Mediterranean diet, overweight and body composition in children from eight European countries: Cross-sectional and prospective results from the IDEFICS study
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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How do the home food environment, parenting practices, health beliefs, and screen time affect the weight status of European children? The Feel4Diabetes-Study
2022, NutritionCitation Excerpt :In reference to disparities between northern and southern regions, higher body stature and resting energy expenditure for children dwelling in northern latitudes along with a genetic predisposition toward weight gain in southern-European children would partially explain this paradox [23]. Furthermore, accumulating evidence from other Mediterranean studies suggests that lack of physical exercise, insufficient sleep, excessive screen time, and a gradual shift away from the healthy Mediterranean diet to a more Westernized diet are obesity risk factors prevalent in these populations [24–27]. Antonogeorgios et al. documented that Greek children with low adherence to the Mediterranean diet were more likely to be overweight or obese [28].
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On behalf of the IDEFICS Consortium.