Metabolic and behavioral predictors of weight gain in Hispanic children: the Viva la Familia Study

BACKGROUND: Despite the high prevalence of overweight among Hispanic children in the United States, definitive predictors of weight gain have not been identified in this population. OBJECTIVE: The study objective was to test sociodemographic, metabolic, and behavioral predictors of 1-y weight gains in a large cohort of Hispanic children studied longitudinally. DESIGN: Subjects (n = 879) were siblings from 319 Hispanic families enrolled in the Viva la Familia Study. Families were required to have at least one overweight child aged 4-19 y. One-year changes in weight and body composition by dual-energy X-ray absorptiometry were measured. Data were from parental interviews, birth certificates, multiple-pass 24-h dietary recalls, 3-d accelerometry, 24-h respiration calorimetry, measurements of eating in the absence of hunger, and measurement of fasting blood biochemistry indexes by radioimmunoassay. Generalized estimating equations and principal component analysis were applied. RESULTS: Weight gain increased with age (P = 0.001), peaking at approximately 10 y of age in girls and approximately 11 y of age in boys. Mean (+/-SD) weight gain was significantly higher in overweight (7.5 +/- 3.7 kg/y) than in nonoverweight (4.4 +/- 2.4 kg/y) children and in boys than in girls. When adjusted for age, age squared, sex, and Tanner stage, the final model indicated a child's body mass index (BMI; kg/m2) status, maternal BMI, energy expenditure (total energy expenditure, basal metabolic rate, and sleeping metabolic rate), and fasting blood biochemistry indexes (total triiodothyronine, insulin, leptin, and ghrelin) as independent, positive predictors of weight gain (P = 0.01-0.001). CONCLUSION: Knowledge of the metabolic and behavioral predictors of weight gain in Hispanic children will inform prevention and treatment efforts to address this serious public health problem in the United States.     

Viva la Familia Study: genetic and environmental contributions to childhood obesity and its comorbidities in the Hispanic population

BACKGROUND: Genetic and environmental contributions to childhood obesity are poorly delineated. OBJECTIVE: The Viva la Familia Study was designed to genetically map childhood obesity and its comorbidities in the Hispanic population. The objectives of this report were to describe the study design and to summarize genetic and environmental contributions to the phenotypic variation in obesity and risk factors for metabolic diseases in Hispanic children. DESIGN: The Viva la Familia cohort consisted of 1030 children from 319 families selected based on an overweight proband between the ages of 4 and 19 y. In-depth phenotyping to characterize the overweight children and their siblings included anthropometric and body-composition traits by dual-energy X-ray absorptiometry and assessments of diet by 24-h recalls, physical activity by accelerometry, and risk factors for metabolic diseases by standard biochemical methods. Univariate quantitative genetic analysis was used to partition phenotypic variance into additive genetic and environmental components by using the computer program SOLAR. RESULTS: Sex, age, and environmental covariates explained 1-91% of the phenotypic variance. Heritabilities of anthropometric indexes ranged from 0.24 to 0.75. Heritability coefficients for the body-composition traits ranged from 0.18 to 0.35. Diet and physical activity presented heritabilities of 0.32 to 0.69. Risk factors for metabolic diseases were heritable with coefficients ranging from 0.25 to 0.73. Significant genetic correlations between obesity traits and risk factors for metabolic diseases substantiated pleiotropy between traits. CONCLUSION: The Viva la Familia Study provides evidence of a strong genetic contribution to the high prevalence of obesity and its comorbidities in Hispanic children.     

Socioeconomic Status and Overweight: A Population-Based Cross-Sectional Study of Japanese Children and Adolescents

Background

Socioeconomic status (SES) as a determinant of obesity has received scant attention in Japan. This study examined the association between SES and overweight among Japanese children and adolescents.

Methods

Cross-sectional analyses of a representative sample of Japanese children (6–11 years: n = 397) and adolescents (12–18 years: n = 397) were performed, with measured heights and weights from the 2010 National Health and Nutrition Examination Survey and the 2010 Comprehensive Survey of Living Conditions. Overweight, including obesity, was defined by International Obesity Task Force cut-offs. SES indicators included household income, equivalent household expenditure, parental educational attainment, and parental occupational class.

