The KIDMED questionnaire was published in 2004 to evaluate adherence to the Mediterranean diet (MD) in children and adolescents. In the last 14 years, several respected official dietetics and health organizations have recommended appropriate dietary habits, including eating whole grains and consuming whole fruit rather than fruit juice. We propose an update of the KIDMED questionnaire.

Based on the scientific evidence, the present commentary suggests some changes to the KIDMED questionnaire.

We suggest deleting ‘or fruit juice’ from the first question of the questionnaire, rewording the question as ‘Takes a fruit every day’, and assigning a positive value of +1. We suggest adding ‘whole-grain’ to the eighth question of the questionnaire, rewording the question as ‘Consumes whole-grain pasta or whole-grain rice almost every day (5 or more times per week)’, and assigning a positive value of +1. Further, we propose to add ‘whole cereals or whole grains’ to the ninth question of the questionnaire, reword the question as ‘Has whole cereals or whole grains (whole-meal bread, etc.) for breakfast’, and assign a positive value of +1.

The present commentary examines some signs of a paradigm shift about fruit juice and whole grains after the development of the KIDMED questionnaire. The changes are of paramount importance in order to make the questionnaire an updated tool to evaluate adherence to the MD.

To investigate demographic and lifestyle factors associated with adherence to the Mediterranean diet (MD) in Israeli adolescents.

Cross-sectional.

School-based.

Schoolchildren (n 5268) aged 11–19 years answered self-administered questionnaires on food consumption, eating habits and lifestyle; a subset (n 578) also completed 24 h food recalls.

Using a modified KIDMED index, 25·5 % of the students had poor, 55·2 % had average and 19·3 % had good MD adherence. Jewish middle-school children had the highest proportion (28·2 %) of poor MD adherence. Olive oil usage, derived from 24 h food recalls, was 18·1 % in Jewish families v. 71·1 % in Arab homes. In Jewish boys, the odds (OR; 95 % CI) of having poor MD adherence was higher in those who watched television/videos/listened to music for ≥2 h/d (1·25; 0·98, 1·58) and those who sometimes/don’t read food labels (1·69; 1·31, 2·18). In Jewish girls, the odds for having poor MD adherence was significantly higher in those whose mother’s schooling was <12 years (2·06; 1·41, 3·00) and those who sometimes/don’t read food labels (1·35; 1·08, 1·69). In Arab boys, watching television/videos/listening to music for ≥2 h/d was significantly associated with poor MD adherence (1·89; 1·16, 3·07). In Arab girls, no aerobic activity or ball games weekly was associated with poor MD adherence (1·38; 0·91, 2·09).

Israeli adolescents had overall a high rate of poor MD adherence. Jewish middle-school children were at the highest risk. Interventions aimed at increasing physical activity, reducing sedentary time, improving mother’s education and promoting reading of food labels are recommended.