Adherence to the Mediterranean diet and changes in body mass index in Spanish children

doi:10.21203/rs.3.rs-3310696/v1

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Adherence to the Mediterranean diet and changes in body mass index in Spanish children

https://doi.org/10.21203/rs.3.rs-3310696/v1

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Background

Unhealthy diets are a major driver of childhood obesity. On the other hand, the Mediterranean diet is considered one of the healthiest diets worldwide. Therefore, the objective of the present study was to analyze the prospective association between adherence to the Mediterranean diet at baseline and changes in standardized body mass index (zBMI) in children and the incidence of excessive weight in Spanish children.

Methods

This community-based cohort study was carried out between 2012 and 2014 with a mean follow-up of 15 months and included 1389 children from 8 to 10 years old. Weight and height were measured at baseline and follow-up. Adherence to the Mediterranean was determined by the KidMed index.

Results

Multiple logistic regression analysis revealed that a high increase in zBMI (5th quintile of change) was associated with lower odds of having vegetables once [OR 0.74 (95% CI 0.57–0.98)] or more than once a day [OR 0.68 (95% CI 0.49–0.95)], having nuts 2-3times/week [OR 0.74 (95% CI 0.56–0.97)] or 2 cups of yoghurts or/and cheese daily [OR 0.74 (95% CI 0.55–0.99)]. Multiple linear regression analysis showed a negative (β=-0.010, p = 0.040) association between adherence to the Mediterranean diet at baseline and changes in zBMI at follow-up, although the statistical significance disappeared (p = 0.082) after final adjustment for baseline zBMI. Conclusions: Baseline adherence to the Mediterranean diet was not significantly associated with the incidence of excessive weight (overweight and obesity) at follow-up. Adherence to the Mediterranean diet was favorably associated with changes in zBMI in Spanish children, however the effect size was small.

Diet Quality

Mediterranean Diet

Obesity in Childhood

Body Mass Index

Cohort Studies

The Mediterranean diet is considered one of the healthiest diets worldwide.
The evidence of the potential beneficial effects of this diet on child weight status is scarce and not fully consistent: more longitudinal high-quality studies are needed.

What is new:

A higher adherence to the Mediterranean diet in children at baseline was prospectively and inversely associated with changes in zBMI after 15 months of follow-up.
In children, having fresh or cooked vegetables once a day or more than once a day; consuming nuts (at least 2–3 times/week) and taking 2 cups of yoghurts and/or some cheese (40g) daily were associated with a lower likelihood of having a high increase in zBMI after 15 months of follow-up.

The prevalence of childhood obesity has increased substantially in the last decades worldwide and is one of today’s greatest public health challenges [1–3]. The prevalence of overweight and obesity is especially worrying in Spain, with values above 30% over the last two decades. Recent data showed a prevalence of 40,6% of overweight and 17% obesity, in children aged 6 to 9 years [4–6]. Somewhat lower, but still high, prevalence’s were reported for children aged 8 to 16 years.

Obesity is a multifactorial disease determined by genetic, biological, environmental, psychosocial, and behavioral factors that impact children's current and future health [7]. Moreover, this disease in childhood is predictive for obesity in adolescence and adulthood [8]. Indeed, it is estimated that the 55% of children living with obesity will present this weight status during the adolescence and the 80% of adolescents with obesity will be presenting this condition during adulthood [8]. Evidence indicates that most common risk factors for obesity are modifiable such as physical inactivity [9], unhealth diets [10], and not meeting sleep recommendations [11], and psychological unbalance [12].

It is especially concerning in children the high consumption of obesogenic food [13], lack of physical activity [14] are key factors for childhood obesity and should be adequately addressed in prevention and treatment efforts [15].

The Mediterranean diet (MedDiet) is characterized by a predominant consumption of vegetables, fruit, legumes, whole grain cereals, nuts seeds, olive oil, low intake of red meat, low to moderate intake of fish and poultry, and moderate but steady intake of dairy products [16]. MedDiet is considered one of the most balanced dietary patterns worldwide, as it is particularly rich of plan-based proteins, low glycemic index carbohydrates, monounsaturated fatty acids, dietary fibers and antioxidants [16].

