Academic performance in relation to adherence to the Mediterranean diet and energy balance behaviors in Greek primary schoolchildren

Is higher adherence to the mediterranean diet associated with greater academic performance in children and adolescents? A systematic review and meta-analysis

OBJECTIVE

The aim of the present study was to synthesize the available evidence from the relationship between adherence to the Mediterranean diet (MedDiet) and academic performance in children and adolescents.

METHODS

A systematic review and meta-analysis was conducted, which adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Four electronic databases (PubMed, Scopus, Web of Science, and the Cochrane Library) were examined from inception to April 8th, 2024.

RESULTS

Eighteen studies were included in the current systematic review and sixteen in the meta-analysis. The relationship between adherence to the MedDiet and academic performance among children and adolescents was statistically significant (Pearson's correlation coefficient [r] = 0.17, 95% confidence interval [CI]: 0.14 to 0.21, p < 0.001; inconsistency index [I2] = 56.7%). The influence analysis revealed that removing individual studies one at a time did not result in any changes to the overall results (p < 0.05 in all cases).

CONCLUSIONS

A higher adherence to the MedDiet could play a relevant role in academic performance among children and adolescents.

The effects of diet quality, eating behavior, and sleep on the academic performance among elementary school students

The academic success of children contributes to their income, social status, and public health. This study was conducted with 217 elementary school students from western China. Scores on the Chinese Children Dietary Index (CCDI), Dietary Approaches to Stop Hypertension (DASH), adjusted DASH, and KIDMED index were calculated to evaluate diet quality. Eating behavior and sleep quality were assessed using the Children's Eating Behavior Questionnaire (CEBQ) and Children's Sleep Habits Questionnaire (CHSQ), respectively. Academic achievement was measured using school-provided average grades. Higher CCDI scores, longer sleep time, lower total CHSQ scores, and lower subscores on "satiety responsiveness," "slowness in eating," "emotional undereating," and "food fussiness" dimensions of the CEBQ were associated with high academic achievement. In conclusion, good diet quality, sleep quality, healthy eating behaviors, and adequate sleep duration were associated with better academic performance. Interventions are recommended to be developed in education system to improve healthy diets and lifestyles, enhancing academic achievement.

Higher adherence to the Mediterranean Diet is associated with better academic achievement in Spanish university students: A multicenter cross-sectional study

The objective was to assess the association of the overall score and different items of the Mediterranean Diet Adherence Screener (MEDAS) questionnaire with academic achievement in Spanish university students. We hypothesized that university students with greater adherence to the Mediterranean Diet (MedDiet) would have better academic achievement. A cross-sectional study was performed involving 266 first-year students from the University of Castilla-La Mancha, Spain, during the 2017-2018 academic year. Adherence to the Mediterranean diet was evaluated with the 14-item MEDAS questionnaire. As an indicator variable for academic achievement, the average marks of the examinations required for access to Spanish universities were used. A total of 63 participants (23.6%) adhered to MedDiet recommendations. Analysis of covariance models showed that participants with higher adherence to the MedDiet had significantly higher scores on academic achievement than their peers with low adherence (P < .001) after controlling for potential confounders. Additionally, the evaluation of each item of the MEDAS questionnaire showed that a diet rich in olive oil, vegetables, fruits, legumes, fish and shellfish, and a low consumption of sweets and carbonated beverages were positively associated with academic achievement; nevertheless, wine intake was inversely associated. This study showed that Spanish university students had a low prevalence of good adherence to the MedDiet. Additionally, our results suggested that higher adherence to the MedDiet is associated with better academic achievement in Spanish university students. From a public health perspective and because of low adherence, it is important to continue to focus on promoting adherence to the MedDiet as part of a healthy lifestyle pattern to improve the academic performance of young university students.

Dietary habits among 177,091 Greek schoolchildren by age, sex, weight status, region, and living area. A cross-sectional study

BACKGROUND

This study aimed to investigate the dietary habits from early childhood to adolescence among participants from all regions of the country and living areas (rural/urban) and assess potential associations between dietary habits and obesity in both sexes.

METHODS

Population data were derived from a cross-sectional health survey on a representative sample of 177,091 children aged 6-18 years. Dietary habits were considered via a self-completed questionnaire (Mediterranean diet quality index for children and adolescents [KIDMED]). Trained investigators assessed the anthropometric data.

RESULTS

KIDMED scores were 6.7 ± 2.4 and 6.8 ± 2.3 for boys and girls, respectively, whereas a percentage of almost 10% of the total study population had insufficient dietary habits. Dietary habits peaked around age 11 years and then gradually worsened until the end of adolescence in both sexes, with an annual trend equal to -0.28 ± 0.02 (p < 0.001) for boys and -0.31 ± 0.03 (p < 0.001) for girls. Schoolchildren who are overweight/obese presented higher percentages in all unhealthy dietary habits (e.g., skipping breakfast, going often to a fast food restaurant, and consuming a lot of sweets) than children with a normal weight (all p-values < 0.001). Dietary habits did not noteworthy differ by area of living, that is, urban versus rural, of participants in both sexes. In addition, no noticeable differences in the values of the KIDMED index were found among all regions of Greece, with the highest values in Attica and Crete in both sexes.

CONCLUSIONS

Because Greek schoolchildren do not fully adopt the traditional cardio-protective Mediterranean diet, it could be helpful to provide certain recommendations, especially for adolescents, to decrease the risk for future adverse health consequences.

Adherence to the Mediterranean Diet in Children and Adolescents and Association with Multiple Outcomes: An Umbrella Review

The Mediterranean Diet (MD) has been linked to numerous health benefits. This umbrella review aims to synthesize evidence from systematic reviews on the MD's impact on children and adolescents aged 6 to 19 years. Following Joanna Briggs Institute guidelines, we included 11 systematic reviews focusing on the MD's effects on health outcomes, such as asthma, anthropometric measures, physical fitness, and inflammatory markers. The results indicate a protective role of the MD against childhood asthma due to its antioxidant-rich components. However, evidence for its impact on allergic conditions like rhinitis and eczema is inconclusive. Findings regarding anthropometric outcomes, particularly BMI, are limited and inconsistent. A positive correlation was observed between MD adherence and increased physical activity, improved physical fitness, quality of life, and reduced sedentary behavior. Additionally, the MD showed an inverse relationship with pro-inflammatory biomarkers, suggesting anti-inflammatory benefits. The inconsistency in BMI findings and the potential anti-inflammatory properties of the MD warrant further longitudinal research. Future studies should explore the MD's impact on cognitive functions, academic performance, and mental health in this age group, highlighting the significance of establishing healthy eating habits early in life.

Effects of 2-year dietary and physical activity intervention on cognition in children-a nonrandomized controlled trial

BACKGROUND AND OBJECTIVE

We investigated the effects of a combined dietary and PA intervention on cognition in children and whether changes in diet quality, PA, sedentary behavior (SB), and sedentary time (ST) are associated with changes in cognition.

METHODS

We conducted a 2-year nonrandomized controlled trial in 504 children aged 6-9 years at baseline. The children were allocated to a combined dietary and PA intervention group (n = 237) or a control group (n = 160) without blinding.

