Trends in the adherence to the Mediterranean diet in Israeli adolescents: results from two national health and nutrition surveys, 2003 and 2016

Nutritional Barriers to the Adherence to the Mediterranean Diet in Non-Mediterranean Populations

Adherence to the Mediterranean diet has been shown to lower the risk of developing chronic non-communicable diseases like cardiovascular and neurodegenerative diseases and cancer. Improvements in depression, participation in daily activities in older individuals, weight loss and a reduction in adverse pregnancy outcomes are associated with adherence to the Mediterranean diet. The number of studies that have evaluated barriers to adherence to the Mediterranean diet in the US and, in particular, in racial and ethnic minority populations within the US are few. Among Native American and Alaskan Native populations, studies evaluating traditional or alternative Mediterranean diet adherence for chronic non-infectious diseases is unavailable. Mediterranean diet scoring instruments used in studies in European and Mediterranean countries and among white participants in the US fail to capture the dietary patterns of racial and ethnic minority populations. In this narrative review, the food components of the traditional Mediterranean diet are discussed, adherence to the Mediterranean diet is examined in Mediterranean and non-Mediterranean countries and barriers preventing adherence to the Mediterranean diet in the US and among racial and ethnic minority populations is reviewed. Recommendations for improving nutrition education and intervention and for increasing adherence and cultural adaptions to the Mediterranean diet are provided.

Relationships of the gut microbiome with cognitive development among healthy school-age children

Background

The gut microbiome might play a role in neurodevelopment, however, evidence remains elusive. We aimed to examine the relationship between the intestinal microbiome and cognitive development of school-age children.

Methods

This cross-sectional study included healthy Israeli Arab children from different socioeconomic status (SES). The microbiome was characterized in fecal samples by implementing 16S rRNA gene sequencing. Cognitive function was measured using Stanford-Binet test, yielding full-scale Intelligence Quotient (FSIQ) score. Sociodemographics and anthropometric and hemoglobin measurements were obtained. Multivariate models were implemented to assess adjusted associations between the gut microbiome and FSIQ score, while controlling for age, sex, SES, physical growth, and hemoglobin levels.

Results

Overall, 165 children (41.2% females) aged 6-9 years were enrolled. SES score was strongly related to both FSIQ score and the gut microbiome. Measures of α-diversity were significantly associated with FSIQ score, demonstrating a more diverse, even, and rich microbiome with increased FSIQ score. Significant differences in fecal bacterial composition were found; FSIQ score explained the highest variance in bacterial β-diversity, followed by SES score. Several taxonomic differences were significantly associated with FSIQ score, including Prevotella, Dialister, Sutterella, Ruminococcus callidus, and Bacteroides uniformis.

Conclusions

We demonstrated significant independent associations between the gut microbiome and cognitive development in school-age children.

Lifestyle Risk Factors for Overweight/Obesity in Spanish Children

Childhood obesity is one of the main public health concerns in Europe. The aim was to identify possible risk factors associated with overweight/obesity in Spanish preschool and school-age children. The sample (1075 (50.7% girls) children aged 3 to 12) is part of the project 'Alimentando el Cambio' whose objective is to promote healthy lifestyles in schools. Child height and weight were measured, and parents filled out questionnaires related to the children's lifestyle. There was a positive and significant association between sweetened beverage consumption and body mass index (BMI) z-score in both sexes and age groups. There was a negative and significant association between BMI z-score and dairy products in girls of both age groups. There was also a protective effect of regular nut consumption on overweight/obesity in girls 6-12 y. Night-time sleep during weekdays showed a negative association with BMI z-score for older boys and girls. A positive and significant association was found between total screen time and BMI z-score during weekdays. Regarding emotional well-being and self-esteem, having girls 6-12 y laughing and feeling happy and good about themselves in the last week was a protective factor against overweight/obesity. Childhood obesity prevention efforts may benefit from targeting these key risk factors.

Mediterranean Diet in Developmental Age: A Narrative Review of Current Evidences and Research Gaps

Numerous studies in recent decades have shown that Mediterranean diet (MD) can reduce the risk of developing obesity in pediatric patients. The current narrative review summarizes recent evidence regarding the impact of MD across the different stages of child development, starting from fetal development, analyzing breastfeeding and weaning, through childhood up to adolescence, highlighting the gaps in knowledge for each age group. A literature search covering evidence published between 1 January 2000 and 1 March 2022 and concerning children only was conducted using multiple keywords and standardized terminology in PubMed database. A lack of scientific evidence about MD adherence concerns the age group undergoing weaning, thus between 6 months and one year of life. In the other age groups, adherence to MD and its beneficial effects in terms of obesity prevention has been extensively investigated, however, there are still few studies that correlate this dietary style with the incidence of non-communicable diseases. Furthermore, research on multi-intervention strategy should be implemented, especially regarding the role of education of children and families in taking up this healthy dietary style.

The Environmental Footprint Associated With the Mediterranean Diet, EAT-Lancet Diet, and the Sustainable Healthy Diet Index: A Population-Based Study

Providing a growing global population with healthy and sustainable diets is an immediate challenge. In the current study, estimates were obtained for the environmental footprints (land, water, and greenhouse gas (GHG) emissions) in association with the Mediterranean diet (MED) and the EAT-Lancet reference diet, which represents a healthy diet derived from sustainable food systems. We used a newly developed Sustainable Healthy Diet (SHED) index that was validated for the Israeli population by Tepper et al. in 2020.

