Association of eating behaviors, lifestyle, and maternal education with adherence to the Mediterranean diet in Spanish children

A comparative study of healthy lifestyle behaviors and related factors among Iranian male and female adolescents: a cross-sectional study

BACKGROUND

Adolescent health requires focused attention due to their vulnerability to risky behaviors and emerging health challenges such as mental health disorders, non-communicable diseases and unhealthy lifestyle patterns. This study, therefore, explored and compared healthy lifestyle behaviors and associated factors among Iranian male and female adolescents.

METHODS

This cross-sectional study was conducted in first and second high schools in the Iran 2023. Sampling was done first in clusters and then simple random sampling (N = 500). Data were collected using a demographic characteristic and the Health Promoting Lifestyle Profile II (HPLP-II) questionnaires. The inclusion criteria were obtaining written consent form to participate and the absence of any physical or mental disabilities. The exclusion criteria included withdrawal of consent during the study and incomplete completion of the questionnaires. Statistical analyses, including ANOVA, independent t-tests, and linear multiple regression, were performed using SPSS version 22, with a significance level set at p < 0.05.

RESULTS

There was a significant difference between the mean score of physical activity and gender (p < 0.05). In the male adolescents, an inverse correlation was observed between age and the total score of health-promoting behaviors across all dimensions. Furthermore, a direct correlation was identified between stress management with both adolescents' grade and father's education level. Additionally, there was a positive relationship between nutrition dimension with the presence of parents within the household, as well as the status of having a mother who is a housewife (p-value < 0.05). Among females, there was a negative significant relationship between health-promoting behaviors total score and its three dimensiones of physical activity, spiritual growth, and health responsibility with of age and grade of adolescents. Also, there was a positive correlation between nutrition dimention and presence of parents in the family (p-value < 0.05).

CONCLUSIONS

Fmale adolescents reported lower physical activity levels than males. These findings underscore the importance of paying attention to promoting physical activity in adolescent females. A notable finding was the decline in health-promoting behaviours with age among both genders. This suggests that interventions begin early in adolescence and address the unique challenges that older adolescents face, such as academic pressures and increased autonomy.

Co-Creating Snacks: A Cross-Cultural Study with Mediterranean Children Within the DELICIOUS Project

Mediterranean diet adherence has been decreasing during the last few decades, and non-appropriate snacking habits have also been identified among Mediterranean children and adolescents. To co-create new snacks and to explore children's interests and preferences, a multi-method approach was used in the present study, including some qualitative and quantitative research phases. Conducted in collaboration with schools in Lebanon, Egypt, Portugal, Italy, and Spain, different snack prototypes were designed and tested in a Mediterranean cross-cultural context. The results showed significant differences among countries in snacking preferences and general food-related attitudes. Italian children exhibited higher levels of neophobia, resulting in lower acceptance of all proposed snacks. Some sensory and contextual insights were collected, such as Egyptian children favoring sweet and crunchy textures and "At school", "With my friends", and "As a morning/afternoon snack" being identified as linked to snack acceptance in some countries. The present study underscores the value of co-creation processes involving children to address non-recommended dietary patterns, highlighting the critical role of sensory properties, cultural differences, and contextual factors in designing healthy snacks that meet the Mediterranean diet's principles but are highly appreciated by the young segment of the population.

Lifestyles and their association with stress and sleep during the COVID-19 lockdown in students

AIM/QUESTION

To assess lifestyle changes during Covid-19 lockdown and how they are associated with mental health through stress and sleep of university students in health sciences.

METHODS

Cross-sectional design with a descriptive analysis of lifestyles and multivariate logistic regression to determine their association with stress, insomnia and perceived health were carried out.

RESULTS

Most of 153 students were not active smokers, but the rate of not consumer was less than 20%. The multivariate models showed the influence of stress, insomnia and self-perceived health on each other, with the participation of factors related with diet pattern and alcohol consumption.

CONCLUSIONS

It is widely known that insomnia increases with stress; in our study it is also negatively influenced and, therefore, in a healthy way, by adherence to the Mediterranean diet, which is consistent with the results described by other authors. These results are important for organizing mental Health care for young students, as well as for young people from vulnerable populations where it is foreseeable that the effects derived from lifestyles on the stress- insomnia-health axis will be magnified.