INTERVENTIONS

The children and their parents allocated to the intervention group had six dietary counseling sessions of 30-45 min and six PA counseling sessions of 30-45 min during the 2-year intervention period. The children were also encouraged to participate in after-school exercise clubs. Cognition was assessed by the Raven's Colored Progressive Matrices. We assessed dietary factors by 4 days food records and computed the Baltic Sea Diet Score (BSDS) as a measure of diet quality. PA and ST were assessed by a combined heart rate and body movement monitor, types of PA and SB by a questionnaire.

RESULTS

The intervention had no effect on cognition. Increased BSDS and consumption of low-fat milk and decreased consumption of red meat and sausages were associated with improved cognition over 2 years. Increased organized sports, ST, and reading were positively, while unsupervised PA, computer use, and writing were negatively associated with cognition.

CONCLUSION

Combined dietary and PA intervention had no effect on cognition. Improved diet quality and increased organized sports and reading were associated with improved cognition.

Lifestyle Behaviours, Self-Esteem and Academic Performance in Primary Education Students-A Structural Equation Model According to Sex and School Type

(1) Background: The present study aimed to examine the relationship between physical activity (PA), screen time (ST), maximal oxygen uptake (VO2max), Mediterranean diet (MD) adherence, self-esteem (SE) and academic performance (AP) in primary education students. In order to address this aim, an explanatory model was developed to examine the existing relationships between PA, ST, VO2max, MD adherence, SE and AP. Further, the proposed structural model was examined via multi-group analysis as a function of sex and school type. (2) Methods: A non-experimental, descriptive, comparative and cross-sectional study was designed with a total sample of 269 Spanish students (11.29 ± 0.62). Validated questionnaires were administered to collect data on study variables. (3) Results: Relative to boys, girls reported better academic grades and showed a stronger positive relationship between MD adherence and AP, MD adherence and PA, and VO2max and SE. Likewise, girls showed a stronger negative relationship between ST and VO2max, and ST and MD adherence. At the same time, mixed funding school (MFS) students reported higher PA engagement than state school (SS) students. However, SS students reported better MD adherence, ST and AP than MFS students. Further, a stronger positive relationship was found in SS students between MD adherence or VO2max and SE than in MFS students. Also, within the former group, ST was more negatively related to MD adherence and VO2max. (4) Conclusions: Scientific and educational communities must develop future strategies that consider potential determinants in order to target more desirable outcomes.

Dietary patterns and cognitive achievement among school children in socio-cultural context, a case of Montevideo, Uruguay

PURPOSE

The benefits of a healthy diet on children´s cognition have been described in several studies. However, many previous studies have analyzed the effect on general cognitive domains (e.g. intelligence), used measures based almost exclusively on local examinations, and rarely consider social context.

OBJECTIVE

The objective of the present study was to examine the relationship between two diet patterns and contextualized cognitive performance measures of children aged 6-8 years from low-average income neighborhoods in Montevideo, Uruguay.

METHODS

270 first-grade children with complete data participated in the study. Consumption of foods was determined via two averaged 24-h dietary recalls with the mother. Two dietary patterns were identified via principal component analysis: "processed (high calorie) foods" and "nutrient dense". Children´s cognitive performance, including general cognitive abilities, achievement in mathematics and reading, and discrepancy scores between predicted and actual achievement was assessed with the Woodcock-Muñoz Cognitive and Achievement scales. The association of dietary patterns and cognitive endpoints was analyzed in multilevel models, clustered by children´s school. Sociodemographic and biological variables were used as covariates.

RESULTS

The nutrient dense foods pattern, characterized by higher consumption of dark leafy and red-orange vegetables, eggs, beans & peas, potatoes, was associated with better performance in reading, with beta coefficient 3.28 (95% CI 0.02, 6.54). There was also an association between the nutrient dense foods factor and the Discrepancy in reading, 2.52 (0.17, 4.87). Processed (high calorie) foods pattern, characterized by higher consumption of breads, processed meats, fats and oils, sweetened beverages, and sweetened yogurt/dairy products; reduced intake of milk, pastries and pizza dinners was not associated with cognitive performance.

CONCLUSIONS

Nutrient dense food pattern was positively associated with children's reading achievement. A nutrient-rich diet may benefit written language acquisition at the beginning of schooling.

The moderating role of recreational substance use in the association of Mediterranean diet with academic performance among adolescents

No study has examined the potential moderating role of recreational substance use in the relationship between the Mediterranean diet (MedDiet) and academic performance. The aim of this study was to test the potential moderating role of recreational substance use (i.e., alcohol, tobacco, and cannabis) in the association of adherence to the MedDiet with academic performance among adolescents. This cross-sectional study included a sample of 757 adolescents (55.6% girls) aged 12-17 years from the Valle de Ricote (Region of Murcia). The Region of Murcia is an autonomous community of Spain located in the southeast of the Iberian Peninsula, along the coast of the Mediterranean Sea. Adherence to the MedDiet was assessed by the Mediterranean Diet Quality Index for Children and Teenagers (KIDMED). Recreational substance use (i.e., tobacco, alcohol, cannabis) was self-reported by adolescents. Academic performance was assessed by the school records at the end of the academic year. The relationship between adherence to the MedDiet and academic performance was moderated by both tobacco and alcohol use (for grade point average and all school records). In conclusion, higher adherence to the MedDiet was related to greater academic performance in adolescents, but recreational substance use could moderate this association.

Nut consumption and academic performance among adolescents: the EHDLA study

PURPOSE

The aim of this study was to examine the relationship between nut consumption and academic performance in Spanish adolescents and to explore the role of sociodemographic, anthropometric, and lifestyle covariates on this association.

METHODS

A cross-sectional study was carried out using a food frequency questionnaire for estimating nut consumption in the number of 20-30 g servings per week, and academic performance data were obtained from school records. Analyses of covariance were adjusted for sociodemographic, anthropometric and lifestyle covariates, including total energy intake.

RESULTS

Among the 846 adolescents included in the analyses (55.3% girls, age range from 12 to 17 years), the mean ± standard deviation consumption of nuts was 2.7 ± 2.8 servings per week, while the mean of all school grades recorded was 6.5 ± 2.0. Furthermore, compared to no consumption, the consumption of ≥ 3 nut servings per week was consistently associated with higher grades in language (p for trend = 0.005), combination of language and math (p for trend = 0.026), grade point average (p for trend = 0.039), and combination of all school records (p for trend = 0.046). These associations were observed regardless of all covariates considered, although sex and socioeconomic level played a significant role in the completely adjusted models.

CONCLUSION

Nut consumption is associated with higher academic performance in a representative sample of Spanish adolescents. These cross-sectional results should be confirmed in longitudinal and intervention studies.

KIDMED 2.0, An update of the KIDMED questionnaire: Evaluation of the psychometric properties in youth

BACKGROUND AND AIMS

As children and adolescents' eating patterns have changed over the last few years, researchers have found inconsistencies in the current questionnaires. Therefore, this research aims to (i) update the 2019 KIDMED questionnaire; and (ii) test the psychometric properties of this new questionnaire.

