Download - Maraki md adolescents 25 01_16
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Mediterranean diet and health in children and adolescents
Maria Maraki, PhD
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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
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Seven Countries Study
Ancel Keys
Greece
Japan
Finland
Italy Netherlands
Yugoslavia
USA
Early 60s
12.763 men, 40-59 yrs
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Seven Countries Study
25 yrs follow-up
CHD mortality per 1000
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Mediterranean basin
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Mediterranean diet
7-countries study:
Special dietary habits
CVD & neoplastic diseases
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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
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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
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Mediterranean diet
Italy
Total fat intake: ~ 30%
Greece
Total fat intake: ~ 40% Main dietary fat :
monounsaturated fatty
acids
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Reduced frequency of
consumption
Increased frequency of consumption
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Vitamins, minerals, dietary
fibers, antioxidants & water
Dietary fibers, vitamins
& minerals
Mediterranean diet
proteins, vitamins,
calcium, phosphorus
Vitamin Ε, β- carotene,
monounsaturated fatty
acids
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omega-3 fatty acids
Low fat
Dietary fibers,
proteins
Monounsaturated fatty
acids, antioxidants
Mediterranean diet
proteins, fatty
acids, vitamins &
minerals
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proteins, iron,
animal fat
Mediterranean diet
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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
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Mediterranean
diet
Improves quality of life
Increases life expectancy
Effects of Mediterranean diet on health
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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
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HOW TO EVALUATE MD ADHERENCE?
Adults: Med Diet Score (Panagiotakos et al. 2006)
Children & Adolescents: Kidmed questionnaire (Serra-Majem. et al 2004)
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Assessment of MD adherence
• Kid med questionnaire
• 16-questions
• score/adherence to MD
o 3 → low
o 4 - 7 → medium
o ≥8 → high
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MD ADHERENCE IN CHILDREN & ADOLESCENTS IN SEVERAL COUNTRIES
Greece, Spain, Italy etc
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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
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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
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SPAIN, 1998-2000 n=3850, 2-24 yrs
Serra-Majem L. et al 2004
Large cities had more positive results
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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
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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
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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)
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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)
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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
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HELP YOUR STUDENTS GET TO KNOW THE MEDITERRANEAN DIET AND EAT ON THIS BASIS
Tips to go
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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.
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Homework for MD
• The MD pattern: health benefits
• The history and evolution of the MD
• Traditional Mediterranean recipes
• My favorite Mediterranean dish
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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.
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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
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• 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
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Thank U!