Nutrient adequacy and Mediterranean Diet in Spanish school children and adolescents

Improvement of Adherence to the Mediterranean Diet through a Nutrition Education Teaching Pack for Teachers within the "School Fruit Scheme" Program: An Italian Long-Term Trial in School Children

A previous short time span study related to the effectiveness of a teaching pack (TP) in improving the adherence to the Mediterranean Diet (MD) showed positive results. The present study was aimed at investigating and confirming those results, with a follow up data collection, in the same sample, a year after the baseline intervention. Pre- and post-intervention assessments were conducted. Weight and height were measured. Eating patterns/lifestyle were assessed by the KIDMED test and questionnaires. Thirteen schools in three areas with low, medium and high prevalence of overweight/obesity (North, Center and South respectively) were involved, with a representative baseline cluster sample of 494 fourth class children (8-10 years old) in 2015. An intervention group and a control group were recruited in each school; the intervention group (n = 395) got the intervention, the control group (n = 99) did not. The children's KIDMED score changes were the main outcome measures. Differences in percentages of adherence and in yes/no answers on the KIDMED test, at baseline and after one year, for both the intervention and the control groups, were assessed through contingency tables and statistical tests. Improvements in the high and low adherence rates to MD were observed (high adherence: 24.4% to 43.3%; low adherence: 15.0% to 3.9%, p < 0.0001). The percentages of subjects with optimal adherence improved in both sexes (females: 25.5% to 49.5%, p < 0.0001; males: 23.1% to 36.6%, p < 0.0001) in all the geographical areas and ponderal status classes. Accompanying free distribution of fruit and vegetables with a nutritional intervention led by trained teachers with a cross-curricular approach can be successful in promoting healthy eating in children.

Early morning physical activity is associated with healthier white matter microstructure and happier children: the ActiveBrains project

The background of this study is to examine the associations of individual and combined early morning patterns (i.e., active commuting to school, physical activity before school, having breakfast and good sleep) with white matter microstructure (WMM) and, whether the associated white mater microstructure outcomes were related to mental health outcomes in children with overweight or obesity. 103 children with overweight or obesity (10.0 ± 1.1 years old, 42 girls) from the ActiveBrains project participated in this cross-sectional study. Early morning patterns and mental health indicators (i.e., self-esteem, optimism, positive and negative affect, stress, depression and anxiety) were self-reported by the children using validated questionnaires. WMM was assessed by magnetic resonance imaging using diffusion tensor imaging. When examined independently, early morning patterns were not related with WMM (all P > 0.05). However, the combination of early morning patterns was related with WMM (P < 0.05). Specifically, physically active early morning patterns (i.e., active commuting to school and physical activity before school) were associated with global fractional anisotropy (FA) (β = 0.298, P = 0.013) and global radial diffusivity (RD) (β = - 0.272, P = 0.021), as well as with tract-specific FA (β = 0.314, P = 0.004) and RD (β = - 0.234, P = 0.032) in the superior longitudinal fasciculus (SLF). Furthermore, combined physically active early morning pattern-associated global (i.e., FA and RD) and tract-specific (i.e., FA and RD in the SLF) WMM indicators were positively associated with happiness (β absolute value range from 0.252 to 0.298, all P < 0.05). A combination of physically active early morning patterns may positively relate to white matter microstructure in children with overweight or obesity, and, in turn, happiness.

Effects of AIDiet intervention to improve diet quality, immuno-metabolic health in normal and overweight PCOS girls: a pilot study

This study was conducted in two groups of girls with PCOS (polycystic ovary syndrome) categorized as slim (group N) and overweight-to-obese (group Ov/Ob). The study's primary outcome was to assess the impact of a 12-week anti-inflammatory diet (AIDiet) intervention, without energy deficit, on daily diet quality improvement, evaluated according to the KIDMED index. The secondary outcome was improving inflammatory, redox, hormonal, and metabolic statuses. In the study, which was completed by 13 girls from the Ov/Ob group and 19 girls from the N group, a significant improvement in the mean KIDMED score was obtained. Moreover, the intervention significantly improves concentration of total antioxidant capacity (TAC), fasting insulin, and the homeostatic model assessment for insulin resistance (HOMA-IR) index, in the Ov/Ob group, while both groups experienced a reduction in the concentration of interleukin (IL)-1 and IL-6, tumour necrosis factor (TNF-α), and androstenedione. The AIDiet intervention effectively improved the quality of the subjects' diets, which was associated with the improvement of hormonal and immuno-metabolic markers. However, these changes in normal-weight patients were observed regardless of body weight reduction. ClinicalTrials.gov Identifier NCT04738409.

Nutrition fact label (NFL) use is related to meeting the requirements for vitamins and minerals not listed on NFLs: Data from the Korea National Health and Nutritional Examination Survey VIII (2019-2021) for the prepandemic and pandemic periods

The credibility and wide usability of nutrition fact labels (NFLs) have increased due to the pandemic, which may lead to healthier nutritional choices. This cross-sectional study aimed to evaluate the association between NFL use and meeting the estimated average requirements (EARs) for vitamins and minerals not listed on NFLs during the prepandemic (2019, n = 6606) and pandemic periods (2020 and 2021, n = 12085) using KNHANES data. Household surveys, health behavior interviews, and health checkup examinations were conducted for all participants. Subjects were included in the unAware+noUse, Aware+noUse, and Aware+Use groups according to NFL usage, and nutritional intake was analyzed by the 24-hour recall method. Complex-sample multiple logistic regression analysis was used to determine the odds ratios (ORs) and 95% confidence intervals (CIs) for meeting the EARs according to NFL usage in the crude and adjusted (including metabolic conditions) models. The primary finding was that awareness and NFL use were associated with adequate intake above the EARs for vitamin A, vitamin B2, niacin, folate, Ca, Fe, and P; this association was more evident during the pandemic. After adjusting for covariates, during the pandemic, the ORs of meeting the EARs in the Aware+noUse group and Aware+Use group were 1.25 (CI 1.06-1.47) and 1.36 (CI 1.05-1.75) for vitamin A, 1.26 (CI 1.06-1.50) and 1.54 (CI 1.19-2.00) for vitamin B2, 1.32 (CI 1.13-1.56) and 1.46 (CI 1.15-1.85) for folate, and 1.46 (CI 1.06-2.00) and 1.73 (1.09-2.75) for P, respectively. Additionally, the ORs for niacin (1.21, 1.02-1.43) and Fe (1.29, 1.08-1.54) were significant in the Aware+noUse group, and that for Ca (1.39, 1.08-1.78) was significant in the Aware+Use group (all p <0.05). In conclusion, NFL awareness and use are associated with meeting the EARs for vitamins and minerals not listed on NFLs. For future recurring health crises, effective NFL use is necessary for healthy dietary practices.

Higher adherence to the Mediterranean Diet is associated with lower micronutrient inadequacy in children: the SENDO project

OBJECTIVE

To assess whether the Mediterranean Diet (MedDiet) is associated with lower micronutrients inadequacy in a sample of Spanish preschoolers.

DESIGN

We conducted a cross-sectional study with 4-5-year-old children participating in the SENDO project. Information was gathered through an online questionnaire completed by parents. Dietary information was collected with a previously validated semi-quantitative FFQ. The estimated average requirements or adequate intake levels as proposed by the Institute of Medicine were used as cut-off point to define inadequate intake.

STATISTICAL ANALYSES

Crude and multivariable adjusted estimates were calculated with generalised estimated equations to account for intra-cluster correlation between siblings.

PARTICIPANTS

We used baseline information of 1153 participants enrolled in the SENDO project between January 2015 and June 2022.

MAIN OUTCOMES MEASURES

OR and 95 % CI of presenting an inadequate intake of ≥ 3 micronutrients associated with the MedDiet.

RESULTS

The adjusted proportion of children with inadequate intake of ≥ 3 micronutrients was 27·2 %, 13·5 % and 8·1 % in the categories of low, medium and high adherence to the MedDiet, respectively. After adjusting for all potential confounders, children who had a low adherence to the MedDiet showed a significant lower odds of inadequate intake of ≥ 3 micronutrients compared to those with a high adherence (OR 9·85; 95 % CI 3·33, 29·09).