METHOD

A study with 419 children and adolescents in southwestern Spain was conducted in 2021. The new version of the KIDMED 2.0 was tested, which measures adherence to the Mediterranean diet through 16 items, of which 12 are positive, and 4 are negative. Content validation involved consultation with nutritionists, experts, and adolescents to assess whether the questionnaire was reliable and valid regarding dietary patterns associated with the Mediterranean diet. The expert assessment provided content validity indices for the clarity and representativeness of the questionnaire. Construct validity and test-retest reliability involved 419 students (M age = 14.40 ± 2.00) from southwestern Spain. Students responded twice (one week apart) to the KIDMED developed in the previous stage and completed a 7-day dietary record.

RESULTS

Regarding validity, results show a moderate agreement for 10 items (ranging between 0.21 and 0.47) of the KIDMED and the 7-day dietary record. Concerning Items 3, 4, 5, and 6, the agreement was slight (ranging between 0.08 and 0.17), whereas the agreement for Item 8 was low. Cohen's kappa showed that most items had moderate to substantial test-retest reliability. Also, kappa showed significant test-retest values for all items (p < 0.001).

CONCLUSION

The new version of the KIDMED 2.0 was shown to be a reliable and valid instrument to measure adherence to the Mediterranean diet in children and adolescents.

Differing associations with childhood outcomes using behavioural patterns derived from three data reduction techniques

BACKGROUND

Behavioural patterns help to understand the influence of multiple health behaviours on childhood outcomes. Behavioural patterns derived using different data reduction techniques can be non-identical and may differentially associate with childhood outcomes. This study aimed to compare associations of behavioural patterns derived from three methods with three childhood outcomes.

METHODS

Data were from the Healthy Active Preschool and Primary Years study when children were 6-8 years old (n = 432). Cluster analysis (CA), latent profile analysis (LPA) and principal component analysis (PCA) were used to derive behavioural patterns from children's diet, physical activity, sedentary behaviour and sleep data. Behavioural data were obtained through parent report and accelerometry. Children's height, weight and waist circumference were measured by trained study staff. Health-related quality of life data were obtained using the Pediatric Quality of Life Inventory and academic performance scores were from a national test. Associations between derived patterns from each method and each of the outcomes were tested using linear regression (adjusted for child age and sex and parent education).

RESULTS

Three patterns were each derived using CA and LPA, and four patterns were derived using PCA. Each method identified a healthy, an unhealthy and a mixed (comprising healthy and unhealthy behaviours together) pattern. Differences in associations were observed between pattern groups from CA and LPA and pattern scores from PCA with the three outcomes.

CONCLUSIONS

Discrepancies in associations across pattern derivation methods suggests that the choice of method can influence subsequent associations with outcomes. This has implications for comparison across studies that have employed different methods.

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.

Early Childhood Dietary Intake and Subsequent Socioemotional and Cognitive School Readiness Among Australian Children

Dietary intake can affect the physical, cognitive, and socioemotional development of young children. Few studies have explored the relationships between dietary intake and the cognitive and socioemotional dimensions of school readiness. This study aimed to investigate the longitudinal associations between children's dietary intake in early childhood, and cognitive and socioemotional school readiness indicators at age 4-5 years using data from the Longitudinal Study of Australian Children. A total of 4,253 children were included in the analysis. Multiple linear regression models were built to investigate whether dietary intake (measured by questionnaire at parent interview) at age 2-3 years predicted school readiness indicators of socioemotional and behavioral functioning (measured by parent-reported Strengths and Difficulties Questionnaire [SDQ total score and pro-social scale]), verbal (assessed by Peabody Picture Vocabulary Test-Third Edition [PPVT-III]) and nonverbal (assessed by "Who Am I" test [WAI] cognitive skills) at age 4-5 years. Furthermore, using cross-sectional data at age 4-5 years, four multiple linear regression models were built to investigate if dietary intake was correlated with the aforementioned school readiness indicators. All models were adjusted for potential confounders. It was found that every one-point increase in child dietary intake score at age 2-3 years led to a decrease in SDQ total score by 0.19 (95% confidence interval [CI] = [0.10, 0.28], and an increase in SDQ pro-social scale, WAI score and PPVT score by 0.07 (95% CI = [0.03, 0.10]), 0.27 (95% CI = [0.13, 0.41]), and 0.20 (95% CI = [0.09, 0.30]), respectively, at age 4-5 years. Children's dietary intake was also a correlate of their school readiness at age 4-5 years. These results add to the limited evidence base suggesting that children's early dietary intake may play an important role in later socioemotional and behavioral development, and the development of cognitive skills, which are critical school readiness indicators.

Associations between the Mediterranean Diet Pattern and Weight Status and Cognitive Development in Preschool Children

Cognitive dysfunctions are a global health concern. Early-life diet and weight status may contribute to children’s cognitive development. For this reason, we explored the associations between habitual food consumption, body mass index (BMI) and cognitive outcomes in 54 preschool children belonging to the Pisa birth Cohort (PISAC). We estimated groups of foods, nutrients and calorie intakes through a food frequency questionnaire (FFQ) and Italian national databases. Then, we adopted the Mediterranean diet (MD) score to assess relative MD adherence. Cognition was examined using the Griffiths Mental Development Scales-Extended Revised (GMDS-ER). We found that higher, compared to low and moderate, adherence to MD was associated with higher performance scores. Furthermore, white meat consumption was positively related to BMI, and BMI (age–gender specific, z-scores) categories were negatively related to practical reasoning scores. All associations were independent of maternal IQ estimates, parents’ socioeconomic status, exclusive/non-exclusive breastfeeding, actual age at cognitive assessment and gender. In conclusion, in preschool children, very high adherence to MD seemed protective, whereas BMI (reinforced by the intake of white meat) was negatively associated with cognition.

Parental health literacy and nutrition literacy affect child feeding practices: A cross-sectional study

BACKGROUND

Health literacy (HL) and nutrition literacy (NL) are important issues to consider, in the provision of health care to children and the establishment of healthy eating behaviors.

AIM

The study investigates the possible role of HL and NL levels of Greek parents, in parental Feeding Practices (PFP).

METHODS

This is a cross-sectional study which was conducted in the urban area of the Attica region, Greece. The sample consisted of 402 parents (68.4% mothers). Parents completed the Greek version of Comprehensive Parental Feeding Questionnaire, the European Health Literacy Questionnaire 47 and the Greek version of the Nutrition Literacy Scale. Sociodemographic and anthropometric characteristics were also assessed. The non-parametric tests Mann-Whitney and Kruskal Wallis, the chi-square test and linear regression models were applied.

RESULTS

The median for HL and NL were 33.69 and 24.00, respectively. Mothers applied the "child control" practice more frequently than fathers (p = 0.015). Linear regression analysis revealed that HL was associated positively with "healthy eating guidance" and "monitoring" (p = 0.009 and p < 0.0001, respectively) and negatively with "emotion regulation/food as reward" and "child control" (p = 0.037 and p = 0.015, respectively). NL was associated positively only with "healthy eating guidance" (p = 0.009), positively but marginally with "monitoring" (p = 0.051) and negatively with "emotion regulation/food as reward" (p = 0.020).

CONCLUSIONS

Higher parental levels of HL and NL are significantly positively associated with better parental feeding practices in Greece.

Adherence to the Mediterranean diet and academic performance in adolescents: Does BMI status moderate this association?

