Background/Objectives: This paper aims to assess the unhealthy dietary habits and sedentary behaviours among adolescents and young adults simultaneously. Methods: The sample consists of 682 participants aged 10-24 years old (58.9% males and 68.2% aged 15-19 years old), recruited for the ALIMA (ALImentazione Multiculturale negli Adolescenti) study in both secondary schools and youth aggregation centres, located in Rome. The study utilizes structured questionnaires to gather data on anthropometric measurements, eating habits, alcohol consumption, physical activity, and sedentary behaviours. Data are analyzed by using the Pearson chi-squared test. Results: Excessive screen time (>3 h/day) and inadequate dietary habits (insufficient consumption of fruit, vegetables, and legumes, skipping breakfast, and a high consumption of sugar-sweetened beverages and alcohol) are observed in the total sample, but mainly in older adolescents aged 15-19 years old. The adherence to the MD, measured via the KIDMED index, is significantly different among the three age groups (p = 0.001); 47.8% of the sample has a medium adherence, while among those with a low adherence, the highest percentage is represented by older adolescents (39.8%); those with foreign-born parents have healthier diets, whereas lower parental education correlates with unhealthy behaviours. Conclusions: These results highlight the need for targeted interventions tailored to adolescents and young adults to encourage healthier lifestyle choices.

Despite the widespread interest in overweight/obese children and adolescents, there is a lack of bibliometric research on the factors influencing eating behaviors.

Collated and screened research papers published between 2003 and 2023 on eating behaviors in children and adolescents affected by overweight or obesity, searched on January 1, 2024. The primary data, comprising complete records and referenced citations of publications, was extracted from the Web of Science Core Collection. Analysis of data using Bibliometrix of R package, CiteSpace, and VOSviewer.

A total of 2,142 articles were included. The United States had the most publications in the field and was also the center point for world collaborations. Harvard University had the most affiliated publications, while Luis Moreno was the most prolific author. NUTRIENTS was the most published journal. High-frequency keywords included Children, overweight, physical activity, body mass index, and childhood obesity. Research trends include Epidemiology and Environment factors of obesity; Health risks associated with childhood obesity; Key eating habits and interventions for childhood obesity; Prevention and treatment of childhood and adolescent obesity.

This research provides a comprehensive overview of global trends and key areas in studying dietary behaviors among overweight/obese children and adolescents. It offers a detailed summary of recent advancements, emphasizing this field's critical principles and practices. By exploring these developments, the study highlights the growing importance of this research within global healthcare and suggests pathways for future research and applications.

Background/Objectives: The cultural and socioeconomic changes to which societies are exposed can alter individuals' lifestyles and dietary habits. The nutritional patterns of Mediterranean countries may also be affected by these factors at varying levels, depending on the changing social characteristics of the countries. This study aimed to determine Mediterranean diet (MedDiet) adherence among family members from four Mediterranean countries (Türkiye, Spain, Italy, and Lebanon). Methods: The survey was structured around sociodemographic data, family relationships, the Mediterranean diet adherence screener (MEDAS), the Mediterranean lifestyle index (MEDLIFE), the Mediterranean diet quality index (KIDMED), and the obstacles and drivers of MedDiet adherence. Results: The data were obtained from adults (n = 812), with the contribution of their children (n = 500) if they had any. According to the MEDAS, 22% of the adults strongly adhered to the MedDiet. Similar results were obtained when Mediterranean lifestyle adherence was analyzed using the MEDLIFE score, with 20% of the adults presenting a strong adherence, while significantly stronger adherence was found in Lebanon than in the other countries. Regarding the children and adolescents, around 30% presented strong adherence to the MedDiet. Price, availability, and accessibility were significant obstacles, whereas the perceptions of health and diet quality were identified as the drivers of the MedDiet. Conclusions: Overall, our results highlight the need for national policies to reduce the economic burden of healthy food options while encouraging equitable access to re-popularize the MedDiet pattern. Future research should focus on intervention strategies tailored to different age groups and socioeconomic backgrounds, the long-term impact of family-based strategies, and the cultural influences on MedDiet adherence.

Background/Objectives: There is a limited body of evidence regarding dietary intake in children with inflammatory bowel disease despite increasing research about the nutritional implications in the disease pathogenesis. Functional abdominal pain disorders (FAPDs) are also chronic disorders marked by chronic abdominal pain, currently described with the ROME IV criteria. This study was aimed to investigate the adherence to healthy eating habits in an inflammatory bowel disease pediatric population when compared to a matched population with functional abdominal pain gastrointestinal disorders. Methods: We performed a single centre study focused on dietary patterns in children with IBD and FAPDs between January 2021 and April 2024. Data collected included general information, disease phenotype, and the KIDMED index regarding healthy eating. Results: The final analysis was based on full data from the KIDMED index available for 122 (57 vs. 65) participants. Overall, the average KIDMED score did not vary significantly between the study population, meaning 6.89 ± 2.33 for the IBD group and 7.11 ± 2.67 for FAPDs group, p = 0.34. In the same KIDMED index group, mean values were higher for FAPDs patients, but results differ statistically significant only for "medium" adherence to healthy diet, showing that larger proportion of IBD patients were previously exposed to non-healthy diets: 8.99 vs. 11.1, p = 0.45, 5.02 vs. 6.92, p = 0.05, 2.89 vs. 2.56, p = 0.43, for group 1, 2, and 3, respectively. Conclusions: This study showed in our cohort that overall adherence to a healthy pattern diet is poor prior to diagnosis of different gastrointestinal pathologies in children.