CONCLUSION

Lower adherence to the MedDiet is associated with higher odds of nutritional inadequacy.

Study of the Effects of Physical-Activity Practice and Adherence to the Mediterranean Diet on Emotional Intelligence in Elementary School Education Students

Research shows that regular physical exercise and a healthy lifestyle have a beneficial effect on the health of adolescents. Other studies have also shown that gender is also a determining factor when it comes to leading an active and healthy lifestyle. The aims of this study are (a) to develop a structural-equation model formed by the variables of emotional intelligence, physical-activity practice, and adherence to the Mediterranean diet and (b) to consider that model through a multigroup analysis. A descriptive, comparative, and cross-sectional study was carried out. The sample consisted of 567 primary school students. The KIDMED, PAQ-C, and TMMS-24 questionnaires were used for data collection. We found that there are differences in the effects of the practice of physical activity and adherence to the Mediterranean diet on the emotional domain. We also concluded that, during adolescence, gender is a key element in acquiring a healthy and active lifestyle.

Associations between Dietary Patterns and Physical Activity with Physical Fitness among Adolescents in Shandong Province, China: A Cross-Sectional Study

Background: The trend of physical fitness (PF) and physical activity (PA) among Chinese adolescents is not optimistic, and unhealthy dietary behaviors are common. PA and dietary patterns (DPs) have been linked to PF in adolescents, but the associations between DPs and PF with PF in Chinese adolescents are rarely discussed. Methods: A total of 8796 adolescents aged 11–18 were enrolled from Shandong Province, China. The CNSPFS battery was applied to assess PF. PA levels and diet quality were determined using the Physical Activity Questionnaire for Adolescents and the modified Chinese Diet Quality Questionnaire, respectively. This study used factor analysis to identify DPs and linear regression models to investigate the association between PF and related factors. Results: The average PF score of the participants was 75.67. Adolescents who were girls, lived in rural areas and were active in PA performed better on the PF test (p < 0.05). Boys whose fathers were university educated or above had a higher probability of achieving higher PF scores (OR 4.36, 95% CI 1.32–14.36); however, if their mothers were university educated or above, they had a lower probability of achieving higher PF scores (OR 0.22, 95% CI 0.063–0.76). Unhealthy dietary pattern was negatively correlated with cardiorespiratory fitness in boys (OR 0.56, 95% CI 0.31–0.98). The association between unhealthy dietary pattern and girls’ BMI became significant after adjustment for PA (p < 0.05). Conclusions: Girls performed better in PF than boys. Highly educated fathers could contribute to improve the PF performance in boys. There were four DPs among adolescents in Shandong Province, and different DPs may have different effects on PF in boys and girls.

Exploring the association between circulating trace elements, metabolic risk factors, and the adherence to a Mediterranean diet among children and adolescents with obesity

Diet is one of the most important modifiable lifestyle factors for preventing and treating obesity. In this respect, the Mediterranean diet (MD) has proven to be a rich source of a myriad of micronutrients with positive repercussions on human health. Herein, we studied an observational cohort of children and adolescents with obesity (N = 26) to explore the association between circulating blood trace elements and the degree of MD adherence, as assessed through the KIDMED questionnaire. Participants with higher MD adherence showed better glycemic/insulinemic control and a healthier lipid profile, as well as raised plasma levels of selenium, zinc, cobalt, molybdenum, and arsenic, and increased erythroid content of selenium. Interestingly, we found that these MD-related mineral alterations were closely correlated with the characteristic metabolic complications behind childhood obesity, namely hyperglycemia, hyperinsulinemia, and dyslipidemia (p < 0.05, |r| > 0.35). These findings highlight the pivotal role that dietary trace elements may play in the pathogenesis of obesity and related disorders.

Association between Adherence to the Mediterranean Diet and Anthropometric and Health Variables in College-Aged Males

The present study aimed to verify the association between adherence to the Mediterranean diet (MD) and anthropometric and health variables. Four-hundred-and-ninety-five college-aged males aged 18–25 participated in this cross-sectional research. The KIMED (Mediterranean Diet Quality Index for children and adolescents) was used to assess the adherence to MD. The following variables were also assessed: body mass (BM), height (HE), body mass index (BMI), body fat percentage (%FAT), lean mass (LEAN), abdominal girth (AG), waist-to-hip ratio (WHR), oxygen saturation (SPO2), systolic blood pressure (SBP), diastolic blood pressure (DBP), double product (DP), and fasting blood glucose (GLU). The results showed that adherence to MD presented a strong negative correlation with most of the anthropometric parameters (BM: r = −0.571; BMI: r = −0.614; %FAT: r = −0.558; and AG: r = −0.564), a moderate or weak correlation with most of the health variables (GLU: r = −0.407; SBP: r = −0.238; DBP: r = −0.217, and DP: r = −0.265) and LEAN (r = −0.497), and a very weak correlation with WHR (r = −0.090). Many anthropometric parameters (BM, BMI, %FAT, LEAN, AG, WHR) present significant correlations with health variables (SBP, DBP, DP, and GLU). We conclude that greater adherence to Mediterranean diet is associated with healthier values of the selected anthropometric and health parameters. Since most of the anthropometric and health parameters present significant correlations among themselves, this finding could be useful in medical diagnosis, health monitoring, and risk detection. Based on the level of adherence to Mediterranean diet and the KIDMED found in the present study, and considering the prevalence of obesity in the Middle East, it is imperative to implement nutritional interventions with the target population of this research to prevent nutrition-related diseases and promote public health.

Mediterranean diet and physical activity in Down syndrome pediatric subjects: the DONUT STUDY

INTRODUCTION

Children with Down syndrome (DS) are characterised by peculiar dietary choices and approach to physical activity. The aim of this study is to quantify their adherence to the Mediterranean diet, their level of physical activity and lipid profile.

METHODS

Cross-sectional study, involving 61 children affected by DS. Parents of the patients were requested to complete two questionnaires, Mediterranean Diet Quality Index in children and adolescents (KIDMED) and Godin Leisure-Time Physical Activity Questionnaire (Godin). In addition, children underwent a venous sampling to check their lipid profile.

RESULTS

High scores on KIDMED and Godin were found and were associated with a reduced likelihood of being overweight or obese (0.001< p < 0.077; 0.001< p < 0.248). The level of physical activity and the probability of finding pathological HDL values in plasma were inversely related (0.001< p < 0.263).

CONCLUSIONS

The DONUT study proves that KIDMED and Godin questionnaires can identify children affected by DS that can lead to develop inadequate anthropometric variables and low levels of HDL cholesterol. Moreover, the results of this study show that, despite potential difficulties in the pursuit of a correct diet and an adequate approach to physical activity, children with DS could achieve results that are substantially like those of non-DS children.

Effects of adherence to the Mediterranean diet in children and adolescents with irritable bowel syndrome

BACKGROUND

Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder in children and adults, which increased over the past twenty years. The Mediterranean diet is a well-known diet full of antioxidants and anti-inflammatory ingredients.

AIM

To evaluate the safety, tolerability, and effects of adherence to the Mediterranean diet on disease patterns in children and adolescents with IBS.

METHODS

This prospective, cross-sectional case-controlled study included 100 consecutive IBS patients diagnosed according to Rome IV criteria, aged 12-18 years. Patients were subdivided into two groups (50 patients each); Group I received a Mediterranean diet, and Group II on their regular diet for six months. Besides IBS scores (IBS-SSS, IBS-QoL, and total score), different clinical and laboratory parameters were evaluated at the start and end of the study.

RESULTS

The Mediterranean diet was safe and well-tolerated in IBS patients. IBS children and adolescents with good adherence to the Mediterranean diet (KIDMED Score ≥ 8 points); group I showed significant improvement in IBS scores. IBS-SSS in the Mediterranean diet group was 237.2 ± 65 at the beginning of the study and decreased to 163.2 ± 33.8 at the end of the study (P < 0.001). It did not show a significant improvement in the group with a regular diet (248.3 ± 71.1 at the beginning of the study compared to 228.5 ± 54.3 at the study end with P < 0.05). The mean IBS-SSS in the Mediterranean diet group significantly improved compared with the group with a regular diet. Mean IBS-QoL in group I improved from 57.3 ± 12.9 at the start of the study to 72.4 ± 11.2 at the study end (P < 0.001) and significantly improved when compared to its level in group II at the study end (59.2 ± 12.7 with P < 0.001), while group II showed no significant improvement in IBS-QoL at the study end when compared to the beginning of the study (59.2 ± 11.7 with P >0.05). The mean total IBS score in group I became 28.8 ± 11.2 at the end of our study compared to 24.1 ± 10.4 at the start (P < 0.05) and significantly improved when compared to its level in group II at the end of the study (22.1 ± 12.5 with P < 0.05), while in group II, non-significant improvement in the total score at the end of our study compared to its mean level at the start of the study (22.8 ± 13.5 with P > 0.05).