Lifestyle Factors Associated with Children's and Adolescents' Adherence to the Mediterranean Diet Living in Mediterranean Countries: The DELICIOUS Project

Background/Objectives. Traditional dietary patterns are being abandoned in Mediterranean countries, especially among younger generations. This study aimed to investigate the potential lifestyle determinants that can increase adherence to the Mediterranean diet in children and adolescents. Methods. This study is a cross-sectional analysis of data from five Mediterranean countries (Italy, Spain, Portugal, Egypt, and Lebanon) within the context of the EU-funded project DELICIOUS (UnDErstanding consumer food choices & promotion of healthy and sustainable Mediterranean Diet and LIfestyle in Children and adolescents through behavIOUral change actionS). This study comprised information on 2011 children and adolescents aged 6-17 years old collected during 2023. The main background characteristics of both children and parents, including age, sex, education, and family situation, were collected. Children's eating (i.e., breakfast, place of eating, etc.) and lifestyle habits (i.e., physical activity level, sleep, and screen time) were also investigated. The level of adherence to the Mediterranean diet was assessed using the KIDMED index. Logistic regression analyses were performed to test for likelihood of higher adherence to the Mediterranean diet. Results. Major determinants of higher adherence to the Mediterranean diet were younger age, higher physical activity level, adequate sleep duration, and, among dietary habits, having breakfast and eating with family members and at school. Parents' younger age and higher education were also determinants of higher adherence. Multivariate adjusted analyses showed that an overall healthier lifestyle and parents' education were the factors independently associated with higher adherence to the Mediterranean diet. Conclusions. Higher adherence to the Mediterranean diet in children and adolescents living in the Mediterranean area is part of an overall healthy lifestyle possibly depending on parents' cultural background.

Adherence to the Mediterranean diet and changes in body mass index

BACKGROUND

Diet is considered a determinant of weight status, however, more evidence is needed for children. The Mediterranean diet (MedDiet) is one of the healthiest worldwide. This study analyzes the prospective association between adherence to the MedDiet at baseline and changes in standardized body mass index (zBMI) and the incidence of excessive weight.

METHODS

1389 children participated with a follow-up of 15 months. Weight, height, and adherence to the MedDiet were measured (baseline and follow-up).

RESULTS

Multiple logistic regression analysis revealed that a high increase in zBMI was associated with lower odds of eating vegetables once [OR 0.74 (95% CI 0.57-0.98)] or more a day [OR 0.68 (95% CI 0.49-0.95)], nuts 2-3 times/week [OR 0.74 (95% CI 0.56-0.97)] or 2 cups of yogurt or/and cheese daily [OR 0.74 (95% CI 0.55-0.99)]. Not consuming each food item was used as reference. Multiple linear regression analysis showed a negative (β = -0.010, p = 0.040) association between the MedDiet at baseline and changes in zBMI at follow-up, significance disappeared (p = 0.082) after final adjustment for baseline zBMI.

CONCLUSION

Baseline MedDiet was not significantly associated with the incidence of excessive weight at follow-up. The MedDiet was positively associated with changes in zBMI, however the effect size was small.

IMPACT

The present longitudinal study contributes knowledge regarding the adherence to Mediterranean diet as a predictive variable of weight status evolution in children. Higher adherence to the Mediterranean diet at baseline was prospectively and inversely associated with changes in zBMI after 15 months of follow-up. Consuming vegetables, nuts, and yoghurt/cheese according to the recommendations reduces the likelihood of having a high increase in zBMI after 15 months of follow-up.

Isotemporal Substitution Effects of Daily Time Use on Cardiorespiratory Fitness of Children in the OptiChild Study: A Mediation Analysis with Diet Quality

(1) Background: Although daily time-use is associated with diet quality and cardiorespiratory fitness (CRF) in children, their interdependence remains unexplored. This study first examined the associations between reallocating daily movement time and diet quality and CRF, and second the mediating role of diet quality in the relationship between daily time-use and CRF. (2) Methods: This study included 1131 Chinese children (aged 8 to 10 years; median [interquartile range]: 8.5 [8.3, 8.8]) at baseline (September 2022) and 1268 children at the 9-month follow-up (June 2023) from the OptiChild study. Daily durations of moderate-to-vigorous physical activity (MVPA), sleep, and sedentary behavior (e.g., screen time) were self-reported or proxy-reported by parents. Diet quality was assessed via the Diet Quality Questionnaire (DQQ), which uses a 24 h dietary recall and is categorized according to the Global Dietary Recommendations (GDR) score and Food Group Diversity Score (FGDS). The CRF was measured using VO2max after the 20 m shuttle run test. Longitudinal associations between daily time-use, diet quality, and CRF were calculated using isotemporal substitution models. Mediation analyses were used to determine whether diet quality mediated the associations between daily time-use and CRF. (3) Results: Reallocation of 30 min from screen time to MVPA resulted in significant improvements in the GDR score (β baseline = 0.11, p = 0.024; β follow-up = 0.26, p < 0.001), FGDS (β baseline = 0.11, p = 0.006; β follow-up = 0.19, p < 0.001), and CRF (β baseline = 0.40, p < 0.001; β follow-up = 0.26, p = 0.001). Diet quality partially mediated the associations between MVPA, screen time, and CRF. Substituting 30 min of screen time for MVPA led to diet quality mediating a proportion of the association with CRF (GDR score: 11.4%, FGDS: 6.6%). (4) Conclusions: These findings underscore the importance of optimizing daily time-use of MVPA and screen time and improving diet quality to promote physical fitness in school-aged children.

