Larruy García, AliciaVázquez Cobela, RocíoLeis Trabazo, María RosauraMoreno Aznar, Luis Alberto2026-01-162026-01-162025-01-11Larruy-García, A., De Miguel-Etayo, P., Babio, N., Flores-Rojas, K., Picáns-Leis, R., Gómez-Martínez, C., Miguel-Berges, M. L., Martínez, J. A., Corella, D., de la Torre-Aguilar, M. J., Vázquez-Cobela, R., Shyam, S., Pastor-Villaescusa, B., Córdoba-Rodríguez, D. P., Schröder, H., Fernández de la Puente, M., Jurado-Castro, J. M., Ni, J., Navas-Carretero, S., Leis, R., … Moreno, L. A. (2025). Validity of the MED4CHILD tool for assessing adherence to the Mediterranean diet in preschool children. European journal of pediatrics, 184(2), 130. https://doi.org/10.1007/s00431-024-05945-10340-6199https://hdl.handle.net/10347/45213Most of the available tools to assess adherence to Mediterranean diet (MedDiet) were constructed for adults, having limited applicability to children and adolescents. The aim of this study is to validate a specific questionnaire to assess adherence to MedDiet in children aged 3 to 6 years (MED4CHILD questionnaire). The validation was performed in a baseline examination of a cohort of children who were recruited in schools in seven cities. Of the total sample of 1509 children, we included 858 children aged 3 to 6 years with complete information on adherence to the MedDiet, food consumption, anthropometry and cardiometabolic characteristics. Adherence to the MedDiet was assessed using an 18-item questionnaire, adapted from validated questionnaire for adults using the Delphi method. Food and beverage consumption was assessed using a validated COME-Kids Food and Beverage Frequency Questionnaire. Anthropometric measurements and cardiometabolic risk factors were assessed using standard methods. Statistical analyses included kappa agreement, ANOVA and linear regression models. Higher MED4CHILD scores were associated with higher intakes of food characteristic of the MedDiet. The MED4CHILD questionnaire showed moderate validity, especially for key items of the Mediterranean diet (kappa ranging from 0.333 to 0.665). Direct significant associations were found between MED4CHILD scores and cardiometabolic profile, including waist circumference (p), triglycerides and HOMA-IR (p < 0.05).engThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/ChildhoodDietary intakeMediterranean patternShort screenerValidation study3206 Ciencias de la nutriciónjournal article10.1007/s00431-024-05945-1open access