However, the evidence of the potential beneficial effects of MedDiet on child weight status is scarce and not fully consistent: a systematic review based on 55 studies, reported that despite many cross-sectional studies published in children, there is only limited prospective evidence of a beneficial impact of following a traditional MedDiet to maintain a healthy body weight [17].In the same line with Lassale and colleagues, a newly narrative review, reported a lack of evidence regarding the association between MedDiet diet and body weight in childhood [18]. However, a recently published meta-analysis based on intervention studies revealed a protective effect of the MedDiet on BMI in children and adolescents [19]. Furthermore, most of the studies didn’t show a significant effect and the pooled effect size of the interventions was small. As noted by the authors the findings should be interpreted with caution because the quality of most studies included in this meta-analysis was low. More longitudinal high-quality studies are highly needed to elucidate the association between the MedDiet adherence and childhood obesity.

Therefore, the aim of the present study was to analyze the prospective association between adherence to the MedDiet and changes in the BMI z-score (zBMI) and the incidence of excessive weight in Spanish children.

2.1. Study design

The current study was a prospective cohort in the framework of the POIBC study (Spanish acronym for Prevention of Childhood Obesity: a community-based model). The entire POIBC protocol has been published elsewhere [20]. In brief, the POIBC intervention study determined the efficacy of the THAO-Child Health Program to prevent childhood obesity in 2249 children aged 8 to 10 years from 4 municipalities: 2 formed the intervention group and 2 the control group [21]. The study was carried out during two academic years (2012/2014) with a mean follow-up of 15 months. After excluding participants with missing data on any of the included variables, a final sample of 1,389 children (694 girls and 704 boys) with a mean age of 10.1 ± 0.6 years old was included. The local ethics committee (CEIC-PSMAR, Barcelona, Spain, approval number: (2011/4296/I) approved the study. Children were informed about the study and about the fact that their participation was voluntary. Written consent was obtained on behalf of their parents.

2.2. Outcome measure

Anthropometric measurements were assessed by trained personnel at baseline and follow-up. For each participant, body weight, height, and waist circumference were measured, with the subject in underwear without shoes using an electronic scale (SECA 813), to the nearest 100 g, a portable stadiometer (SECA 213), to the nearest 1 mm, and a measuring tape (SECA 201), respectively. BMI z-score was computed using age- and sex-specific reference values from the World Health Organization (WHO) [22]. Overweight and obesity were defined as BMI > 1 SD < 2 SD and BMI > 2 SD, respectively, from the mean of the WHO reference population. Changes in zBMI were calculated by subtracting follow-up zBMI from baseline zBMI. The top quintile of changes in zBMI was used to classify a high increase in zBMI. Excessive weight was defined as having overweight or obese.

2.3. Measurement of Exposure

Adherence to the MedDiet was examined by the KidMed index [23]. The KidMed questionnaire was administered in schools with the assistance of trained field researchers at baseline and follow-up. The KisMed questionnaire includes 16-items and estimates MedDiet adherence in children and young adults based on the dietary principles of the Mediterranean diet. This index follows a binary response format (yes/no). Four items indicating lower adhesion to the MedDiet were assigned a value of -1 [Goes more than once a week to a fast-food restaurant; skips breakfast; has commercially baked goods or pastries for breakfast; takes sweets and candy several times every day] and the 12 items related to a greater adherence were rated + 1[takes a (serving/piece of) fruit or fruit juice every day; has a second (serving/piece of) fruit every day; has fresh or cooked vegetables once a day; has fresh or cooked vegetables more than once a day; consumes fish regularly; likes legumes and eats them more than once a week; consumes pasta or rice almost every day (5 or more times per week); has cereals or grains (bread, etc.) for breakfast; consumes nuts regularly (at least 2–3 times per week); uses olive oil at home; has a dairy product for breakfast (yogurt, milk, etc.); consumes two yogurts and/or some cheese (40 g) daily]. The range of scores was between − 4 and 12, with scores from 8 to 12 reflecting a high adherence to the MedDiet, from 4 to 7 a medium adherence and from − 4 to 3 a low adherence.