Inflammatory index score in children: its relationship with neophobia, dietary quality and anthropometric measurements

The aim of this study was to examine the correlation between the Diet Inflammatory Index (DII) scores and dietary quality in children, which was measured by the Mediterranean Diet Quality Index (KIDMED), also neophobia scores and anthropometric measurements. This study was conducted in primary schools in Famagusta, Cyprus. A total of 300 children (150 girls, 150 boys) in the 3rd, 4th and 5th grade were included in the study. The frequency of food consumption was measured to calculate the DII scores. Moreover, neophobia and KIDMED scores were obtained. The KIDMED score is a popular tool that is mostly used as a practical scale to assess adherence to the Mediterranean diet among children. Additionally, anthropometric measurements (body weight, height, waist circumference, neck circumference) were collected. Finally, DII scores were compared with KIDMED scores, neophobia scores, and anthropometric measurements. Anthropometric measurements and body mass index (BMI) values were found to be significantly different (p < 0.05) based on the DII scores. Children with DII scores in the 1st quartile had significantly different anthropometric measurements compared to those who had scores in the 2nd, 3rd, and 4th quartiles (p < 0.05). The DII scores of normal-weight children were higher than those of obese children. A significant negative correlation was observed between KIDMED scores and DII scores of the children (p < 0.05). Furthermore, a significant positive correlation was observed between neophobia scores and DII scores (p < 0.05). Additionally, DII scores were correlated with dietary quality and anthropometric measurements (p < 0.05). The MD enhances the anti-inflammatory properties of the diet; it has clearly demonstrated positive effects on diet quality and anthropometric measurements. Furthermore, the MD is suggested to reduce the risk of chronic diseases as a result of improving DII scores at an early age.

Trend in Breakfast Consumption among Primary School Children in Italy

Eating breakfast daily improves cognitive function, may contribute to learning and academic performance in children and can decrease the risk of childhood obesity. The aim of this study was to analyse how breakfast consumption changed in the period from 2008/9 to 2019 in Italy among children aged 8-9 years old participating in the OKkio alla SALUTE surveys and to explore the associations with some socio-demographic and lifestyle factors. Information about children's daily breakfast consumption (adequate, inadequate, and no breakfast) and the socio-demographic characteristics of the children and their mothers was collected through four questionnaires addressed to parents, children, teachers and head teachers. Data were analysed for the 272,781 children from 21 Italian regions from 2008/9 to 2019. The prevalence of adequate breakfast decreased from 60.7% in 2008/9 to 55.7% in 2019 and no breakfast from 10.9 to 8.7%; conversely, inadequate breakfast increased from 28.4 to 35.6%. Logistic regression models showed that the occurrence of inadequate or no breakfast consumption was significantly higher among girls, children living in the southern regions and children with less educated mothers. These findings highlight the need for effective interventions to increase daily breakfast consumption and its adequacy among children.

Parents' Diet Quality and Physical Activity Are Associated with Lifestyle in Spanish Children and Adolescents: The PASOS Study

BACKGROUND

Non-communicable chronic diseases are associated with a low-quality diet, low physical activity, and sedentary behavior.

OBJECTIVE

To assess how parents' diet and physical activity habits were associated with their offsprings' lifestyles.

STUDY DESIGN

A cross-sectional analysis of 8-16-year-old children and adolescents (n = 2539; 51.9% girls) was carried out within the frame of the first edition of the Physical Activity, Sedentarism, Lifestyles, and Obesity in Spanish Youth study (PASOS-2019). Data on adherence to the Mediterranean Diet (MedDiet), daily moderate-vigorous physical activity (MVPA), and screen time per day (television, computer, video games, and mobile phone) were collected from children and adolescents, and data on parents' diet quality and physical activity were compiled. Logistic regression models were used to assess the association between parents' lifestyles and those of children and adolescents.

RESULTS

High diet quality of parents was associated with higher adherence to the MedDiet of children and adolescents, as well as high consumption of fruit, vegetables, fish, nuts, and legumes. The high physical activity level of parents was associated with the low consumption of fast foods, sweets, and candies in children and adolescents. Children with high levels of physical activity were those whose parents showed better diet quality and physical activity levels.

CONCLUSIONS

Parents' high diet quality and physical activity were associated with healthy lifestyles, higher adherence to the MedDiet, and physical activity of their offspring, mainly in adolescents.