CONCLUSION

The Mediterranean diet was safe and associated with significant improvement in IBS scores in children and adolescent patients with IBS.

A Nutritional Approach for the Management of Chemotherapy-Induced Diarrhea in Patients with Colorectal Cancer

This study aimed to determine if dietary modifications using a nutritional regimen could prevent or reduce the incidence of cancer therapy-induced diarrhea in patients with metastatic colorectal cancer and to evaluate the relationship of Vitamin D blood levels with diarrhea severity. Patients with metastatic colorectal cancer were enrolled. A Mediterranean diet, containing some special limitations aiming to reduce the risk of diarrhea, was administered before and during the entire chemotherapy program. Enrolled patients numbering 60/137 (44%) had diarrhea during chemotherapy. Adherence to the diet was high in 36 (26.3%) patients, medium in 94 (68.6%), and low in 7 (5.1%). Mean adherence to the diet was significantly lower in patients who experienced diarrhea with maximum grade 2−3 compared to those who had no diarrhea or grade 1 diarrhea (score = 5.4 ± 1.9 vs. 7.1 ± 1.5, p < 0.001). Patients with higher adherence to the diet had a lower risk of grade 2−3 diarrhea (odds ratio: 0.5 (95% CI: 0.3−0.7, p < 0.001)). In addition, patients who completed a higher number of chemotherapy cycles had an increased risk of grade 2−3 diarrhea (odds ratio: 1.2 (95% CI: 1.0−1.5, p = 0.02)). Of note, a lower level of Vitamin D correlated with an increased risk of G2-G3 diarrhea (p = 0.03). A diet based on vegetables with a controlled fiber content, Mediterranean Modified Healthy Diet (MMHD), is useful to control the incidence of cancer therapy-induced diarrhea.

Adherence to the Mediterranean Diet Improved Clinical Scores and Inflammatory Markers in Children with Active Inflammatory Bowel Disease: A Randomized Trial

Objective

Methods

Results

Conclusion

Exploring the Correlation between Time Management, the Mediterranean Diet, and Physical Activity: A Comparative Study between Spanish and Romanian University Students

BACKGROUND

The investigation started from the premise that there are links between time management (TM), physical activity (PA), and the Mediterranean diet (MD). The aim of our study is to determine the correlation between the variables TM, the MD, and PA in Spanish and Romanian university students.

METHODS

The study was conducted on a group of 296 students (198 Romanian and 98 Spanish students between the ages of 23.44 ± 5.92 years, with 108 males and 188 females, where 171 were from the sports faculty and 125 were from the psychology faculty), using the Time Management Questionnaire (TMQ) to measure TM, the KIDMED test to measure MD, and the International Physical Activity Questionnaire-Short Form (IPAQ-SF) to measure PA.

RESULTS

The obtained results show that there are significant differences, regarding MD and PA, between the Romanian and Spanish respondents, between the respondents from the sports faculty and those from the psychology faculty, and between the female and male respondents. The TM variable did not show a significant difference depending on the country, faculty, or gender. There was only a significant relationship between the MD and the other two variables (TM and PA).

CONCLUSIONS

Significant differences were observed between the variables the MD and PA, but not TM, depending on the country, gender, and faculty. There was only a significant correlation between the MD and the other two variables (TM and PA). The results provided us with relevant data for the need for a TM protocol to improve the MD adherence and PA in university students.

Healthy Aging and Dietary Patterns

A number of factors contribute to the complex process of aging, which finally define whether someone will or not develop age-associated chronic diseases in late life. These determinants comprise genetic susceptibility as well as various behavioral, environmental, and dietary factors, all of which have been shown to influence specific pathways regulating the aging process and the extension of life, which makes longevity a multidimensional phenomenon. Although a “miraculous elixir” or a “nutrition pill” are not plausible, researchers agree on the notion that nutritional factors have major impact on the risk of age-associated chronic non-communicable diseases and mortality. In recent years nutrition research in relation to health outcomes has considerably changed from focusing exclusively on single nutrients to considering combinations of foods rather than nutrients in isolation. Although research on specific nutrients is scientifically valid providing crucial evidence on the mechanisms by which nutrition impacts health, the recent switch targeting the multifaceted synergistic interplay among nutrients, other dietary constituents, and whole foods, has promoted emerging interest on the actions of total dietary patterns. This narrative review aims to describe some specific dietary patterns with evidence of associations with reduction in the incidence of chronic diseases allowing older adults to live a long-lasting and healthier life, and confirming the powerful impact nutrition can exert on healthy aging.

Adherence to the Japanese Food Guide: The Association between Three Scoring Systems and Cardiometabolic Risks in Japanese Adolescents

The Japanese Food Guide Spinning Top (JFGST) indicates optimal intake of five food groups (grain, fish and meat, vegetables, milk, and fruits) and sugar and confectionaries. We aimed to investigate whether adherence to the JFGST in 8th grade junior high school students (n = 3162) was associated with cardiometabolic risks and how different scorings of the JFGST influenced the associations. Metabolic risks were assessed from anthropometrics, blood pressure measurements, and blood glucose and lipid profile measurements. Three types of scoring adherent to the JFGST were analyzed (10 points were given for each item with optimal intake; range: 0–60): the original scoring (ORG scoring); first modified scoring, which had no upper limits for vegetables and fruits (MOD1 scoring); and MOD2 scoring without upper limits for five dishes (MOD2 scoring). The MOD2 scoring was positively associated with dietary fiber, potassium, calcium, and vitamins. All types of scorings were associated with low glucose levels (p ≤ 0.001); the MOD2 scoring was associated with low systolic blood pressure (p = 0.001) and low cardiometabolic risk (p = 0.003). Our findings suggest that Japanese adolescents adherent to the JFGST had low cardiometabolic risks and should not fall below lower limits for intake of the abovementioned five food groups.

Adherence to the Mediterranean Diet Improves Fatty Acids Profile in Pediatric Patients with Idiopathic Nephrotic Syndrome

The fatty acid profiles of patients with idiopathic nephrotic syndrome (INS) are different from that of healthy controls, even during remission, revealing an increase of the pro-inflammatory omega 6 series. It is still unknown whether the concomitance of nephrotic syndrome affects the potential positive effects of the Mediterranean diet on the levels of omega 3 and 6 fatty acids. We performed a cross-sectional study to evaluate the association between the adherence to the Mediterranean diet and fatty acid profile in 54 children with INS. The dietary habits were assessed through the validated Kidmed questionnaire. Patients with higher adherence had lower levels of linoleic acid and total omega-6. Moreover, a negative correlation between proteinuria and the anti-inflammatory omega-3 series was found. In conclusion, patients with INS with proteinuria and low adherence to the Mediterranean diet have an imbalance in the omega-6/omega-3 ratio that may benefit from following the Mediterranean diet.

Technology-based nutrition interventions using the Mediterranean diet: a systematic review

CONTEXT

Over the past 2 decades, overweight and obesity rates have increased exponentially, along with related comorbidities including type 2 diabetes, hypertension, cardiovascular disease, and some cancers. The Mediterranean Diet (MDiet) has been suggested as a potential way to mitigate the health burdens related to overweight and obesity.

OBJECTIVE

For this review, the literature on MDiet-focused digital interventions was examined to determine efficacy, best practices, and potential limitations.

DATA SOURCES

The search was conducted across 15 databases for relevant publications published through April 2020 in English, French, Spanish, Arabic, or Italian.

DATA EXTRACTION

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using a combination of keywords and phrases and evaluated independently for relevance, merit, and inclusion and exclusion criteria.

