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

Diet Quality Scores, Obesity and Metabolic Syndrome in Children and Adolescents: A Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

We aimed to examine the relationship between various diet quality scores and obesity and Metabolic Syndrome (MetS) in children and adolescents.

RECENT FINDINGS

Obesity and MetS, which increase the risk of type 2 diabetes and cardiovascular disease from childhood through adolescence, have been associated with adherence to various diet quality scores. A systematic search was performed in PubMed/Medline, Scopus, SciELO, Embase, and Cochrane, covering the period until March 2024. Two researchers evaluated 3,519 studies according to the inclusion criteria. Finally, 73 articles that analysed the relationship between diet quality scores and obesity and MetS were included, and 6 of them were included in a meta-analysis. Children younger than 12 years old showed statistically significant differences indicating a higher Mediterranean diet (MD) score adherence compared to those with a low score adherence for BMI (MD = 0.33 kg/m2, 95% CI: 0.01, 0.64) and WC values (MD = 1.21 cm, 95% CI: 0.50, 1.93). Additionally, in the meta-regression analysis, boys showed stronger associations for BMI, z-score BMI and WC (β = 19.82, 95% CI: 17.62, 22.03, β = 0.64, 95% CI: 0.33, 0.96 and β = 67.03, 95% CI: 57.29, 76.77, respectively). Studies in this review suggest an association between high adherence to different diet quality scores and low BMI. Meta-analysis assessing the association between adherence to the MD and BMI, and WC, showed a protective effect of the MD pattern against obesity outcomes. This systematic review and meta-analyses provided evidence on the effect of the diet quality on obesity and MetS in children and adolescents.

Children's perception of food parenting practices: adaptation and validation of the comprehensive feeding practices questionnaire in Chilean adolescents

Introduction

Assessment of the Comprehensive Feeding Practices Questionnaire in adolescents (CFPQ-Teen) is still limited, with no evaluation of the measurement invariance. The participants comprised 473 Chilean adolescents of both sexes from dual-income nuclear families. The aims of this study were: (1) to adapt to Spanish and validate a model of five-factor version the CFPQ-Teen; (2) to examine the psychometric properties, (3) to evaluate the measurement invariance according to the adolescents' gender; and (4) to compare the scores of each factor between female and male adolescents.

Methods

The instrument was translated, back-translated, and adapted from the CFPQ-Teen, confirming the equivalence, conceptual, and face validity in a pilot sample of 40 adolescents. An exploratory factor analysis was performed on the five-factor model of the CFPQ-Teen: Monitoring, Adolescent Control, Restriction for weight control, Parental Modeling, and Environment. The Environment factor was eliminated as a result.

Results

The confirmatory factor analysis presented good reliability, convergent, discriminant, and concurrent validity values. In addition, medium to high goodness-of-fit levels were obtained by eliminating an item from the Adolescent Control factor. These results confirm a final 20-item model representing four factors. The multigroup invariance analysis of the measurement model verified configural, metric, scalar, and partial strict invariance. No significant differences were found between females and males in the scores on the four factors.

Discussion

These results enable comparisons by sex on the perceptions of Food Parenting Practices from the analyzed factors, primarily within the context of the Chilean sample.

Younger age, higher father education level, and healthy lifestyle behaviors are associated with higher adherence to the Mediterranean diet in school-aged children

OBJECTIVES

This study aimed to assess adherence to the Mediterranean Diet (MDiet) in school-aged children in Turkey and explore the associated factors with high adherence to the MDiet.

METHOD

This cross-sectional was conducted with 2693 school-aged children. Sociodemographic, dietary, and lifestyle data were collected using a questionnaire. Mediterranean Diet Quality Index (KIDMED) was used to evaluate adherence to the MDiet. Body weight, height, neck, waist, and hip circumference were measured. Dietary intake was assessed with a 24-h food consumption record.

RESULTS

Of the 2693 children, 29.5% had high, 53.9% had moderate, and 16.6% had low adherence to the MDiet. Primary school children had significantly higher adherence to the diet than secondary school children. Adherence to the MDiet was higher in children whose fathers were university graduates. There were no significant differences in sex, body mass index (BMI), or anthropometric measurements according to MDiet adherence. The high adherence group had a significantly higher intake of protein, fiber, vitamins C, B1, B6, B2, folate, polyunsaturated fatty acids, zinc, potassium, and calcium, but lower carbohydrate intake compared with the low/moderate adherence group. Higher adherence to the MDiet was associated with adequate sleep duration (≥9 to <12 h) (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.24-2.78), whereas poor/moderate adherence was associated with age (OR, 0.80; 95% CI, 0.73-0.87) and screen time (OR, 0.50; 95% CI, 0.40-0.63). Children who reported engaging in regular physical activity were more likely to have higher MDiet adherence (OR, 1.46; 95% CI, 1.16-1.85).