Relationships among Postpartum Weight Retention, Stress, and Disinhibited Eating: A Scoping Review

Postpartum weight retention (PPWR) is a significant contributor to maternal cardiometabolic disease risk. The transition to motherhood is a stressful time period in which women report consuming food to cope, an eating behavior that is associated with PPWR. In this scoping review, we identified original research and review articles published since 2010 that examined relationships among PPWR, maternal stress, and disinhibited eating. In total, 16 articles met the inclusion criteria. Findings were inconsistent related to PPWR and stress. PPWR and disinhibited eating were not significantly correlated; however, disinhibition scores were higher during the postpartum period compared to prenatally. Stress and disinhibited eating were directly correlated in 4 studies. Our findings suggest these concepts, particularly disinhibited eating, have not been robustly examined during the postpartum period. Additionally, instruments used to measure maternal stress vary widely and should be further studied and refined.

Trends in Adherence to the Mediterranean Diet in Spanish Children and Adolescents across Two Decades

Unhealthy dietary habits determined during childhood may represent a risk factor to many of the chronic non-communicable diseases (NCDs) in adulthood. Mediterranean Diet (MD) adherence in children and adolescents (8-16 years) living in Spain was investigated using the KIDMED questionnaire in a comparative analysis of two cross-sectional nationwide representative studies: enKid (1998-2000, n = 1001) and PASOS (2019-2020, n = 3540). Taking into account the educational level of pupils, as well as the characteristics of the place of living, a significant association was found between a KIDMED score ≥ 8 (optimal MD adherence) and primary education as well as residency in an area of <50,000 inhabitants, while living in the southern regions was associated with non-optimal MD adherence (p < 0.001). Participants of the 2019-2020 study showed an increase in the consumption of dairy products (31.1% increase), pasta/rice (15.4% increase), olive oil (16.9% increase), and nuts (9.7% increase), as well as a decreased sweets and candies intake (12.6% reduction). In contrast, a significantly lower MD adherence was found when comparing the 2019-2020 (mean ± SE: 6.9 ± 0.04) and the 1998-2000 study (7.37 ± 0.08); p < 0.001), due to less consumption of fish (20.3% reduction), pulse (19.4% reduction), and fruits (14.9% reduction), and an increased intake of commercial goods/pastries or fast-food intake (both 19.4% increase). The lowest adherence was recorded for adolescents also in the most recent study, where 10.9% of them presented a KIDMED score ≤ 3. This study shows that eating habits are deteriorating among Spanish children and adolescents. Such findings point out the urgency of undertaking strong measures to promote the consumption of healthy, sustainable, and non-ultra-processed food, such as those available in an MD, not only at a scientific and academic level, but also at a governmental one.

The Association of Eating Behaviour with Physical Activity and Screen Time among Adolescents in the Klang Valley, Malaysia: A Cross-Sectional Study

Over the last few decades, the time adolescents spend using electronic devices has increased significantly. The aim of this study was to evaluate the impact of screen time and physical activity on eating behaviour in adolescents. This study used the Physical Activity Questionnaire for Adolescents (PAQ-A) Malay version and the Dutch Eating Behaviour Questionnaire (DEBQ) Malay version methods with secondary students around the Klang Valley. The sampling technique used was purposive sampling. With parents' consent, an online survey was conducted among adolescent school children aged between 13 and 17 years during the COVID-19 pandemic in the Klang Valley, Malaysia. There were 372 respondents participating in this study. The results showed that 99.4% of them had more than 4 h screen time a day, and that 38.5% have more than three devices at home. Moreover, there was a significant mean difference in screen time for console games without a handheld device between male and female adolescents (p < 0.05). There was also a significant mean difference in the emotional, restricted and external eating behaviour scores between male and female adolescents (p < 0.001). There was a significant relationship between physical activity and the time duration spent on a television, telephone and laptop during weekends (p < 0.05). There was a significant relationship between eating behaviour and time spent watching television and using laptops during weekends (p < 0.05). Based on the moderation model, gender as a moderator variable indicated that there was a significant relationship between screen time and interaction screen time and gender with emotional eating (p < 0.001). Female adolescents had a stronger relationship between screen time and emotional eating compared to male adolescents (p < 0.05). Meanwhile, for physical activity level as a moderator variable, the results showed that there was a significant interaction between screen time and physical activity for emotional eating behaviour (p < 0.05). In conclusion, this study indicates that screen time was higher among female adolescents and significantly related to emotional eating behaviour. Therefore, the educational sector should emphasise the motivation of adolescents to engage in physical activity, reduce their screen time and eat healthy foods such as fruits and vegetables.