DATA ANALYSIS

The systematic literature review resulted in 15 articles that met the search criteria. Ten interventions were delivered online, and 5 were delivered via smartphone using an app. The majority of online MDiet-focused interventions were effective, particularly when modeled after evidence-based and best-practice online nutrition education interventions. Such interventions also are effective for promoting positive health behaviors and health outcomes, such as increased physical activity, increased levels of high-density lipoprotein cholesterol, and a lower total high-density lipoprotein cholesterol ratio.

CONCLUSION

Technology-based interventions to educate and promote adherence to the MDiet are successful in helping individuals achieve the stated outcomes. More research is needed to determine the efficacy of MDiet interventions delivered via smartphone apps.

Meeting international screen-time guidelines is associated with healthy dietary patterns in Spanish schoolchildren

Introduction

Objective: the aim of this research was to explore the relationship between dietary pattern habits and compliance with screen-time guidelines in Spanish schoolchildren. Material and methods: a cross-sectional and associative study was performed in a total of 370 schoolchildren (44.9 % girls) aged 6-13 (8.7 ± 1.8) years. Results: for boys, those who did not meet these guidelines presented lower chances of eating vegetables regularly (OR = 0.50; 95 % CI = 0.28-0.89) or more than once a day (OR = 0.43; 95 % CI = 0.22-0.85). In girls, it was observed that those who did not meet the guidelines presented a lower probability of eating one piece of fruit (OR = 0.43; 95 % CI = 0.19-0.99) as well as a second piece (OR = 0.22; 95 % CI = 0.22-0.81), vegetables more than once a day (OR = 0.39; 95 % CI = 0.19-0.80), fish (at least 2-3 times/week) (OR = 0.40; 95 % CI = 0.20-0.78) and nuts (at least 2 or 3 times per week) (OR = 0.46; 95 % = 0.24-0.87). Conclusion: some healthy eating patterns, such as the consumption of fruits and vegetables, appeared to be more prevalent in those children who met the international screen-time guidelines.

Comparative Study Regarding the Adherence to the Mediterranean Diet and the Eating Habits of Two Groups-The Romanian Children and Adolescents Living in Nord-West of Romania and Their Romanian Counterparts Living in Italy

Background: The Mediterranean diet (MD) is associated with significant health benefits, including prevention of noncommunicable diseases (NCDs). Given the important migratory flow from Romania to Italy in recent decades, this study seeks to evaluate the differences between the nutritional habits of Romanian children and adolescents in Romania compared with those of Romanian children who moved to Italy or were born in Italy from both Romanian parents. Method: To assess adherence to MD, parents of Romanian children in Romania (RCR) and Romanian children in Italy (RCI) answered questions from an adapted version of the KIDMED test. Results: The results show that the high KIDMED index among RCI is significantly higher than the same index among RCR (68.09 versus 17.76, p < 0.05). RCR obtained a higher KIDMED score on different items: they had a lower consumption of fast food and sweets but an increased consumption of nuts, yogurts, and cheese. Conclusions: RCI have a better adherence to MD, but, at the same time, they are more exposed to westernized diet and practice less physical activity. Nutrition education is an important tool for improving health outcome.

Impact of Mediterranean Diet on Chronic Non-Communicable Diseases and Longevity

The average life expectancy of the world population has increased remarkably in the past 150 years and it is still increasing. A long life is a dream of humans since the beginning of time but also a dream is to live it in good physical and mental condition. Nutrition research has focused on recent decades more on food combination patterns than on individual foods/nutrients due to the possible synergistic/antagonistic effects of the components in a dietary model. Various dietary patterns have been associated with health benefits, but the largest body of evidence in the literature is attributable to the traditional dietary habits and lifestyle followed by populations from the Mediterranean region. After the Seven Countries Study, many prospective observational studies and trials in diverse populations reinforced the beneficial effects associated with a higher adherence to the Mediterranean diet in reference to the prevention/management of age-associated non-communicable diseases, such as cardiovascular and metabolic diseases, neurodegenerative diseases, cancer, depression, respiratory diseases, and fragility fractures. In addition, the Mediterranean diet is ecologically sustainable. Therefore, this immaterial world heritage constitutes a healthy way of eating and living respecting the environment.

Impact of Mediterranean Diet on Chronic Non-Communicable Diseases and Longevity

The average life expectancy of the world population has increased remarkably in the past 150 years and it is still increasing. A long life is a dream of humans since the beginning of time but also a dream is to live it in good physical and mental condition. Nutrition research has focused on recent decades more on food combination patterns than on individual foods/nutrients due to the possible synergistic/antagonistic effects of the components in a dietary model. Various dietary patterns have been associated with health benefits, but the largest body of evidence in the literature is attributable to the traditional dietary habits and lifestyle followed by populations from the Mediterranean region. After the Seven Countries Study, many prospective observational studies and trials in diverse populations reinforced the beneficial effects associated with a higher adherence to the Mediterranean diet in reference to the prevention/management of age-associated non-communicable diseases, such as cardiovascular and metabolic diseases, neurodegenerative diseases, cancer, depression, respiratory diseases, and fragility fractures. In addition, the Mediterranean diet is ecologically sustainable. Therefore, this immaterial world heritage constitutes a healthy way of eating and living respecting the environment.

Association of organic food consumption with obesity in a nationally representative sample

The increased prevalence and adverse health consequences of obesity have made it one of the leading public health issues in recent years. Importantly, several epidemiological studies have revealed significant associations between BMI and organic food consumption. However, although these studies have suggested that this factor holds promise to prevent obesity, they all suffer from methodological limitations, including self-reporting methods to assess BMI, not controlling for potential confounding factors or using a non-representative sample. Moreover, all were restricted to an adult sample. We present the results of a cross-sectional epidemiological study assessing the association of organic food consumption with BMI and obesity in a representative lifespan French sample (INCA3 study). Objective methods were used to measure BMI, and several potentially confounding variables were controlled for. In total, 1775 children and adolescents and 2121 adults underwent anthropometric measurements and completed questionnaires concerning their dietary habits and lifestyle. Unadjusted models systematically revealed negative associations between organic food consumption and both BMI and obesity across all age groups. These associations tended to remain statistically significant even after controlling for several confounding variables concerning socio-economic status, quality of the diet and physical activity. The effect sizes were, however, small. These data confirm the association between organic food consumption and obesity during both childhood and adulthood. Evidence from randomised controlled trials is required to investigate causality between organic food consumption and lower BMI or obesity rate.

[Assessment of adherence to the Mediterranean diet in university Health Sciences students and its relationship with level of physical activity]

Introduction

Objective: to assess the degree of adherence to the Mediterranean diet and the practice of physical activity in university Health Sciences students in Castile-La Mancha. Methods: this was a cross-sectional, observational study by means of a dietary and physical activity survey. The sample consisted of 575 university students (77.7 % women). An initial data collection survey was developed using the Google Forms platform (https://www.google.com/forms/about/). Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Adherence Screener (MEDAS) questionnaire and the modified Prevention with Mediterranean Diet (PREDIMED) questionnaire. The Rapid Assessment of Physical Activity Scale (RAPA) questionnaire was used to measure physical activity. Results: we found a 58.3 % adherence to Mediterranean diet among Health Sciences students, with 38.6 % of average adherence, and 5.0 % of poor adherence, with a low consumption of fruits with no gender differences, and a high consumption of red or processed meat and butter or cream with significant differences between women and men. There is also a high consumption of carbonated beverages (more frequent in women). Likewise, a high percentage of students (22.5 %) do practically no physical activity. As for physical exercise, it is always higher in men, with significant differences (p > 0.05). Conclusion: this study suggests that the sample of university Health Sciences students in Castile-La Mancha shows an acceptable adherence to the Mediterranean diet and insufficient levels of physical activity.

