The present study examined the association of body mass index (BMI), screen and sleep time, physical fitness and eating behaviour with Mediterranean diet (MD) adherence in a sample of pre-schoolers from Granada, Spain.

A cross-sectional, non-randomised design was employed. A multilinear regression model with backward elimination was used for analysis.

Variables included age, BMI, screen time, hours of nightly sleep, physical fitness, food approach and food avoidance. The developed model met assumptions of multiple regression in terms of linearity, homoscedasticity, normality, independence and non-multicollinearity.

Data were collected from 653 of the 2250 three-to-six-year-old children attending the 18 schools invited to take part in the present study.

Better sleep time and lower screen time and food avoidance were found to be predictive of MD adherence. These variables explained 15% of the variance in pre-schoolers MD adherence.

The present study suggests that sleep and screen time and food avoidance are important components to consider when targeting improvements in MD adherence in pre-schoolers. Future research should explore the way in which parental health behaviours influence their children’s health habits in order to better understand outcomes.