Results

Overweight prevalence was 12.3% in children and 9.1% in adolescents. Adolescents living in middle-income households were more likely to be overweight than those living in high-income households (OR 2.26, 95% CI, 1.01–5.67) after adjustment for age, sex, and parental weight status. Similarly, adolescents living in households with low expenditure levels were more likely to be overweight than those living in households with high expenditure levels (OR 3.40, 95% CI, 1.20–9.60). In contrast, no significant association was observed among children.

Conclusions

Our results indicated that low household economic status was associated with being overweight, independent of parental weight status, among Japanese adolescents.Key words: socioeconomic status, overweight, children, adolescent, Japan     

Association of Yogurt Consumption with Nutrient Intakes,Nutrient Adequacy,and Diet Quality in American Children and Adults

The popularity of yogurt has increased among consumers due to its perceived health benefits. This study examined the cross-sectional association between yogurt consumption and nutrient intake/adequacy, dietary quality, and body weight in children and adults. National Health and Nutrition Examination Survey 2001–2016 data (n = 65,799) were used and yogurt consumers were defined as those having any amount of yogurt during in-person 24-h diet recall. Usual intakes of nutrients were determined using the National Cancer Institute method and diet quality was calculated using the Healthy Eating Index-2015 (HEI-2015) scores after adjusting data for demographic and lifestyle factors. The data show that approximately 6.4% children and 5.5% adults consume yogurt, with a mean intake of yogurt of 150 ± 3 and 182 ± 3 g/d, respectively. Yogurt consumers had higher diet quality (10.3% and 15.2% higher HEI-2015 scores for children and adults, respectively); higher intakes of fiber, calcium, magnesium, potassium, and vitamin D; and higher percent of the population meeting recommended intakes for calcium, magnesium, and potassium than non-consumers. Consumption of yogurt was also associated with lower body weight, body mass index (BMI), and 23% showed a lower risk of being overweight/obese among adults only. In conclusion, yogurt consumption was associated with higher nutrient intake, nutrient adequacy, and diet quality in both children and adults.     

Socioeconomic Status and Diet Quality in College Students

ObjectiveTo investigate the existence and trajectory of diet disparities among college students from different socioeconomic statuses (SESs).MethodsA random sample of freshman and sophomore students was invited to participate in an online survey on eating behaviors. Ordinary least squares regressions were fit to 148 complete responses to examine the association between family income ≤200% of the federal poverty level and overall, healthy, and unhealthy food consumption.ResultsLow-SES students reported eating significantly more unhealthy food during their freshman year than their non–low-SES peers. This difference is not statistically significant for second-year students and robust to on-campus spending power.Conclusions and ImplicationsDisparities in diets for students from different socioeconomic backgrounds that were observed in the freshman year of college were absent in the sophomore year. Awareness of these disparities and trend is important to broadly promote healthy eating.     

Socioeconomic Status and Body Mass Index Among Hispanic Children of Immigrants and Children of Natives

