Mediterranean diet adherence and body composition among Southern Italian adolescents.

INTRODUCTION Adherence to the traditional Mediterranean diet has been associated with health benefits in young populations. The aim of this study was to evaluate the association between adherence to the Mediterranean diet and cardio-metabolic parameters in adolescents living in Sicily, Southern Italy. METHODS A cross-sectional study was conducted during two school years (2012-2013 and 2013-2014) on 1643 adolescents of 11-16 years attending 15 secondary schools. Socio-demographic, dietary, lifestyle, and anthropometric data were collected. The KIDMED score was used to evaluate the adherence to the Mediterranean diet. Linear and logistic regression models were used to test the association between the variable of interest and the outcomes. RESULTS A higher percentage of boys compared with girls was overweight (30.8% vs. 25.4%) and obese (28.7% vs. 18.5%) and only 9.1% had high adherence to the Mediterranean diet. Vegetable intake was negatively associated with being overweight/obese whereas higher intake of sweets, sugar-sweetened beverages, and fast foods was associated with overweight and obesity. A good adherence to the Mediterranean diet resulted in 30% decreased odds of being overweight or obese (odd ratio 0.70, 95% confidence interval: 0.56-0.87) in both boys and girls. An inverse correlation was found between KIDMED score and BMI, waist circumference and fat mass. No relation with blood pressure was found. CONCLUSIONS Mediterranean dietary pattern resulted significantly associated with weight status in adolescents. These results underline the importance of providing lifestyle and dietary habits education to prevent overweight and obesity in adolescent.

[1]  Setting Brazil Establishing a standard definition for child overweight and obesity worldwide: international survey. , 2008 .

[2]  G. Grosso,et al.  Beneficial effects of the Mediterranean diet on metabolic syndrome. , 2014, Current pharmaceutical design.

[3]  G. Grosso,et al.  Protective role of the Mediterranean diet on several cardiovascular risk factors: evidence from Sicily, southern Italy. , 2014, Nutrition, metabolism, and cardiovascular diseases : NMCD.

[4]  L. Schwingshackl,et al.  Monounsaturated fatty acids, olive oil and health status: a systematic review and meta-analysis of cohort studies , 2014, Lipids in Health and Disease.

[5]  C. Lazarou,et al.  Urbanization influences dietary habits of Cypriot children: the CYKIDS study , 2009, International Journal of Public Health.

[6]  A. Trichopoulou,et al.  Portuguese households’ diet quality (adherence to Mediterranean food pattern and compliance with WHO population dietary goals): trends, regional disparities and socioeconomic determinants , 2008, European Journal of Clinical Nutrition.

[7]  W. Ahrens,et al.  Mediterranean diet, overweight and body composition in children from eight European countries: Cross-sectional and prospective results from the IDEFICS study , 2016 .

[8]  Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial , 2018, Canadian Medical Association Journal.

[9]  C. Lorini,et al.  Adherence to Mediterranean diet in a sample of Tuscan adolescents. , 2014, Nutrition.

[10]  B. Popkin The nutrition transition: an overview of world patterns of change. , 2004, Nutrition reviews.

[11]  D. Panagiotakos,et al.  Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. , 2011, Metabolic syndrome and related disorders.

[12]  I. Pigeot,et al.  Adherence to a Mediterranean-like dietary pattern in children from eight European countries. The IDEFICS study , 2014, International Journal of Obesity.

[13]  Chrystalleni Lazarou,et al.  Dietary and other lifestyle characteristics of Cypriot school children: results from the nationwide CYKIDS study , 2009, BMC public health.

[14]  A. Martí,et al.  Predictor factors for childhood obesity in a Spanish case-control study. , 2007, Nutrition.

[15]  G. Grosso,et al.  Mediterranean diet adherence rates in Sicily, southern Italy , 2013, Public Health Nutrition.

[16]  J. Martínez,et al.  Carbohydrate quality, weight change and incident obesity in a Mediterranean cohort: the SUN Project , 2014, European Journal of Clinical Nutrition.

[17]  L. Iacopino,et al.  Body composition changes and cardiometabolic benefits of a balanced Italian Mediterranean Diet in obese patients with metabolic syndrome , 2013, Acta Diabetologica.

[18]  F. Sofi,et al.  Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score , 2013, Public Health Nutrition.

[19]  Y. Xiang,et al.  Fish consumption and all-cause mortality: a meta-analysis of cohort studies , 2016, European Journal of Clinical Nutrition.

[20]  G. Grosso,et al.  Factors Associated with Adherence to the Mediterranean Diet among Adolescents Living in Sicily, Southern Italy , 2013, Nutrients.

[21]  M. Torres-Tamayo,et al.  Mediterranean-style diet reduces metabolic syndrome components in obese children and adolescents with obesity , 2014, BMC Pediatrics.