CONCLUSION

The results of this study showed that >50% of the children presented moderate MDiet adherence. Younger age, adequate sleep duration, engaging in regular physical activity, less screen time, and higher education level of fathers were associated with higher adherence to the diet.

Health-Related Quality of Life in Childhood and Adolescence: The Interrelation with Level of Adherence to Mediterranean Diet and Dietary Trajectories: Highlights from the DIATROFI Program (2021-2022)

Children's dietary habits can have a key role in contributing to an improvement in their Health-Related Quality of Life (HRQoL). This study aims to assess the connection between Mediterranean diet adherence and HRQoL in a sample of Greek students, utilizing data from the DIATROFI program. The parents of 3774 students (mean age 7.8 (2.6) years) reported their children's HRQoL and level of adherence to the Mediterranean dietary pattern at the beginning and end of the 2021-2022 school year. At baseline, most students' adherence was characterized as moderate (55.2%) or high (25.1%). Students with moderate or high adherence tο the Mediterranean diet were less likely to report a total HRQoL below the median at baseline (OR = 0.56, 95%CI = 0.44, 0.70), along with all its dimensions (physical, emotional, social, and school functions). A one-unit improvement in KIDMED score _{(beginning-end of schoolyear)} was associated with the likelihood of an improvement in total HRQoL _{(beginning-end of schoolyear)} (OR = 1.09, 95%CI = 1.02, 1.17), emotional (OR = 1.09, 95%CI = 1.02, 1.17), and social functions (OR = 1.13, 95%CI = 1.05, 1.22), but not with physical and school functions. The health benefits of the Mediterranean diet in children may not be limited to disease prevention but also extend to their overall wellbeing.

Contributions of Work-to-Family Enrichment to Parental Food Monitoring and Satisfaction with Food-Related Life during the COVID-19 Pandemic in Dual-Earner Parents and Their Adolescent Children

Evidence shows that numerous family-related variables influence parents’ use of different food parenting practices (FPP), but less is known about the influence of parents’ work-related variables on their use of FPP, and their own and their children’s outcomes in the food domain. To fill this gap, the present study explored intra-individual and inter-individual effects between work-to-family enrichment (WtoFE), parents’ monitoring practices, the adolescent’s perception of their parents’ monitoring practices, and the three family members’ satisfaction with food-related life (SWFoL), in different-sex dual-earner parents with adolescent children. The mediating role of monitoring between WtoFE and SWFoL was also tested. A sample of 430 different-sex dual-earner parents and one of their adolescent children (average age 13.0 years, 53.7% female) were recruited in Rancagua, Chile, during March and June 2020. The three family members answered the monitoring dimension of the Compressive Feeding Practices Questionnaire and the Satisfaction with Food-Related Life Scale. Parents answered a measure of WtoFE based on the Work−Home Interaction Survey. Analyses were conducted using the Actor−Partner Interdependence Model and structural equation modelling. Results showed a positive association between WtoFE and SWFoL, directly (p < 0.001) and through monitoring in fathers (95% confidence interval [0.010, 0.097], actor effect). The father’s (p = 0.042) and mother’s (p = 0.006) WtoFE was positively associated with their adolescent’s SWFoL (partner effects). The father’s (p = 0.002) and mother’s (p = 0.036) WtoFE were positively associated with their own monitoring (actor effect), while only the father’s WtoFE (p = 0.014) was positively associated with the adolescent’s perception of their parents’ monitoring (partner effect). The father’s (p = 0.018) and mother’s (p = 0.003) monitoring, as well as the adolescents’ perception of their parents’ monitoring (p = 0.033), were positively associated with their own SWFoL (actor effects), while the mother’s monitoring (p = 0.043) was also associated with the father’s SWFoL (partner effects). Findings suggest that both parents’ WtoFE improved their monitoring practices, which, in turn, improved their own SWFoL and their adolescent child’s SWFoL. Policymakers and organizations must aim to promote the WtoFE of working parents.

