Introduction Dietary patterns provide insights into how diet, rather than specific nutrients, affects bone health. We aimed to evaluate whether Mediterranean diet associates with bone mineral density at 13 years-old.

Methods We used data from 1232 adolescents (44.7% males) born in 1990 and assessed at 13 years-old (EPITeen cohort). Adolescents were evaluated through physical examination, including height, weight and forearm bone mineral density (BMD) using dual-energy x-ray absorptiometry. Dietary intake was assessed using a food frequency questionnaire and adherence to the Mediterranean diet was evaluated through an adapted score (KIDMED index). The final score, the sum of all items, was classified into three adherence levels: −2 to 3, 4 to 6 and ≥7. The association between KIDMED index and BMD was quantified using linear regression. Coefficients were adjusted for body mass index, physical activity, smoking status and parental formal education.

Results Low KIDMED index was found in 23.9% of the girls and in 22.5% of the boys and 47.3% of girls and 46.1% of boys had intermediate index results. Mean (SD) BMD was 0.361 (0.058) g/cm² in girls and 0.344 (0.051) g/cm² in boys. Adherence to the Mediterranean diet showed no relation with BMD in girls. Significantly higher average BMD was found among boys with intermediate (0.013, 95% CI: 0.003 to 0.023) and high KIDMED index (0.017, 95% CI 0.006 to 0.028) when compared to those with low index.

Conclusion A Mediterranean dietary pattern can be associated to better bone health since early in life.