Objectives. We examined how Hispanic parents'' income and education, combined with their nativity status, influenced the body mass index (BMI) of their children, compared with non-Hispanic White children and their parents.Methods. We used data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998–99 to estimate linear growth curve models of children''s initial BMI in kindergarten and change in BMI through fifth grade. Socioeconomic status was measured by logged household income and parental educational attainment (less than high school, high school graduate, some college, college graduate or higher).Results. Parental education was negatively associated with children''s BMI (baseline and growth) for non-Hispanic White children. Among Hispanic children, the association of parental education with growth in BMI was negative but much weaker. The weak effect of parental education was not explained by the presence of immigrants in the Hispanic population. Income was strongly negatively associated with children''s BMI in kindergarten among children of Hispanic and White natives, but positively associated among Hispanic immigrant families.Conclusions. The positive income–BMI association among Hispanic immigrant children might reflect cultural differences that immigrant parents carry with them from their countries of origin.In the United States and other more developed countries, lower socioeconomic status (SES)—particularly parental education—is often associated with overweight or obesity among children.^1,2 It is therefore puzzling that SES does not appear to have a consistent relationship with children''s health outcomes, such as overweight, among Hispanics. In a study of Mexican American adolescents, parental education was unrelated to obesity.³ In a study of Hispanic 3-year-olds, maternal education and household income were unrelated to obesity.⁴ In another study of younger children (aged 2–9 years), poverty was associated with overweight among Whites but not among Mexican Americans.⁵Several studies have speculated that the lack of a significant SES gradient for Hispanic health outcomes might be a result of the large proportion of immigrants in the US Hispanic community. If the SES gradient for immigrant Hispanics were different from those for US-born Hispanics and US-born non-Hispanic Whites, the immigrant pattern could weaken the results when all Hispanics are pooled together. However, little work on Hispanic children has examined SES and body mass index (BMI; defined as weight in kilograms divided by height in meters squared) separately by the nativity status of the parents, even though 60% of Hispanic children in the United States have at least 1 immigrant parent.⁶ The SES gradient for the children of immigrants could differ from that for the children of natives because (1) parental education, a commonly used indicator of SES, may not have the same meaning for immigrants as for natives, especially if parents'' schooling took place outside the United States, and (2) cultural differences carried by immigrant parents from their countries of origin that associate social position with obesity may influence BMI among their children.⁷We hypothesized that the relationship between SES and overweight is positive for the children of immigrants, particularly when income is used as an indicator of SES. Parental education has typically been used as an indicator of SES even though income has been shown to be an independent correlate of health.⁸ Among immigrant families in particular, income provides a better indication of purchasing power than education because recently arrived immigrants are less able than natives to translate their educational attainment into earnings.^9,10 After subtracting the effects of educational attainment, we expected that higher-income immigrant families might be more likely to indulge their children with food than would native families with similar resources.To assess this hypothesis, we analyzed a nationally representative sample of non-Hispanic White children of natives, Hispanic children of immigrants, and Hispanic children of natives. The research used growth curve models to estimate the relationship between 2 indicators of SES—parental education and family income—and children''s BMI at baseline (kindergarten) and growth in BMI between kindergarten and fifth grade. We further assessed whether the relationship of BMI with education and income varied significantly by Hispanic origin and immigrant status.     

Association Between Diet Quality and Cardiometabolic Risk Factor Clustering Stratified by Socioeconomic Status Among Chinese Children

BackgroundFew studies have evaluated the long-term relationship between diet quality and cardiometabolic risk factor clustering among children. The moderating effect of socio-economic status (SES) is of interest.ObjectiveTo investigate the association between diet quality with cardiometabolic risk among Chinese children and to explore the moderating effect of SES.DesignIn this cohort study, 5 waves (1997-2009) of the China Health and Nutrition Survey were used. Diet quality was measured by a modified version of the Chinese Children Dietary Index (mCCDI) based on Dietary Guidelines for Chinese.ParticipantsChildren between the ages of 7 and 17 (n = 2903) who completed at least 2 surveys were included. Those who missed measures or had hypertension or diabetes at baseline were excluded.Main outcome measuresThe fasting blood samples were collected in 2009. Waist circumference (WC) and blood pressure (BP) were measured in each survey.Statistical analysis performedA continuous cardiometabolic risk score (MetScore) was derived by a confirmatory factor analysis of 5 components: WC, BP, glucose, triglycerides, and high-density lipoprotein cholesterol. Considering the latency period of the effect of behaviors, the mCCDI was lagged by the period between surveys. Linear regression was used to analyze the association of mCCDI with MetScore and its components. Mixed effect linear regression and lagged mCCDI were used for WC and BP models.ResultsHigher mCCDI was independently associated with a lower MetScore at follow-up (β: −.11; 95% CI: −.18 to −.04). Higher lagged mCCDI over time was associated with a lower WC z score overall (β: −.05; 95% CI: −.08 to −.01) and among children in the low SES group (β: −.09; 95% CI: −.14 to −.04) but not those in the high SES group. When examining the 15 mCDDI components separately, scores for 5 components: more grains, vegetables, soybeans and its products; less sugar-sweetened beverages; and more diet variety were significantly associated with a lower MetScore.ConclusionsAmong Chinese children, higher diet quality measured by mCCDI was independently associated with a lower MetScore at follow-up.     

Nutritional Adequacy and Diet Quality in Colorectal Cancer Patients Postsurgery: A Pilot Study

Recent evidence has shown that an unhealthy diet is associated with a higher risk of tumor recurrence, metastasis, and death among patients with colorectal cancer (CRC). The aims of this study were to assess nutritional adequacy and diet quality in a group of CRC patients postsurgery and to identify possible associations between dietary and nutritional aspects and environmental factors and weight status. This was an observational study conducted on a random sample of 74 patients, aged 50–69 years. Dietary intake was evaluated utilizing a validated frequency questionnaire, and diet quality was evaluated utilizing the Healthy Eating Index for Spanish Diet and the MedDietScore. Data regarding socioeconomic, demographic, lifestyles, dietary supplements use, and body mass index were collected. Subjects followed a diet characterized by a low carbohydrate intake (94% of the cases), excessive protein (48%), high fat intake (67%), and some micronutrient deficiencies. The inadequacy of some nutrients was associated with male gender, overweight/obesity, smoking, and low educational level; and low adherence to the MedDiet was identified in those with a low educational level (adjusted odds ratio = 4.16, P < 0.05). Therefore, such patients should be an important target group when applying educational programs and giving individualized nutritional advice to improve their quality of life.     