BACKGROUND

Adolescence is a critical period for neurodevelopment, it is characterised by the establishment of behavioural patterns that can affect children's physical, mental and cognitive health, both immediately and later in life.

OBJECTIVE

The aim of the present research was to examine the association between adherence to the Mediterranean diet (MeD) and academic performance, as well as to analyze the moderating role of body mass index (BMI) status in this relationship.

METHODS

This cross-sectional study had a total 1290 adolescents (13.07 ± 0.82 years old, 714 boys and 576 girls) aged 12-14 years were included in this study. Adherence to the MeD was assessed using the Mediterranean Diet Quality Index. Academic performance was assessed through school records using four subjects: language, mathematics, English and grade point average (GPA).

RESULTS

Results showed a positive association between adherence to the MeD and all academic indicators after adjusting for potential confounders (β ranging from 0.165 to 0.213, all p < 0.001). The group of good adherence to the MeD had significantly higher scores in all the academic indicators compared with the poor/average group (p < 0.01). No interaction was found between BMI status and adherence to MeD in relation to academic indicators (all p > 0.340). These differences remained significant for both normal weight and overweight/obesity groups (p < 0.01).

CONCLUSIONS

Our results suggest that adherence to the MeD may be positively associated academic performance on adolescents regardless, of BMI status.

Association of Lifestyle Factors and Neuropsychological Development of 4-Year-Old Children

BACKGROUND

We aimed to assess how lifestyle factors such as diet, sleep, screen viewing, and physical activity, individually, as well as in a combined score, were associated with neuropsychological development in pre-school age children.

METHODS

We conducted a cross-sectional study in 1650 children of 4 years of age, from the Environment and Childhood Project (INMA) population-based birth cohorts in four regions of Spain. Children were classified per a childhood healthy lifestyle score (CHLS) with a range of 0 to 4 that included eating in concordance with the Mediterranean diet (1 point); reaching recommended sleep time (1 point); watching a maximum recommended screen time (1 point); and being physically active (1 point). The McCarthy Scales of Children's Abilities (MSCA) were used to test neuropsychological development. Multi-adjusted linear regression models were created to assess the association with the lifestyle factors individually and as a combined score.

RESULTS

CHLS was not associated with MSCA general cognitive score (1-point increment = -0.5, 95% CI: -1.2, 0.2). Analyzed by separate lifestyle factors, physical activity had a significant negative association with MSCA score and less TV/screen time had a negative association with MSCA score.

CONCLUSION

In this cross-sectional study, a combined score of lifestyle factors is not related to neuropsychological development at pre-school age.

Adherence to the Mediterranean diet and weight status in children: the role of parental feeding practices

The study examines Parental Feeding Practices (PFP) in relation to adherence to the Mediterranean Diet (MD) and children's weight status. It's a cross-sectional study of 402 parents (68.4% mothers), with children aged 2-12 years. Parents completed the Comprehensive Parental Feeding Questionnaire and the Mediterranean Diet Quality Index for children and adolescents (KIDMED), evaluating children's adherence to the MD. Logistic regression showed that in children aged 2-<6 years, "emotion regulation/food as reward" and "pressure" decrease MD adherence (OR = 0.186, p < 0.0001 and OR = 0.496, p = 0.004), and "monitoring" decrease excess body weight (OR = 0.284, p = 0.009). In older children (6-12 years), "healthy eating guidance" and "monitoring" increase MD adherence (OR = 3.262, p = 0.001 and OR = 3.147, p < 0.0001), "child control" decreases MD adherence (OR = 0.587, p = 0.049), "pressure" decrease excess body weight (OR = 0.495, p < 0.0001) and "restriction" increase excess body weight (OR = 1.784, p = 0.015). "Healthy eating guidance" and "monitoring" seem to be the best PFP employed, in terms of children's MD adherence and weight status.

Is Academic Achievement Related to Mediterranean Diet, Substance Use and Social-Cognitive Factors: Findings from Lebanese Adolescents

There is substantial evidence that good academic performance significantly enhances the prospects of success for adolescents in terms of employment, social status, quality of life and health. Identifying which factors are correlated to good academic achievement and which factors may need to be addressed by policies is crucial. Despite its importance, there is insufficient data concerning factors associated with academic achievement in the Middle East, particularly Lebanon. This study assessed the association of lifestyle, socio-demographics and motivational factors with academic achievement of Lebanese adolescents. Grade 10 and 11 Lebanese adolescents aged 15 to 18 years (n = 600), from private and public schools in Beirut and the Mount Lebanon area, completed a multi-component questionnaire assessing health behaviors, socio-demographic characteristics and motivational factors. Height and weight were physically measured and, subsequently, Body Mass Index was calculated. Academic achievement was assessed using self-reported grades and was categorized into high and low. Associations between all factors and academic achievement were tested using logistic regression models. Adherence to the Mediterranean diet, high self-efficacy and intention were positively associated with academic achievement, whereas smoking was associated with poor achievement. Our findings support the need for targeting adolescents with an unhealthier lifestyle and focusing on socio-cognitive determinants interventions aimed at enhancing academic achievement.

An Overview on the Associations between Health Behaviors and Brain Health in Children and Adolescents with Special Reference to Diet Quality

Unhealthy diet has been associated with overweight, obesity, increased cardiometabolic risk, and recently, to impaired cognition and academic performance. The aim of this review is to provide an overview of the associations between health behaviors and cognition and academic achievement in children and adolescents under 18 years of age with a special reference to diet quality. Dietary patterns with a low consumption of fish, fruits, and vegetables, and high in fast food, sausages, and soft drinks have been linked to poor cognition and academic achievement. The studies on the associations between the high intake of saturated fat and red meat and low intake of fiber and high-fiber grain products with cognition are limited. The available evidence and physiological mechanisms suggest that diet may have direct, indirect, and synergistic effects on brain and cognition with physical activity, sedentary behaviors, cardiometabolic health, and sleep, but the associations have been modest. Therefore, integrating a healthy diet, physically active lifestyle, and adequate sleep may provide optimal circumstances for brain development and learning. We conclude that most of the existing literature is contained in cross-sectional studies, which therefore highlights the need for longitudinal and intervention studies on the effects of diet, physical activity, sedentary behavior, and sleep on cognition and academic performance.