Meeting the Physical Activity Recommendations and Its Relationship with Obesity-Related Parameters, Physical Fitness, Screen Time, and Mediterranean Diet in Schoolchildren

The up-to-date scientific evidence suggests that adequate levels of physical activity provide essential health benefits for children and adolescents and help to maintain a healthy body weight. In this sense, children and adolescents should at least accumulate 60 min of moderate-to-vigorous physical activity in a daily basis to achieve these benefits and be considered active. Likewise, some lifestyle-related elements may interact with each other in an antagonistic or synergistic way to modify physical activity status. Thus, a better understanding of how meeting physical activity recommendations influences these potentially modifiable lifestyle factors (obesity-related parameters, physical fitness, dietary habits, or sedentary behaviour) would significantly reinforce the importance of complying with those recommendations from a health perspective and support the establishment of strategies for the promotion of diminishing the lower trends of physical activity among the young population. This study seeks to verify the association of meeting physical activity international recommendations with obesity-related parameters, global physical fitness, screen time, and Mediterranean diet in Spanish schoolchildren aged 8 to 13. A cross-sectional study was performed including 250 schoolchildren (41.2% girls) aged 8-13 (9.7 ± 1.2) from six primary schools in the Region of Murcia (Spain). Results: A higher proportion of children who complying with physical activity recommendations shows normal weight, no abdominal obesity, and low adiposity in comparison to other with different obesity-related parameters categories. Higher values in global physical fitness score were found in those who meet the physical activity international recommendations in both sexes. These higher values were also shown for adherence to the Mediterranean diet in both sexes; not being so in the case of screen time. Notwithstanding, none of these mean differences were statistically significant. To conclude, the proportion of schoolchildren meeting the physical activity recommendations in our study is low. A higher proportion of children who meet with physical activity recommendations present normal weight, no abdominal obesity and low adiposity in comparison to other obesity-related parameters categories in both sexes. Likewise, those considered as active children seem to have higher global physical fitness score and adherence to the Mediterranean diet than children who do not meet the recommendations.

High variability of food and nutrient intake exists across the Mediterranean Dietary Pattern-A systematic review

A Mediterranean style dietary pattern (MDP) is considered beneficial for health. The MD Score (MDS) definition has evolved, resulting in considerable variability in the foods and nutrients associated with MDS adherence. We systematically investigated food and nutrient composition of the MD between studies, countries, and methods of classifying the MDS. We searched Embase for MD systematic reviews and selected observational studies reporting intakes of foods, macronutrients, or micronutrients by categories of MDS adherence. The percentage differences in food and nutrient intakes between categories of high and low adherence to the MDS were calculated for each study. A total of 369 full-text primary papers were reviewed from the included systematic reviews and 74 papers selected (66 adults, 8 children). We found considerable differences in MDS definitions and scoring criteria. Between-study variation in food intake between high- and low-adherence MDS adherence categories ranged from a mean of -23% for meat, to 119% for fruit, and 278% for fish. Greater variability was evident in non-Mediterranean than Mediterranean regions. We conclude that few studies report food and nutrient intakes across the range of the MDP in adults and even fewer in children. The considerable variability in the foods and nutrients reported makes comparison of results from studies and translation into dietary guidelines difficult. We recommend that future publications of MD studies include full details of the range of food and nutrient intakes across the distribution of MD adherence in order to facilitate translation into health policy and practice.

Sufficient vitamin D status positively modified ventilatory function in asthmatic children following a Mediterranean diet enriched with fatty fish intervention study

Asthma in children is the most prevalent allergic disease worldwide that has become a major public health priority. The objective of this study was to examine the relationship between baseline serum vitamin D status, spirometry, and fractional exhaled nitric oxide levels (FeNO) in 64 Greek children with 'mild asthma' aged 5 to 12 years (51.6% male) in a dietary intervention study. We hypothesized that baseline serum vitamin D levels modify the beneficial response of fatty fish intake on pulmonary function in asthmatic children following a Mediterranean diet. The intervention group consumed 2 fatty fish meals/week (≥150 g cooked filleted fish/meal) as part of the Mediterranean diet for six months, and the control group consumed their usual diet. Baseline serum 25(OH)D was determined using enzyme-linked immunoassay and defined as sufficient levels of 25(OH)D ≥25 ng/mL. Only 36% of children were graded as sufficient in 25(OH)D levels on entry into the study with a higher proportion of girls insufficient than boys (61% vs 39% respectively). Participants with sufficient levels of serum 25(OH)D at baseline, consuming the intervention diet increased FEV₁/FVC by 4.89 units (β = 4.89; 95%CI: 1.19-8.61; p = 0.013) and FEF_25-75% by 12.83 units (β = 12.83; 95%CI: 4.27-21.40; p = 0.006) compared to controls. No significant differences in pulmonary function or FeNO were observed for those with insufficient levels of 25(OH) D in the intervention or control groups. In conclusion, sufficient serum vitamin D levels enhanced ventilatory function in response to a dietary intervention in asthmatic children.

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.

Impact of an educational intervention on the quality of the Mediterranean diet, physical activity and weight status in adolescents: Randomised clinical trial

OBJECTIVE

To analyse the impact of an educational intervention on the quality of the Mediterranean diet, physical activity and weight status in adolescents.

METHOD

Randomised clinical trial (RCT), controlled with a multimodal educational intervention (control group [n=36] and experimental group [n=46]). Data collection at the beginning and end of the study, in teenagers from Cáceres, Spain. In both groups anthropometric measurements and sociodemographic data were determined. The quality of the Mediterranean diet was assessed through the KIDMED test, the degree of physical activity through the PAQ-A questionnaire and weight status with the growth charts of the Faustino Orbegozo Eizaguirre Foundation.

RESULTS

We obtained a significant increase in the experimental group in the PAQ-A questionnaire that assesses physical activity (P=.029). No significant differences were observed between groups in the weight status (P=.916). When comparing the quality of the Mediterranean diet (high vs moderate or low quality) with physical activity (Pcontrol=.730; experimental P=.495) and with weight status (Pcontrol=.838; experimental P=.372), No significant differences are observed.

CONCLUSIONS

The educational intervention did not improve the quality of the Mediterranean diet or physical activity, although most of our sample had normal weight and acceptable physical activity. We must continue to improve the healthy eating pattern of our adolescents, to ensure an adequate state of health in the future.

Adherence to Mediterranean Diet Related with Physical Fitness and Physical Activity in Schoolchildren Aged 6-13

The relationship between adherence to the Mediterranean Diet (MD) and both physical fitness (PF) and physical activity (PA) level has been analysed in several studies. The aim of this research was to describe, compare and analyse the level of PF and PA in schoolchildren aged 6–13 in the Region of Murcia, according to adherence to the MD. A descriptive and cross-sectional study was performed. A total of 370 schoolchildren (44.9% girls) aged 6–13 (8.7 ± 1.8) from six primary schools in the Region of Murcia (Spain). Mediterranean Diet Quality Index for children and teenagers (KIDMED) was used to determinate the adherence to the MD. The ALPHA-FIT Test Battery was applied for assess body composition and PF. PA level was determined using Physical Activity Questionnaire for Older Children (PAQ-C). Only 25.9% of the schoolchildren had optimal adherence to the MD. Regarding the scores of the different PF tests in MD groups, only statistically significant differences were found for cardiorespiratory fitness (CRF) (p = 0.048) in boys. PA level showed statistically significant differences in both boys (p = 0.040) and girls (p = 0.016). A positive relationship was found between the KIDMED and PA level (p = 0.235). A higher probability of having a greater CRF (OR = 1.17; CI = 1.02–1.34) and PA level (OR = 7.84; CI = 2.84–21.60) was found in high MD group. These results suggest that an optimal adherence to the MD is associated with higher CRF and PA level in the selected schoolchildren.

Burnout Syndrome Risk in Child and Adolescent Tennis Players and The Role of Adherence to the Mediterranean Diet

This cross-sectional study examined the impact of adherence to Mediterranean diet on burnout syndrome risk in 94 athletes 8-15 years old. Diet pattern and burnout syndrome risk were assessed through the Athlete Burnout Questionnaire and the KIDMED Questionnaire. 55.3% of girls and 16.1% of boys had a high risk of burnout syndrome and the risk increased with age. Of the 78.7% with low adherence to Mediterranean diet, 31.1% showed no risk of burnout syndrome, 33.8% had a moderate risk, and 35.1% high risk. Of the 21.3% with a high adherence to Mediterranean diet, 35% had no risk of burnout syndrome, 45% had a moderate risk, and 20% had a high risk. Participants with moderate/high burnout syndrome risk were more likely to be girls and spend a higher number of hours watching television or playing video games. There is not enough statistical evidence in this study to reject the independence between the level of adherence to the Mediterranean diet and the risk of burnout syndrome in children, except in the case of daily consumption of fresh or cooked vegetables.