Socioeconomic Status Impact on Diet Quality and Body Mass Index in Eight Latin American Countries: ELANS Study Results

Poor health and diet quality are associated with living within a low socioeconomic status (SES). This study aimed to investigate the impact of SES on diet quality and body mass index in Latin America. Data from the “Latin American Health and Nutrition Study (ELANS)”, a multi-country, population-based study of 9218 participants, were used. Dietary intake was collected through two 24 h recalls from participants of Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. Diet quality was assessed using the dietary quality score (DQS), the dietary diversity score (DDS) and the nutrients adequacy ratio (NAR). Chi-squared and multivariate-variance analyses were used to estimate possible associations. We found that participants from the low SES consumed less fruits, vegetables, whole grains, fiber and fish and seafood and more legumes than those in the high SES. Also, the diet quality level, assessed by DQS, DDS and NAR mean, increased with SES. Women in the low SES also showed a larger prevalence of abdominal obesity and excess weight than those in the middle and high SES. Health policies and behavioral-change strategies should be addressed to reduce the impact of socioeconomic factors on diet quality and body weight, with gender as an additional level of vulnerability.     

Validation of the Diet Quality Questionnaire in Chinese Children and Adolescents and Relationship with Pediatric Overweight and Obesity

The low-burden Diet Quality Questionnaire (DQQ) has been developed to rapidly assess diet quality globally. Poor diet is often correlated with body size, and certain dietary risk factors can result in overweight and obesity. We aimed to examine the extent to which the DQQ captured food group consumption among children and adolescents in China, and to understand the association of several new indicators of diet quality scores derived from the DQQ with overweight and obesity, using the 2011 wave of the China Health and Nutrition Survey. The DQQ questions are constructed using sentinel foods—that is, food items that are intended to capture a large proportion of the population consuming the food groups. The overall Global Dietary Recommendations (GDR) score, GDR-Healthy score, and GDR-Limit score are novel indicators of diet quality that reflect dietary risk factors for non-communicable diseases derived from the DQQ questions. Multivariable logistic regression analysis was used to examine the associations of the GDR scores with overweight and obesity in the sample. The DQQ questions captured over 95% of children who consumed the food groups. Additionally, we found that the GDR-Limit score was positively associated with general obesity (odds ratio (OR) = 1.43, 95% confidence interval (CI): 1.17–1.74) and abdominal obesity (OR = 1.22, 95% CI: 1.05–1.43), whereas the overall GDR score was negatively related to general obesity (OR = 0.85, 95% CI: 0.74–0.97). The low-burden DQQ could be a valid tool to assess diet quality for the Chinese pediatric population aged 7–18 years. Poor diet quality, as determined by the GDR-Limit score, is associated with the increased risk of obesity in Chinese children and adolescents.     

Increased Mortality Among Hispanic Testis Cancer Patients Independent of Neighborhood Socioeconomic Status: A SEER Study

Testis cancer-specific survival (CSS) varies by Hispanic ethnicity. Our goal was to assess whether neighborhood socioeconomic status (SES) accounts for elevated testis CSS among Hispanic patients. We queried the Surveillance, Epidemiology, and End Results (SEER) database for Hispanic (HW) and Non-Hispanic white (NHW) patients. Multivariate Cox regression analyses evaluated Hispanic ethnicity’s impact on tCSS while adjusting for neighborhood socioeconomic status (education and income levels). HWs constituted 14.3% of the 26,258 patients in the cohort. Neighborhood SES factors such as county income (P < 0.001) and education level (P < 0.001) were significant predictors of testis cancer-specific survival (tCSS). Controlling for SES and other variables, Hispanic ethnicity remained a significant predictor of tCSS. Compared to NHWs, HWs experienced a 41% greater cancer-specific mortality (HR: 1.406, 95% CI: 1.178–1.678, P < 0.001). The mechanism underlying the increased testis cancer mortality experienced by Hispanic patients remains unknown.     