Previous studies have examined the relationships between some eating distractions and diet quality in the young population. However, to our knowledge, no study has analyzed the associations between multiple eating distractions (e.g., using a mobile phone, watching television [TV], eating while standing) and diet quality, particularly in terms of ultra-processed food (UPF) consumption and adherence to the Mediterranean diet (MedDiet) among adolescents. The objective of the current study was to analyze the relationships of eating distractions with UPF consumption and adherence to the MedDiet in a sample of Spanish adolescents. This cross-sectional study used data from 826 adolescents aged 12-17 years from the Eating Healthy and Daily Life Activities study in Spain. The following eating distractions were assessed via a self-report questionnaire: "(1) eating while talking on the phone/sending short message service [SMS]/emails or using social networks", (2) watching TV while dinner, and (3) eating while standing". The Mediterranean Diet Quality Index for children and adolescents (KIDMED) was utilized to evaluate adherence to the MedDiet. A self-administered food frequency questionnaire, previously validated for the Spanish population, was used to assess UPF consumption. The associations of eating distractions with UPF consumption and MedDiet adherence were analyzed via generalized linear models. The models were adjusted for sex, age, socioeconomic status, body mass index, physical activity, sedentary behavior, and sleep duration. A significant association was found, with a higher eating distraction score corresponding to greater UPF consumption (unstandardized beta coefficient [B] = 71.25; 95% confidence interval [CI] 34.69-107.82; p < 0.001). Furthermore, a higher eating distraction score was associated with a lower KIDMED score (B - 0.29; 95% CI - 0.39 to - 0.18; p < 0.001). Individually, for grams of UPFs consumed, a significant association was observed for eating while using a phone or social network, which was linked to higher UPF consumption (B = 120.70; 95% CI 57.83-183.57; p < 0.001). However, the associations for eating while watching TV (B = 49.60; 95% CI - 9.01 to 108.21; p = 0.098) and eating while standing (B = 63.66; 95% CI - 37.92 to 165.25; p = 0.220) did not reach statistical significance. For KIDMED score, all the eating distractions were associated with a significant decrease, with the largest effect observed for phone or social network use (B = - 0.44; 95% CI - 0.62 to - 0.26). Watching TV (B = - 0.18; 95% CI - 0.35 to - 0.01; p = 0.037) and eating while standing (B = - 0.42; 95% CI - 0.71 to - 0.13; p = 0.004) also showed significant negative associations. Although diet quality is influenced by multiple factors, eating distractions may negatively impact adolescents by increasing UPF consumption and reducing adherence to the MedDiet. These findings underscore the importance of understanding the role of the eating environment in shaping healthy dietary habits.

Proper nutrition represents 1 of the domains of adolescents' well-being. In this context, the Mediterranean diet (MD), as a healthy, traditional, and sustainable dietary pattern, plays a crucial role in promoting adequate growth and preventing chronic noncommunicable diseases.

The currently available evidence on the effects of adherence to the MD (AMD) in association with several physical health outcomes in adolescence is summarized in this review.

Five electronic databases were searched.

Systematic reviews with or without meta-analysis of observational studies and randomized clinical trials, published in English during 2013-2022, and that assessed the health impact of AMD among adolescents were eligible.

Details on study design, methods, population, assessment of dietary patterns, health outcomes, and main results were extracted.

The search yielded 59 references after removal of duplicates. Applying PICOS criteria, 4 systematic reviews and 3 meta-analyses ultimately were included in this review. The AMD was evaluated in association with overweight/obesity and adiposity in 2 studies, musculoskeletal health in another 2, inflammation in 1 study, and cardiometabolic health in 1 study. The seventh review examined all mentioned health outcomes (overweight and obesity, musculoskeletal health, inflammation, and cardiometabolic health) in relation to AMD.

Overall, this umbrella review showed limited evidence and a lack of consistency about the relation between AMD and health outcomes of interest in adolescence, indicating the need for more studies to better understand it.

PROSPERO registration no. CRD42023428712.

Background/Purpose: To our knowledge, no previous study has analyzed the associations between self-efficacy and adherence to the Mediterranean diet (MedDiet) in adolescents, nor have sex-based differences in this relationship been examined. The aim of the current study was to examine the relationship between self-efficacy and MedDiet adherence in Spanish adolescents. Methods: This research was cross-sectional and involved 619 adolescents (56.5% girls) who were part of the Eating Habits and Activities of Daily Living (EHDLA) project. Self-efficacy was assessed using a 10-item scale (general self-efficacy scale), which yielded scores ranging from 20 to 100 points. The Mediterranean Diet Quality Index for Children and Adolescents (KIDMED), which consists of a 16-item questionnaire with scores ranging from -4 to 12, was used to evaluate adherence to the MedDiet. Unhealthy behaviors related to the MedDiet were assigned a score of -1, whereas healthy behaviors received a score of +1. Results: Overall, for each 20-point increase in self-efficacy, boys had a greater non-significant likelihood of having optimal MedDiet adherence (1.33%, 95% confidence interval [CI] -5.15 to 7.82, p = 0.687). Conversely, girls had a greater significant likelihood of having optimal MedDiet adherence per further point in self-efficacy (7.40%, 95% CI 2.28 to 12.53, p = 0.005). Individually, among boys, a 20-point increase in self-efficacy was associated with a 4.8% higher probability of having a dairy product for breakfast (95% CI 0.2 to 9.4, p = 0.042). Among girls, the same increase in self-efficacy was linked to a greater probability of consuming fruit or fruit juice daily (6.8%, 95% CI 2.2 to 11.4, p = 0.004), eating a second fruit every day (8.6%, 95% CI 3.4 to 13.8, p = 0.001), consuming fish regularly (6.2%, 95% CI 1.1 to 11.2, p = 0.017), enjoying pulses and eating them more than once a week (4.5%, 95% CI 0.3 to 8.8, p = 0.035), having cereals or grains for breakfast (5.4%, 95% CI 0.4 to 10.5, p = 0.035), and regularly consuming nuts (5.2%, 95% CI 0.2 to 10.2, p = 0.041). Additionally, increases in self-efficacy was associated with a 5.0% lower probability of skipping breakfast (95% CI -8.8 to -1.1, p = 0.012). Conclusions: Our results revealed a significant association between self-efficacy and MedDiet adherence among girls, whereas the relationship between self-efficacy and the MedDiet in boys was not significant. These results suggest that interventions aimed at improving adolescent dietary patterns should consider incorporating strategies to increase self-efficacy, potentially with sex-specific approaches.