Cultural influences on infant and toddler feeding among low-income Latinx mothers

Latinx infants and toddlers experience higher obesity rates than their black or white counterparts, increasing chronic disease risk later in life. Infant and toddler feeding (ITF) interventions are shown to improve dietary behaviours, but few studies target Latinx populations. Culturally tailoring such interventions is imperative, but cultural influences on Latinx ITF practices remain unclear. The purpose of this study was to characterize how culture influences ITF practices among Latinx mothers of low income. A brief survey and semistructured interview informed by the theory of planned behaviour (TPB) were conducted on Zoom with New York City-based Latinx mothers of children 4 to 24 months old. A directed content analysis approach was used to identify themes using TPB theoretical codes and inductive codes. Transcripts were coded independently by two researchers using NVivo 12. Survey data were analyzed using descriptive statistics in Excel. Participants (n = 19) were of Dominican, Mexican and Central and South American origin, had low acculturation scores and mean child age was 16.7 months (range: 5-24 months old). The central theme identified was that participants balanced cultural information with evidence-based health information to determine which ITF practices were most beneficial to infant/toddler health. This resulted in the adoption of evidence-based ITF recommendations, adoption of cultural practices that aligned with evidence-based recommendations and dismissal or postponement of cultural ITF practices that contradicted evidence-based recommendations. The present results can be applied to culturally relevant ITF education as follows: emphasizing the benefits of desirable ITF practices on children's health and promoting healthy cultural ITF practices.

Mediterranean Diet in Developmental Age: A Narrative Review of Current Evidences and Research Gaps

Numerous studies in recent decades have shown that Mediterranean diet (MD) can reduce the risk of developing obesity in pediatric patients. The current narrative review summarizes recent evidence regarding the impact of MD across the different stages of child development, starting from fetal development, analyzing breastfeeding and weaning, through childhood up to adolescence, highlighting the gaps in knowledge for each age group. A literature search covering evidence published between 1 January 2000 and 1 March 2022 and concerning children only was conducted using multiple keywords and standardized terminology in PubMed database. A lack of scientific evidence about MD adherence concerns the age group undergoing weaning, thus between 6 months and one year of life. In the other age groups, adherence to MD and its beneficial effects in terms of obesity prevention has been extensively investigated, however, there are still few studies that correlate this dietary style with the incidence of non-communicable diseases. Furthermore, research on multi-intervention strategy should be implemented, especially regarding the role of education of children and families in taking up this healthy dietary style.

Determinants of Healthy Diet Among Children Exposed and Unexposed to Gestational Diabetes

OBJECTIVES

To evaluate the association between individual and environmental determinants of diet quality with diet quality of children exposed to gestational diabetes mellitus (GDM+) and unexposed (GDM-); to study the association between mother and child vegetables and fruit (VF) intakes.

DESIGN

Cross-sectional study.

PARTICIPANTS

One hundred forty-two children (104 GDM+; 38 GDM-) aged 6.2 ± 2.5 years.

VARIABLES

Canadian Healthy Eating Index 2007 (HEI-C) and VF were obtained with 2 24-hour dietary recall questionnaires in children. Maternal VF was obtained by a validated food frequency questionnaire, and weight and height were measured. Sociodemographic determinants were obtained by questionnaires.

ANALYSIS

Linear regression models were used to evaluate the association between individual and environmental determinants and the HEI-C score with interaction for GDM status.

RESULTS

Family meals were associated with HEI-C among GDM- but not GDM+ children (β = 9.97, P = 0.01 and β = -0.41, P = 0.84, respectively; P for interaction = 0.02). Children's age (β = -1.45; 95% confidence interval, -2.19 to -0.72; P < 0.001) was a determinant of HEI-C among all children. Maternal VF intakes were positively associated with children's VF intake (r = 0.30, P < 0.001, r² = 0.09), with association of larger variance among GDM- children (r = 0.38, r² = 0.14, P = 0.02) than GDM+ children (r = 0.23, r² = 0.05, P = 0.02).

CONCLUSIONS

The food environment at home was associated differently with the diet quality of GDM+ and GDM- children. Whether targeting family meals and maternal diet quality is a good strategy to improve children's diet quality among GDM+ children needs to be further investigated.

Mediterranean diet and adiposity in children and adolescents: A systematic review

Our aim was to summarize, through a systematic review, the current evidence from dietary intervention and observational studies on the impact of adherence to the Mediterranean diet on adiposity markers and obesity in children and adolescents. We searched Medline up to June 1, 2021 for the identification of intervention and observational studies meeting the inclusion criteria, following the PRISMA statement. We included 55 articles: 8 intervention studies and 47 observational studies. Three trials report a beneficial effect of the dietary intervention, whereas two did not, and three did not compare with a control. All observational studies were cross-sectional, and only five studies also included a longitudinal analysis. More than half of the cross-sectional studies found no significant association between adherence to Mediterranean diet and adiposity. Three out of the five longitudinal studies found a negative association. The majority of both observational and intervention studies was of low quality. Despite a large number of published studies, overall, there is only limited evidence of a beneficial effect of following a traditional Mediterranean diet to maintain a healthy body weight in childhood. More high-quality intervention and longitudinal data are needed to form the base of large-scale health programs to prevent childhood obesity.

