Mediterranean Diet Index (KIDMED) Adherence, Socioeconomic Determinants, and Nutritional Status of Portuguese Children: The Eat Mediterranean Program

Abstract

Background: Despite its health benefits, adherence to the Mediterranean diet (MD) has been decreasing, particularly in young generations and in Mediterranean regions, including Portugal. Socioeconomic and lifestyle factors have been shown to influence children and adolescents’ eating habits. This study aimed to assess the association between socioeconomic factors and children’s nutritional status with the MD adherence using the Eat Mediterranean (EM) program. Methods: Participant’s BMI and adherence to the MD diet was assessed at baseline and after the intervention. Data regarding socioeconomic status and KIDMED Index were collected using a family record form. The intervention consisted of various educational sessions addressing the principles and promoting a Mediterranean dietary pattern in schools belonging to two municipalities in the central area of Portugal. A total of 1,772 participants (from preschool to secondary school) met the inclusion criteria for the study. Results: At the end of the program, the adherence to the MD diet improved significantly with participants increasing their adherence to an optimal diet by 17.6%. Daily intake of foods belonging to the MD diet also increased significantly, and the intake of high energy density foods decreased. Mother’s educational level and household income were significantly (p < 0.0001) associated with optimal MD adherence by participants, in both stages. Nutritional status was not associated with the KIDMED Index. Discussion: The EM program showed to be effective in increasing MD adherence in this study population since optimal MD adherence was reported in most participants at the end of the EM program. Household income and mother’s educational level were positively associated with the diet quality of the children and adolescents.

Evaluation of Physical Fitness, Body Composition, and Adherence to Mediterranean Diet in Adolescents from Estonia: The AdolesHealth Study

“…The data from the KIDMED questionnaire (low 41.6%, average 44.05%, and high adherence to the MD, 14.28%) provide notably lower results than those of studies conducted in Mediterranean countries [56,57], but similar to those of studies carried out in non-Mediterranean countries [19]. In turn, the results obtained in the current study match those found by similar studies in southern European countries [20,58,59], with a comparable percentage in subjects with a medium adherence to the MD, but with higher results in those who presented a low adherence to the MD. However, the adherence is inferior in comparison to the results of a recent study by Galan-Lopez et al, conducted in Icelandic adolescents, and where 14.99% of low adherence was found, 60.72% of mild adherence, and 24.29% of high adherence [24].…”

Health behaviours as predictors of the Mediterranean diet adherence: a decision tree approach

“…The daily consumption of a second piece of fruit, the variable with the highest differentiating power in our CHAID analysis, was reported by 37•8 % of our sample (n 123). This prevalence was lower than the one reported by Rito et al (47•9 %) for the same variable, in another recent study also developed in Portugal (57) .…”

Adherence to the Mediterranean Diet in a School Population in the Principality of Asturias (Spain): Relationship with Physical Activity and Body Weight

“…Similar results have been observed in other studies carried out with Spanish and Portuguese children. In Spain, the enKid study showed an optimal adherence in 46.4% of children [ 34 ], while The Eat Mediterranean Program in Portugal reported an optimal adherence in 58.4% of the sample [ 43 ]. These results are in contrast with other Mediterranean countries, such as Greece, Cyprus, or, to a lesser extent, Italy, where lower optimal MD adherence percentages have been described.…”

“…Children’s age, gender, and school educational level, all of them previously related to the adherence to the MD in several studies [ 10 , 33 , 38 , 39 , 40 ], were recorded. Other variables related to adherence to the MD, such as parental educational level [ 41 , 42 , 43 ] and the school’s area and setting [ 30 , 38 , 40 ], were also recorded. The collection of these variables allows us to control them as possible confounding variables.…”