Impact of Parental Socioeconomic Status on Childhood and Adolescent Overweight and Underweight in Korea

Background

The prevalence of overweight and underweight is steadily increasing among children and adolescents. To explore the relationship between parental socioeconomic status and body mass index, we examined levels of overweight and underweight among representative samples of children and adolescents in South Korea.

Methods

We analyzed data from the 2009 Korean Survey on the Obesity of Youth and Children, conducted by the National Youth Policy Institute. The sample response rate for this survey was 93.9%. After excluding 745 subjects who had missing information on age, height, or weight, 9411 subjects were included. To measure parental socioeconomic status, 4 categories were assessed by using a structured questionnaire: subjective economic status, parental education level, parental occupational status, and family structure. We used the chi-squared test in univariable analysis and multinomial logistic regression in multivariable analysis.

Results

Multinomial logistic regression analysis identified sex, education level, parental interest in weight management, and parental body shapes as statistically significant characteristics affecting overweight in children, and sex, place of residence, parental interest in weight management, and paternal and maternal body shapes as statistically significant characteristics affecting underweight (P < 0.05).

Conclusions

Underweight and overweight coexist among adolescent Korean males of low socioeconomic status, which indicates that these conditions can coexist in developed countries. Appropriate interventions to address both overweight and underweight in adolescents are required.Key words: childhood and adolescent overweight and underweight, Korea, parental factors, risk factor, socioeconomic status     

The Nutritional Adequacy and Diet Quality of Vegetarian Menu Substitutions in Urban Kansas Childcare Centers

While plant-based eating has become increasingly popular, little is known of how this trend has impacted childcare center meals. The purpose of this study was to measure the nutrient content and diet quality of vegetarian alternative lunches and compare these measures to those of standard childcare lunches and nutrient benchmarks representing one-third of the Dietary Reference Intake for 3-year-olds and 4–5-year-olds. Menu data were obtained from seven urban Kansas childcare centers participating in the Child and Adult Care Food Program and regularly providing a vegetarian alternative lunch. The centers provided detailed menu information for 27 days’ worth of meals. The most common vegetarian substitution was cheese, which was used to fulfill all or part of the meat/meat alternative requirement in over three-quarters of the vegetarian alternative meals (n = 22). Compared to the standard meals, the vegetarian alternative meals were higher in calories, fat, saturated fat, calcium, and sodium and lower in protein, choline, and diet quality (p = 0.05). Both lunch options met the benchmarks for vitamin A, vitamin D, vitamin B12, calcium, and protein. Iron content for both (95% CI: standard 1.61–2.17 mg; vegetarian 1.37–2.7 mg) was below the benchmark. Although additional research is needed to better understand how vegetarianism has impacted childcare meals in the U.S., important differences in the nutrient contents were observed between the standard and vegetarian alternative meals. In addition, the results suggest vegetarian alternative meals that rely heavily on cheese may be of lower diet quality.     

Stress and the City: Housing Stressors are Associated with Respiratory Health among Low Socioeconomic Status Chicago Children

Asthma disproportionately affects non-whites in urban areas and those of low socioeconomic status, yet asthma's social patterning is not well-explained by known risk factors. We hypothesized that disadvantaged urban populations experience acute and chronic housing stressors which produce psychological stress and impact health through biological and behavioral pathways. We examined eight outcomes: six child respiratory outcomes as well as parent and child general health, using data from 682 low-income, Chicago parents of diagnosed and undiagnosed asthmatic children. We created a continuous exposure, representing material, social and emotional dimensions of housing stressors, weighted by their parent-reported difficulty. We compared the 75th to the 25th quartile of exposure in adjusted binomial and negative binomial regression models. Higher risks and rates of poor health were associated with higher housing stressors for six of eight outcomes. The risk difference (RD) for poor/fair general health was larger for children [RD = 6.28 (95% CI 1.22, 11.35)] than for parents [RD = 3.88 (95% CI −1.87, 9.63)]. The incidence rate difference (IRD) for exercise intolerance was nearly one extra day per 2 weeks for the higher exposure group [IRD = 0.88 (95% CI 0.41, 1.35)]; nearly one-third extra day per 2 weeks for waking at night [IRD = 0.32 (95% CI 0.01, 0.63)]; and nearly one-third extra day per 6 months for unplanned medical visits [IRD = 0.30 (95% CI 0.059, 0.54)]. Results contribute to the conceptualization of urban stress as a “social pollutant” and to the hypothesized role of stress in health disparities. Interventions to improve asthma outcomes must address individuals' reactions to stress while we seek structural solutions to residential stressors and health inequities.     