Background: The increasing rates of childhood obesity (CO) are an ongoing problem. We focused on the adherence to the Mediterranean diet (MD), physical activity, and sleep habits of preschool children in order to investigate the relationship between lifestyle habits and health outcomes through parental perception. Methods: In the context of "EpPOI: Education to prevent CO", we investigated physical activity (PA) and sleep hygiene using an online survey for caregivers. Parents also completed the Mediterranean Diet Quality Index for children and adolescents (Kid-Med) questionnaire. Results: A total of 5.3% of the interviewees achieved a score indicating an adequate adherence to the MD. Additionally, 50.5% of children ate sweets every day, and 80% skipped breakfast. We also found that the parents' perceptions of their children's PA were a predictor of MD adherence, and PA was also positively correlated with fruit consumption [p < 0.034], vegetable consumption [p < 0.015], and fish consumption [p < 0.005]. Conclusions: Parents seem to be oriented towards a healthy lifestyle, but the children's level of adherence to the Mediterranean diet is poor. CO prevention requires a synergic effort that includes an adherence to healthy eating patterns such as the MD and a greater awareness of parents on the importance of adopting a healthy lifestyle at an early age.

Background: The Mediterranean diet (MD) has been shown to have cardioprotective effects, as demonstrated in adults, but data on hyperlipidemic children are scanty. This study assessed the impact of MD adherence, evaluated with the updated KIDMED score, on the lipid profiles of pediatric patients affected by primary hyperlipidemias. Methods: This retrospective study included data on 157 children (mean age: 10.01 ± 3.54 years) dating from 2016 to 2020. Dietary adherence and lipid levels were assessed at baseline (T0) and after 6 months (T1) of dietary counseling. Adherence was categorized using the KIDMED score: ≥8 (optimal), 4-7 (improvement needed), and ≤3 (very low). Results: KIDMED scores improved for 65% of patients, with adherence classes increasing for 33.8%. Significant reductions in LDL-C and non-HDL-C (p < 0.0001) levels were associated with even a one-point score increase, beyond which no additional benefits were observed. Conclusions: MD adherence, as measured using the updated KIDMED score, significantly improved the lipid profiles of children with dyslipidemia. These findings will support the performance of early dietary interventions to reduce cardiovascular risk factors.

The Mediterranean diet (MedDiet) is a healthy dietary pattern associated with reduced risk of chronic diseases. However, adherence is declining, particularly among younger populations. Therefore, it is crucial to identify the main aspects that affect its adherence, particularly food preferences and sensory function, which have received insufficient attention. Our aims were to investigate the impact of socio-demographic and lifestyle factors on adherence to the MedDiet among young individuals; to assess the association of taste preferences and food liking with MedDiet adherence; and to evaluate the associations between taste perception modalities, taste and food preferences, and adherence.

A cross-sectional study on young adults (aged 20.5 ± 4.7 years) in a Mediterranean country (n = 879) was carried out. Demographic characteristics, clinical characteristics, anthropometric characteristics, lifestyle characteristics, MedDiet adherence, taste preferences, and food preferences were assessed. Taste perception for bitter, salty, sweet, sour, and umami was determined by rating different concentrations of prototypical tastants. We computed a total taste perception score and three scores to combine food preferences.

We identified several socio-demographic and lifestyle factors associated with adherence to the MedDiet, as well as food preferences, taste preferences, and taste perception determinants. Food preferences were significantly associated with total adherence to the MedDiet. Higher preference for olive oil, oranges, broccoli, fish, and legumes was associated with higher MedDiet adherence (p < 0.05 for all). Conversely, higher preference for sweet foods, red meat, and butter was associated with lower adherence (p < 0.05 for all). The combined positive score for food preference was strongly associated with higher MedDiet adherence (p = 1.4 × 10-23) in the multivariate adjusted model. The combined negative food preference score was inversely associated (p = 1.9 × 10-8). Likewise, taste preferences were significantly associated with adherence to the MedDiet (strong inverse association for sweet taste preference and direct association for bitter taste preference; both p < 0.001). Moreover, bitter taste perception was inversely associated with adherence to the MedDiet and with bitter foods (p < 0.05). In conclusion, future precision nutrition studies should measure food liking and taste preferences, which are crucial determinants of MedDiet adherence, especially in young people.

Children's diets in school-age are inherently unhealthy, with few meeting dietary recommendations. Yet, little is known about similarities and differences on dietary patterns across countries and their association with obesity. We aimed to derive dietary patterns in childhood and explore their association with adiposity-related outcomes in childhood and adolescence.

This study included data from six European countries (Spain, France, UK, Greece, Lithuania and Norway) during childhood (n = 1597) and adolescence (n = 803). Using a food frequency questionnaire, we derived data-driven dietary patterns through exploratory factor analyses and calculated the Mediterranean KIDMED index. We assessed body mass index z-score (zBMI), fat mass proportion and waist-to-height ratio at both visits. Associations were estimated using generalized linear regressions, adjusted for key-confounders.

"Meat", "Dairy", "Western", "Healthy" and "Sweets and fats" dietary patterns were derived. Norwegian children showed better diet quality, with higher consumption of fruits and vegetables, and highest "Healthy pattern" adherence, and Lithuanian children, the worst, with higher sweets consumption, and highest "Western pattern" adherence. Children with lower intake of healthy foods (vegetables, fruits, fish) tended to have higher adiposity, e.g., children with average or low "Healthy pattern" adherence (vs. high) had higher fat mass proportion in childhood (average: β (95% CI) 1.44 (0.48; 2.39), low: 1.10 (0.09; 2.12)). Low adherence to a "Healthy pattern" (vs. high) was associated with increased adolescent zBMI, and child and adolescent waist-to-height ratio. Low "Dairy pattern" adherence (vs. high), was associated with lower zBMI and fat mass in childhood, but not in adolescence. No significant associations were seen with the KIDMED index.

