The Mediterranean diet has been linked to improved cardiovascular health outcomes in adults, but whether this healthfulness can be generalized to younger ages is not known. Our objective was to examine the association between a Mediterranean eating pattern and cardiovascular risk factors in US adolescents.


This was a cross-sectional analysis of data from National Health and Nutrition Examination Survey (2007-2014), limited to subjects 12-19 years old who provided a fasting blood sample and completed two 24-hour diet recall surveys. Mediterranean diet adherence was assessed using the KIDMED diet score. Weighted regression modeling was used to determine the association between metabolic outcomes and diet adherence. Metabolic syndrome was defined using the ATP-3 pediatric adaptation.


Mediterranean diet adherence was low for the entire sample (mean KIDMED score 0.91 ± 0.08, range of possible scores -4 to +12). Subjects with average or higher Mediterranean diet adherence had a lower systolic blood pressure z-score (-0.58 ± 0.07 vs -0.41 ± 0.04, p = 0.035), and higher HDL-cholesterol (54.5 mg/dl ± 0.92 mg/dl vs. 52.1 mg/dl ± 0.39 mg/dl, p = 0.017) compared to those with poor adherence.KIDMED score was not associated with presence of metabolic syndrome.


US adolescents show low adherence to a Mediterranean diet eating pattern. Adolescents with average or greater Mediterranean diet adherence tend to have lower systolic blood pressure and higher HDL-cholesterol. Further research is needed to determine if promotion of a Mediterranean diet eating pattern is feasible and effective at improving health outcomes among adolescents.