Healthy and Sustainable Dietary Patterns in Children and Adolescents: A Systematic Review

Abstract

The need to adherence to healthy and sustainable dietary pattern in pediatric age is discussed worldwide, being linked to a progressively incidence of non-communicable diseases in adulthood. The aims of this systematic review were to summarize the healthy and/or sustainable dietary patterns, defined a priori, described in the literature for use among the pediatric age; to evaluate the adherence to these dietary patterns and identify the health-related benefits associated with the adherence to these patterns. A literature search was carried out on MEDLINE, SCOPUS and WEB of SCIENCE from 2010 up to 2021, according to the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number: CRD42020221788). A hundred and twenty-eight papers were included according to the following criteria: 2-17 years old participants, healthy and /or sustainable dietary patterns defined by an a priori methodology; papers written in English or Portuguese and published since 2010. Fifty instruments with 14 adaptations that measure adherence to healthy and/or sustainable dietary patterns in children and adolescents were found. The Mediterranean Diet was the most studied dietary pattern. Adherence to healthy and/or sustainable dietary patterns has wide variations worldwide. Most of the instruments described have been little studied in pediatric age, reducing the ability to extrapolate results. A higher adherence to these dietary patterns was associated to lower body fat, waist circumference, blood pressure and metabolic risk. There is no consensus regarding the association with body mass index. No studies have proofs of the sustainability characteristics of these instruments, being necessary to produce a new sustainable instrument or test the association of the previous ones with, for example, the ecological footprint. Further validations of these instruments in each country and more prospective are needed studies to establish temporal relationships with health-related outcomes.

Adherence to the Mediterranean Diet in Children and Adolescents and Association with Multiple Outcomes: An Umbrella Review

“…After duplicates were removed, we screened n = 139 abstracts. The research team screened all of the potential full text papers (n = 26), and, finally, a total of n = 11 papers [24][25][26][27][28][29][30][31][32][33][34] met the inclusion criteria, as described in Figure 1. Among a total number of 11 systematic reviews included in the present umbrella review, only 2 papers included a meta-analysis [25,28].…”

The effect of nutritional and lifestyle education intervention program on nutrition knowledge, diet quality, lifestyle, and nutritional status of Croatian school children

“…A recent systematic review assessed 50 healthy and sustainable dietary patterns in children and adolescents by measuring adherence to healthy and/or sustainable dietary patterns, with the Mediterranean diet as the most studied dietary pattern. The review found that higher adherence to the reviewed sustainable dietary patterns was associated with lower body fat, waist circumference, blood pressure, and metabolic risk, but there was no consensus regarding the association with BMI (Teixeira et al, 2022) and concluded that there is a need for a new sustainable instrument or test in association with, e.g., the ecological and water footprints since no studies provide evidence of the sustainability. Recently, a 30-item Sustainable-Healthy-Diet (SHED) Index score was developed for measuring healthy and sustainable individual diets and reflecting the nutritional, environmental, and sociocultural aspects of sustainable diets (Tepper et al, 2021) that found a significant correlation between the SHED index score and the Mediterranean diet score, confirming the MD as a sustainable diet.…”

Mediterranean Diet in Developmental Age: A Narrative Review of Current Evidences and Research Gaps

“…Despite the cumulative data reporting the possible beneficial effects of MD diet on children, this narrative review, showed that few studies have evaluated the effects of MD on specific age groups [ 52 , 53 , 76 ]. As we move towards more “tailored” medicine [ 77 ], it is important to perform ad hoc studies for each age group to avoid biased generalizations.…”