Evaluation of Mediterranean diet adherence in children diagnosed with pancreatitis: a case-control study

Introduction

Background: the incidence of childhood acute pancreatitis has been increasing in the last two decades. The number of studies on the effects of diet on the pathogenesis of pancreatitis is very small. The aim of this study was to evaluate adherence to the Mediterranean diet among children with acute pancreatitis. Material and method: this study was conducted by administering the Mediterranean Diet Quality Index (KIDMED) to 100 children -children diagnosed with acute pancreatitis (n = 50) and a control group (n = 50). Results: there was a statistically significant difference between groups in terms of body mass index Z-score (p = 0.017). When the KIDMED scores of the children diagnosed with pancreatitis (4.48 ± 2.45) and the control group (6.62 ± 2.18) were compared, the KIDMED scores of the children diagnosed with pancreatitis group were significantly lower (u = 638.5; p < 0.001). Those with a moderate KIDMED index (score: 4-7) (OR: 3.734, 95 % CI, 1.068-13.058, p = 0.039) and those with a poor KIDMED index (score ≤ 3) (OR: 6.444, 95 % CI, 1.595 -26.075, p = 0.009) were found to have an increased risk of developing pancreatitis. It was found that the risk of pancreatitis increased with age (OR: 1.136, 95 % CI, 1.020-1.266, p = 0.021). Conclusion: according to the data obtained from our study, it was found that the pancreatitis group had poorer dietary habits than the control group. Larger and multicenter studies are needed to evaluate the role of diet in pancreatitis development.

Relative validation of the adapted Mediterranean Diet Score for Adolescents by comparison with nutritional biomarkers and nutrient and food intakes: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

OBJECTIVE

To investigate whether adherence to the adapted Mediterranean Diet Score for Adolescents (MDS_A) and the adapted Mediterranean Diet Quality Index for Adolescents (KIDMED_A) is associated with better food/nutrient intakes and nutritional biomarkers.

DESIGN

The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study is a cross-sectional study aiming to obtain comparable data on a variety of nutritional and health-related parameters in European adolescents aged 12·5-17·5 years.

SETTING

Nine European countries.

PARTICIPANTS

European adolescents (n 2330) recruited to the HELENA study. Dietary intake was obtained with 24 h dietary recalls, an FFQ and a Food Choices and Preferences questionnaire. MDS_A was calculated as a categorical variable using cut-offs (MDS_A), as a continuous variable (zMDS_A) and with energy adjustments (zEnMDS_A). The KIDMED_A score was also calculated.

RESULTS

Multilevel linear regression analysis showed positive associations for zMDS_A and KIDMED_A with serum levels of vitamin D, vitamin C, plasma folate, holo-transcobalamin, β-carotene and n-3 fatty acids, while negative associations were observed with trans-fatty acid serum levels. For categorical indices, blood biomarkers showed few significant results. zMDS_A and KIDMED_A showed positive associations with vegetables and fruits intake, and negative associations with energy-dense and low-nutritious foods. zMDS_A and KIDMED_A were positively associated with all macronutrients, vitamins and minerals (all P < 0·0001), except with monosaccharides and PUFA for KIDMED_A and cholesterol for both indices (P < 0·05).

CONCLUSIONS

zMDS_A and KIDMED_A have shown the strongest associations with the dietary indicators and biomarkers that have been associated with the Mediterranean diet before, and are therefore considered the most appropriate and valid Mediterranean diet scores for European adolescents.

Validation of the CIMI-Ethiopia Program and Seasonal Variation in Maternal Nutrient Intake in Enset (False Banana) Growing Areas of Southern Ethiopia

BACKGROUND

Tools for the rapid and accurate analysis of nutrient intakes from diets of individuals in Southern Ethiopia are lacking. The Calculator of Inadequate Micronutrient Intake program for Ethiopia (CIMI-Ethiopia) has been developed to overcome this problem. CIMI-Ethiopia also computes protein and energy intakes from the diet. The objectives of the current study were to validate CIMI-Ethiopia for the dietary pattern of Southern Ethiopia, and assess the nutrient intakes in postharvest dry and lean wet seasons.

METHODS

24-h dietary recall (24HR) data was collected from 578 women of a reproductive age in postharvest dry and lean wet seasons in 2017. For analysis, 24HR data was entered into NutriSurvey (NS), which was the reference nutrition software, and then into CIMI-Ethiopia. For validation, the mean and standard deviation (SD) of the difference between CIMI-Ethiopia and NS were computed. The percentage of participants with an inadequate intake was calculated. The correlation between CIMI-Ethiopia and NS results was determined. The nutrient intakes in postharvest dry and lean seasons were compared.

RESULTS

Among the nutrients, pantothenic acid, vitamin B1, and protein showed a very high accuracy in CIMI-Ethiopia calculation (|difference (D)| < 5.0% of the NS result). Nutrients with a good accuracy (|D| = 5%-15%) were iron, zinc, magnesium, vitamin B12, vitamin B6, and energy. The accuracy for calcium, niacin, and vitamin A was moderate (|D| = 15%-30%). The intakes calculated by CIMI-Ethiopia and NS of iron, zinc, magnesium, calcium, B-complex vitamins, vitamin A, protein, and energy were highly correlated (r = 0.85-0.97, p < 0.001). NS analysis identified a significant reduction in the mean intake of iron; zinc; magnesium; pantothenic acid; vitamin B1, B12, and D; protein; and energy in the lean wet season; however, calcium and vitamin A intake increased.

CONCLUSIONS

It has been found that CIMI-Ethiopia is a valid tool for estimating nutrient intakes at an individual level in Southern Ethiopia. The study demonstrated a decline in intakes of iron; zinc; magnesium; pantothenic acid; vitamin B1, B12, and D; protein; and energy in the lean wet season. This result provides some hint for fortification and supplementation programs that aim to combat maternal malnutrition in rural Southern Ethiopia.

Benefits of the Mediterranean diet: Epidemiological and molecular aspects

More than 50 years after the Seven Countries Study, a large number of epidemiological studies have explored the relationship between the Mediterranean diet (MD) and health, through observational, case-control, some longitudinal and a few experimental studies. The overall results show strong evidence suggesting a protective effect of the MD mainly on the risk of cardiovascular disease (CVD) and certain types of cancer. The beneficial effects have been attributed to the types of food consumed, total dietary pattern, components in the food, cooking techniques, eating behaviors and lifestyle behaviors, among others. The aim of this article is to review and summarize the knowledge derived from the literature focusing on the benefits of the MD on health, including those that have been extensively investigated (CVD, cancer) along with more recent issues such as mental health, immunity, quality of life, etc. The review begins with a brief description of the MD and its components. Then we present a review of studies evaluating metabolic biomarkers and genotypes in relation to the MD. Other sections are dedicated to observation and intervention studies for various pathologies. Finally, some insights into the relationship between the MD and sustainability are explored. In conclusion, the research undertaken on metabolomics approaches has identified potential markers for certain MD components and patterns, but more investigation is needed to obtain valid measures. Further evaluation of gene-MD interactions are also required to better understand the mechanisms by which the MD diet exerts its beneficial effects on health. Observation and intervention studies, particularly PREDIMED, have provided invaluable data on the benefits of the MD for a wide range of chronic diseases. However further research is needed to explore the effects of other lifestyle components associated with Mediterranean populations, its environmental impact, as well as the MD extrapolation to non-Mediterranean contexts.

A New Analysis on Self-Control in Intertemporal Choice and Mediterranean Dietary Pattern

This paper completes Muñoz Torrecillas et al. (1) results and conclusions investigating the relationship between adherence to healthy dietary habits, specifically the Mediterranean Diet (hereinafter, MD), and impulsivity in intertemporal choices. Impulsivity can be defined as the strong preference for small immediate payoffs over larger delayed payoffs, and in the original study this behavior was captured by the parameter k (discount rate of the hyperbolic discount function), calculated using an automated scoring mechanism. Adherence to MD was measured by the KIDMED index and then grouped into three levels: high, medium, and low. While the authors observed that individuals in the high adherence group had the shallowest discounting and individuals in the low adherence group had the steepest discounting, the data were not statistically analyzed in depth. Therefore, the purpose of the present paper is to propose a preliminary quantitative model for this relationship and evaluate its significance. Tests revealed a significant interaction between adherence to MD and magnitude of delayed rewards when predicting discount rates. Specifically, the degree to which impulsivity decreases as adherence to MD increases is strongly influenced by delayed rewards of smaller magnitude. These findings are consistent with the authors' claims that healthy dietary habits may be closely linked with greater self-control when payoffs are small, and thus warrant further examination. The results do not indicate causality though, so future studies could also investigate the directions of this relationship as a means of developing behavioral interventions.