2.4. Other variables

2.4.1. Physical activity

Physical activity was measured by the Physical Activity Questionnaire for Children (PAQ-C) [24]. The PAQ-C asks about different activities to define the PA level over the last week (the last 7 days). It provides a summary PA score derived from nine items. Each question is scored on a 5-point scale, with higher scores indicating higher levels of physical activity. The first question is a checklist of 22 common leisure and sports activities.

2.4.2. Screen-time

Screen-time was assessed by the Screen-Time Sedentary Behaviour Questionnaire [25]. This questionnaire asks about the time spent in four activities, separately for weekdays and weekends: (a) watching television, (b) playing computer games, (c) playing console (video) games, and (d) using a mobile phone.

2.4.3. Maternal socioeconomic status

Maternal education level was collected as an indicator of socioeconomic status and categorized into 3 levels: i) primary school, ii) secondary school, iii) university degree.

2.5. Statistical analysis

Participant characteristics were described as mean (standard deviation), and proportions, as appropriate. Changes in continuous variables between baseline and follow-up were compared by the Student’s t test. Proportion comparisons for categorical variables were assessed by chi-square test. Interactions of sex and age with adherence to the MedDiet were tested.

Logistic regression models were fitted to determine the association between each item of the KidMed index and a high increase in zBMI, defined as the top quintile of changes in zBMI at follow-up.

Linear regression models were fitted to determine the association between baseline adherence to the MedDiet and changes in zBMI. The final model was adjusted for sex, age, school, intervention group, maternal education, screen time, physical activity, and baseline zBMI. The assumption of normality in the regression models was assessed by normal probability plot.

The relationship between adherence to the MedDiet and incidence of excessive weight at follow-up was analyzed by logistic regression analysis. The first model was adjusted for sex and age, the second model additionally for school, intervention group, maternal education, screen time, and physical activity, and the final model additionally for baseline zBMI. Children with excessive weight (n = 564) were excluded from this analysis. The dose-response relationship between adherence to the MedDiet and changes in zBMI was performed by cubic spline analysis with the use of the “gam” package in R version 3.0.2.

The associations were considered significant if p < 0.05. All statistical analysis, except for the dose-response analysis, was performed using SPSS for Windows version 22 (SPSS, Inc., Chicago, IL, United States).

Table 1 presents the characteristic of the study populations at baseline and follow-up. At baseline 9.4%, 49.5%, and 41.2% of the participants were classified as low, medium, and high adherence to the MedDiet, respectively.

Table 1

Characteristics of the study population at baseline and follow-up.
Total (n = 1389)	Baseline (2012)	Follow-up (2013)	p value^a
Age (years)	10,1 ± 0,6
Sex Female	50% (694)
Maternal Education Primary Secondary University	26.2% (364) 39.5% (548) 34.3% (477)
Adherence to the Mediterranean diet^b Low Medium High	9.4% (130) 49.5% (687) 41.2% (572)	10.2% (141) 51.8% (720) 38% (528)	< 0.001
KidMed score (score − 4 to 12)	6.87 ± 2,36	6.65 ± 2.40	< 0.001
zBMI	0.69 ± 1.16	0.60 ± 1.16	< 0.001
Physical Activity (score 1 to 5)	2.97 ± 0,73	3.05 ± 0.71	< 0.001
Screen time (min/day)	121 ± 109	132 ± 105	< 0.001
^a Significance was tested by the student´s t test and by the chi-square test for continuous and categorical variables, respectively.
^b Low adherence: Kidmed score < 4; Medium adherence: Kidmed score 4 to 8; High adherence: Kidmed score > 8.

There was no significant interaction between age/sex and adherence to the MedDiet (p > 0.05). Significant changes of variables between baseline and follow-up were found. Adherence to the MedDiet and zBMI decreased at follow-up, whereas the opposite was found for screen-time and physical activity (Table 1). The proportion of participants with low and high adherence to the MedDiet increased and decreased.