Prospective Association of Maternal Educational Level with Child's Physical Activity, Screen Time, and Diet Quality

Evidence has identified unhealthy lifestyle behaviors as the main contributors to obesity in children, so it is essential to identify factors that could influence children’s lifestyles. The objective of the present study was to analyze the association of baseline maternal educational level with child’s physical activity, screen time, and dietary habits at follow-up. This community-based cohort study was carried out between 2012 and 2014 and included 1405 children aged 8 to 10 years old. Maternal educational level was used as an indicator of child’s socioeconomic status. Physical activity, screen time, and dietary habits were assessed by validated questionnaires. The odds of having commercially baked goods for breakfast [OR 1.47 (95% CI 1.03 to 2.10)], going more than once a week to a fast-food restaurant [OR 1.64 (95% CI 1.20 to 2.26)], and taking sweets and candys several times a day [OR 3.23 (95% CI 2.14 to 4.87) were significantly higher among children whose mothers had a lower educational level compared to their peers whose mothers had a higher level. These associations held for taking sweets and candy several times a day after additional adjustment for the corresponding dietary behavior at baseline. Maternal educational level was inversely associated (p < 0.001) with child’s screen time at follow up and being in the lowest maternal educational category was associated with an increased odds of surpassing the maximum recommended time of screen time of 120 min per day (OR (95% CI) 1.43 (1.07 to 1.90), p = 0.016). Maternal education is a predictor for unhealthy dietary habits and high screen time in children.

Healthy and Sustainable Dietary Patterns in Children and Adolescents: A Systematic Review

The need for adherence to a healthy and sustainable dietary pattern in the pediatric stage is discussed worldwide, being linked to a progressive incidence of noncommunicable diseases in adulthood. The aims of this systematic review were to summarize the healthy and/or sustainable dietary patterns, defined a priori, described in the literature for use during the pediatric stage; to evaluate the adherence to these dietary patterns; and identify the health-related benefits associated with adherence to these patterns. A literature search was carried out on Medline, Scopus, and Web of Science from 2010 up to 2021, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 128 articles were included according to the following criteria: participants 2-17 y old, healthy and/or sustainable dietary patterns defined by an a priori methodology; articles written in English or Portuguese; and published since 2010. Fifty instruments with 14 adaptations that measure adherence to healthy and/or sustainable dietary patterns in children and adolescents were found. The Mediterranean Diet was the most studied dietary pattern. Adherence to healthy and/or sustainable dietary patterns has wide variations worldwide. Most of the instruments described have been little studied at pediatric ages, reducing the ability to extrapolate results. Higher adherence to these dietary patterns was associated with lower body fat, waist circumference, blood pressure, and metabolic risk. There is no consensus regarding the association with BMI. No studies have proofs of the sustainability characteristics of these instruments, it being necessary to produce a new sustainable instrument or test the association of the previous ones with, for example, the ecological footprint. Further validations of these instruments in each country and more prospective studies are needed to establish temporal relations with health-related outcomes. This systematic review was registered at www.crd.york.ac.uk/prospero/ as CRD42020221788.

Nutritional status, lifestyle habits and cancer mortality: a population-based prospective cohort study

PURPOSE

We aimed to investigate the relationship between overall nutritional status and cancer mortality.

METHODS

A total of 12 262 US adults from six consecutive surveys of the National Health and Nutrition Examination Survey (NHANES 2003-2014) were analyzed. The overall health nutritional biomarkers index (HNBI) score, capturing characteristics of 17 biomarkers was developed to assess the overall nutritional status. The lower the HNBI score, the healthier nutritional status would be. Hazard ratio (HR) and 95% confidence intervals (95% CIs) were calculated by Cox proportional hazards regression models to evaluate the association between the HNBI score and cancer mortality.

RESULTS

The lower overall HNBI score was associated with decreased risk of cancer mortality, compared with participants in the 4th quartile of overall HNBI score, the HR (95% CIs) for participants in the 1st quartiles was 0.54 (0.33-0.89) (P-trend = 0.019). Healthier lifestyle habits and not obesity interacted with HNBI score, compared with participants with higher HNBI score and smoking currently/not exercising regularly/obesity, participants with lower HNBI score and not smoking currently/exercising regularly/not obesity were associated with lower risk of cancer mortality, the HR (95% CIs) were 0.43 (0.26-0.73), 0.57 (0.33-0.97), and 0.62 (0.47-0.97), respectively. These significant associations remained among participants who were followed-up more than 2 years.

