Adherence rates to the Mediterranean diet are low in a representative sample of Greek children and adolescents

Greater Mediterranean diet adherence is observed in Dutch compared with Greek university students

BACKGROUND AND AIMS

Research has demonstrated that Mediterranean youth appear to abandon the traditional diet. The present study aimed to assess Mediterranean diet (MD) adherence in Greek university students, compared with a non-Mediterranean (Dutch) population.

METHODS AND RESULTS

The MD was assessed through the MD score (MedDietScore, MDS) in 100 nutrition students from Amsterdam and 85 from Thessaloniki. Subjects at both sites demonstrated average MDS, which was higher in the Dutch sample (27.5 ± 3.9) compared to the Greek (26.1 ± 3.4) (p ≤ 0.001). The highest score was observed in Amsterdam (39). Potatoes, non-refined cereals, vegetables and olive oil were more frequently consumed by Dutch students (p ≤ 0.001), but the Greeks demonstrated a higher legume intake (p ≤ 0.05). The Dutch diet comprised 17% protein, 50% carbohydrate and 33% fat, whereas the Greeks consumed 14% protein, 48% carbohydrate and 38% fat (p ≤ 0.001 and p ≤ 0.031 for between-country protein and fat intake, respectively). In Amsterdam, significantly greater amounts of polyunsaturated (PUFA) and monounsaturated (MUFA) fatty acids as a percentage of energy intake (p ≤ 0.001, p ≤ 0.01) were consumed.

CONCLUSION

The findings indicate that the MD has been transmitted to non-Mediterranean populations, probably as a result of its declared health benefits. However, it is alarming that an average adherence score was demonstrated by the Greek nutrition students and this is indicative of the need for new approaches in transmitting the Mediterranean dietary pattern.

Use of dietary indexes among children in developed countries

In this article, we review studies that have used dietary indexes to assess different aspects of diet in relation to health outcomes and sociodemographic factors in childhood populations of developed countries. Eighty-four papers published from 1980 to mid-2010 including 90 unique dietary indexes were reviewed. Seventy-two indexes were developed (or have been adapted) specifically for childhood populations; 38 of these were used to assess diet-disease associations, mostly of diet and obesity. In the majority of these studies, small inverse associations between dietary indexes and obesity indexes were shown. Children who were younger, female, and from high-income families had better dietary quality scores. Forty-nine indexes (of 90) were compared with other aspects of dietary intakes or behaviors, with correlations ranging from very low to modest (∼r = 0.05-0.50). Only 2 validation studies compared an index with nutritional biomarkers, and correlations were quite weak for most plasma nutrients (P < 0.10). Overall, a large number of indexes have been created and used, but the majority of studies are descriptive. Fewer analytic studies on index-health associations have been performed, and most analyses insufficiently adjusted for confounders. Thus, prospective and intervention research in diverse populations is needed to further test these tools. In conclusion, indexes are potentially useful methods for dietary assessment, because they offer valuable information on overall dietary patterns in children. However, understanding the advantages and limitations when applying them in research and public health settings is important, and more research is needed to further develop their utility.

Compliance with Mediterranean Diet Quality Index (KIDMED) and nutrition knowledge levels in adolescents. A case study from Turkey

Adopting an eating pattern complying with the Mediterranean diet not only decreases body fat mass and obesity risk, but also reduces development of various health problems. This study investigated the nutritional awareness and diet quality Mediterranean Diet Quality Index (KIDMED) of Turkish adolescents. The study was conducted with 890 voluntary participants (464 boys and 426 girls) aged 10-14 years. A questionnaire form was used to learn demographic characteristics of the participants. Participants' nutritional awareness was determined through a 20-item knowledge form and their nutritional habits through a 16-item Mediterranean Diet Quality Index (KIDMED). The average nutritional knowledge score was X=82.22 ± 0.42. Results indicated that 17.9% of the participants had a low quality diet (≤ 3 points), 59.2% had a mid-quality/needs-improvement diet (4-7 points) and 22.9% had an optimal quality diet (≥ 8 points). The study results showed that the subjects' diet quality was low and that their nutrition knowledge levels were related to their nutritional habits.

Season-related variation in dietary recalls used in a paediatric population

BACKGROUND

The effect of seasonality in estimating population mean nutrient intake using a single dietary recall has not been fully explored. The present study aimed to evaluate variation in energy and nutrient intake using a single 24-h recall between two seasons (spring/summer and autumn/winter) in a sample of children and adolescents.

METHODS

  A randomly selected subgroup (n = 623) of a representative sample of 3-18-year-old Greek children and adolescents was used in the present analysis. Information on participants' socio-demographic characteristics, body weight/height and dietary intake were collected through telephone interviews. Dietary assessment was based on two 24-h recalls (the first during the spring/summer season and the second 6 months later, during autumn/winter season).