Logistic regression analysis, showed in Table 2, revealed that the following baseline items of the KidMed index: i) “Has fresh or cooked vegetables regularly once a day” (OR = 0.74; 95% CI: 0.57; 0.98 and p = 0.033); ii) “Has fresh or cooked vegetables more than once a day” (OR = 0.68; 95% CI: 0.49; 0.95 and p = 0.024); iii) “Consumes nuts regularly (at least 2–3 times per week) ” (OR = 0.74; 95% CI: 0.56; 0.97 and p = 0.030); and iiii) “Takes 2 cups of yoghurts and/or some cheese (40g) daily” (OR = 0.74; 95% CI: 0.55; 0.99 and p = 0.044) were negatively associated with a high increase in zBMI between baseline and follow-up, after adjusting for sex, age, allocation to intervention group, school, maternal education, physical activity, screen time, and zBMI at baseline. All other items associations, albeit not statically significant, were in the expected direction.

Table 2

Association of baseline categories of each item of the KidMed index and a high increase of zBMI between baseline and follow-up ^a.
	OR	95% CI	p value
Takes a fruit or fruit juice every day	0.89	0.66;1.18	0.959
Has a second fruit every day	1.01	0.77;1.33	0.886
Has fresh or cooked vegetables regularly once a day	0.74	0.57; 0.98	0.033
Has fresh or cooked vegetables more than once a day	0.68	0.49; 0.95	0.024
Consumes fish regularly (at least 2–3 times/week)	0.97	0.73; 1.30	0.837
Eats > 1 meal/week in fast food restaurants	1.06	0.75; 1.51	0.734
Likes pulses and eats them more than once a week	1.18	0.89; 1.57	0.253
Consumes pasta or rice at least 5 days per week	1.21	0.93; 1.59	0.159
Has cereals or grains (bread, etc.) for breakfast	0.84	0.63; 1.11	0.221
Consumes nuts regularly (at least 2–3 times/week)	0.74	0.56; 0.97	0.030
Uses olive oil at home	1.13	0.72; 1.77	0.594
Skips breakfast	0.94	0.48; 1.85	0.939
Has a dairy product for breakfast (yoghurt, milk, etc.)	0.80	0.56; 1.14	0.215
Has commercially baked goods or pastries for breakfast	1.11	0.81; 1.54	0.510
Takes 2 cups of yoghurts and/or some cheese (40g) daily	0.74	0.55; 0.99	0.044
Takes sweets and candy several times every day	1.23	0.86; 1.78	0.257
^a Logistic regression analysis adjusted for sex, age, allocation to intervention group, school, maternal education, physical activity, screen time, and zBMI at baseline. High increase of zBMI = 5th quintile of changes in zBMI during follow-up.

Table 3 presents a multiple linear regression analysis adjusted for sex, age, school, allocation to intervention group, maternal education, screen time, and physical activity revealed a negative (p = 0.040) association between adherence to the MedDiet at baseline and changes in zBMI between baseline and follow-up. The magnitude of this association was slightly attenuated and statistical significance disappeared (p = 0.082) after further adjustment for baseline zBMI.

Table 3

Association between baseline adherence to the Mediterranean diet and changes in zBMI during follow up in Spanish boys and girls (n = 1389) ^a
	zBMI
	Beta coefficient	95% CI	p value
KidMed score (unit)
Model 1 ^b	-0.009	-0.018; -0.001	0.043
Model 2 ^c	-0.010	-0.020; -0.001	0.040
Model 3^d	-0.009	-0-018;0.001	0.082
^a Performed by linear regression analysis
^b Adjusted for sex and age
^c Adjusted for variables of model 1 and allocation to intervention group, school, maternal education, physical activity, and screen time.
^d Adjusted for variables of model 2 and baseline zBMI

Dose response analysis adjusted for sex, age, allocation to intervention group, school, maternal education, physical activity, screen time, and zBMI at baseline revealed no significant non-linear association (p = 0.256) between adherence to the MedDiet and changes in zBMI between baseline and follow-up is showed in Fig. 1. However, changes in the zBMI decreased after 4 units of the score, which is the cut-off point for low adherence to the MedDiet, up to 10 units with no further improvements.

A multiple logistic regression analysis showed in Table 4, revealed a lower likelihood of presenting excessive weight at follow-up between the participants that at baseline presented a high level of adherence to the MedDiet in comparation with the participants that presented a low level of adherence to MedDiet that were used as a reference. The results were not statistically significant for the 3 adjusted models. Model 1 was adjusted by sex and age (OR = 0.87; 95% CI: 0.36; 2.08 and p = 0.715); model 2 by sex and age, allocation to intervention group, school, maternal education, physical activity, and screen time (OR = 0.74; 95% CI: 0.30; 1.83 and p = 0.489) and a model 3 by all the covariables of model 2 and baseline zBMI (OR = 0.67; 95% CI: 0.24; 1.85 and p = 0.234).