Many European children have poor diets and a low adherence to a healthy diet pattern may be of concern for adiposity-related outcomes. Assessment of children's dietary patterns can help tailor dietary advice and provide support for families aiming to prevent future excess weight gain.

recent studies have suggested that components typical of the Mediterranean diet (MedDiet) are associated with depression and anxiety prevention. In this sense, the main objective of this study was to analyse the associations between adherence to the MedDiet and depression and anxiety symptoms and to examine whether this relationship is mediated by lean mass and the muscle strength index (MSI).

a cross-sectional study (based on data obtained from the Nuts4Brain-Z study) was conducted from 2023-2024, involving 428 university students, aged 18-30 years, from a Spanish public university. Depression was assessed using the Beck Depression Inventory (BDI-II), and anxiety was assessed via the General Anxiety Disorder-7 (GAD-7) tool. Adherence to the MedDiet was assessed using the MEDAS questionnaire. Lean mass was assessed via bioimpedance, and MSI was measured via a dynamometer. ANCOVA models were used to test the mean differences in depression and anxiety scores using MEDAS categories (low adherence < 9 points vs high adherence ≥ 9 points). Serial multiple mediation models, adjusted for the main confounders, were used to explore the role of lean mass and MSI in the relationships between adherence to the MedDiet and depression and anxiety symptoms.

university students with high adherence to the MedDiet exhibited lower scores for depression and anxiety symptoms (p < 0.05) than did students with low adherence to the MedDiet. The mediation analysis preliminarily revealed that both lean mass and MSI acted as mediators of the relationships between adherence to the MedDiet and depression and anxiety.

adherence to the MedDiet in university students per se does not appear to have a direct effect on depression and anxiety symptoms because these associations are partially (for depression) or entirely (for anxiety) explained by lean mass and MSI.

Most of the available tools to assess adherence to Mediterranean diet (MedDiet) were constructed for adults, having limited applicability to children and adolescents. The aim of this study is to validate a specific questionnaire to assess adherence to MedDiet in children aged 3 to 6 years (MED4CHILD questionnaire). The validation was performed in a baseline examination of a cohort of children who were recruited in schools in seven cities. Of the total sample of 1509 children, we included 858 children aged 3 to 6 years with complete information on adherence to the MedDiet, food consumption, anthropometry and cardiometabolic characteristics. Adherence to the MedDiet was assessed using an 18-item questionnaire, adapted from validated questionnaire for adults using the Delphi method. Food and beverage consumption was assessed using a validated COME-Kids Food and Beverage Frequency Questionnaire. Anthropometric measurements and cardiometabolic risk factors were assessed using standard methods. Statistical analyses included kappa agreement, ANOVA and linear regression models. Higher MED4CHILD scores were associated with higher intakes of food characteristic of the MedDiet. The MED4CHILD questionnaire showed moderate validity, especially for key items of the Mediterranean diet (kappa ranging from 0.333 to 0.665). Direct significant associations were found between MED4CHILD scores and cardiometabolic profile, including waist circumference (p), triglycerides and HOMA-IR (p < 0.05).

The 18-item MED4CHILD questionnaire showed moderate validity for assessing adherence to the MedDiet in children aged 3 to 6 years, in terms of agreement with food and beverage consumption and favourable cardiometabolic profile.

• The Mediterranean diet has been linked to a number of health benefits and the assessment of children's adherence to this diet is important for public health and research. • The tools available to assess MedDiet compliance are mainly for adults.

• The MED4CHILD questionnaire is a simple, inexpensive and rapid tool for assessing MedDiet compliance in children. • This tool showed moderate relative validity and a high score was associated with a favourable cardiometabolic profile.

Mediterranean diet adherence has been decreasing during the last few decades, and non-appropriate snacking habits have also been identified among Mediterranean children and adolescents. To co-create new snacks and to explore children's interests and preferences, a multi-method approach was used in the present study, including some qualitative and quantitative research phases. Conducted in collaboration with schools in Lebanon, Egypt, Portugal, Italy, and Spain, different snack prototypes were designed and tested in a Mediterranean cross-cultural context. The results showed significant differences among countries in snacking preferences and general food-related attitudes. Italian children exhibited higher levels of neophobia, resulting in lower acceptance of all proposed snacks. Some sensory and contextual insights were collected, such as Egyptian children favoring sweet and crunchy textures and "At school", "With my friends", and "As a morning/afternoon snack" being identified as linked to snack acceptance in some countries. The present study underscores the value of co-creation processes involving children to address non-recommended dietary patterns, highlighting the critical role of sensory properties, cultural differences, and contextual factors in designing healthy snacks that meet the Mediterranean diet's principles but are highly appreciated by the young segment of the population.

Pediatric cancer survivors are at greater risk of cardiometabolic complications than their peers. This study evaluates the preliminary impact of the VIE (Valorization, Implication, Education) intervention, which integrates nutrition, physical activity, and psychological support, on dietary intake and cardiometabolic health among children and adolescents during cancer treatment.

This comparative study includes pediatric cancer patients recruited to either the VIE intervention group or a control group receiving standard care. Post-treatment data on dietary intake, anthropometric measures, blood pressure, and biochemical parameters were compared between groups and stratified by level of involvement in the nutritional intervention and age at diagnosis (children and adolescents).

In the intervention group, 45 participants were included (51.1% male, mean age at evaluation 10.2 ± 4.5 years, mean time since end of treatment of 1.3 ± 0.8 years), and the control group comprised 77 participants (44.2% male, mean age at evaluation 12.0 ± 5.6 years, mean time since end of treatment of 1.4 ± 0.8 years). The intervention group had lower total caloric intake (mean: 1759 ± 513 vs. 1997 ± 669 kcal, p = 0.042) and higher calcium intake (mean: 567 ± 240 vs. 432 ± 197 mg/1000 kcal, p = 0.001). The participants who were highly involved in the nutritional intervention had greater protein-derived energy intake than the controls (mean: 17 ± 5 vs. 15 ± 4%, p = 0.029). While there was a tendency for a lesser proportion of cardiometabolic risk factors in the adolescents from the intervention group, the differences did not reach statistical significance.

The VIE intervention improved some specific dietary intakes in the medium term after treatment completion but did not significantly impact cardiometabolic health outcomes. Additional strategies are needed to improve the diet of pediatric cancer patients, and further research is warranted to assess the long-term impact of such interventions.