Associations between Food Group Intake, Cognition, and Academic Achievement in Elementary Schoolchildren

Nutrition plays an important role in proper physical and cognitive functioning. However, there is limited evidence on the relationship between overall diet, cognition, and academic success in children, particularly among low-income and diverse groups. The objective of this study was to examine the relationships between healthful versus less healthful food group intake, cognitive performance, and academic achievement in a diverse sample of schoolchildren. 868 urban schoolchildren (age 8 to 10 years) participated in the study. Intake of healthful (fruits, vegetables, unsweetened beverages) and less healthful (sweet and salty snacks, sugar-sweetened beverages) food groups was determined via a food frequency questionnaire. Digit Span and Stroop test scores were used to assess cognitive performance. Academic achievement was assessed via standardized test scores. Multiple Poisson and multiple linear regression were used to test the associations between diet and cognitive scores. Multiple ordered logistic regression was used to assess the associations between diet and academic achievement. Potential confounders (age, sex, body mass index (BMI) z-score, race/ethnicity, English language learner status, individualized education plan enrollment, physical activity, and parent education level) were tested for inclusion in all models. The sample included 868 children (56.7% girls; 33.2% non-Hispanic white, 26.2% Hispanic, 17.1% multiracial/other, 8.3% non-Hispanic black; 40.5% overweight/obese). The most frequently consumed foods were fruits and sweet snacks (1.9 and 1.6 servings per day, respectively). There were no statistically significant associations between diet and cognitive test scores. Greater intake of less healthful food groups (sweet snacks, salty snacks, and sweetened beverages) was associated with lower math (OR = 0.91, CI [0.84, 0.98], p = 0.014) and English standardized test scores (OR = 0.87, CI [0.80, 0.94, p = 0.001). Greater intake of sweet snacks and fruits was associated with lower English scores (OR = 0.72, 95% CI [0.59, 0.88] p = 0.001; and OR = 0.75, 95% CI [0.72, 0.94] p = 0.003, respectively). Consumption of less healthful food groups was associated with poorer academic achievement. Further research may shed light on unexpected associations between fruit consumption and achievement. Policies targeting multiple dietary components may positively influence child academic achievement and development.

Association Between Screen Media Use and Academic Performance Among Children and Adolescents: A Systematic Review and Meta-analysis

IMPORTANCE

The health consequences of excessive screen media use in children and adolescents are increasingly being recognized; however, the association between screen media use and academic performance remains to be elucidated.

OBJECTIVES

To estimate the association of time spent on screen-based activities with specific academic performance areas in children and adolescents and to examine this association separately in these populations.

DATA SOURCES

MEDLINE, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and ERIC were searched from database inception through September 2018.

STUDY SELECTION

Cross-sectional studies of the association between time or frequency of screen media use and academic performance in children and adolescents were independently screened by 2 researchers. A total of 5599 studies, published between 1958 and 2018 from 23 countries, were identified.

DATA EXTRACTION AND SYNTHESIS

Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Random-effects models were used to estimate the pooled effect size (ES).

MAIN OUTCOMES AND MEASURES

Academic performance areas included composite scores, language, and mathematics. Screen media measurements included time or frequency of computer, internet, mobile phone, television, video game, and overall screen media use.

RESULTS

In total, 58 cross-sectional studies (1.0%) of 5599 articles were included in the systematic review, of which 30 (52%) were included in the meta-analysis. The systematic review studies involved 480 479 participants aged 4 to 18 years, ranging from 30 to 192 000 people per study, and the meta-analysis studies involved 106 653 total participants, ranging from 70 to 42 041 people per study. Across studies, the amount of time spent on overall screen media use was not associated with academic performance (ES = -0.29; 95% CI, -0.65 to 0.08). Individually, television viewing was inversely associated with composite academic performance scores (ES = -0.19; 95% CI, -0.29 to -0.09), language (ES = -0.18; 95% CI, -0.36 to -0.01), and mathematics (ES = -0.25; 95% CI, -0.33 to -0.16). Video game playing was inversely associated with composite scores (ES = -0.15; 95% CI, -0.22 to -0.08). Subgroup analyses found that television viewing was inversely associated with language only in children (ES = -0.20; 95% CI, -0.26 to -0.15), whereas both television viewing (ES = -0.19; 95% CI, -0.30 to -0.07) and video game playing (ES = -0.16; 95% CI, -0.24 to -0.09) were inversely associated with composite scores only in adolescents.

CONCLUSIONS AND RELEVANCE

Findings from this study suggest that each screen-based activity should be analyzed individually for its association with academic performance, particularly television viewing and video game playing, which appeared to be the activities most negatively associated with academic outcomes. Education and public health professionals should consider supervision and reduction to improve the academic performance of children and adolescents exposed to these activities.

The longitudinal impact of diet, physical activity, sleep, and screen time on Canadian adolescents' academic achievement: An analysis from the COMPASS study

Adequate amounts of physical activity, sleep, and screen time along with a healthy diet have been demonstrated to have positive associations with academic achievement. No longitudinal study has investigated the simultaneous relationship between all of these behaviours and academic achievement. Data from 11,016 adolescent participants of the COMPASS study in Alberta and Ontario were analysed. Students self-reported their adherence to Canadian recommendations for health behaviours and academic achievement in Math and English on school-based surveys administered in the 2015/16 and 2016/17 waves of COMPASS. Multinomial generalized estimating equations were used to evaluate the association between longitudinal changes in adherence to recommendations and academic achievement at follow-up. Models were adjusted for self-reported sociodemographic information, body weight status, and baseline academic achievement. Students who adhered to a greater number of recommendations performed better than students who adhered to fewer recommendations. Meeting recommendations for Meat and Alternatives (protein-rich foods) and screen time were consistently associated with higher academic achievement compared to students who did not meet these recommendations. A change from not meeting recommendations for Vegetables and Fruit to meeting the recommendation in the following year was associated with higher achievement in both subjects. There was no association between sleep behaviours or physical activity and academic achievement. Results indicate that adherence to recommendations for protein-rich foods, screen time, and vegetables and fruit show promise as behavioural targets for higher academic achievement among youth. Further study using objectives measurements of behaviours and further consideration of socioeconomic variables is merited.

Higher Adherence to the Mediterranean Diet is Related to More Subjective Happiness in Adolescents: The Role of Health-Related Quality of Life

Adherence to the Mediterranean diet (MD) has previously been related to better quality of life in the general population. Further, children and adolescents have obtained better health outcomes when they have shown high adherence to the MD in recent studies. Nevertheless, the association between the adherence to this type of diet and subjective happiness have not been previously analysed in this population. The main aim of the present study was to evaluate the relationship between MD adherence, health-related quality of life (HRQOL) and subjective happiness in a sample of 527 Spanish adolescents. Results obtained show positive associations of MD adherence with higher levels of subjective happiness and better HRQOL. Moreover, mediation analyses showed a full mediation effect of some components of HRQOL, namely, emotional well-being, mood and emotions, financial resources and social acceptance, in the association between MD adherence and subjective happiness. This study advances our understanding of the association of MD and levels of happiness in the general population, specifically in adolescents, through the positive effects of specific components of HRQOL. Future studies should evaluate other variables that could influence or also mediate this relationship, evaluating specific groups of adolescents, such as clinical samples.

The influence of adherence to the Mediterranean diet on academic performance is mediated by sleep quality in adolescents

AIM

This study examined the association of adherence to the Mediterranean diet with academic performance and tested whether this association was mediated by sleep in Spanish adolescents.

METHODS

We recruited 269 adolescents (52% boys) aged 13.9 ± 0.3 years from the Deporte, ADOlescencia y Salud study of 38 secondary schools and sport clubs in Castellon, Spain, between February and May 2015. Adherence to the Mediterranean diet was assessed by the KIDMED questionnaire, sleep quality was evaluated with the Pittsburgh Sleep Quality Index test and sleep duration was objectively computed using a wrist-worn accelerometer. Academic performance was assessed through final school grades and a validated test.

