Mediterranean Diet, Overweight and Body Composition in Children From Eight European Countries: Cross-Sectional and Prospective Results From the IDEFICS Study

Study Questions:

Is a Mediterranean dietary pattern associated with lower risk of obesity among children?


Data for the present study were collected as part of the IDEFICS (Identification and prevention of Dietary and lifestyle induced health EFects In Children and infantS) study, which recruited a representative sample of children (n = 16,220 ) ages 2-9 years from study centers in eight European countries. The aim of the study was to investigate the risks and long-term consequences of overweight and obesity in children, which started at the end of 2006 and ran for 5 years. The baseline survey (2007-2008), was followed by an intervention phase and repeated after 2 years on 9,114 children. The intervention focused on diet, physical activity, and stress-coping capacity. It was community-based and integrated throughout various levels of society, for a total of 10 modules: three at community level, six at school level, and one for parents. All materials for the interventions were centrally developed and culturally adapted. Weight, height, waist circumference, and skinfolds were measured at baseline and in 9,114 children of the original cohort after 2 years. Diet was evaluated by a parental questionnaire reporting children’s usual consumption of 43 food items. Adherence to a Mediterranean-like diet was calculated by a food frequency-based Mediterranean Diet Score.


The highest Mediterranean Diet Score levels were observed in Sweden, and the lowest in Cyprus. Parental education was a determinant of high Mediterranean Diet Score levels (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.11-1.32) and high parental income tended to be the same direction (OR, 1.07; 95% CI, 0.98-1.17). Children’s age and gender were not associated with Mediterranean Diet Score. High scores were inversely associated with overweight including obesity (OR, 0.85; 95% CI, 0.77-0.94) and percent fat mass (β = -0.22; 95% CI, -0.43 to -0.01) independently of age, sex, socioeconomic status, study center, and physical activity. High Mediterranean Diet Score at baseline protected against increases in BMI (OR, 0.87; 95% CI, 0.78-0.98), waist circumference (OR, 0.87; 95% CI, 0.77-0.98) and waist-to-height ratio (OR, 0.88; 95% CI, 0.78-0.99) with a similar trend observed for percent fat mass (p = 0.06).


The investigators concluded that although a Mediterranean dietary pattern is inversely associated with childhood obesity, it is not common in children living in the Mediterranean region and should therefore be advocated as part of European Union obesity prevention strategies.


These data suggest that a Mediterranean Dietary pattern is inversely associated with overweight and obesity among European children. Public health efforts to promote such a dietary pattern in childhood may translate into reductions in obesity and concomitant chronic conditions such as diabetes.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Diet

Keywords: Odds Ratio, Life Style, Overweight, Pediatric Obesity, Body Weight, Diet, Mediterranean, Social Class, Waist Circumference, Public Health, Body Mass Index, Research Personnel, Motor Activity, Obesity, European Union, Confidence Intervals, Questionnaires, Diabetes Mellitus

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