title: Association of lifestyle behaviours with self-esteem through health-related quality of life in Spanish adolescents.
abstract: The present research examined the association of Mediterranean diet adherence and physical activity with self-esteem through five components of health-related quality of life. Data were collected from 456 adolescents attending one of five schools in Granada, Spain using a cluster-randomised design. Participants completed questionnaires on Mediterranean diet adherence, physical activity, self-esteem and health-related quality of life (HRQoL). Models were constructed to identify associations between Mediterranean diet adherence and physical activity on self-esteem. Mediational analysis using bootstrapped confidence intervals examined possible mediation by five components of HRQoL. Mediterranean diet adherence and physical activity engagement were associated with four components of HRQoL: more positive physical wellbeing, psychological wellbeing, family relationships and autonomy support and perceptions of the school environment. Both lifestyle behaviours were positively associated with self-esteem. Both relationships were mediated through positive psychological wellbeing and perceptions of the school environment. Physical wellbeing was also a mediator of the relationship between physical activity and self-esteem.
  
  
  CONCLUSIONS
  Interventions promoting Mediterranean diets or physical activity to adolescents may facilitate improvements in self-esteem in addition to wider health benefits previously identified. Approaches within such interventions targeting improvements in physical wellbeing, psychological wellbeing and positive perceptions of the school environment may improve their efficacy. What is Known: • It is known that engagement in lifestyle behaviours such as physical activity is positively linked with psychological health. • Whilst its consumption is declining, the Mediterranean diet is nutritionally recommended and remains popular in parts of Greece, Southern Italy and Spain. Research into Mediterranean diet adherence and psychological health is lacking. What is New: • The present research furthers this knowledge by examining potential mechanisms through which two lifestyle behaviours (physical activity and following a Mediterranean diet) may be associated with self-esteem. • Implications for the promotion of positive mental health in young people. Mediterranean diet and physical activity were positively associated with self-efficacy via positive psychological self-concept and perceptions of the school environment. These novel findings can contribute to the development of more efficacious interventions targeting positive self-esteem in young people.
authors.affiliation: School of Health Sciences, University of Nottingham, Queens Medical Centre, Nottingham, UK. Emily.knox@nottingham.ac.uk.
authors.forename: Emily
authors.initials: E
authors.lastname: Knox
authors.affiliation: School of Health Sciences, University of Nottingham, Queens Medical Centre, Nottingham, UK.|Department of Nutrition and Food Science, University of Granada, Granada, Spain.
authors.forename: Jose Joaquin
authors.initials: JJ
authors.lastname: Muros
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D003430:Cross-Sectional Studies; D038441:Diet, Mediterranean / Q000523:psychology*; D015444:Exercise; D005260:Female; D000070497:Healthy Lifestyle; D006801:Humans; D008297:Male; D011788:Quality of Life; D012649:Self Concept; D013030:Spain; D011795:Surveys and Questionnaires
keywords: Adolescents; Health-related quality of life; Mediterranean diet; Physical activity; Self-esteem