Abstract
The Mediterranean diet (MD) is considered one of the healthiest dietary patterns. The aim of this study was to assess MD adherence in children and youth living in the Mediterranean region in Croatia and evaluate the differences in adherence to the MD among different educational stages. In total, 2722 individuals aged 2 to 24 years were enrolled in this study. Subjects were divided into different groups according to the Croatian educational system. Mediterranean Diet Quality Index (KIDMED) was used to assess adherence to the MD. In the total sample, the adherence to the MD was poor in 19.2%, average in 60.8%, and good in 20.1% of the study participants. The prevalence rate of poor adherence to the MD increased with higher educational stage, i.e., the highest prevalence rate of poor MD adherence was observed for college students (39.3%). Children having a higher number of snacks on days-off, those with lower physical activity, and not having breakfast together with a family are more likely to have poor MD adherence, while children having a higher number of snacks on working days are less likely to have a poor MD. The results of this study showed low adherence to the principles of the MD, confirming the need for improvement of adherence to the MD pattern in the studied population.
Highlights
The Mediterranean diet (MD) is considered one of the healthiest dietary patterns in the world, characterized by high consumption of fruits, vegetables, legumes, olive oil, nuts, and cereals, a moderate-high intake of fish, dairy products, and alcohol, and a low intake of saturated lipids, sweets, and red and processed meat [1,2]
The median KIDMED index score was 6 (IQR: 3), while the adherence to the MD was poor in 19.2%, average in 60.7%, and good in 20.1% of the study participants
Regarding the differences in adherence to the MD for different educational stages, the results showed that the KIDMED index score decreased with higher educational stage, i.e., the highest KIDMED index score was observed for children enrolled in kindergartens, followed by children from the first four grades of primary schools, children from grades 5–8 of primary schools and youths enrolled in secondary schools, while the lowest score was observed for students (p < 0.001) (Figure 1)
Summary
The Mediterranean diet (MD) is considered one of the healthiest dietary patterns in the world, characterized by high consumption of fruits, vegetables, legumes, olive oil, nuts, and cereals, a moderate-high intake of fish, dairy products, and alcohol (mostly wine), and a low intake of saturated lipids, sweets, and red and processed meat [1,2]. Despite all the existing evidence about the benefits of this diet, a transition from this dietary pattern towards a high-energy diet style, which is rich in saturated fats and low in micronutrients, has been observed, especially in the younger generation [9]. This change has led to an increase in obesity and numerous negative health-related consequences [6,10]. The results of the European Childhood Obesity Surveillance Initiative in Croatia in 2018/2019 indicate that 35% of children aged 8.0 to 8.9 years had overweight or obesity [12]. According to the research conducted by the Organisation for Economic Cooperation and Development (OECD), in the 30 years, life expectancy in Croatia will be shortened by 3.5 years due to overweight [13]
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