RESULTS

Greater adherence to the Mediterranean diet was associated with higher scores in language, core subjects, grade point average and verbal ability (p < 0.05). Sleep quality acted as a significant mediator of the association between adherence to the Mediterranean diet and final grades in maths, language, core subjects and the grade point average.

CONCLUSION

Our data show that the influence of adherence to the Mediterranean diet on academic performance was mediated by sleep quality in adolescents. Education and public health professionals should work together to achieve both improved health status and academic performance in adolescents.

Visceral Adiposity and Diet Quality Are Differentially Associated With Cognitive Abilities and Early Academic Skills Among Preschool-Age Children

Background: Visceral adipose tissue (VAT) and diet quality influence cognitive health in preadolescents; however, these relationships remain understudied among preschool-age children. Objectives: Investigate the relationship between VAT, diet quality, academic skills, and cognitive abilities among preschool-age children. Methods: Children between 4 and 5 years (N = 57) were enrolled in a cross-sectional study. Woodcock Johnson Early Cognitive and Academic Development Test (ECAD™) was utilized to assess General Intellectual Ability, Early Academic Skills, and Expressive Language. DXA was used to assess VAT. Diet quality was measured using the Healthy Eating Index-2015 (HEI-2015) based on 7-day food records. Results: Greater VAT was associated with poorer Early Academic Skills (r = -0.28, P = 0.03) whereas a diet pattern that included Fatty Acids, Whole Grains, Saturated Fats, Seafood and Plant Proteins, Total Vegetables, and Dairy was positively associated with General Intellectual Ability (r = 0.26, P = 0.04). Conclusions: Higher VAT is negatively related to Early Academic Skills whereas diet quality was positively and selectively related to intellectual abilities among preschool-age children. These findings indicate that the negative impact of abdominal adiposity on academic skills is evident as early as preschool-age while providing preliminary support for the potentially beneficial role of diet quality on cognitive abilities in early childhood.

The 3-Year Longitudinal Impact of Sedentary Behavior on the Academic Achievement of Secondary School Students

BACKGROUND

Sedentary behavior is linked to many adverse health outcomes; however, its relationship with academic achievement is less understood. We examined sedentary behavior's impact on academic achievement over 3 years in 4408 adolescents from the COMPASS study.

METHODS

Sedentary behavior (screen-based: watching/streaming television shows/movies, video/computer games, surfing the internet; communication-based: texting/messaging/emailing, talking on the phone; and doing homework) and academic achievement (overall math and English marks) were self-reported.

RESULTS

Holding time fixed, moving from the lowest quartile (Q1) to Q2, Q3, or Q4 of watching/streaming television shows/movies (Q2: OR = 0.90; 95%CI: 0.84-0.97, Q3: OR = 0.85; 95%CI: 0.74-0.98, Q4: OR = 0.74; 95%CI: 0.64-0.85) or to Q2 of surfing the internet (Q2: OR = 0.87; 95%CI: 0.78-0.97) decreased the likelihood of surpassing English standards. Moving from Q1 to Q2 of communication-based sedentary behavior (OR = 0.90; 95%CI: 0.82-0.99) decreased the likelihood of surpassing math standards. Moving from Q1 to Q4 (OR = 1.31; 95%CI: 1.15-1.50) of watching/streaming television shows/movies increased the likelihood of surpassing math standards. Moving from Q1 to Q4 of doing homework (OR = 1.16; 95%CI: 1.02-1.31) increased the likelihood of surpassing English standards.

CONCLUSIONS

Predicting academic achievement from total sedentary behavior is challenging. Targeting specific types of sedentary behavior should be considered for improving math and English achievement.

Dietary inflammatory index and academic performance in children

Objective

The main aim of the present study was to examine the association between the Dietary Inflammatory Index (DII®) and academic performance in children.

Design

School-based cross-sectional study. The DII was calculated based on dietary information obtained from a single 24h dietary recall. Academic performance was assessed by school records provided by the administrative services (i.e. Maths and Language).

Setting

Porto area (Portugal).

Subjects

A total of 524 children (277 girls) aged 11·56 (sd 0·86) years.

Results

The DII was associated with academic indicators (standardized β values ranging from −0·121 to −0·087; all P<0·05). Significant differences were found between quartiles of the DII (P<0·05); children in the fourth quartile had significantly lower scores in all academic indicators compared with children in the first quartile (score differences ranging from −0·377 to −0·292) after adjustment for potential confounders.

Conclusions

The inflammatory potential of diet may negatively influence academic performance. Children should avoid the consumption of a pro-inflammatory diet and adhere to a more anti-inflammatory diet to achieve academic benefits.

The Apples of Academic Performance: Associations Between Dietary Patterns and Academic Performance in Australian Children

BACKGROUND

The purpose of this study was to determine whether there was an association between dietary patterns and children's academic performance.

METHODS

This cross-sectional study involved 315 children aged 9-11 years from 26 schools in Australia. Academic performance was measured in 4 domains (reading, writing, numeracy, and language-subdomains: spelling, grammarm and punctuation) using the National Assessment Program in Literacy and Numeracy (NAPLAN). A self-reported child questionnaire collected dietary intake data. "Core" (healthy) and "noncore" (unhealthy) dietary patterns were derived using principal components analysis.

RESULTS

The noncore pattern was associated with lower NAPLAN scores across all academic domains (mean: -12.6, 95% CI: -18.7 to -6.4, r² = .073, p < .001) except writing, while the core foods pattern was not associated with NAPLAN scores across all domains. When the noncore model was adjusted for sociodemographic covariates (child body mass index, ethnicity, sex, parental education, household income, marital status, mother's employment hours, and number of siblings), the association was attenuated but remained statistically significant (NAPLAN summary score: -8.5, 95% CI -15.0 to -1.9, r² = .123, p = .011).

CONCLUSIONS

Academic performance was deleteriously associated with a nutrient-poor, energy-dense diet, yet not associated with a nutritious diet.

Poor dietary habits in Greek schoolchildren are strongly associated with screen time: results from the EYZHN (National Action for Children's Health) Program

BACKGROUND/OBJECTIVES

To investigate adherence to the Mediterranean diet (MD) and the relationship between MD and lifestyle factors in a representative sample of Greek school children.

SUBJECTS/METHODS

The data derived from 232,401 (51% boys) children aged 8 to 17 years old who participated in a health survey (2015). Physical fitness (PF) and anthropometric estimations were obtained by trained investigators. Physical activity (PA) status, sedentary activities and sleeping hours were assessed through self-completed questionnaires. Mediterranean diet was evaluated via KIDMED test.

RESULTS

Forty percent of participants presented an optimal adherence to MD (≥8), while one to ten incorporated a low adherence to MD (≤3), in both genders. Participants with optimal adherence to MD presented a more favourable status in anthropometric and lifestyle characteristics. Adjusting for several potential confounders, increased screen time (<2 h/d) augmented odds of low adherence by 135% (95% CI: 2.216-2.491) and 150% (95% CI: 2.346-2.687), in boys and girls, respectively. For each 1-year enlarge in the age of children the odds of low adherence to MD enlarged by almost 11% (95%CI: 1.101-1.138) in both genders, while, boys had almost 6% increased probabilities to the low adherence (95%CI: 1.039, 1.102) than girls. Furthermore, insufficient sleeping hours (>2 h/d) and inadequate PA status were connected to higher odds of low adherence to MD.

