroad, the numbers in this study are consistent with the study done in Turkey among university students where 17.8% of students had high adherence to the MD [ 16 ], but are different than the study done among the university students in Cyprus where 26.9% had high adherence [ 17 ]. Although to our knowledge, no previous study was done in Lebanon to evaluate the level of adherence to the MD among university students, the adherence was evaluated among Lebanese high school adolescents and similar to our study, only 15.8% of the participants had high adherence [ 14 ]. Since the numbers are consistent among different age groups, this seems to be a trend of shifting dietary habits and straying away from the traditional MD in Lebanon, which raises a concern regarding future dietary habits and choices.…”

“…This study found a significant association between breakfast consumption and skipping meals with adherence to the MD. This association was established after a previous study done among Lebanese adolescents found that students who tend to skip breakfast had low adherence to the MD compared to students with regular breakfast consumption who all had high adherence [ 14 ]. Their study also concluded that not only consuming breakfast is associated with adherence to the MD, but the quality of food eaten at breakfast was also a strong predictor of the adherence to the MD.…”

“…Lebanon, a country on the Mediterranean coast and has long been adherent to the MD, is experiencing a shift in food choices away from the MD [ 12 ]. A study done among university students found that there is a trend of consuming a more westernized diet, especially among males [ 13 ] and therefore “encouraging for a new dietary pattern high in fat, refined sugar, and processed foods and causing a higher prevalence of metabolic diseases” [ 14 ].…”

“…Adherence to the MD among university students has been studied and it was found that 37.5% of Turkish university students had low adherence to the MD [ 16 ] compared to 21.8% of Cypriot university students [ 17 ]. The adherence to the MD in Lebanon was studied among high school adolescents and it was found that 43% of students had low adherence to the MD [ 14 ].…”