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Mediterranean diet and health in children and adolescents
Maria Maraki, PhD
Contents
Definition of Mediterranean diet/lifestyle
Effects of Mediterranean diet (MD) on health and disease
In children & adolescents: o Assessment of MD adherence
o MD adherence rates in Greece, Spain, Italy etc
o MD adherence factors
o MD adherence and health
Tips to help your students
Seven Countries Study
Ancel Keys
Greece
Japan
Finland
Italy Netherlands
Yugoslavia
USA
Early 60s
12.763 men, 40-59 yrs
Seven Countries Study
25 yrs follow-up
CHD mortality per 1000
Mediterranean basin
Mediterranean diet
7-countries study:
Special dietary habits
CVD & neoplastic diseases
Combination of dietary habits followed by Mediterranean populations
Dietary pattern characterized by high consumption of :
Olive oil
Vegetables
Legumes
Whole grains
Fruits
Nuts
Mediterranean diet
Mediterranean diet
Other characteristics:
Olive oil: the main source of added fat
Low animal fat intake
Moderate fish consumption
Wine during meal: main alcohol source
Mediterranean diet
Italy
Total fat intake: ~ 30%
Greece
Total fat intake: ~ 40% Main dietary fat :
monounsaturated fatty
acids
Reduced frequency of
consumption
Increased frequency of consumption
Vitamins, minerals, dietary
fibers, antioxidants & water
Dietary fibers, vitamins
& minerals
Mediterranean diet
proteins, vitamins,
calcium, phosphorus
Vitamin Ε, β- carotene,
monounsaturated fatty
acids
omega-3 fatty acids
Low fat
Dietary fibers,
proteins
Monounsaturated fatty
acids, antioxidants
Mediterranean diet
proteins, fatty
acids, vitamins &
minerals
proteins, iron,
animal fat
Mediterranean diet
Effects of Mediterranean diet on health
Anti-inflammatory and antioxidant
properties of Mediterranean diet
mortality of cardiovascular & neoplastic diseases & other
causes
risk: hypertension, obesity, diabetes & neurodegenerative diseases
maybe risk : osteoporosis, rheumatoid arthritis and depression
Mediterranean
diet
Improves quality of life
Increases life expectancy
Effects of Mediterranean diet on health
Mean daily food consumption for men in Crete, Greece (7-countries
study 1960 – 1991)
Food 1960 1991 1960-1991 % change
g/day g/day %
Grains 30 140 ± 25 366
Fruits 464 288 ± 37 -51
Vegetables 191 278 ± 33 46
Meat 35 43 ± 10 24
Fish 18 62 ± 13 244
Cheese 13 26 ± 7 100
Fat 123 75 ± 6 -39
Effects of Mediterranean diet on health
HOW TO EVALUATE MD ADHERENCE?
Adults: Med Diet Score (Panagiotakos et al. 2006)
Children & Adolescents: Kidmed questionnaire (Serra-Majem. et al 2004)
Assessment of MD adherence
• Kid med questionnaire
• 16-questions
• score/adherence to MD
o 3 → low
o 4 - 7 → medium
o ≥8 → high
MD ADHERENCE IN CHILDREN & ADOLESCENTS IN SEVERAL COUNTRIES
Greece, Spain, Italy etc
GREECE, 2013-2014 n~260.000, 8-19 yrs
11%
53%
36% LOW
MEDIUM
HIGH
ADHERENCE TO MD
11%
53%
36%
11%
52%
37%
Total
Risk for obesity
n~260.000, 8-19 yrs
Univariate Model OR (95% CI)
p Full Model OR (95% CI)
p Full model + confounders OR (95% CI)
p
Adherence to MD
LOW 1.22 (1.16-1.28) <0.001 1.07 (1.01-1.12) 0.012 1.17 (1.11-1.23) <0.001
MEDIUM 1.17 (1.14-1.21) <0.001 1.10 (1.07-1.14) <0.001 1.15 (1.12-1.19) <0.001
HIGH Ref
Structured physical activity (for every 1-day increase)
0.94 (0.93-0.94)
<0.001
0.94 (0.94-0.95)
<0.001
0.94 (0.93-0.94)
<0.001
Sleep duration
VERY SHORT 1.25 (1.20-1.29) <0.001 1.21 (1.16-1.25) <0.001 1.23 (1.19-1.27) <0.001
SHORT 1.04 (1.01-1.08) 0.015 1.02 (0.99-1.06) 0.218 1.04 (1.00-1.07) 0.040
NORMAL Ref
Screen view
ABOVE LIMITS (≥2h/d) 1.21 (1.17-1.25) <0.001 1.16 (1.12-1.19) <0.001 1.21 (1.17-1.25) <0.001
WITHIN LIMITS Ref
SPAIN, 1998-2000 n=3850, 2-24 yrs
Serra-Majem L. et al 2004
Large cities had more positive results