Table 4

Logistic regression analysis of the adherence to the Mediterranean diet and incidence of excessive weight (overweight and obesity).
	OR	95% CI
Model 1^a
Low adherence	1 (reference)
Medium adherence	0.93	0.40; 2.19
High adherence	0.87	0.36; 2.08
P for trend	0.715
Model 2^b
Low adherence	1 (reference)
Medium adherence	0.84	0.35; 2.00
High adherence	0.74	0.30; 1.83
P for trend	0.489
Model 3^c
Low adherence	1 (reference)
Medium adherence	1.00	0.38; 2.67
High adherence	0.67	0.24; 1.85
P for trend	0.234
^a Adjusted for sex and age
^b Adjusted for variables of model 1 and allocation to intervention group, school, maternal education, physical activity, and screen time.
^c Adjusted for variables of model 2 and baseline zBMI
Low adherence: Kidmed score < 4; Medium adherence: Kidmed score 4 to 8; High adherence: Kidmed score > 8.
^aAdjusted for sex, age, allocation to intervention group, school, maternal education, physical activity, screen time, and zBMI at baseline.

The present study found that for children aged 8 to 12 years a higher adherence to the MedDiet in children at baseline was prospectively and inversely associated with changes in zBMI. Additionally, having fresh or cooked vegetables regularly once a day or more than once a day; consuming nuts regularly (at least 2–3 times/week) and taking 2 cups of yoghurts and/or some cheese (40g) daily were associated with a lower likelihood of having a high increase in zBMI at follow-up.

Nowadays, there is limited prospective evidence of the association between the MedDiet adherence and childhood obesity. A recent systematic review [17] found limited evidence and heterogenic results from longitudinal studies of a beneficial effect of following a traditional MedDiet to maintain a healthy body weight in childhood. A longitudinal study of Spanish adolescents aged 12 to 15 years [26] didn’t find a significant association between adherence to the MedDiet and BMI. Furthermore, adolescents with obesity reported a high adherence to MedDiet [26]. Conversely, and consistent with the present findings, high adherence to the MedDiet at baseline predicted a lower BMI at follow-up in North American children and adolescents [27]. It is of interest to note that 80% of these children and adolescents reported a low adherence to the MedDiet, compared to only 9.4% in the present study. Additionally, it should be considered that some domains of the original KidMed index have been modified on Martin-Calvo and colleague’s study. Two other longitudinal studies conducted in young European children, one focusing on the age group 4 to 8 and the other 2 to 9, showed that high adherence to the MedDiet at baseline was protective against an increase in BMI [28, 29]. Additionally, Notario-Barandiaran and colleagues [29] analyzed the association between characteristic food groups of the MedDiet and the prevalence and incidence of overweight, obesity, and abdominal obesity. They found an inverseassociation of vegetable, fruit, meat, and olive oil consumption with the incidence of overweight whereas the opposite was found for the consumption of fish and dairy products. In the present study, we found a protective impact of the consumption of vegetables, nuts, and dairy products on a high increase in zBMI. The comparison of our results with that of Notario-Barandiaran and colleagues is difficult due to the different outcomes and other methodological issues as used of a different dietary assessment tool. Farella and colleagues reported that adherence to MedDiet is often difficult to compare because of the heterogeneity of index and methodologies used to assess it and the multiple definition of MedDiet [18].

Nowadays, evidence on the benefits of vegetable consumption with zBMI in children is weak and limited [30, 31]. Regarding the potential benefit of nuts consumption as observed in the present study, a recent systematic review reported limited evidence on the health benefits of this food group consumption in children and adolescents [32]. Contrary to the present findings a meta-analysis[33] found no significant cross-sectional association between cheese and yogurt consumption and the prevalence of excessive weight (overweight and obesity) in children and adolescents. However, the comparison between cross-sectional and prospective findings among studies is somewhat problematic because significant cross-sectional associations do not always hold in a prospective analysis in the same study.

