Cross-sectional study to evaluate the associated factors with differences between city and districts secondary school students of the southeast of Spain (Murcia) for their adherence to the Mediterranean diet.

Introduction: The "Mediterranean diet" is recognized as one of the healthiest dietary patterns but, even in Mediterranean countries it is gradually being lost. Adolescence is a crucial period for changes in dietary patterns.

Objectives: The purpose of this study was to evaluate the Adherence to Mediterranean diet (AMD) of secondary school students and evaluate possible variations between those residents in the city or in the districts.

Methods: A cross-sectional study was designed with 379 secondary school students. To assess the AMD a self-administered questionnaire KIDMED was used. They were classified according to sex and residence (city or districts).

Results: The body mass index (BMI) for the whole sample was 22.34 in boys and 20.79 in girls (p<0.05). Students from the city resulted more physically active than those from the districts (p<0.05). The average AMD score was 5.8, with 20.3% of students showing good adherence. In general, there was a low consumption of fruits, vegetables and pasta or rice, all foods included in the bottom of the dietary pyramid and the consumption of olive oil and legumes was very positive. Around 25% of students skip breakfast regularly.

Conclusions: Although BMI was in general in the range of normality, AMD of secondary school students is lower than expected attending to previous studies. Consume of fruits and vegetables several times per day, having breakfast daily and regular physical activity should be promoted. Educational and informative activities should be designed for adolescents and also for their parents since in these stages menus at home are usually established by them.