Healthy and Sustainable Dietary Patterns in Children and Adolescents: A Systematic Review

The need for adherence to a healthy and sustainable dietary pattern in the pediatric stage is discussed worldwide, being linked to a progressive incidence of noncommunicable diseases in adulthood. The aims of this systematic review were to summarize the healthy and/or sustainable dietary patterns, defined a priori, described in the literature for use during the pediatric stage; to evaluate the adherence to these dietary patterns; and identify the health-related benefits associated with adherence to these patterns. A literature search was carried out on Medline, Scopus, and Web of Science from 2010 up to 2021, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 128 articles were included according to the following criteria: participants 2-17 y old, healthy and/or sustainable dietary patterns defined by an a priori methodology; articles written in English or Portuguese; and published since 2010. Fifty instruments with 14 adaptations that measure adherence to healthy and/or sustainable dietary patterns in children and adolescents were found. The Mediterranean Diet was the most studied dietary pattern. Adherence to healthy and/or sustainable dietary patterns has wide variations worldwide. Most of the instruments described have been little studied at pediatric ages, reducing the ability to extrapolate results. Higher adherence to these dietary patterns was associated with lower body fat, waist circumference, blood pressure, and metabolic risk. There is no consensus regarding the association with BMI. No studies have proofs of the sustainability characteristics of these instruments, it being necessary to produce a new sustainable instrument or test the association of the previous ones with, for example, the ecological footprint. Further validations of these instruments in each country and more prospective studies are needed to establish temporal relations with health-related outcomes. This systematic review was registered at www.crd.york.ac.uk/prospero/ as CRD42020221788.

Precision nutrition based on phenotypical traits and the (epi)genotype: nutrigenetic and nutrigenomic approaches for obesity care

PURPOSE OF REVIEW

The purpose of this article is to rationally review and critically appraise the current knowledge in the most relevant nongenetic and genetic factors influencing obesity predisposition. This information may be translated into the implementation of personalized nutrition approaches involving precision nutrigenetic and nutrigenomic strategies for obesity monitoring and weight management.

RECENT FINDINGS

The importance and influence of several nongenetic contributors to obesity onset and individual responses to weight-loss interventions have been highlighted including the role of age, sex or perinatal feeding and others related to an individual's lifestyle and modifiable. Nutrigenetic studies have analysed potential interactions between polymorphisms influencing energy homeostasis/body composition and dietary factors in relation to adiposity phenotypes and therapy responsiveness. A second approach comprises the Nutrigenomic analysis of gene expression modifications in response to the consumption of specific nutrients or dietary bioactive compounds, which may involve epigenetic mechanisms including deoxyribonucleic acid methylation and micro-ribonucleic acid expression profiles.

SUMMARY

Taken together, these findings encompass the importance of taking into account up-to-date advances in Nutrigenetic and Nutrigenomic hallmarks, globally analysing the risk of weight gain and related outcomes after following nutrition counselling, this contributing to improve obesity care considering phenotypical traits and the genetic make-up for precision obesity care.

Zapico A, Gusi N, Aznar S, Alcaraz PE, González-Valeiro M, Serra-Majem L, Terrados N, Tur JA, Segú M, Lassale C, Homs C, Oses M, González-Gross M, Sánchez-Gómez J, Jiménez-Zazo F, Marín-Cascales E, Sevilla-Sánchez M, Herrera-Ramos E, Pulgar S, Bibiloni MDM, Sancho-Moron O, Schröder H, Barón-López FJ. Screen Time and Parents' Education Level Are Associated with Poor Adherence to the Mediterranean Diet in Spanish Children and Adolescents: The PASOS Study

The aim of this study is to evaluate if screen time and parents' education levels are associated with adherence to a Mediterranean dietary pattern. This cross-sectional study analyzed a representative sample of 3333 children and adolescents (8 to 16 years) included in the Physical Activity, Sedentarism, lifestyles and Obesity in Spanish youth (PASOS) study in Spain (which ran from March 2019 to February 2020). Data on screen time (television, computer, video games, and mobile phone) per day, Mediterranean diet adherence, daily moderate or vigorous physical activity, and parents' education levels were gathered using questionnaires. A descriptive study of the variables according to sex and parents' education level was performed. Logistic regression models (adjusted by sex and weight status) were fitted to evaluate the independent association between screen time and Kids' level of adherence to the Mediterranean diet (KIDMED) index, as well as some of its items. A greater amount of screen time was associated with worse adherence to the Mediterranean diet; a lower consumption of fruit, vegetables, fish, legumes, and nuts; and a greater consumption of fast food, sweets, and candies. A lower parents' education level was associated with worse adherence to the Mediterranean diet. It is necessary to promote the responsible, limited use of screen time, especially in children with parents with a lower education level.