In the present study, we analyzed the dose response relationship between adherence to the MedDiet and changes in zBMI. This analysis revealed an inverse association starting with a KidMed score of 4 units, which is the lower end of the medium level of the adherence to the MedDiet measured by the KidMed score. Furthermore, there was no further decrease in the zBMI at the upper end of the KidMed score. To our best knowledge this is the first dose-response analysis between adherence to the MedDiet and changes in zBMI in children which makes it impossible to compare these results.

There is very scarce evidence on the relationship between adherence to the MedDiet and incidence of excessive weight in children [17]. Notario-Barandiaran and colleagues reported that high adherence to the Mediterranean diet at age 4 was related to a significant lower incidence of overweight, obesity and, abdominal obesity at follow-up at age 8 in Spanish children [29]. This is in contrast to our finding but may be explained by the shorter follow-up and the older age range of children in the present study. Additionally, we have only 66 incidence cases which considerably limits the statistical power of the present analysis. Our results were in line with the recent systematic review with meta-analysis of randomize controlled trials [19]. However, after a close look on this article one might have some doubts about their conclusions due to López-Gil and colleagues highly that results should be viewed with caution because the low quality of the analyses studies. Additionally, the comparison between intervention and prospective findings among studies is also somewhat problematic.

The present study had some strengths and weakness worth to mention. The main strengths were the prospective design and the measurement of anthropometric variables in a relatively large cohort of children. Additionally, the dose response analysis gave an in-depth insight in the relationship between the exposure and outcome. The main study limitation was the use of self-reported questionnaires with their inherent measurement errors due to memory bias or social desirability bias among others. A further important limitation was the absence of data on energy intake, one of the main drivers for weight development [34].

The present study shows that adherence to the MedDiet favorably predicts weight development in Spanish children. The consumption of vegetables, nuts, dairy products were negatively associated with a high increase in zBMI. More longitudinal and high-quality studies are needed to provide robust evidence on the association between adherence to MedDiet and changes in the BMI z-score in children.

MedDiet Mediterranean diet
zBMI BMI z-score
POIBC Spanish acronym for Prevention of Childhood Obesity: a community-based model Cohort Studies
WHO World Health Organization
PAQ-C Physical Activity Questionnaire for Children

Funding:

This work was supported by a grant from Instituto de Salud Carlos III FEDER, co-founded by the European Union (PI11/01900 and PI20/00199). Centro de Investigación Biomédica en Red Epidemiologia y Salud Publica (CIBERESP) is an initiative of the Instituto de Salud Carlos III (ISCIII) of Spain, which is financed by the European Regional Development Fund (ERDF), “A way to make Europe”/“Investing in your future” (CB06/03). It is supported by the official funding agency for biomedical research of the Spanish government, ISCIII, Spain.

Competing Interests:

The authors declare no conflict of interest. The authors have no relevant financial or non-financial interests to disclose.

Authors Contributions:

C.H. and P.B. prepared the manuscript, with significant input and feedback from S.F.G. and H.S. All co-authors participated in the dataset preparation and contributed to the analysis. S.F.G and H.S. designed the study methodology and coordinated the study data collection. All authors have read and agreed to the published version of the manuscript.

Ethic approval:

The study protocol was approved by the local Ethics Committee (CEIC—Parc de Salut Mar, Barcelona, Spain).

Consent to participate:

Parents' written consent was obtained on behalf of the children.

Data Availability:

Available on request.

Acknowledgments:

We are thankful to the staff, pupils, parents, schools, and municipalities of Gavà, Molins de Rei, Sant Boi de Llobregat, and Terrassa for their participation, enthusiasm, and support.