Comparison of The Sleep Status and Nutrition Habits of the Students in The First and Second Education of Trakya University Faculty of Economics and Administrative Sciences

Aim: Sleep duration and quality affect the food consumption and weight gain; also food consumption affects the sleep. It was found that the university students have very serious problems in terms of nutrition and sleep patterns. The aim of this study is to investigate the sleep status and eating habits of the students in the first and secondary education of university. Methods: This cross-sectional study was carried out with 130 students from first and 108 students from secondary education of the university. Height, weight, waist and hip measurements of each participant were taken. Demographic characteristics, habits, dietary behaviors and sleep patterns of the participants were evaluated. Results: It was determined that the students in the secondary education had a significantly higher rate of eating more at nights and skipped meals during the day. When all the participants were considered, there was a opposite and weak opposite correlation in the between the Pittsburgh Sleep Quality Index and Mediterranean Diet Quality Index scores. According to the Mediterranean Diet Quality Index, the ratio of those with very low dietary quality was 51.5% for the students in the first education and 61.1% for the students in the second education. Conclusion: It was found that, secondary education students eat more at night than first education students; they skip meals during the day and had a very low diet quality according to Mediterranean Diet Quality Index. In order to prevent these problems, regular sleep and nutrition training should be given to the students of secondary education.

Effect of Oral Administration of a Mixture of Probiotic Strains on SCORAD Index and Use of Topical Steroids in Young Patients With Moderate Atopic Dermatitis: A Randomized Clinical Trial

Importance

Oral intake of new probiotic formulations may improve the course of atopic dermatitis (AD) in a young population.

Objective

To determine whether a mixture of oral probiotics is safe and effective in the treatment of AD symptoms and to evaluate its influence on the use of topical steroids in a young population.

Design, Setting, and Participants

A 12-week randomized, double-blind, placebo-controlled intervention trial, from March to June 2016, at the outpatient hospital Centro Dermatológico Estético de Alicante, Alicante, Spain. Observers were blinded to patient groupings. Participants were children aged 4 to 17 years with moderate atopic dermatitis. The groups were stratified and block randomized according to sex, age, and age of onset. Patients were ineligible if they had used systemic immunosuppressive drugs in the previous 3 months or antibiotics in the previous 2 weeks or had a concomitant diagnosis of intestinal bowel disease or signs of bacterial infection.

Interventions

Twelve weeks with a daily capsule containing freeze-dried powder with 109 total colony-forming units of the probiotic strains Bifidobacterium lactis CECT 8145, B longum CECT 7347, and Lactobacillus casei CECT 9104 and maltodextrin as a carrier, or placebo (maltodextrin-only capsules).

Main Outcomes and Measures

SCORAD index score and days of topical steroid use were analyzed.

Results

Fifty children (26 [50%] female; mean [SD] age, 9.2 [3.7] years) participated. After 12 weeks of follow-up, the mean reduction in the SCORAD index in the probiotic group was 19.2 points greater than in the control group (mean difference, -19.2; 95% CI, -15.0 to -23.4). In relative terms, we observed a change of -83% (95% CI, -95% to -70%) in the probiotic group and -24% (95% CI, -36% to -11%) in the placebo group (P < .001). We found a significant reduction in the use of topical steroids to treat flares in the probiotic arm (161 of 2084 patient-days [7.7%]) compared with the control arm (220 of 2032 patient-days [10.8%]; odds ratio, 0.63; 95% CI, 0.51 to 0.78).

Conclusions and Relevance

The mixture of probiotics was effective in reducing SCORAD index and reducing the use of topical steroids in patients with moderate AD.

Trial Registration

clinicaltrials.gov Identifier: NCT02585986.

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.

Improved Diet Quality and Nutrient Adequacy in Children and Adolescents with Abdominal Obesity after a Lifestyle Intervention

High rates of childhood obesity require integral treatment with lifestyle modifications that achieve weight loss. We evaluated a lifestyle intervention on nutrient adequacy and diet quality in children and adolescents with abdominal obesity. A randomized controlled trial was performed on 107 participants, assigned either to a usual care group or to an intensive care group that followed a moderate hypocaloric Mediterranean diet and received nutritional education. Intake adequacy was evaluated using Dietary Reference Intakes and diet quality through the Diet Quality Index for Adolescents (DQI-A), the Healthy Lifestyle Diet-Index (HLD-I) and the Mediterranean Diet Quality Index (KIDMED). Both groups achieved a significant reduction in BMI standard deviation score (BMI-SDS), glucose and total cholesterol levels. Intake of Calcium, Iodine and vitamin D were higher in the intensive care group, with enhanced compliance with recommendations. Higher dietary scores were associated with lower micronutrient inadequacy. DQI-A and HLD-I were significantly higher in the intensive care group vs. usual care group after the treatment. In conclusion, we observed that an intensive lifestyle intervention was able to reduce BMI-SDS in children with abdominal obesity. Furthermore, participants significantly improved dietary indices getting closer to the nutritional recommendations. Therefore, these diet quality indices could be a valid indicator to evaluate micronutrient adequacy.

Association of eating behaviors, lifestyle, and maternal education with adherence to the Mediterranean diet in Spanish children

BACKGROUND

The Mediterranean diet serves as a proxy of a high-quality diet. Although several factors are known to affect a child's ability to follow a high-quality diet, no prospective data are available on factors that influence adherence to a Mediterranean diet among children. Our objective was to investigate the association of Mediterranean diet adherence with eating behaviors, lifestyle habits, and maternal education in a prospective cohort of children.

METHODS

The present prospective cohort analysis included 1639 children aged 8-10 years. The study was carried out during two academic years, 2012/2014, with an average follow-up of 15 months. Eating behaviors, physical activity, and adherence to Mediterranean diet were estimated by the Dutch Eating Behavior Questionnaire for Children, the Physical Activity Questionnaire for Children, and the KIDMED index, respectively.

RESULTS

Multivariate linear regression analysis adjusted for sex, age, maternal education, baseline adherence to the Mediterranean diet, and intervention group revealed a significant (p < 0.01) inverse association of external eating and screen time with adherence to the Mediterranean diet at follow-up (mean of 15 months). The opposite association was found for meal frequency and physical activity (p < 0.02). A high level of maternal education increased the odds of a child's high adherence to the Mediterranean diet (OR = 1.56 CI 1.13; 2.14) compared to peers whose mothers had only a primary education.

CONCLUSIONS

Screen time, physical activity, meal frequency, and external eating predict adherence to the Mediterranean diet independently of baseline diet quality. Maternal education level is an important prospective determinant for the adherence to the Mediterranean diet.

TRIAL REGISTRATION NUMBER

ISRCTN68403446.

A Retrospective Cross-Sectional Population-Based Study on Prenatal Levels of Adherence to the Mediterranean Diet: Maternal Profile and Effects on the Newborn

The Mediterranean diet (MD) is a dietary pattern with important benefits. The objectives of this study were to assess the adherence to the MD among pregnant women in Valencia (Spain) and characterize the pregnant women according to their level of adherence. Finally, we aimed to examine the role of MD adherence during pregnancy in the anthropometric development of the newborn. The study included 492 pregnant women who were followed at La Fe Hospital in 2017. The self-administered "Kidmed" questionnaire for data collection on dietary information evaluation was used and a clinical history review of mothers and newborns was performed. Two groups of mothers were identified: those with low adherence (LA) and optimal adherence (OA). The study revealed that 40.2% of the women showed LA to the MD. The newborns born to these women presented a higher risk of being small for gestational age (SGA) {adjusted odds ratio (aOR) = 1.68; 95% confidence interval (CI) 1.02⁻5.46} when adjusting for parental body mass index (BMI) and multiple gestation, but not when adjusting for all significant possible confounders (aOR = 2.32; 95% CI 0.69⁻7.78). The association between MD and SGA was not significantly affected by the use of iron and folic acid supplements (aOR = 2.65; 95% CI 0.66⁻10.65). The profile of the pregnant woman with LA is that of a young smoker, with a low level of education and a low daily intake of dairy products. These results suggest that LA to the MD is not associated with a higher risk of giving birth to a SGA newborn.