[22]  Y. Xiang,et al.  Association between dietary fiber and lower risk of all-cause mortality: a meta-analysis of cohort studies. , 2015, American journal of epidemiology.

[23]  D. Panagiotakos,et al.  The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. , 2011, Journal of the American College of Cardiology.

[24]  C. Cowell,et al.  Bioelectrical impedance analysis to estimate body composition, and change in adiposity, in overweight and obese adolescents: comparison with dual-energy x-ray absorptiometry , 2014, BMC Pediatrics.

[25]  B. Popkin,et al.  The nutrition transition in Spain: a European Mediterranean country , 2002, European Journal of Clinical Nutrition.

[26]  G. Grosso,et al.  Mediterranean diet adherence in children and adolescents in southern European countries , 2016 .

[27]  C. Champagne,et al.  Evaluation of body fat in fatter and leaner 10-y-old African American and white children: the Baton Rouge Children's Study. , 2001, The American journal of clinical nutrition.

[28]  D. Lai,et al.  Overweight, ethnicity, and the prevalence of hypertension in school-aged children. , 2004, Pediatrics.

[29]  G. Grosso,et al.  Impact of lifestyle on metabolic syndrome in apparently healthy people , 2014, Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity.

[30]  J. J. Muros,et al.  Factors associated with low adherence to a Mediterranean diet in healthy children in northern Spain , 2014, Appetite.

[31]  S. Costanzo,et al.  Wine, beer or spirit drinking in relation to fatal and non-fatal cardiovascular events: a meta-analysis , 2011, European Journal of Epidemiology.

[32]  H. Aounallah-Skhiri,et al.  Nutrition transition among adolescents of a south-Mediterranean country: dietary patterns, association with socio-economic factors, overweight and blood pressure. A cross-sectional study in Tunisia , 2011, Nutrition journal.

[33]  J. Tur,et al.  Adherence to the Mediterranean dietary pattern among Balearic Islands adolescents , 2010, British Journal of Nutrition.

[34]  H. Cena,et al.  Reliability and relative validity of a quantitative food-frequency questionnaire for use among adults in Italian population , 2010, International journal of food sciences and nutrition.

[35]  J. Tur,et al.  Western and Mediterranean dietary patterns among Balearic Islands’ adolescents: socio-economic and lifestyle determinants , 2011, Public Health Nutrition.

[36]  Javier Aranceta,et al.  Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents , 2004, Public Health Nutrition.

[37]  A. Cernigliaro,et al.  Adherence to the Mediterranean diet in Italian school children (The ZOOM8 Study) , 2014, International journal of food sciences and nutrition.

[38]  Z. Šatalić,et al.  Comparison of dietary habits in the urban and rural Croatian schoolchildren , 2004, European journal of nutrition.

[39]  G. Grosso,et al.  Nutrition knowledge and other determinants of food intake and lifestyle habits in children and young adolescents living in a rural area of Sicily, South Italy , 2012, Public Health Nutrition.

[40]  R. Tracy,et al.  Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study. , 1998, The New England journal of medicine.

[41]  J. Brug,et al.  Overweight and obesity in infants and pre‐school children in the European Union: a review of existing data , 2010, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[42]  D. Romaguera,et al.  Adherence to the Mediterranean dietary pattern among the population of the Balearic Islands , 2004, British Journal of Nutrition.

[43]  F. Hu,et al.  Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies , 2014, BMJ : British Medical Journal.

[44]  Katerina Belogianni,et al.  Adherence rates to the Mediterranean diet are low in a representative sample of Greek children and adolescents. , 2008, The Journal of nutrition.

[45]  L. Badimón,et al.  Latest Evidence of the Effects of the Mediterranean Diet in Prevention of Cardiovascular Disease , 2014, Current Atherosclerosis Reports.

[46]  F. Sofi,et al.  Mediterranean diet and health , 2013, BioFactors.

[47]  G. Grosso,et al.  Association of dietary patterns with insulin resistance and clinically silent carotid atherosclerosis in apparently healthy people , 2013, European Journal of Clinical Nutrition.

[48]  A. Lorenzo,et al.  The effects of Italian Mediterranean organic diet (IMOD) on health status. , 2010, Current pharmaceutical design.

[49]  S. Larsson,et al.  Systematic Reviews and Meta- and Pooled Analyses Red Meat and Processed Meat Consumption and All-Cause Mortality: A Meta-Analysis , 2014 .

[50]  L. Maes,et al.  Comparison of a short food-frequency questionnaire and derived indices with a seven-day diet record in Belgian and Italian children , 2008, International Journal of Public Health.

[51]  D. Panagiotakos,et al.  High sodium intake of children through ‘hidden’ food sources and its association with the Mediterranean diet: the GRECO study , 2011, Journal of hypertension.