Garrido-Miguel M, Cavero-Redondo I, Álvarez-Bueno C, et al (2019) Prevalence and Trends of Overweight and Obesity in European Children From 1999 to 2016: A Systematic Review and Meta-analysis. JAMA Pediatr 173:e192430–e192430. https://doi.org/10.1001/JAMAPEDIATRICS.2019.2430
Garrido-Miguel M, Oliveira A, Cavero-Redondo I, et al (2019) Prevalence of Overweight and Obesity among European Preschool Children: A Systematic Review and Meta-Regression by Food Group Consumption. Nutrients 11(7), 1698:. https://doi.org/10.3390/nu11071698
Bentham J, Di Cesare M, Bilano V, et al (2017) Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. The Lancet 390:2627–2642. https://doi.org/10.1016/S0140-6736(17)32129-3
Bravo-Saquicela DM, Sabag A, Rezende LFM, Rey-Lopez JP (2022) Has the Prevalence of Childhood Obesity in Spain Plateaued? A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 19:5240. https://doi.org/10.3390/ijerph19095240
Moreno Esteban B (2005) Estrategia nacional de nutrición, actividad física y prevención de la obesidad (NAOS)
Gómez SF, et al. (2019) Resultados principales del estudio PASOS 2019 sobre la actividad física, los estilos de vida y la obesidad de la población española de 8 a 16 años. Sant Boi de Llobregat
Justin D Smith, Emily Fu MAK (2020) Prevention and Management of Childhood Obesity and its Psychological and Health Comorbidities. Annu Rev Clin Psychol 351–378. https://doi.org/10.1146/annurev-clinpsy-100219-060201
Simmonds M, Llewellyn A, Owen CG, Woolacott N (2016) Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obesity Reviews 17:95–107. https://doi.org/10.1111/OBR.12334
Kelley GA, Kelley KS, Pate RR (2015) Exercise and BMI in Overweight and Obese Children and Adolescents: A Systematic Review and Trial Sequential Meta-Analysis. Biomed Res Int 2015:1–17. https://doi.org/10.1155/2015/704539
Neri D, Steele EM, Khandpur N, et al (2022) Ultraprocessed food consumption and dietary nutrient profiles associated with obesity: A multicountry study of children and adolescents. Obesity Reviews 23:e13387. https://doi.org/10.1111/OBR.13387
Miller MA, Kruisbrink M, Wallace J, et al (2018) Sleep duration and incidence of obesity in infants, children, and adolescents: a systematic review and meta-analysis of prospective studies. Sleep 41:1–19. https://doi.org/10.1093/SLEEP/ZSY018
Moradi M, Mozaffari H, Askari M, Azadbakht L (2022) Association between overweight/obesity with depression, anxiety, low self-esteem, and body dissatisfaction in children and adolescents: a systematic review and meta-analysis of observational studies. Crit Rev Food Sci Nutr 62:555–570. https://doi.org/10.1080/10408398.2020.1823813
Liberali R, Kupek E, Assis MAA De (2020) Dietary Patterns and Childhood Obesity Risk: A Systematic Review. Childhood Obesity 16:70–85. https://doi.org/10.1089/chi.2019.0059
Hills AP, Andersen LB, Byrne NM (2011) Physical activity and obesity in children. Br J Sports Med 45:866–870. https://doi.org/10.1136/bjsports-2011-090199
Salam, R. A., Padhani, Z. A., Das, J. K., Shaikh, A. Y., Hoodbhoy, Z., Jeelani, S. M., Lassi Z. S., & Bhutta ZA (2020) Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity : Nutrients 12:2208. https://doi.org/10.3390/nu12082208
Davis C, Bryan J, Hodgson J, Murphy K (2015) Definition of the mediterranean diet: A literature review. Nutrients 7:9139–9153. https://doi.org/10.3390/nu7115459
Lassale C, Fitó M, Morales-Suárez-Varela M, et al (2022) Mediterranean diet and adiposity in children and adolescents: A systematic review. Obesity Reviews 23:1–17. https://doi.org/10.1111/obr.13381
Farella I, Miselli F, Campanozzi A, et al (2022) Mediterranean Diet in Developmental Age: A Narrative Review of Current Evidences and Research Gaps. Children (Basel) 9:. https://doi.org/10.3390/CHILDREN9060906
López-Gil JF, García-Hermoso A, Sotos-Prieto M, et al (2023) Mediterranean Diet-Based Interventions to Improve Anthropometric and Obesity Indicators in Children and Adolescents: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Advances in Nutrition. https://doi.org/10.1016/J.ADVNUT.2023.04.011