Previous research in adults has suggested that healthy dietary patterns could be an effective strategy for blood pressure (BP) control. However, during adolescence, the scientific literature examining this relationship is scarce and controversial since inverse and null associations have been reported. Thus, the aim of our study was to analyze the relationship between the level of adherence to the Mediterranean diet (MD) and consumption of fresh fruits and vegetables at baseline with changes in BP over a two-year period during adolescence.

The analyses included 197 adolescents (92 girls) aged 13.9 ± 0.3 years. Adherence to the MD and consumption of fresh fruits and vegetables were assessed using the KIDMED questionnaire and a food frequency questionnaire, respectively. BP values were measured using an automatic sphygmomanometer according to standardized procedures.

Adolescents with high adherence levels to the MD, and high consumption of vegetables (but not fruits) at baseline, showed smaller increases in diastolic BP changes over two years (percentage of reduction ranging from ~48% to ~88%, all p < 0.026). No significant relationships were identified in systolic BP over the two-year period.

Our findings underscore the importance of promoting MD and vegetable consumption to reduce diastolic BP during adolescence, contributing to lowering future cardiovascular risk.

Background/Objectives. Traditional dietary patterns are being abandoned in Mediterranean countries, especially among younger generations. This study aimed to investigate the potential lifestyle determinants that can increase adherence to the Mediterranean diet in children and adolescents. Methods. This study is a cross-sectional analysis of data from five Mediterranean countries (Italy, Spain, Portugal, Egypt, and Lebanon) within the context of the EU-funded project DELICIOUS (UnDErstanding consumer food choices & promotion of healthy and sustainable Mediterranean Diet and LIfestyle in Children and adolescents through behavIOUral change actionS). This study comprised information on 2011 children and adolescents aged 6-17 years old collected during 2023. The main background characteristics of both children and parents, including age, sex, education, and family situation, were collected. Children's eating (i.e., breakfast, place of eating, etc.) and lifestyle habits (i.e., physical activity level, sleep, and screen time) were also investigated. The level of adherence to the Mediterranean diet was assessed using the KIDMED index. Logistic regression analyses were performed to test for likelihood of higher adherence to the Mediterranean diet. Results. Major determinants of higher adherence to the Mediterranean diet were younger age, higher physical activity level, adequate sleep duration, and, among dietary habits, having breakfast and eating with family members and at school. Parents' younger age and higher education were also determinants of higher adherence. Multivariate adjusted analyses showed that an overall healthier lifestyle and parents' education were the factors independently associated with higher adherence to the Mediterranean diet. Conclusions. Higher adherence to the Mediterranean diet in children and adolescents living in the Mediterranean area is part of an overall healthy lifestyle possibly depending on parents' cultural background.

Obesity is one of the leading causes of chronic diseases, and its prevalence is still rising in children and adolescent populations. Chronic cardiovascular complications result in metabolic syndrome (MS) and type 2 diabetes mellitus. Key factors in the development of MS are insulin resistance and low-grade inflammation. The disorder of glucose and insulin metabolism has not been fully elucidated so far, and an oral glucose tolerance test (OGTT) has been the only tool used to look into the complex metabolism disorder in children and adolescents with obesity. Continuous glucose monitoring (CGM) has become commercially available for over two decades and is primarily used to manage type 1 diabetes mellitus in pediatric populations. This review aims to present the current knowledge about the use of CGM in children and adolescent populations with obesity. CGM systems have the potential to serve as valuable tools in everyday clinical practices, not only in the better diagnosis of chronic complications associated with obesity, but CGM can also assist in interventions to make better adjustments to nutritional and therapeutic approaches based on real-time glucose monitoring data. Despite these promising benefits, further research is needed to fully understand the role of CGM in metabolic disorders in pediatric populations with obesity, which will additionally strengthen the importance of CGM systems in everyday clinical practices.

In recent decades, physical activity intervention programs have been developed to reduce overweight and obesity in adolescents. However, this population is considered hard to reach in physical activity programs due to lack of adherence and poor results. Interventions with mobile phones in the adolescent population with normal weight have shown benefits, so this line of research may provide benefits in adolescents with overweight or obesity, although it has not yet been explored in the scientific literature.

This study aims to determine the changes produced by a 10-week intervention promoted during school lessons on physical education using step tracker mobile apps in out-of-school hours on physical activity, adherence to the Mediterranean diet, body composition, and the physical condition of adolescents who are overweight and obese, and to analyze the changes achieved by the 10-week intervention on the psychological state of adolescents who are overweight and obese.

The study was based on a randomized controlled trial with an initial sample of 50 adolescents aged between 12 and 16 years (from the first to the fourth years of compulsory secondary education), whose body composition, physical activity level, physical condition, and psychological state were measured. Participants were divided into an experimental group (EG) and a control group (CG), where the EG performed a series of walking steps with a mobile app in their free time outside physical education classes. Adolescents in the CG continued to perform their physical activities as normal but did not use any mobile apps. Inclusion in the EG and CG was randomized, and the researchers were blinded.

An increase was found in the EG in corrected arm girth (mean difference -0.46; P=.05), curl-up repetitions (mean difference -6.35; P=.02) and push-up repetitions (mean difference -2.27; P=.04) after the intervention. In the CG, there was a significant increase in hip girth (mean difference -1.37; P=.05), corrected thigh girth (mean difference -1.28; P=.04), and muscle mass (mean difference -0.87; P=.04), as well as a significant decrease in competence (mean difference 3.08; P=.03). The covariates gender and age showed an effect on corrected arm girth (gender: P=.04), curl-up repetitions (gender: P=.04) and push-up repetitions (gender: P=.04) in the EG; while in the CG it affected corrected thigh girth (gender: P=.04), adherence to the Mediterranean diet (gender: P=.04 and age: P=.047) competence (gender: P=.04 and age: P=.04) and relatedness (gender: P=.05 and age: P=.04). No significant differences were found when comparing changes in the CG and EG.

A 10-week program of mobile app use by adolescents who are overweight and obese for physical activity outside of school hours does not appear effective in producing improvements in body composition, physical fitness, or adequate psychological state as it does not appear to significantly increase physical activity.