CONCLUSIONS

Support a modest adherence to the MD and an enhancement considered necessary to adjust dietary intake to current guidelines. However, screen time presented a strong association with low adherence to MD.

Healthy lifestyle behaviours are positively and independently associated with academic achievement: An analysis of self-reported data from a nationally representative sample of Canadian early adolescents

Introduction

The lifestyle behaviours of early adolescents, including diet, physical activity, sleep, and screen usage, are well established contributors to health. These behaviours have also been shown to be associated with academic achievement. Poor academic achievement can additionally contribute to poorer health over the lifespan. This study aims to characterize the associations between health behaviours and self-reported academic achievement.

Methods

Data from the 2014 Canadian Health Behaviour in School-Aged Children Study (n = 28,608, ages 11–15) were analyzed. Students provided self-report of academic achievement, diet, physical activity, sleep duration, recreational screen time usage, height, weight, and socioeconomic status. Multi-level logistic regression was used to assess the relationship of lifestyle behaviours and body weight status with academic achievement while considering sex, age, and socioeconomic status as potential confounders.

Results

All health behaviours exhibited independent associations with academic achievement. Frequent consumption of vegetables and fruits, breakfast and dinner with family and regular physical activity were positively associated with higher levels of academic achievement, while frequent consumption of junk food, not meeting sleep recommendations, and overweight and obesity were negatively associated with high academic achievement.

Conclusions

The present findings demonstrate that lifestyle behaviours are associated with academic achievement, potentially identifying these lifestyle behaviours as effective targets to improve academic achievement in early adolescents. These findings also justify investments in school-based health promotion initiatives.

Diet quality, disordered eating and health-related quality of life in Greek adolescents

Purpose

Health-related quality of life (HRQOL) is a subjective multi-dimensional concept referring to an individual’s perception of health and well-being in domains related to physical, mental, emotional and social functioning. The current study aims at investigating possible associations between dietary quality, disordered eating attitudes and HRQOL in Greek adolescents.

Design/methodology/approach

A total of 400 students (198 boys; 202 girls), 14-17 years old, were recruited from five high schools in the area of Kallithea in Athens, Greece. Standard anthropometric measurements were taken, and obesity classification was conducted using the International Obesity Task Force (IOTF) cut-off points. Students completed the KIDMED index, which evaluates the degree of adherence to the Mediterranean diet (MedDiet) as a diet quality index, the EAT-26 questionnaire, which assesses disordered eating attitudes and the KIDSCREEN-27 questionnaire for children and adolescents assessing perceived HRQOL.

Findings

Disordered eating attitudes are significantly negatively correlated with the total score of HRQOL (p < 0.01) and with the subcategories: psychological well-being (p < 0.01), parents and autonomy (p < 0.01) and school environment (p < 0.001), whereas adherence to the MedDiet was positively correlated with all the components and total score of HRQOL. Linear regression analysis revealed that adherence to the MedDiet (p < 0.05), total number of meals/day (p < 0.01) and number of meals with the family (p < 0.05) were significant predictors of HRQOL in adolescents.

Research limitations/implications

The convenient sampling of 400 students was conducted from five schools, from one municipality of Athens, Greece.

Originality/value

Adherence to the MedDiet positively affects important components of HRQOL in adolescents, whereas disordered eating attitudes has a negative effect. Identifying adolescents with low HRQOL is highly important because it could result in an early detection of individualised healthcare needs and possible non-diagnosed ill-health problems.

Diet quality and attention capacity in European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

Adolescence represents an important period for the development of executive functions, which are a set of important cognitive processes including attentional control. However, very little is known regarding the associations of nutrition with components of executive functions in adolescence. Thus, the aim of this study was to investigate associations of dietary patterns and macronutrient composition with attention capacity in European adolescents. This cross-sectional study included 384 (165 boys and 219 girls) adolescents, aged 12·5-17·5 years, from five European countries in the Healthy Lifestyle in Europe by Nutrition in Adolescence study. Attention capacity was examined using the d2 Test of Attention. Dietary intake was assessed through two non-consecutive 24 h recalls using a computer-based self-administered tool. Three dietary patterns (diet quality index, ideal diet score and Mediterranean diet score) and macronutrient/fibre intakes were calculated. Linear regression analysis was conducted adjusting for age, sex, BMI, maternal education, family affluence scale, study centre and energy intake (only for Mediterranean diet score). In these adjusted regression analyses, higher diet quality index for adolescents and ideal diet score were associated with a higher attention capacity (standardised β=0·16, P=0·002 and β=0·15, P=0·005, respectively). Conversely, Mediterranean diet score or macronutrient/fibre intake were not associated with attention capacity (P>0·05). Our results suggest that healthier dietary patterns, as indicated by higher diet quality index and ideal diet score, were associated with attention capacity in adolescence. Intervention studies investigating a causal relationship between diet quality and attention are warranted.

Adherence to the Mediterranean Diet in children and adolescents: A systematic review

BACKGROUND AND AIM

A decreased adherence to the Mediterranean Diet (MD) may be related to a rise in chronic non-communicable diseases from childhood onward. The aim of this systematic review was to summarize the available literature regarding MD adherence in children and adolescents, and focusing, more specifically, on the association of MD adherence with demographic and anthropometric variables, body composition, lifestyle, and diet adequacy.

METHODS AND RESULTS

A search of scientific literature was carried out on PUBMED, SCOPUS, Clinical Trials Results, Google Scholar, and British Library Inside for studies published in the last 20 years. Fifty-eight papers were finally included according to the following criteria: MD adherence evaluated through a quantifying score or index, age 2-20 years, sample size >200 participants, observational or intervention studies regarding the general population. The KIDMED index was the most widely used scoring system. MD adherence widely varied within the Mediterranean countries for both children and adolescents, with also large differences among various European countries, while few data are available for non-Mediterranean countries. Most of the eligible studies showed that MD adherence was directly associated with physical activity (and possibly with diet adequacy) and inversely with sedentary behavior, while the results for gender, age, socioeconomic status and weight status were not consistent.

CONCLUSIONS

Further validation of MD indexes in terms of reproducibility and consistency with the MD is needed. At the same time, more prospective cohort and intervention studies may better elucidate the relationships of MD adherence with behavioral and health outcomes.

A teachers' training program accompanying the "School Fruit Scheme" fruit distribution improves children's adherence to the Mediterranean diet: an Italian trial

The effects of a nutrition education program, led by trained teachers within the Italian School Fruit Scheme, were evaluated. Pre-post intervention children's adherence to the Mediterranean diet (MD) was assessed by the KIDMED test. A representative cluster sample of 494 fourth grade students from thirteen Italian schools in the three areas of low (North), medium (Centre) and high (South) prevalence of overweight and obesity was investigated. Within the same schools, the intervention group (n = 395) received the program, the control group (n = 99) did not. In the intervention group, the proportion of children with high adherence to the MD significantly increased in the total sample, females and South in the post-intervention; no significant changes in levels of adherence related to ponderal status were detected. A significant increase was found, particularly, in the proportion of children who improved their frequency of consumption of fruit and vegetables (FV) daily, especially in the South.

