Mediterranean diet, overweight and body composition in children from eight European countries: Cross-sectional and prospective results from the IDEFICS study

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Abstract

Background & aims

A Mediterranean-like dietary pattern has been shown to be inversely associated with many diseases, but its role in early obesity prevention is not clear. We aimed to determine if this pattern is common among European children and whether it is associated with overweight and obesity.

Methods and results

The IDEFICS study recruited 16,220 children aged 2–9 years from study centers in eight European countries. Weight, height, waist circumference, and skinfolds were measured at baseline and in 9114 children of the original cohort after two years. Diet was evaluated by a parental questionnaire reporting children's usual consumption of 43 food items. Adherence to a Mediterranean-like diet was calculated by a food frequency-based Mediterranean Diet Score (fMDS).

The highest fMDS levels were observed in Sweden, the lowest in Cyprus. High scores were inversely associated with overweight including obesity (OR = 0.85, 95% CI: 0.77; 0.94) and percent fat mass (β = −0.22, 95% CI: −0.43; −0.01) independently of age, sex, socioeconomic status, study center and physical activity. High fMDS at baseline protected against increases in BMI (OR = 0.87, 95% CI: 0.78; 0.98), waist circumference (OR = 0.87, 95% CI: 0.77; 0.98) and waist-to-height ratio (OR = 0.88, 95% CI: 0.78; 0.99) with a similar trend observed for percent fat mass (p = 0.06).

Conclusions

Although a Mediterranean dietary pattern is inversely associated with childhood obesity, it is not common in children living in the Mediterranean region and should therefore be advocated as part of EU obesity prevention strategies.

Introduction

Greater adherence to a Mediterranean-like dietary pattern is associated with a significant improvement in health status [1]. It may reduce the metabolic syndrome risk [2], major chronic disease morbidity [3], [4] and mortality [5] as well as total mortality [6], [7]. An inverse association between this pattern and overweight, particularly in childhood, could have short- and long-term health implications, but only few papers describe its relationship with childrens' weight status, BMI, waist circumference or waist-to-height ratio [8], [9], [10], [11].

Dietary patterns in south Europe are changing, especially among the young [12]. Animal products and fats are increasingly consumed, while the intake of vegetable-based foodstuffs declines [13]. The IDEFICS study has shown that taste preference for fat and sugar are associated to children's weight status [14], as well as to sedentary attitudes, such as a high-risk TV behaviour, also associated to overweight [15].

Several indices to assess adherence to a Mediterranean-like dietary pattern exist for adults, while for children the KIDMED index has been used in association with obesity indicators [8], [10], [11]. We propose a modified version of the Mediterranean Diet Score (fMDS), adapted to the IDEFICS food frequency questionnaire. We aimed to evaluate whether a Mediterranean-like dietary pattern (i.e. rich in cereals, vegetables, fruit and nuts, fish and low in meat and dairy products) is adopted by European young children and in which geographical areas. We examined both cross-sectionally and prospectively whether a high adherence level to this pattern was associated with overweight or obesity indicators.

Section snippets

Study population and design

IDEFICS, an 8-centre intervention study including a non-representative sample of 16,220 children (2–9 years) from eight different European countries (Sweden, Germany, Hungary, Italy, Cyprus, Spain, Belgium, Estonia), aimed to investigate the risks and long-term consequences of overweight and obesity in children. Started at the end of 2006 and run for five years, it also offered health promotion activities in kindergartens and schools.

The baseline survey (2007–2008), was followed by an

Descriptive results

Sweden had the highest proportion of children with high intake frequencies of vegetables, fruit plus nuts and cereals (Table 1). 56.7% of Swedish children had a fMDS level > 3 followed by the Italians (37.5%) and the Germans (35.1%). The lowest fMDS levels were observed in Cyprus (24.2% of children with fMDS > 3). Between-center differences in the score levels, measured by an analysis of variance, were statistically significant across all centers (p < 0.0001). Cypriot children showed the

Discussion

Adherence to a Mediterranean-like dietary pattern was assessed through a modified version of the Mediterranean diet score used in adults, based on food intake frequencies. To date, two papers in children found no association between this pattern and weight or BMI [8], [9], while two others suggested an association with BMI [10] or other adiposity indicators [11]. Three of these studies were based on the KIDMED index, recently developed by a Spanish group [30] and based on food frequencies as

Disclosures

All authors have no financial disclosures and no conflict of interest.

Authors' contributions

The authors' responsibilities were as follows: GT performed the data analysis and wrote the manuscript, AH, AL, LAM, TV, DM, AS, SDH, VP, MT, WA supported the statistical analyses and their interpretation and provided comments on the manuscript, LL supervised this research, contributed to the interpretation of results and to the writing of the manuscript, WA coordinated the IDEFICS study.

Acknowledgments

This work was carried out as part of the IDEFICS study (www.idefics.eu). We acknowledge the financial support of the European Union within the Sixth RTD Framework Program Contract No. 016181 (FOOD), by the Swedish Council on Working Life and Social Research (FAS) EpiLife Center and the Swedish Research Council. AL received funding from the Hans-Böckler-Stiftung.

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