Adherence to MD
23%
4% 2% 12% 11%
37%
18%
61%
49% 50%
57% 53%
56%
59%
17%
46% 48%
31% 36%
7%
23%
High
Medium
Low
MD & overweight/obesity
• IDEFICS study
• n=16,220, 2–9 yrs
• MD less common in children living in the Mediterranean region
• High MD scores were inversely associated with overweight including obesity at baseline and after 2yrs follow up
Tognon et al 2014. Nutrition, Metabolism & Cardiovascular Diseases (2014) 24
Factors may affect adherence
• Adherence to MD in children & adolescents has been associated with:
– Less time spent on sedentary activities (Kontogianni et al 2008)
– higher parental education (Kontogianni et al 2008)
– higher socioeconomic status (Serra-Majem et al 2004)
• Children who attended state schools, immigrants and those from families with a medium-to-low socio-economic status were less likely to follow MD (Arriscado et al. 2014)
• Adherence to MD in adolescents has been associated with:
– high socioeconomic status and high physical activity (Grosso et al 2013; Schröder et al. 2010)
– high educational level of mother (Sahingoz & Sanlier, 2011; Kontogianni et al 2008; Schröder et al. 2010)
– Increased nutritional knowledge (Tsartsali et al 2009)
• Half of the students have increased MD adherence after a nutrition education program in Valencia, Spain (Martinez et al. 2009)
Effects of adherence to MD in children & adolescents
• Poor adherence to the MD seemed to negatively affect academic performance in children (Vassiloudis et al. 2014)
• Adherence to the MD was associated with lower likelihood of childhood asthma in both urban and rural areas (Grigoropoulou et al. 2011; Arvaniti et al. 2011)
• Adherence to the MD was also found to have negative correlation with arterial stiffness in children (Lydakis et al. 2012)
• Adherence to the MD positively affects important components of HRQOL in adolescents (Costarelli et al 2013)
• Compared with low MD adherers, children with a high KIDMED score were 80% less likely to be OW/OB (Lazarou et al. 2011)
Healthy dietary pattern
Strengthening MD especially, but not
only, in populations that traditionally
followed MD
Mediterranean diet
Variety of nutrients and foods
Chronic Disease Prevention
Increased Survival
HELP YOUR STUDENTS GET TO KNOW THE MEDITERRANEAN DIET AND EAT ON THIS BASIS
Tips to go
Communicate MD
• Beneficial role of MD in the prevention of various diseases
• However, health is not a strong motive for children
• Use other parameters that such as promoting their personal development, improving their school performance.
Homework for MD
• The MD pattern: health benefits
• The history and evolution of the MD
• Traditional Mediterranean recipes
• My favorite Mediterranean dish
Competition/Contest on MD
• Drawing competition to create the most original Mediterranean pyramid or a photo
• Photo contest for the most beautiful Mediterranean dish
• Poster to be posted in classrooms and the corridors of the school.
Run a “research study” on MD adherence
• Distributed kidmed to be completed, collect and edit the data in collaboration with teachers of various disciplines (mathematics and IT teachers)
• Discuss the results in class
• Helps prevent: – Heart attacks – Strokes – Sudden cardiac death – Cancer – Weight gain – Alzheimer , Parkinson d. – Total mortality – Childhood asthma
• Also increases: – Quality of life – Children school
performance
To enjoy these health advantages, follow these dietary guidelines Eat More:
– Fruits – Vegetables – Nuts – Legumes – Whole grains – Fish in place of red meat – Olive oil
Eat less:
– Red/processed meats – Sugar and baked goods – Sweets and soft drinks
In Summary, Mediterranean Diet
Thank U!
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