Self-Control in Intertemporal Choice and Mediterranean Dietary Pattern

Background: The Mediterranean Diet (hereinafter MD) is considered a healthy dietary pattern. Adherence to this pattern can be assessed by means of the KIDMED test by which individuals are assigned an index and classified into three groups of adherence to MD: high, medium, and low. In addition, impulsivity or impatience in intertemporal choice has been defined as a strong preference for small immediate rewards over large delayed ones. Objective: This study examines the relationship between dietary habits, specifically Mediterranean dietary pattern, measured by the KIDMED index, and the exhibited impatience in intertemporal choices, by means of the parameter k (discount rate of the hyperbolic discount function). Methods: A sample of 207 university students answered a questionnaire based on two tests: the KIDMED test, to assess the degree of adherence to MD, and an intertemporal choice questionnaire, to assess impatience or impulsivity. Individuals were grouped depending on their KIDMED score and then the discount rate or impulsivity parameter was calculated for each group. Results: Discount rates were inversely related to the degree of adherence to MD. The values of overall k were 1.53, 1.91, and 3.71% for the groups exhibiting high, medium and low adherence to MD, respectively. We also found higher k-values for larger rewards (magnitude effect) in the three groups. Conclusion: High adherence to MD is related to less steep time discounting, which implies less impulsivity (more self-control) or lower discount rates. Conversely, low adherence to MD is related to steeper time discounting, which implies impulsivity or higher discount rates. These findings could be used to identify the target population where policy interventions are needed in order to promote healthier diet habits.

National nutrition surveys in Europe: a review on the current status in the 53 countries of the WHO European region

OBJECTIVES

The objectives of this study were (1) to determine the coverage of national nutrition surveys in the 53 countries monitored by the World Health Organization (WHO) Regional Office for Europe and identify gaps in provision, (2) to describe relevant survey attributes and (3) to check whether energy and nutrients are reported with a view to providing information for evidence-based nutrition policy planning.

DESIGN

Dietary survey information was gathered using three methods: (1) direct email to survey authors and other relevant contacts, (2) systematic review of literature databases and (3) general web-based searches. Survey characteristics relating to time frame, sampling and dietary methodology and nutrients reported were tabled from all relevant surveys found since 1990.

SETTING

Fifty-three countries of the WHO Regional Office for Europe, which have need for an overview of dietary surveys across the life course.

SUBJECTS

European individuals (adults and children) in national diet surveys.

RESULTS

A total of 109 nationally representative dietary surveys undertaken post-1990 were found across 34 countries. Of these, 78 surveys from 33 countries were found post-2000, and of these, 48 surveys from 27 countries included children and 60 surveys from 30 countries included adults. No nationally representative surveys were found for 19 of 53 countries, mainly from Central and Eastern Europe. Multiple 24hr recall and food diaries were the most common dietary assessment methods. Only 22 countries reported energy and nutrient intakes from post-2000 surveys; macronutrients were more widely reported than micronutrients.

CONCLUSIONS

Less than two-thirds of WHO Europe countries have nationally representative diet surveys, mainly collected post-2000. The main availability gaps lie in Central and Eastern European countries, where nutrition policies may therefore lack an appropriate evidence base. Dietary methodological differences may limit the scope for inter-country comparisons.

Ten-Year Trends (1999-2010) of Adherence to the Mediterranean Diet among the Balearic Islands' Adult Population

The aim of this work was to assess ten-year trends (1999-2010) of adherence to the Mediterranean dietary pattern (MDP) among the Balearic Islands' adult population. Two independent cross-sectional dietary surveys (1999-2000, n = 1200 and 2009-2010 n = 1388, including participants aged 16-65 years) were carried out in the Balearic Islands, Spain. Dietary habits were assessed by means of two 24 h diet recalls and a validated semi-quantitative food-frequency questionnaire that covers 145 food items. Adherence to the MDP was defined according to a score constructed considering the consumption of nine MDP characteristic components: high monounsaturated fatty acids:saturated fatty acids (MUFA:SFA) ratio, moderate ethanol consumption, high legumes, cereals and roots, fruits, vegetables, and fish consumption, and low consumption of meat and milk. Socio-economic status, education level, lifestyle factors and health status were also assessed. Adherence to the MDP was 43.1% (SD 5.8) in 1999-2000 and 44.6% (SD 8.3) in 2009-2010. Higher age was directly associated with higher adherence to the MDP, and this association was stronger in males than in females. Young generations and smokers showed the lowest adherence to MDP, whereas people with higher educational and socio-economic level, and who were physically active showed the highest adherence. According to the place of birth, the increase in the percentage of the adherence to the MDP was observed to be smaller among the Balearic Island's natives than among people born abroad. In 2009-2010, individuals in the MDP's fourth quartile were more likely to be older (aged 46-65 years), and were less likely to have a low occupational level, to have a light physical activity level and to be smoker than in 1999-2000. The adherence to the MDP has been stabilized and slightly recovered among the Balearic Islands' adult population in the last decade.

Dietary Calcium Intake and Adherence to the Mediterranean Diet in Spanish Children: The ANIVA Study

The aim of this study was to evaluate the relationship of dietary calcium intake with anthropometric measures, physical activity and adherence to the Mediterranean diet (MedDiet) in 1176 Spanish children aged 6-9 years. Data were obtained from "Antropometría y Nutrición Infantil de Valencia" (ANIVA), a cross-sectional study of a representative sample. Dietary calcium intake assessed from three-day food records was compared to recommended daily intakes in Spain. Anthropometric measures (weight and height) were measured according to international standards and adherence to the MedDiet was evaluated using the Mediterranean Diet Quality Index (KIDMED) test. For the total sample of children, 25.8% had inadequate calcium intake, a significantly higher prevalence in girls (p = 0.006) and inadequate calcium intake was associated with lower height z-score (p = 0.001) for both sexes. In girls, there was an inverse relationship between calcium intake and body mass index (p = 0.001) and waist/hip ratio (p = 0.018). Boys presented a polarization in physical activity, reporting a greater level of both physical and sedentary activity in comparison with girls (p = 0.001). Children with poor adherence to MedDiet, even if they consume two yogurts or cheese (40 g) daily, adjusted by gender, age, total energy intake, physical activity and father's level of education, are at risk of inadequate total calcium intake (odds ratio adjusted [ORa]: 3.36, 95% confidence interval [CI]: 1.13-9.94, p = 0.001). The intake of these dairy products was insufficient to cover calcium intake recommendations in this age group (6-9 years). It is important to prioritize health strategies that promote the MedDiet and to increase calcium intake in this age group.

Association of diet quality with dietary inflammatory potential in youth

Background: Diet plays a crucial role in the regulation of chronic inflammation. The sparse evidence available in adult populations indicates that diet quality is linked to the dietary inflammatory potential; however, this association has not been established in youth. Design: Data were obtained from a representative national sample of 2889 children and young people in Spain, aged 6-24 years. The dietary inflammatory potential was measured by the dietary inflammatory index (DII), and diet quality by three conceptually different measures: the Mediterranean Diet Quality Index for children and adolescents (KIDMED), energy density, and total dietary antioxidants capacity. Results: The mean DII was 1.96 ± 0.76 units Scoring for the KIDMED index and the total dietary antioxidant capacity significantly decreased (p < 0.001 and p = 0.030, respectively) across quintiles of the DII, whereas the opposite was true for energy density (p < 0.001). The effect size of these associations was strongest for energy density, followed by the KIDMED index and total dietary antioxidant capacity. Conclusion: A healthy diet characterized by high adherence to the Mediterranean diet, high total dietary antioxidant capacity, or low energy density was linked to greater anti-inflammatory potential of the diet, as measured by the DII.