ClinicalTrials.gov NCT06089876; http://clinicaltrials.gov/ct2/show/NCT06089876.

Physical fitness and diet along with body weight are key determinants of health. Excess body weight, poor dietary choices, and low physical fitness, however, are becoming increasingly prevalent in adolescents. In order to develop adequate intervention strategies, additional research on potential interaction effects of these entities is needed. Therefore, this study examined the combined association of physical fitness and diet with body weight in Austrian adolescents.

A total of 164 (56% male) adolescents between 11 and 14 years of age completed the German Motor Test, which consists of eight items that assess cardiorespiratory endurance, muscular endurance and power, speed and agility, flexibility, and balance, along with body weight and height measurements. Additionally, participants completed a standardized food frequency questionnaire.

Spearman correlation analyses showed an inverse association between physical fitness and processed foods consumption (rho = -0.25, p < 0.01), while sweet consumption was positively associated with physical fitness (rho = 0.17, p = 0.03). No significant interaction effects between diet and physical fitness on body weight were observed. However, both higher physical fitness and greater sweet consumption were associated with lower body weight (p < 0.01).

The present study emphasizes the independent and combined interactions of key correlates of health. It also suggests that high fitness may offset detrimental effects of poor dietary choices. In order to address potential health risks early in life and facilitate future health and well-being, it is important to monitor and control physical fitness, diet, and body weight during adolescence.

Populations in Mediterranean countries are abandoning the traditional Mediterranean diet (MD) and lifestyle, shifting towards unhealthier habits due to profound cultural and socioeconomic changes. The SWITCHtoHEALTHY project aims to demonstrate the effectiveness of a multi-component nutritional intervention to improve the adherence of families to the MD in three Mediterranean countries, thus prompting a dietary behavior change.

A parallel, randomized, single-blinded, and controlled multicentric nutritional intervention study will be conducted over 3 months in 480 families with children and adolescents aged 3-17 years from Spain, Morocco, and Turkey. The multi-component intervention will combine digital interactive tools, hands-on educational materials, and easy-to-eat healthy snacks developed for this study. Through the developed SWITCHtoHEALTHY app, families will receive personalized weekly meal plans, which also consider what children eat at school. The engagement of all family members will be prompted by using a life simulation game. In addition, a set of activities and educational materials for adolescents based on a learning-through-playing approach will be codesigned. Innovative and sustainable plant-based snacks will be developed and introduced into the children's dietary plan as healthy alternatives for between meals. By using a full-factorial design, families will be randomized into eight groups (one control and seven interventions) to test the independent and combined effects of each component (application and/or educational materials and/or snacks). The impact of the intervention on diet quality, economy, and the environment, as well as on classical anthropometric parameters and vital signs, will be assessed in three different visits. The COM-B behavioral model will be used to assess essential factors driving the behavior change. The main outcome will be adherence to the MD assessed through MEDAS in adults and KIDMED in children and adolescents.

SWITCHtoHEALTHY will provide new insights into the use of sustained models for inducing dietary and lifestyle behavior changes in the family setting. It will facilitate generating, boosting, and maintaining the switch to a healthier MD dietary pattern across the Mediterranean area. Registered Trial, National Institutes of Health, ClinicalTrials.gov (NCT06057324).

The diet quality of younger individuals is decreasing globally, with alarming trends also in the Mediterranean region. The aim of this study was to assess diet quality and adequacy in relation to country-specific dietary recommendations for children and adolescents living in the Mediterranean area.

A cross-sectional survey was conducted of 2011 parents of the target population participating in the DELICIOUS EU-PRIMA project. Dietary data and cross-references with food-based recommendations and the application of the youth healthy eating index (YHEI) was assessed through 24 h recalls and food frequency questionnaires.

Adherence to recommendations on plant-based foods was low (less than ∼20%), including fruit and vegetables adequacy in all countries, legume adequacy in all countries except for Italy, and cereal adequacy in all countries except for Portugal. For animal products and dietary fats, the adequacy in relation to the national food-based dietary recommendations was slightly better (∼40% on average) in most countries, although the Eastern countries reported worse rates. Higher scores on the YHEI predicted adequacy in relation to vegetables (except Egypt), fruit (except Lebanon), cereals (except Spain), and legumes (except Spain) in most countries. Younger children (p < 0.005) reporting having 8-10 h adequate sleep duration (p < 0.001), <2 h/day screen time (p < 0.001), and a medium/high physical activity level (p < 0.001) displayed a better diet quality. Moreover, older respondents (p < 0.001) with a medium/high educational level (p = 0.001) and living with a partner (p = 0.003) reported that their children had a better diet quality.

Plant-based food groups, including fruit, vegetables, legumes, and even (whole-grain) cereals are underrepresented in the diets of Mediterranean children and adolescents. Moreover, the adequate consumption of other important dietary components, such as milk and dairy products, is rather disregarded, leading to substantially suboptimal diets and poor adequacy in relation to dietary guidelines.

The main objective of this study was to examine the association between lifestyle patterns (physical activity, screen and sleep time and diet) and abdominal obesity, and endocrine, metabolic, and immunological biomarkers in adolescents with Down syndrome (DS).

Eighty-three DS adolescents (38.6% girls), aged 11 to 18 years, from the UP&DOWN study were included. Cluster analysis was performed by including the compliance of recommendations of lifestyle variables, such as moderate to vigorous physical activity (MVPA), screen and sleep time and adherence to the Mediterranean diet (AMD). The waist-to-height ratio was used as an indicator of abdominal obesity. Haematological, biochemical and inflammatory biomarkers were analysed.

A three-cluster solution was identified: Cluster 1: adolescents with low compliance; Cluster 2: youth with medium compliance; and Cluster 3: adolescents with high compliance. Significant differences in MVPA (p = 0.000), screen time (p = 0.004), sleep time (p = 0.0001), AMD (p = 0.000) and abdominal obesity (p = 0.003) were found. Clusters 2 and 3 had lower levels of triglycerides and LDL-cholesterol than Cluster 1. Cluster 2, in which all adolescents met the MVPA recommendations, had the lowest levels of galactin 3.