Adherence to the Mediterranean Diet in Maltese Adults

Background: Populations living in Mediterranean islands are experiencing a nutrition transition process from traditional to Westernized dietary patterns. No information on this matter regarding individuals living in Malta have been published to date. The aim of this study was to assess the level of adherence of the Maltese people to the Mediterranean diet and which factors were associated with it. Methods: A nationwide cross-sectional study was conducted in the island of Malta between 2014 and 2016. A literature-based Mediterranean diet adherence score was used to assess the level of adherence to the dietary pattern. Results: Out of 3947 adults, the overall Mediterranean diet adherence score mean was 7.19 (SD 1.91): being female, non-smoker, and having older age was associated with higher adherence to the Mediterranean diet. Less clear pattern of association was found for educational and occupational status, for which medium educational level and a high occupational level were associated with lower adherence to Mediterranean diet. Higher adherence was finally associated with consumption of healthier food groups (more rice and dark bread and less pasta and white bread; more all plant-food groups and fish, less animal-food sources, including fast foods; more light cheeses and yogurt were more frequently consumed among higher adherent individuals in spite of regular ones). Conclusions: Adherence to the Mediterranean diet in Malta is lower than in those of populations living in companion Mediterranean islands. Given the lack of data on this topic, further studies should be conducted among the Maltese people and public health nutrition interventions should be planned to improve current eating habits toward more traditional dietary patterns.

The Influence of Adherence to the Mediterranean Diet among Children and Their Parents in Relation to Childhood Overweight/Obesity: A Cross-Sectional Study in Greece

Background: Childhood overweight/obesity constitutes a serious issue, as may cause several health problems. The main characteristics of the Mediterranean Diet have been acknowledged as the most appropriate shield mainly for obesity. Methods: The study was performed on 1728 primary students, during school years 2014-2016, in Greece. Children and their parents completed questionnaires which included dietary and lifestyle habits. The KIDMED score (range -4 to 12) was used to assess the level of childhood adherence to the Mediterranean diet and the MedDietScore (range 0 to 55) was used to assess parental adherence. For the purposes of this analysis, the examined sample was n = 875 of students (522 girls)-parents pairs whose level of adherence to the Mediterranean diet was able to be evaluated. Results: The prevalence of overweight and obesity in the Greek sample was 26.0%, according to International Obesity Task Force (IOTF) cutoff criteria for children. KIDMED Score was significantly lower in children with overweight/obesity compared with children with normal weight (4.65 ± 2.14 vs. 5.16 ± 2.05, p = 0.002). The multiadjusted analysis revealed that children close to the Mediterranean diet were less likely to be overweight/obese (p < 0.001), either parents are away from or close to the Mediterranean diet. Conclusions: This study revealed that children's adherence to the Mediterranean diet was inversely associated with weight status either parents are away from or close to this dietary pattern. Future interventions against childhood obesity have to take into consideration the crucial importance of familial aggregation of healthy food choices and interfamily influences in the home environment on children's weight status.

Clustering of Dietary Patterns and Lifestyles Among Spanish Children in the EsNuPI Study †

Dietary patterns (DPs) are known to be tied to lifestyle behaviors. Understanding DPs and their relationships with lifestyle factors can help to prevent children from engaging in unhealthy dietary practices. We aimed to describe DPs in Spanish children aged 1 to <10 years and to examine their associations with sociodemographic and lifestyle variables. The consumption of toddler and young children milk formulas, enriched and fortified milk within the Spanish pediatric population is increasing, and there is a lack of evidence whether the consumption of this type of milk is causing an impact on nutrient intakes and if they are helping to reach the nutrient recommendations. Within the Nutritional Study in the Spanish Pediatric Population (EsNuPI), we considered two study cohorts and three different age groups in three year-intervals in each of them. The study cohort included 740 children in a representative sample of the urban non-vegan Spanish population and 772 children in a convenience cohort of adapted milk consumers (AMS) (including follow-on formula, toddler’s milk, growing up milk, and fortified and enriched milks) who provided information about sociodemographics, lifestyle, and dietary habits; a food frequency questionnaire was used for the latter. Principal component analysis was performed to identify DPs from 18 food groups. Food groups and sociodemographic/lifestyle variables were combined through a hierarchical cluster algorithm. Three DPs predominated in every age group and study sample: a palatable energy-dense food dietary pattern, and two Mediterranean-like DPs. However, children from the AMS showed a predominant dietary pattern markedly related to the Mediterranean diet, with high consumption of cereals, fruits and vegetables, as well as milk and dairy products. The age of children and certain lifestyle factors, namely level of physical activity, parental education, and household income, correlated closely with the dietary clusters. Thus, the findings provide insight into designing lifestyle interventions that could reverse the appearance of unhealthy DPs in the Spanish child population.