Low Calorie Beverage Consumption Is Associated with Energy and Nutrient Intakes and Diet Quality in British Adults

It is unclear whether consumption of low-calorie beverages (LCB) leads to compensatory consumption of sweet foods, thus reducing benefits for weight control or diet quality. This analysis investigated associations between beverage consumption and energy intake and diet quality of adults in the UK National Diet and Nutrition Survey (NDNS) (2008–2011; n = 1590), classified into: (a) non-consumers of soft drinks (NC); (b) LCB consumers; (c) sugar-sweetened beverage (SSB) consumers; or (d) consumers of both beverages (BB), based on 4-day dietary records. Within-person data on beverage consumption on different days assessed the impact on energy intake. LCB consumers and NC consumed less energy and non-milk extrinsic sugars than other groups. Micronutrient intakes and food choices suggested higher dietary quality in NC/LCB consumers compared with SSB/BB consumers. Within individuals on different days, consumption of SSB, milk, juice, and alcohol were all associated with increased energy intake, while LCB and tea, coffee or water were associated with no change; or reduced energy intake when substituted for caloric beverages. Results indicate that NC and LCB consumers tend to have higher quality diets compared with SSB or BB consumers and do not compensate for sugar or energy deficits by consuming more sugary foods.     

Peer Reviewed: Low Awareness of Overweight Status Among Parents of Preschool-Aged Children,Minnesota, 2004-2005

Introduction

Many studies have found that parents of overweight children do not perceive their child to be overweight. Little is known, however, about the extent to which such misperceptions exist among parents of preschool-aged children.

Methods

We analyzed data that were collected in 2004-2005 from parents of 593 preschool-aged children in 20 child care centers in the Minneapolis-St. Paul, Minnesota, metropolitan area. Parents were asked how they would classify their preschooler''s weight, and children''s height and weight were measured.

Results

Of the predominantly white, educated sample, most parents (90.7%) of overweight preschoolers classified their child as normal weight. An even higher percentage (94.7%) of children at risk for overweight were classified as normal weight by their parents. Most parents of normal-weight children classified their child''s weight as average. However, 16.0% classified their normal-weight child as underweight or very underweight.

Conclusion

Results indicate that parents are unlikely to recognize childhood overweight among preschool-aged children, which is concerning because parents of overweight children may be unlikely to engage in obesity prevention efforts for their child if they do not recognize their child''s risk status. A notable proportion of parents of normal-weight children perceived their child to be underweight, which suggests that parents of normal-weight children may be more concerned with undernutrition than overnutrition.     

Low Adherence to the Mediterranean Diet Is Associated with Poor Socioeconomic Status and Younger Age: A Cross-Sectional Analysis of the EpiDoC Cohort

The Mediterranean diet (MD) is recognized as one of the healthiest dietary patterns as it has been consistently associated with several beneficial health outcomes. Adherence to the MD pattern has been decreasing in southern European countries for the last decades, especially among low socioeconomic groups. The aim of this study was to assess the adherence to the MD in Portugal, to evaluate regional differences, and explore associated factors (sociodemographic, economic, and lifestyles behaviors). This study used the third data collection wave of the Epidemiology of Chronic Diseases Cohort Study (EpiDoC 3). MD adherence was assessed using the Portuguese-validated MD adherence score (MEDAS) questionnaire. Non-adjusted and adjusted logistic regression models were used to assess the risk factors for low MD adherence and individual MEDAS items. In this cross-sectional evaluation of the EpiDoC 3 cohort study (n = 5647), 28.8% of the Portuguese population had low adherence to a MD. Azores and Madeira had lower adherence to the MD than the rest of the country. Younger individuals in lower income categories (e.g., OR_{finding it very difficult} = 1.48; 95% CI 1.16–1.91) and with a lower educational level (e.g., OR_{0–4 years} = 2.63; 95% CI 2.09–3.32) had higher odds of having a lower adherence to the MD. Portuguese adults have a high prevalence of low adherence to the MD, especially among those who are younger and have lower socioeconomic status. Public health policies to promote adherence to the MD should pay special attention to these groups.