Compliance with lifestyle recommendations (PA, screen and sleep time and AMD) and the absence of abdominal obesity seem to be associated with better biochemical and inflammatory values.

Obesity is currently an increasing public health burden due to its related metabolic and cardiovascular complications. In Western countries, a significant number of people are overweight or obese, and this trend is, unfortunately, becoming increasingly common even among the pediatric population. In this narrative review, we analyzed the role of nutrition during growth and its impact on the risk of developing metabolic syndrome and cardiovascular complications later in life. An impactful role in determining the phenotypic characteristics of the offspring is the parental diet carried out before conception. During intrauterine growth, the main risk factors are represented by an unbalanced maternal diet, excessive gestational weight gain, and impaired glycemic status. Breastfeeding, on the other hand, has many beneficial effects, but at the same time the quality of breast milk may be modified if maternal overweight or obesity subsists. Complementary feeding is likewise pivotal because an early introduction before 4 months of age and a high protein intake contribute to weight gain later. Knowledge of these mechanisms may allow early modification of risk factors by implementing targeted preventive strategies.

. This cross-sectional study aimed to evaluate the degree of children's adherence to the Mediterranean Diet (MD), to estimate the weekly cost of MD, and to assess the role of food cost and demographic/socio-economic factors as potential barriers to comply with a healthy dietary model.

. Data collection was conducted through an online questionnaire sent to parents of children (6-11 years old) living in Italy. This survey allowed the collection of demographic/socio-economic information about the family and their dietary habits. Adherence to the MD in children was assessed through the KIDMED index. The weekly diet cost was calculated based on the food prices of two Italian supermarket chains. Descriptive statistics and inferential tests were run to evaluate the sample's characteristics and correlations between diet cost, socio-demographics, and adherence to MD.

. Data highlighted that 31.5% of the children achieved high compliance with the MD, whereas 22.2% showed low adherence. The average diet cost increased significantly with the increasing level of adherence to the MD (Spearman's Rho = 0.322, p = 0.018). Moreover, results showed that a high parent educational level was positively associated with the KIDMED score (Spearman's Rho = 0.323, p = 0.017). No significant correlations were found between dietary cost and other characteristics such as economic status and house type.

. Despite the small sample size, our results suggest that nutrition education interventions targeted at children and their parents/caregivers might favour more conscious dietary choices, which in turn will help reduce the differences in diet quality caused by the educational level gaps existing in families.

Diet is considered a determinant of weight status, however, more evidence is needed for children. The Mediterranean diet (MedDiet) is one of the healthiest worldwide. This study analyzes the prospective association between adherence to the MedDiet at baseline and changes in standardized body mass index (zBMI) and the incidence of excessive weight.

1389 children participated with a follow-up of 15 months. Weight, height, and adherence to the MedDiet were measured (baseline and follow-up).

Multiple logistic regression analysis revealed that a high increase in zBMI was associated with lower odds of eating vegetables once [OR 0.74 (95% CI 0.57-0.98)] or more a day [OR 0.68 (95% CI 0.49-0.95)], nuts 2-3 times/week [OR 0.74 (95% CI 0.56-0.97)] or 2 cups of yogurt or/and cheese daily [OR 0.74 (95% CI 0.55-0.99)]. Not consuming each food item was used as reference. Multiple linear regression analysis showed a negative (β = -0.010, p = 0.040) association between the MedDiet at baseline and changes in zBMI at follow-up, significance disappeared (p = 0.082) after final adjustment for baseline zBMI.

Baseline MedDiet was not significantly associated with the incidence of excessive weight at follow-up. The MedDiet was positively associated with changes in zBMI, however the effect size was small.

The present longitudinal study contributes knowledge regarding the adherence to Mediterranean diet as a predictive variable of weight status evolution in children. Higher adherence to the Mediterranean diet at baseline was prospectively and inversely associated with changes in zBMI after 15 months of follow-up. Consuming vegetables, nuts, and yoghurt/cheese according to the recommendations reduces the likelihood of having a high increase in zBMI after 15 months of follow-up.

To adapt four dietary patterns for children and adolescents, and study their associations with sustainability (greenhouse-gas emissions-GHGE and land use-LU), and health (body mass index-BMI) indicators.

Dietary intake of children (3-9y) and adolescents (10-17y) from the National Food, Nutrition and Physical Activity Survey 2015-2016, Portugal (n = 1153) was assessed through two non-consecutive interviews: one-day food diaries (children), and 24-h recalls (adolescents), using an automated multiple-pass method, including a picture book for portion sizes estimation. Adherence to the Eat-Lancet and World Health Organization (WHO) recommendations, Mediterranean and Atlantic diets were evaluated using adapted versions for pediatrics of the World Index for Sustainability and Health (WISH), Diet Quality Index (DQI), Mediterranean Diet Score (MDS) and Southern-European Atlantic Diet (SEAD), respectively. Diet-related GHGE and LU were estimated using the SHARP-Indicators database. BMI (measured) z-scores were classified according to WHO criteria. A standardized weighted health-sustainability composite index was created (BMI + 0.5*GHGE+0.5*LU). Adjusted linear regression models were computed.

WISH, DQI, MDS, and SEAD had weighted mean scores (range) of 50 (0-130), 24 (9-36), 20 (8-32), and 17 (8-32), respectively. All dietary patterns were associated with lower environmental impact, particularly in children, but not with BMI. Only MDS explained both health and sustainability indicators in childhood (composite index: sd.β = -0·223,95%CI:-0·347,-0·072,R2 = 25.1 %), and adolescence (composite index: sd.β = -0·159,95%CI:-0·315,-0·003,R2 = 31.3 %).

The Mediterranean diet was the most related to (higher) environmental sustainability and (lower) BMI. However, in children (not adolescents), the WISH, DQI, and SEAD showed then same associations.

The aim of this study was to analyse whether the association between adherence to the Mediterranean diet and health-related quality of life (HRQoL) is mediated by physical fitness components (i.e., cardiorespiratory fitness, lower-limb strength, upper-limb strength and motor competence) in adolescents.