Socioeconomic disparities and household crowding in association with the fecal microbiome of school-age children

The development of the gut microbiome occurs mainly during the first years of life; however, little is known on the role of environmental and socioeconomic exposures, particularly within the household, in shaping the microbial ecology through childhood. We characterized differences in the gut microbiome of school-age healthy children, in association with socioeconomic disparities and household crowding. Stool samples were analyzed from 176 Israeli Arab children aged six to nine years from three villages of different socioeconomic status (SES). Sociodemographic data were collected through interviews with the mothers. We used 16 S rRNA gene sequencing to characterize the gut microbiome, including an inferred analysis of metabolic pathways. Differential analysis was performed using the analysis of the composition of microbiomes (ANCOM), with adjustment for covariates. An analysis of inferred metagenome functions was performed implementing PICRUSt2. Gut microbiome composition differed across the villages, with the largest difference attributed to socioeconomic disparities, with household crowding index being a significant explanatory variable. Living in a low SES village and high household crowding were associated with increased bacterial richness and compositional differences, including an over-representation of Prevotella copri and depleted Bifidobacterium. Secondary bile acid synthesis, d-glutamine and d-glutamate metabolism and Biotin metabolism were decreased in the lower SES village. In summary, residential SES is a strong determinant of the gut microbiome in healthy school-age children, mediated by household crowding and characterized by increased bacterial richness and substantial taxonomic and metabolic differences. Further research is necessary to explore possible implications of SES-related microbiome differences on children's health and development.

Mediterranean diet and adiposity in children and adolescents: A systematic review

Our aim was to summarize, through a systematic review, the current evidence from dietary intervention and observational studies on the impact of adherence to the Mediterranean diet on adiposity markers and obesity in children and adolescents. We searched Medline up to June 1, 2021 for the identification of intervention and observational studies meeting the inclusion criteria, following the PRISMA statement. We included 55 articles: 8 intervention studies and 47 observational studies. Three trials report a beneficial effect of the dietary intervention, whereas two did not, and three did not compare with a control. All observational studies were cross-sectional, and only five studies also included a longitudinal analysis. More than half of the cross-sectional studies found no significant association between adherence to Mediterranean diet and adiposity. Three out of the five longitudinal studies found a negative association. The majority of both observational and intervention studies was of low quality. Despite a large number of published studies, overall, there is only limited evidence of a beneficial effect of following a traditional Mediterranean diet to maintain a healthy body weight in childhood. More high-quality intervention and longitudinal data are needed to form the base of large-scale health programs to prevent childhood obesity.

Dietary Patterns among Adolescents Are Associated with Growth, Socioeconomic Features, and Health-Related Behaviors

Dietary patterns (DPs), usually established in adolescents, are important modifiable risk factors in the etiology of malnutrition and chronic diseases. This study aimed to identify DPs of adolescents and examine their associations with growth, sociodemographic, and lifestyle characteristics. A nationally representative, school-based, cross-sectional study was conducted in Israeli adolescents aged 11-18 years during 2015-2016. A self-administered survey queried sociodemographics, health behaviors, and diet. Weight and height were measured, and WHO height z-scores and BMI cutoffs were calculated. Food frequency questionnaire data were analyzed using principal components analysis (PCA) to identify DPs. Associations between growth, lifestyle, and sociodemographic characteristics and DPs were modeled using multivariable logistic regressions. A total of 3902 adolescents (46% males, mean age 15.2 ± 1.6 years) completed the survey. PCA identified five DPs, accounting for 38.3% of the total variance. The first two prominent DPs were the 'plant-based food' DP, which was associated with the female sex, higher socioeconomic status, overweight/obesity, and healthy lifestyle and the 'junk food' DP, which was associated with lower SES, unhealthy lifestyle, and lower height z-scores. Our results elucidate major DPs that strongly correlate with lifestyle risk behaviors and suboptimal growth among adolescents. Implementing screening for DPs should be further examined to identify higher risk health factors among youth.

The Role of Socioeconomic Status in Adherence to the Mediterranean Diet and Body Mass Index Change: A Follow-Up Study in the General Population of Southern Croatia

The Mediterranean diet (MD) is one of the most healthful dietary patterns, beneficial for humans and the environment. However, the MD has recently exhibited a declining trend, especially in younger and less affluent people. This study investigated the association between socioeconomic indicators and adherence to the MD in 4671 adult subjects from Dalmatia, Croatia (age range 18–98 years; 61.9% were women). Additionally, in the follow-up we examined the change in adherence to the MD and in BMI (subsample, N = 1342; 62.5% were women; mean follow-up time of 5.8 years). The adherence to the MD was based on the Mediterranean Diet Serving Score (range 0–24 points, cut-off value ≥ 14 points), with a prevalence in the overall sample of 28.5%. Higher odds of adherence to the MD were recorded in women, older subjects, and those with higher level of objective material status, while it was less likely in the period after economic crisis of 2007–2008. Additionally, we detected no change in adherence to the MD in the follow-up subsample (−8.5%, p = 0.056), but there was an increase in BMI (+6.5%, p < 0.001). We recorded an increase in adherence for nuts (+127.5%), sweets (+112.6%), red meat (+56.4%), and wine (+50.0%), unlike the reduction in adherence for vegetables (−35.1%), fish (−23.4%), white meat (−11.6%), cereals (−10.9%), and dairy products (−9.6%). Similar results were obtained across all quartiles of objective material status. Over time, the absolute change in the MD score was positively associated with female gender, age, higher education, and moderate physical activity, but it was negatively associated with adherence to the MD at baseline. BMI change was positively associated with female gender, and negatively with initial BMI, initial adherence to the MD, and MD change. Our findings point towards a less than ideal adherence to the MD in the general population of southern Croatia, and identify important characteristics associated with adherence change over time, informing necessary interventions aimed at increasing MD uptake.