CONCLUSION

Our findings suggested that healthier overall nutritional status was associated with lower risk of cancer mortality among US adults. Not smoking, exercise regularly and not obesity interacted with overall nutritional status. Adherence to better overall nutritional status, lifestyle habits and optimal weight would prevent premature death from cancer.

Comparative Study Regarding the Adherence to the Mediterranean Diet and the Eating Habits of Two Groups-The Romanian Children and Adolescents Living in Nord-West of Romania and Their Romanian Counterparts Living in Italy

Background: The Mediterranean diet (MD) is associated with significant health benefits, including prevention of noncommunicable diseases (NCDs). Given the important migratory flow from Romania to Italy in recent decades, this study seeks to evaluate the differences between the nutritional habits of Romanian children and adolescents in Romania compared with those of Romanian children who moved to Italy or were born in Italy from both Romanian parents. Method: To assess adherence to MD, parents of Romanian children in Romania (RCR) and Romanian children in Italy (RCI) answered questions from an adapted version of the KIDMED test. Results: The results show that the high KIDMED index among RCI is significantly higher than the same index among RCR (68.09 versus 17.76, p < 0.05). RCR obtained a higher KIDMED score on different items: they had a lower consumption of fast food and sweets but an increased consumption of nuts, yogurts, and cheese. Conclusions: RCI have a better adherence to MD, but, at the same time, they are more exposed to westernized diet and practice less physical activity. Nutrition education is an important tool for improving health outcome.

Association between Leisure Screen Time and Junk Food Intake in a Nationwide Representative Sample of Spanish Children (1-14 Years): A Cross-Sectional Study

Evidence on the association between new patterns of leisure screen time and junk food consumption in Spanish children at the national level is scarce. The aim of this study is to assess the relation between daily leisure screen time and the frequency of sweet, soft drink, fast food, and snack intake in a representative sample of Spanish children and adolescents aged from 1 to 14 years. We conducted a cross-sectional study using a representative sample of the Spanish population under 15 years recruited for the 2017 Spanish National Health Survey (n = 5480). We dichotomized sweet, soft drink, fast food, and snack intake (high/low) and categorized daily leisure screen time (0–59, 60–119, 120–179, and ≥180 min). We calculated crude prevalence ratios and adjusted prevalence ratios, and their 95% confidence intervals (95% CI), of high frequency of sweet, soft drink, fast food, and snack intake. Children spending at least one hour of daily leisure screen time had higher prevalence of high frequency of sweet and snack intake than children being exposed less than one hour. For soft drinks and fast food, prevalence of high frequency intake was significantly higher from two and three hours of exposure, respectively. Longer periods of screen exposure in Spanish children during their leisure time may be associated with poorer dietary behaviors. The negative effects of excessive screen time in pediatrics population should be further studied.

Zapico A, Gusi N, Aznar S, Alcaraz PE, González-Valeiro M, Serra-Majem L, Terrados N, Tur JA, Segú M, Lassale C, Homs C, Oses M, González-Gross M, Sánchez-Gómez J, Jiménez-Zazo F, Marín-Cascales E, Sevilla-Sánchez M, Herrera-Ramos E, Pulgar S, Bibiloni MDM, Sancho-Moron O, Schröder H, Barón-López FJ. Screen Time and Parents' Education Level Are Associated with Poor Adherence to the Mediterranean Diet in Spanish Children and Adolescents: The PASOS Study

The aim of this study is to evaluate if screen time and parents' education levels are associated with adherence to a Mediterranean dietary pattern. This cross-sectional study analyzed a representative sample of 3333 children and adolescents (8 to 16 years) included in the Physical Activity, Sedentarism, lifestyles and Obesity in Spanish youth (PASOS) study in Spain (which ran from March 2019 to February 2020). Data on screen time (television, computer, video games, and mobile phone) per day, Mediterranean diet adherence, daily moderate or vigorous physical activity, and parents' education levels were gathered using questionnaires. A descriptive study of the variables according to sex and parents' education level was performed. Logistic regression models (adjusted by sex and weight status) were fitted to evaluate the independent association between screen time and Kids' level of adherence to the Mediterranean diet (KIDMED) index, as well as some of its items. A greater amount of screen time was associated with worse adherence to the Mediterranean diet; a lower consumption of fruit, vegetables, fish, legumes, and nuts; and a greater consumption of fast food, sweets, and candies. A lower parents' education level was associated with worse adherence to the Mediterranean diet. It is necessary to promote the responsible, limited use of screen time, especially in children with parents with a lower education level.

