Adherence to the Mediterranean diet of school-age children in Moroccan oases, Draa-Tafilalet Region

Younger age, higher father education level, and healthy lifestyle behaviors are associated with higher adherence to the Mediterranean diet in school-aged children

OBJECTIVES

This study aimed to assess adherence to the Mediterranean Diet (MDiet) in school-aged children in Turkey and explore the associated factors with high adherence to the MDiet.

METHOD

This cross-sectional was conducted with 2693 school-aged children. Sociodemographic, dietary, and lifestyle data were collected using a questionnaire. Mediterranean Diet Quality Index (KIDMED) was used to evaluate adherence to the MDiet. Body weight, height, neck, waist, and hip circumference were measured. Dietary intake was assessed with a 24-h food consumption record.

RESULTS

Of the 2693 children, 29.5% had high, 53.9% had moderate, and 16.6% had low adherence to the MDiet. Primary school children had significantly higher adherence to the diet than secondary school children. Adherence to the MDiet was higher in children whose fathers were university graduates. There were no significant differences in sex, body mass index (BMI), or anthropometric measurements according to MDiet adherence. The high adherence group had a significantly higher intake of protein, fiber, vitamins C, B1, B6, B2, folate, polyunsaturated fatty acids, zinc, potassium, and calcium, but lower carbohydrate intake compared with the low/moderate adherence group. Higher adherence to the MDiet was associated with adequate sleep duration (≥9 to <12 h) (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.24-2.78), whereas poor/moderate adherence was associated with age (OR, 0.80; 95% CI, 0.73-0.87) and screen time (OR, 0.50; 95% CI, 0.40-0.63). Children who reported engaging in regular physical activity were more likely to have higher MDiet adherence (OR, 1.46; 95% CI, 1.16-1.85).

CONCLUSION

The results of this study showed that >50% of the children presented moderate MDiet adherence. Younger age, adequate sleep duration, engaging in regular physical activity, less screen time, and higher education level of fathers were associated with higher adherence to the diet.

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.

The effect of a Mediterranean diet vs. a low-fat diet on non-alcoholic fatty liver disease in children: a randomized trial

Non-alcoholic fatty liver disease (NAFLD) is becoming ever more common in children, due to the increasing global prevalence of obesity. The first-line treatment consists of weight loss through a combination of a healthy diet and exercise. The objective of this study was to determine the effects of a Mediterranean Diet or a low-fat diet on reducing hepatic steatosis and insulin resistance in children with NAFLD. This 12-week randomised clinical trial was conducted with children aged 9-17 years diagnosed with NAFLD and randomised into either a Mediterranean Diet or a low-fat diet group. By the end of the study, hepatic steatosis had decreased significantly in both groups (p < 0.001). Liver enzymes also improved significantly, while significant decreases were observed in insulin resistance in both groups, although this decrease was greater in the Mediterranean Diet group (p = 0.010). This study demonstrated that a decrease in hepatic steatosis and an improvement in insulin sensitivity can be achieved with both a Mediterranean Diet and a low-fat diet over 12 weeks, with no significant decrease in the energy required for growth, in children with NAFLD.