RESULTS

Reported daily energy intake in spring/summer was 344 ± 130 kJ (82 ± 31 kcal) higher compared to the one in autumn/winter after adjusting for potential confounders (P = 0.008). However, the contribution of the macronutrients to the total energy intake was not statistically different between the two periods and the same was also true for vitamin C and calcium. The results remained unchanged after excluding low energy reporters.

CONCLUSIONS

The use of a second 24-h recall in a different season of the year does not confer additional information with regard to a population assessment of macronutrient contribution to the total energy intake in paediatric samples; its use appears to be justified in the light of a more accurate assessment of energy intake.

Adherence to the Mediterranean dietary pattern among Balearic Islands adolescents

The aim of the present work was to assess the prevalence of the Mediterranean dietary pattern (MDP) in Balearic Islands adolescents, and socio-demographic and lifestyle factors that might determine adherence to the MDP. A cross-sectional nutritional survey was carried out in the Balearic Islands between 2007 and 2008. A random sample (n 1231) of the adolescent population (12-17 years old) was interviewed. Dietary questionnaires and a general questionnaire incorporating questions related to socio-economic status, parental education level and lifestyle factors were used. Dietary habits were assessed by means of two 24 h recalls and a quantitative FFQ. Adherence to the MDP was defined according to a score constructed considering the consumption of nine MDP characteristic components: high MUFA:SFA ratio, moderate ethanol consumption, high legumes, cereals and roots, fruits, vegetables and fish consumption, and low consumption of meat and milk. Then, socio-demographic, lifestyle and health status variables that could determine a higher or ower adherence were assessed. The mean adherence was 57.9 (sd 8.9) % and the median adherence was 57.3 %. Half of the Balearic Islands adolescents (50.5 %) showed an adherence to the MDP comprised between 52.7 and 62.8 %. By multivariate analyses, a high maternal level of education, increased physical activity, reduced alcohol intake and abstinence from smoking were independent associations of better adherence to the MDP. The promotion of not only the MDP but also the Mediterranean lifestyle, including greater physical activity, should be reinforced among the Balearic younger generations.

Session 4: CVD, diabetes and cancer Evidence for the use of the Mediterranean diet in patients with CHD

Diet is associated with the development of CHD. The incidence of CHD is lower in southern European countries than in northern European countries and it has been proposed that this difference may be a result of diet. The traditional Mediterranean diet emphasises a high intake of fruits, vegetables, bread, other forms of cereals, potatoes, beans, nuts and seeds. It includes olive oil as a major fat source and dairy products, fish and poultry are consumed in low to moderate amounts. Many observational studies have shown that the Mediterranean diet is associated with reduced risk of CHD, and this result has been confirmed by meta-analysis, while a single randomised controlled trial, the Lyon Diet Heart study, has shown a reduction in CHD risk in subjects following the Mediterranean diet in the secondary prevention setting. However, it is uncertain whether the benefits of the Mediterranean diet are transferable to other non-Mediterranean populations and whether the effects of the Mediterranean diet will still be feasible in light of the changes in pharmacological therapy seen in patients with CHD since the Lyon Diet Heart study was conducted. Further randomised controlled trials are required and if the risk-reducing effect is confirmed then the best methods to effectively deliver this public health message worldwide need to be considered.

Adoption and maintenance of a Mediterranean diet in patients with coronary heart disease from a Northern European population: a pilot randomised trial of different methods of delivering Mediterranean diet advice

BACKGROUND

A Mediterranean diet has been shown to protect against coronary heart disease (CHD). Adherence to a Mediterranean diet can be assessed using a Mediterranean diet score. The primary aim of this pilot study was to examine whether CHD patients in a Northern European population would adopt and maintain a Mediterranean diet, with a secondary aim of comparing the effectiveness of different methodologies aimed at improving compliance.

METHODS

Sixty-one patients with a diagnosis of CHD were randomised to one of three groups: either to receive conventional dietetic advice for CHD or advice to implement a Mediterranean-style diet using either behavioural counselling or nutritional counselling. Patients received a follow-up assessment at 6 months (adoption) and a subset of patients was followed up at 12 months (maintenance). The primary outcome measure was the between-group difference in the mean change in Mediterranean diet score (MDS).

RESULTS

The change in MDS was not significantly different between groups. However, all three groups reported a significant within-group increase in MDS (P < 0.01) at 6 and 12 months follow-up.

CONCLUSIONS

All three groups made dietary changes towards a Mediterranean diet, but behavioural counselling did not have significant additional benefit over nutritional counselling in initiating and maintaining dietary change, and neither method offering specific Mediterranean diet advice had any significant benefit in terms of improvement in MDS over conventional dietetic practice.

