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!