Data from studies in pediatric samples exploring adherence to the Mediterranean diet are scarce. The aim of the present work was to explore adherence to a Mediterranean diet pattern in a representative sample of Greek children and adolescents. The study sample (n = 1305, 3-18 y) was representative of the Greek pediatric population in terms of sex and age. Information on participants' sociodemographic, anthropometric, and lifestyle characteristics were collected through telephone interviews. Adherence to the Mediterranean diet guidelines for adults and to the general dietary guidelines for children was evaluated using KIDMED scores: the higher the score, the more favorable the dietary pattern. The Goldberg cut-off limits for the ratio of energy intake:basal metabolic rate were used to evaluate dietary underreporting and children were accordingly classified as low energy reporters (LER) or non-LER. Only 11.3% of children and 8.3% of adolescents had an optimal KIDMED score (>/=8). In adolescents, partial correlation analysis revealed a negative weak association between KIDMED and BMI (r = -0.092; P = 0.031), which remained significant in the non-LER subgroup (r = -0.137, P = 0.011). Multiple regression analysis revealed that higher KIDMED scores were associated, in non-LER children, with less time spent on sedentary activities (P = 0.002) and higher paternal education (P = 0.050), whereas in adolescents, with younger age (P = 0.001), less time spent on sedentary activities (P = 0.015), higher maternal education (P = 0.014), and higher eating frequency (P = 0.041). In conclusion, low adherence rates to the Mediterranean diet were observed in Greek children and adolescents; this evidence needs to be further explored regarding its impact on health and disease.

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The overall high prevalence of overweight and obesity in the current population is significant and underscores the need for environmental and genetic information that will shed light on the phenomenon of childhood obesity.