Weight Loss and Improvement of Metabolic Alterations in Overweight and Obese Children Through the I2AO2 Family Program: A Randomized Controlled Clinical Trial

Childhood obesity is a major public health concern. We wanted to evaluate the effectiveness of a multidisciplinary program based on healthy eating, exercise, cognitive-behavioral therapy, and health education to achieve weight loss and improve metabolic parameters in overweight and obese children. A randomized, controlled clinical trial with long-term follow-up (24 months) was conducted at a community care center in overweight and obese individuals aged 6-12 years. A sample of 108 children was divided into an experimental and a control group receiving a standard care program. The experimental groups received a 12-month interdisciplinary program; the results were evaluated at 4 months, the end of the intervention, and at follow-up 12 months later. Anthropometric and biological marker measurements related to metabolic alterations, dyslipidemia (based on total cholesterol), hyperglycemia, fasting glycaemia, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol in blood were recorded. The intervention had a significant effect (p < 0.001) in terms of decreased body mass index, skinfolds, and waist and arm circumferences. These changes were accompanied by biochemical changes underlying an improvement in metabolic parameters, such as a significant reduction in total cholesterol, low-density lipoprotein-cholesterol, triglycerides, and hyperglycemia and a significant increase in high-density lipoprotein-cholesterol. These effects were still significant for markers of excess weight or obesity in the experimental group 12 months after the end of the intervention, suggesting that an enduring change in healthy lifestyles had been maintained period. This interdisciplinary, nurse-led program helped to reduce childhood and adolescent excess weight and obesity and had long-lasting effects.

Is adherence to the Mediterranean diet associated with healthy habits and physical fitness? A systematic review and meta-analysis including 565 421 youths

The relationship between adherence to the Mediterranean diet (MD), physical activity (PA), sedentary behaviour and physical fitness levels has been analysed in several studies; however, there is mixed evidence among youth. Thus, this study aimed to meta-analyse the associations between adherence to the MD, PA, sedentary behaviour and physical fitness among children and adolescents. Three databases were systematically searched, including cross-sectional and prospective designs with a sample of healthy youth aged 3–18 years. Random effects inverse-variance model with the Hartung–Knapp–Sidik–Jonkman adjustment was used to estimate the pooled effect size (correlation coefficient (r)). Thirty-nine studies were included in the meta-analysis, yielding a total of 565 421 youth (mean age, 12·4 years). Overall, the MD had a weak-to-moderate positive relationship with PA (r 0·14; 95 % CI 0·11, 0·17), cardiorespiratory fitness (r 0·22; 95 % CI 0·13, 0·31) and muscular fitness (r 0·11; 95 % CI 0·03, 0·18), and a small-to-moderate negative relationship with sedentary behaviour (r –0·15; 95 % CI –0·20, –0·10) and speed–agility (r –0·06; 95 % CI –0·12, –0·01). There was a high level of heterogeneity in all of the models (I2 ≥ 75 %). Overall, results did not remain significant after controlling for sex and age (children or adolescents) except for PA. Improving dietary habits towards those of the MD could be associated with higher physical fitness and PA in youth, lower sedentary behaviours and better health in general.

Primary school children and nutrition: lifestyles and behavioral traits associated with a poor-to-moderate adherence to the Mediterranean diet. A cross-sectional study

The Mediterranean diet has consistently shown a beneficial influence on health and longevity. The aim of this cross-sectional study was to identify all the various factors-such as socio-demographics, lifestyles, and behavioral traits-associated with the risk of a poor adherence to the Mediterranean diet in a sample of Italian primary school children. The study sample included 267 children in their first year of primary school. Their mothers were asked to answer an anonymous, self-administered questionnaire that investigated their children's adherence to the Mediterranean diet (using the KidMed score) and variables related to their lifestyles, behavioral traits, and socio-economic factors. A multivariate logistic regression was performed to test the association between adherence to the Mediterranean diet and the other variables investigated. Most of the children involved in this study (73.9%) were classifiable as having a poor-to-moderate adherence to the Mediterranean diet. Higher odds of a poor adherence to the Mediterranean diet were associated with videogame playing for more than 1 h a day and lower levels of mothers' health consciousness. On the other hand, the odds were lower in association with more time spent practicing sport, higher levels of prosocial behavior, and with mothers having a high school education as opposed to fewer years of schooling.Conclusions: These results point to the need to consider the role of mothers' health consciousness and formal education in influencing their children's diets. Health promotion interventions should focus on the importance of a healthy overall lifestyle, which includes not only appropriate nutrition but also time spent on physical activity and leisure activities (such as playing videogames).What is Known:• Most of the children were classified as having a poor or moderate adherence to the Mediterranean diet. This result reflects a trend common to numerous countries of the Mediterranean area in recent years.• A mother's level of formal education influences her child's diet.What is New:• Higher levels of prosocial traits coincided with lower odds of a poor adherence to the Mediterranean diet.