Association between dietary intake and 'school-valued' outcomes: a scoping review

Approximately one in four Australian children aged 5-17 years are overweight or obese. Most of the health effects of overweight and obesity in childhood do not eventuate until into adulthood; therefore, motivation for children to have a healthy diet may be low. This scoping review examined the literature for associations between diet quality in 5-18 year olds and 'school-valued' outcomes including student attendance, academic performance, behaviour at school and mental health. A literature search for studies that assessed dietary intake and at least one 'school-valued' outcome in schoolchildren, in highly developed countries was conducted. After applying selection criteria, 35 studies were included examining academic performance (46%), behaviour (11%), mental health (31%) and 11% examining two of these outcomes each. No relevant studies addressed attendance. In general, dietary factors including consumption of fruit and vegetables, discretionary foods and/or beverages, or overall diet quality, were suggested to be correlates of the 'school-valued' outcomes. However, the evidence is not comprehensive. This review elucidates the extent and nature of available literature, and provides a basis for future research where the potential benefits of diet on 'school-valued' outcomes can be thoroughly explored.

Association of lifestyle behaviours with self-esteem through health-related quality of life in Spanish adolescents

The present research examined the association of Mediterranean diet adherence and physical activity with self-esteem through five components of health-related quality of life. Data were collected from 456 adolescents attending one of five schools in Granada, Spain using a cluster-randomised design. Participants completed questionnaires on Mediterranean diet adherence, physical activity, self-esteem and health-related quality of life (HRQoL). Models were constructed to identify associations between Mediterranean diet adherence and physical activity on self-esteem. Mediational analysis using bootstrapped confidence intervals examined possible mediation by five components of HRQoL. Mediterranean diet adherence and physical activity engagement were associated with four components of HRQoL: more positive physical wellbeing, psychological wellbeing, family relationships and autonomy support and perceptions of the school environment. Both lifestyle behaviours were positively associated with self-esteem. Both relationships were mediated through positive psychological wellbeing and perceptions of the school environment. Physical wellbeing was also a mediator of the relationship between physical activity and self-esteem.

CONCLUSION

Interventions promoting Mediterranean diets or physical activity to adolescents may facilitate improvements in self-esteem in addition to wider health benefits previously identified. Approaches within such interventions targeting improvements in physical wellbeing, psychological wellbeing and positive perceptions of the school environment may improve their efficacy. What is Known: • It is known that engagement in lifestyle behaviours such as physical activity is positively linked with psychological health. • Whilst its consumption is declining, the Mediterranean diet is nutritionally recommended and remains popular in parts of Greece, Southern Italy and Spain. Research into Mediterranean diet adherence and psychological health is lacking. What is New: • The present research furthers this knowledge by examining potential mechanisms through which two lifestyle behaviours (physical activity and following a Mediterranean diet) may be associated with self-esteem. • Implications for the promotion of positive mental health in young people. Mediterranean diet and physical activity were positively associated with self-efficacy via positive psychological self-concept and perceptions of the school environment. These novel findings can contribute to the development of more efficacious interventions targeting positive self-esteem in young people.

Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update

This systematic review is an update examining the relationships between objectively and subjectively measured sedentary behaviour and health indicators in children and youth aged 5–17 years. EMBASE, PsycINFO, and Medline were searched in December 2014, and date limits were imposed (≥February 2010). Included studies were peer-reviewed and met the a priori-determined population (apparently healthy children and youth, mean age: 5–17 years), intervention (durations, patterns, and types of sedentary behaviours), comparator (various durations, patterns, and types of sedentary behaviours), and outcome (critical: body composition, metabolic syndrome/cardiovascular disease risk factors, behavioural conduct/pro-social behaviour, academic achievement; important: fitness, self-esteem) study criteria. Quality of evidence by outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Due to heterogeneity, a narrative analysis was conducted. A total of 235 studies (194 unique samples) were included representing 1 657 064 unique participants from 71 different countries. Higher durations/frequencies of screen time and television (TV) viewing were associated with unfavourable body composition. Higher duration/frequency of TV viewing was also associated with higher clustered cardiometabolic risk scores. Higher durations of TV viewing and video game use were associated with unfavourable behavioural conduct/pro-social behaviour. Higher durations of reading and doing homework were associated with higher academic achievement. Higher duration of screen time was associated with lower fitness. Higher durations of screen time and computer use were associated with lower self-esteem. Evidence ranged from “very low” to “moderate” quality. Higher quality studies using reliable and valid sedentary behaviour measures should confirm this largely observational evidence.

Low Frequency of Fruit and Vegetable Consumption Among Canadian Youth: Findings From the 2012/2013 Youth Smoking Survey

BACKGROUND

Frequent fruit and vegetable (FV) consumption is protective against some cancers, cardiovascular disease, and other chronic diseases. This study explores self-reported frequency of FV consumption in a nationally generalizable sample of Canadian youth in grades 6-12.

METHODS

Data from grades 6-12 students who participated in the 2012-2013 Youth Smoking Survey (N = 47,203) were used to examine frequency of FV consumption. Logistic regression models were fitted to examine differences in meeting national FV intake recommendations by sociodemographic, student, and regional characteristics.

RESULTS

Approximately 10% of Canadian grade 6-12 students met FV recommendations. Students in grades 6 and 7 had significantly higher odds of meeting recommendations relative to students in grades 8-12. Students who reported achieving "mostly As" on their report cards had significantly higher odds of meeting FV recommendations relative to those receiving As and Bs, Bs and Cs, or Cs (OR = 0.71, OR = 0.53, and OR = 0.46, respectively, p < .0001 for each). Students in British Columbia and Ontario had higher odds of meeting recommendations relative to students in Newfoundland, Prince Edward Island, and Nova Scotia.

CONCLUSIONS

Only 1 in 10 Canadian youth are meeting FV recommendations. Programs and policies to encourage FV consumption are required to help mitigate future health issues associated with inadequate FV consumption.

Associations of diet quality with cognition in children – the Physical Activity and Nutrition in Children Study

Evidence on the associations of dietary patterns with cognition in children is limited. Therefore, we investigated the associations of the Baltic Sea Diet Score (BSDS) and the Dietary Approaches to Stop Hypertension (DASH) score with cognition in children. The present cross-sectional study sample included 428 children aged 6–8 years (216 boys and 212 girls). The BSDS and the DASH score were calculated using data from 4 d food records, higher scores indicating better diet quality. Cognition was assessed by the Raven's Coloured Progressive Matrices (CPM) score, a higher score indicating better cognition. Among all children, the BSDS (standardised regression coefficient β = 0·122,P =0·012) and the DASH score (β = 0·121,P =0·015) were directly associated with the Raven's CPM score. Among boys, a lower BSDS (β = 0·244,P< 0·001) and a lower DASH score (β = 0·202,P= 0·003) were related to a lower Raven's CPM score. Boys in the lowest quartile of the BSDS (22·5v. 25·3,P= 0·029) and the DASH score (22·4v. 25·7,P= 0·008) had a lower Raven's CPM score than those in the highest quartile of the corresponding score. Among girls, the BSDS or the DASH score were not associated with cognition. In conclusion, a poorer diet quality was associated with worse cognition in children, and the relationship was stronger in boys than in girls.