This is a cross-sectional study including mediation analyses. This study involved 181 adolescents (86 girls) aged 15.8 ± 0.3 years recruited from secondary schools and sport clubs located in Castellon (Spain). Adherence to the Mediterranean diet was evaluated using the KIDMED questionnaire. HRQoL was assessed with the KIDSCREEN-10 questionnaire. Cardiorespiratory fitness was assessed using the 20-m shuttle run test. Lower-limb strength was assessed through the standing broad jump test. Upper-limb strength was evaluated using a handgrip dynamometer. Motor competence was assessed using the 4 × 10 m shuttle run test. Mediation analyses were performed for each physical fitness component in order to assess its mediating effect on the association between adherence to the Mediterranean diet and HRQoL. Indirect effects (IE) with confidence intervals (CI) not including zero were interpreted as statistically significant.

Cardiorespiratory fitness and lower-limb strength had a mediating effect on the positive association between adherence to the Mediterranean diet and HRQoL (IE = 0.11, 95 % CI = 0.01; 0.27 and IE = 0.07, 95 % CI = 0.01; 0.19). Upper-limb strength and motor competence did not act as mediators in the association between adherence to the Mediterranean diet and HRQoL (IE = 0.00, 95 % CI = -0.04; 0.07 and IE = 0.01, 95 % CI = -0.03; 0.07, respectively).

Our findings showed that the positive association of adherence to the Mediterranean diet on adolescents' HRQoL was mediated by physical fitness. Educational and public health strategies aiming to improve Spanish adolescents' HRQoL should focus on diet and physical fitness.

Mediterranean diet (MD) is regarded as one of the healthier dietary patterns which is recommended for athletes. This study aims to investigate the adherence to the Mediterranean diet (AMD) and associated beliefs in a large, diverse sample of competitive adolescent athletes from various sports, including both lean and non-lean sports. Additionally, the study examines factors important regarding intention to AMD within the Theory of Planned Behavior (TPB). In the study took part 711 adolescents (357 male, aged = 14.93 ± 1.38, and 354 female, aged = 14.85 ± 1.35) athletes. The level of AMD was not a significant different between lean (mean = 4.98, SD = ±3.90) and non-lean (mean = 4.77, SD = ±3.68) sport. According to the sport type the 35% of lean sport athletes demonstrated low AMD, 34.1% moderate adherence and 30.9% a high degree. The non lean athletes demonstrated low AMD in 36.3%, moderate adherence 33% and high degree in 30.7%. The results of the mediation analysis indicated a significant mediation effect of intention in the relationship between TPB variables and MD. Based on the results of the study the type of sport does not play a role in the AMD, which, as in the general population, is low. Also validate the TPB and underscore the significance of targeting individuals' intentions to promote positive dietary behaviors.

Down's syndrome (DS), or Trisomy 21, represents the most common chromosomal abnormality in live births, characterized by an extra chromosome 21. Children affected by Down's syndrome are more susceptible to the development of obesity and of becoming overweight compared with other children. Furthermore, they seem to present a more unfavorable lipid profile than the non-DS obese pediatric population. Diet and physical activity are closely related to the development of overweight and obesity, and they can be assessed using questionnaires such as the Mediterranean Diet Quality Index in children and adolescents (KIDMED) and the Godin-Shephard Leisure-Time Physical Activity Questionnaire. This review aims to undertake a comprehensive analysis of the intricate interplay between diet and physical activity in children affected by Down's syndrome. Specifically, it seeks to deepen understanding regarding the question of how diet and exercise can influence and prevent the development of overweight and obesity in that special pediatric population.

Depression and anxiety are prevalent and disabling conditions among adolescents. The aim of this study was to examine the relationship between adherence to the Mediterranean diet (MD) and depressive, anxiety, and stress symptoms in adolescents. This cross-sectional study included a sample of 698 adolescent students from a region of Spain (mean age of 13.9 ± 1.5 years; 56.2% girls). Adherence to the MD was evaluated with the Mediterranean Diet Quality Index in children and adolescents (KIDMED). Mental health symptoms were measured with the Depression, Anxiety, and Stress Scale (DASS-21). Logistic regression models were performed, including a wide range of potential confounders. Compared to individuals with low adherence to the MD, those with moderate and high adherence had lower odds of experiencing depressive symptoms (odds ratio [OR] = 0.40, 95% confidence interval [CI] 0.24-0.65 and OR = 0.33, 95% CI 0.20-0.55, respectively), which were statistically significant even after adjustment. No significant associations were found regarding anxiety or stress symptoms. Therefore, according to our results, higher adherence to the MD is inversely related to having depressive symptoms among adolescents, regardless of socioeconomic, anthropometric, and lifestyle factors. Considering the deleterious effects of mental health problems in youths, further research on the role of nonpharmacological strategies for the prevention and treatment of depressive symptoms in adolescence is essential.

We examined the inter-correlation between diet quality, objectively measured sleep duration, and subjectively measured sleep quality with flash glucose monitoring (FGM)-measured glycemia among young patients with type 1 diabetes (T1D).

Following cross-sectional design, Fitbit® accelerometers were used to objectively assess sleep duration, while the validated questionnaires Pittsburgh sleep quality index and Mediterranean diet (MD) adherence were used to subjectively assess sleep quality and diet quality, respectively. Glycated hemoglobin (HbA1c) and FGM-reported glycemia components among children with T1D were assessed as well.

Of the 47 participants surveyed (25 boys, 22 girls, 9.31 ± 2.88 years), the majority reported high HbA1c, good sleep quality, and high adherence to the MD. However, only one-third of the participants reported a healthy sleep duration. Only the sleep latency was significantly (P < 0.05) associated with the time above range level 2 and time below range level 2 (P = 0.048) components of the FGM. A positive correlation (r = 0.309, P = 0.035) was reported between adherence to MD and time in range of the FGM.

Diet quality and sleep quality are variably inter-correlated with FGM-measured glycemia among young patients with T1D and are suggested to be considered influential factors in FGM-monitored diabetes research on this age group.