Gomez SF, Casas R, Palomo VT, et al (2014) Study protocol: Effects of the THAO-child health intervention program on the prevention of childhood obesity -The POIBC study. BMC Pediatr 14:4–9. https://doi.org/10.1186/1471-2431-14-215
Felipe Gómez S, Casas Esteve R, Subirana I, et al (2018) Effect of a community-based childhood obesity intervention program on changes in anthropometric variables, incidence of obesity, and lifestyle choices in Spanish children aged 8 to 10 years. Eur J Pediatr 177:1531–1539. https://doi.org/10.1007/s00431-018-3207-x
De Onis M, Onyango AW, Borghi E, et al (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85:660–667. https://doi.org/10.2471/BLT.07.043497
Serra-Majem L, Ribas L, Ngo J, et al (2004) Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr 7:931–935. https://doi.org/10.1079/phn2004556
Voss C, Dean PH, Gardner RF, et al (2017) Validity and reliability of the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A) in individuals with congenital heart disease. PLoS One 12:1–15. https://doi.org/10.1371/journal.pone.0175806
Rey-López JP, Ruiz JR, Ortega FB, et al (2012) Reliability and validity of a screen time-based sedentary behaviour questionnaire for adolescents: The HELENA study. Eur J Public Health 22:373–377. https://doi.org/10.1093/eurpub/ckr040
Voltas N, Arija V, Aparicio E, Canals J (2016) Longitudinal study of psychopathological, anthropometric and sociodemographic factors related to the level of Mediterranean diet adherence in a community sample of Spanish adolescents. Public Health Nutr 19:1812–1822. https://doi.org/10.1017/S1368980015003560
Martin-Calvo, N., Chavarro, J. E., Falbe, J., Hu, F. B., & Field AE (2016) Adherence to the Mediterranean dietary pattern and BMI change among U.S. adolescents. Int J Obes (Lond) 4:1103–1108. https://doi.org/10.1038/ijo.2016.59
Tognon G, Hebestreit A, Lanfer A, et al (2014) Mediterranean diet, overweight and body composition in children from eight European countries: Cross-sectional and prospective results from the IDEFICS study. Nutrition, Metabolism and Cardiovascular Diseases 24:205–213. https://doi.org/10.1016/j.numecd.2013.04.013
Notario-Barandiaran L, Valera-Gran D, Gonzalez-Palacios S, et al (2020) High adherence to a mediterranean diet at age 4 reduces overweight, obesity and abdominal obesity incidence in children at the age of 8. Int J Obes 44:1906–1917. https://doi.org/10.1038/s41366-020-0557-z
Bayer O, Nehring I, Bolte G, Von Kries R (2014) Fruit and vegetable consumption and BMI change in primary school-age children: A cohort study. Eur J Clin Nutr 68:265–270. https://doi.org/10.1038/ejcn.2013.139
Field AE, Gillman MW, Rosner B, et al (2003) Association between fruit and vegetable intake and change in body mass index among a large sample of children and adolescents in the United States. Int J Obes 27:821–826. https://doi.org/10.1038/sj.ijo.0802297
Mead LC, Hill AM, Carter S, Coates AM (2021) The effect of nut consumption on diet quality, cardiometabolic and gastrointestinal health in children: A systematic review of randomized controlled trials. Int J Environ Res Public Health 18:1–15. https://doi.org/10.3390/ijerph18020454
Babio N, Becerra-Tomás N, Nishi SK, et al (2022) Total dairy consumption in relation to overweight and obesity in children and adolescents: A systematic review and meta-analysis. Obesity Reviews 23:1–17. https://doi.org/10.1111/obr.13400
Hill JO, Wyatt HR, Peters JC (2012) Energy balance and obesity. Circulation 126:126–132. https://doi.org/10.1161/CIRCULATIONAHA.111.087213

No competing interests reported.

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Adherence to the Mediterranean diet and changes in body mass index in Spanish children

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Abstract

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What is known

What is new:

1. Introduction

2. Material and Methods

2.1. Study design

2.2. Outcome measure

2.3. Measurement of Exposure

2.4. Other variables

2.4.1. Physical activity

2.4.2. Screen-time

2.4.3. Maternal socioeconomic status

2.5. Statistical analysis

3. Results

4. Discussion

5. Conclusions

Abbreviations

Declarations

References

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