Adherence to the Mediterranean Diet among high-school pupils in the North Moroccan Rif region

BACKGROUND: The traditional Moroccan diet is typical of the Mediterranean diet (MD), but there have been few studies of the adherence of Moroccans adolescents to this diet and associated factors. OBJECTIVE: To evaluate MD adherence and its association with socioeconomic factors, nutritional status and dietary intake in a sample of secondary school pupils in the Rif region of Morocco. METHODS: In a cross-sectional study of a sample (n = 302) of Moroccan Riffian adolescents (13–18 years) from three secondary schools, we measured adherence to MD with the Mediterranean Diet Quality Index for children and teenagers questionnaire (KIDMED). A score below 8 was qualified as poor to average adherence to MD, while an optimal adherence was defined as a score of 8 or higher. Bivariate analyses and a logistic regression model were used to examine associations between adherence to MD and socioeconomic factors, nutritional status and dietary intake. RESULTS: Only 14.9% of adolescents had an optimal adherence to the MD (score≥8 points), 72.8% had average adherence (score 4–7) and 12.3% had poor adherence to the MD (score≤3). The factors associated with optimal adherence to MD were female sex (OR 2.28; 95% CI 1.07 –4.85; p = 0.031), high monthly family income >  8000 MAD (OR 7.10; 95% CI 1.52 –33.1; p = 0.013) and living in an apartment (OR 3.85; 95% CI 1.43 –10.3; p = 0.007). For others factors such as nutritional status and dietary intake, no associations were observed. CONCLUSION: We found a low level of adherence to the MD among adolescents in the Rif region, supporting the hypothesis that the dietary pattern of these Moroccan adolescents is in a transitional state characterised by a shift away from the traditional MD. The findings of this study suggest that interventions to optimize MD adherence should target boys, shared residences and lower income families.