The number of index components affects the diagnostic accuracy of a diet quality index: the role of intracorrelation and intercorrelation structure of the components

PURPOSE

The aim of this work was to evaluate whether the number of components influences the diagnostic accuracy of a diet quality index and whether this association is affected by the intercorrelation structure of components and by the association of components with an outcome (intracorrelation).

METHODS

Simulated data were used to develop theoretical indices with various intracorrelation and intercorrelation structures of the components and outcomes. Moreover, dietary intake data of 668 elderly people from the MEDIS (Mediterranean Islands) study were also used to develop a diet index and to test it toward obesity status (outcome).

RESULTS

On the basis of 1,000 simulations, we observed that the diagnostic accuracy of an index increases as the number of components increases, only when the components are not intercorrelated or have low intercorrelation. Moreover, the diagnostic accuracy of an index developed with all components associated with an outcome is higher compared with an index developed by using only some components related to the outcome. Finally, the predictive ability of an isolated component is lower than that of an index developed by using non-intercorrelated or low-intercorrelated components. Real data confirmed the aforementioned findings.

CONCLUSION

Low-intercorrelated or non-intercorrelated components, strongly associated with a particular outcome, should be used in order to obtain an accurate composite index.

Diet quality of a population sample from coastal north-east Spain evaluated by a Mediterranean adaptation of the diet quality index (DQI)

OBJECTIVE

To assess the adherence to the Mediterranean dietary pattern in the population from a coastal region from north-east Spain and its relationship to diseases, applying the Mediterranean Diet Quality Index (M-DQI) validated by the use of several biomarkers.

DESIGN

Cross-sectional nutrition survey.

SETTING

Population-based random sample derived from the Catalan Nutrition Survey.

SUBJECTS

A total of 621 healthy adults.

RESULTS

The Catalan representative sample presented a mean M-DQI score of 6.6 (sd 2.3, median 7, range 0-14). The percentage of adherence to the Mediterranean diet was 53 %; 10 % of subjects showed high adherence to the Mediterranean diet, while only 2 % were categorized as poorest adherence. The plasma fatty acid profile of the Catalan sample progressed with perfect regularity throughout the index ranges. Both EPA and DHA presented a significant correlation to the M-DQI (r = -0.410 for EPA and -0.360 for DHA). A significant increase in palmitic, oleic and alpha-linolenic acids and a significant decrease in stearic, linoleic and arachidonic acids content were also observed. The mean values for the M-DQI according to the clinical characteristics of the Catalan sample were also calculated.

CONCLUSIONS

The M-DQI has been demonstrated a suitable tool for assessment of an individual's nutritional status according to the Mediterranean dietary pattern and for clinical purposes. Although the current diet followed in Catalonia seems to agree with the main characteristics of the Mediterranean diet, the promotion of the Mediterranean pattern should be reinforced in the Catalan population, especially among young people.

Dietary and other lifestyle characteristics of Cypriot school children: results from the nationwide CYKIDS study

BACKGROUND

Dietary and lifestyle behaviors at young ages have been associated with the development of various chronic diseases. Schools are regarded as an excellent setting for lifestyle modification; there is a lack, however, of published dietary data in Cypriot school children. Thus, the objective of this work was to describe lifestyle characteristics of a representative segment of Cypriot school children and provide implications for school health education.

METHODS

The CYKIDS (Cyprus Kids Study) is a national, cross-sectional study conducted among 1140 school children (10.7 +/- 0.98 years). Sampling was stratified and multistage in 24 primary schools of Cyprus. Dietary assessment was based on a 154-item semi-quantitative food-frequency questionnaire and three supplementary questionnaires, assessing dietary patterns and behaviors. Adherence to the Mediterranean diet was evaluated by the KIDMED index (Mediterranean Diet Quality Index for children and adolescents). Physical activity was assessed by a 32-item, semi-quantitative questionnaire.

RESULTS

Analysis revealed that 6.7% of the children were classified as high adherers, whereas 37% as low adherers to the Mediterranean diet. About 20% of boys and 25% of girls reported "not having breakfast on most days of the week", while more than 80% of the children reported having meals with the family at least 5 times/week. Some food-related behaviors, such as intake of breakfast, were associated with socio-demographic factors, mostly with gender and the geomorphological characteristics of the living milieu. With respect to physical activity, boys reported higher levels compared to girls, however, one fourth of children did not report any kind of physical activity.

CONCLUSION

A large percentage of Cypriot school children have a diet of low quality and inadequate physical activity. Public health policy makers should urgently focus their attention to primary school children and design school health education programs that target the areas that need attention in order to reduce the future burden of metabolic disorders and chronic diseases.