Determinants of Dietary Quality and Their Relationships with Nutritional Status, Physical Activity, and Mental Health Among Moroccan Adolescents

Moroccan adolescents experience a dual burden of malnutrition. Limited information is available on dietary quality and its associated overall health and nutrition status among Moroccan adolescents. This study explored the determinants of dietary diversity and associations with depressive disorder, physical activity, and nutritional status. A total of 469 adolescents aged 11-18 years old living in Salé, Khemisset and Azrou were assessed at school. Their diet was assessed using a 7-day food frequency questionnaire, generating a modified Global dietary quality score (mGDQS). Physical activity status was assessed by Physical Activity Questionnaire for Older Children (PAQ-C) tool. Mental health status was examined using Beck Depression Inventory (BDI). Height and weight were measured to calculate Body Mass Index (BMI). Multivariable regression analysis was conducted to examine socio-economic determinants of mGDQS. The associations between mGDQS and mental health, physical activity, and nutritional status were tested using linear or logistic regression analysis, accounting for demographic and socio-economic characteristics. The mean mGDQS score was poor at 20.53 (SD:4.92). The mean BMI value was 20.40 kg/m^2 (SD:2.85), where 7% of the participants were overweight/obese. mGDQS was positively associated with living in Salé, having 2-3 siblings, and inversely associated with female adolescents (all p<0.05). mGDQS was positively associated with physical activity score (β= 0.02; 95%CI: 0.01, 0.03), inversely associated with BDI (β= -0.22; 95%CI: -0.42, -0.02) but not associated with BMI. Moroccan adolescents showed a moderate level of dietary quality. Females living in Urban settings such as Sale were likely to have better access to food. Healthy diet programs consider enhancing physical activity and mental health in the settings.