Physical Activity, Body Mass, and Adherence to the Mediterranean Diet in Preschool Children: A Cross-Sectional Analysis in the Split-Dalmatia County (Croatia)

Abstract

Physical activity, body mass, and dietary habits are known to be important determinants of overall health status, but there is an evident lack of studies that examine these issues specifically in preschool children. The aim of this study was to identify associations that may exist between adhering to the Mediterranean diet (MD), levels of physical activity (PA), and body composition indices in apparently healthy preschool children from southern Croatia. Participants were 5- to 6-year-old preschoolers from the Mediterranean part of the country (the Split-Dalmatia County; n = 260, 126 females). Adherence to the MD was observed by the Mediterranean Diet Quality Index (KIDMED), PA level was evaluated by the Preschool-age Children’s Physical Activity Questionnaire (Pre-PAQ), and responses were collected from the parents. The participants’ waist circumferences (in cm), waist-to-hip ratios, and body mass index (in kg/m2, and in a z-score calculated relative to the normative value for age and sex) were used as indicators of body composition. All children were of the same age and tested over a one-month period of the same year as a part of the regular examination undertaken before attending elementary school. With only 6% of the children having a low KIDMED score, adherence to the MD was high. MD adherence was higher in girls (Chi-square = 15.31, p < 0.01) and children who live on the coast of the Adriatic Sea (Chi-square = 18.51, p < 0.01). A mixed effects logistic regression (with kindergarten as random factor) identified sedentary activity to be negatively associated with MD adherence (OR per point: 0.65, 95% CI: 0.44–0.91). High adherence to the MD in the studied sample may be attributed to regulated feeding in kindergarten. Considering that most Croatian elementary schools do not provide food to their students, MD adherence should be investigated later in life and also in other parts of the country where the MD is culturally less prevalent.

Anthropometric Parameters and Mediterranean Diet Adherence in Preschool Children in Split-Dalmatia County, Croatia—Are They Related?

“…In previous studies, the adherence to the MeDi, calculated using the KIDMED index, has shown poor results among children [18] and adolescents [19] from the European Union, suggesting the necessity of nutritional intervention in this particular population. On the contrary, the results of an earlier study involving preschool children from Split-Dalmatia County indicate an exceptionally high adherence to the MeDi with only 6% out of 260 children having a low KIDMED score [20]. The difference in the results can be explained by the smaller number of respondents in the above-mentioned study, as well as parental overestimation or underestimation of the quality of a child's nutrition.…”

Mediterranean diet and adiposity in children and adolescents: A systematic review

“…The majority of studies included BMI as the main anthropometric marker, except three: waist circumference, 75 abdominal obesity, 72 or body fat percentage 63 . In cross‐sectional studies, regarding general adiposity expressed by BMI, continuous or in categories (overweight/obesity), a total of 27 studies 31,32,34–37,40,41,45,46,49–51,55–58,62,65,67,68,70–74,76 found statistically non significant associations, 16 a negative association, 30,38,39,42–44,47,48,54,59–61,64,66,69,77 and 1 a positive association 52 with greater adherence to the Mediterranean diet. Regarding central adiposity, 11 studies found no significant association, 30,32,34,46,49–51,55,57,72,73 whereas 5 found an inverse association 35,39,48,53,75 and 2 a positive association 39,52 .…”

“…In cross‐sectional studies, regarding general adiposity expressed by BMI, continuous or in categories (overweight/obesity), a total of 27 studies 31,32,34–37,40,41,45,46,49–51,55–58,62,65,67,68,70–74,76 found statistically non significant associations, 16 a negative association, 30,38,39,42–44,47,48,54,59–61,64,66,69,77 and 1 a positive association 52 with greater adherence to the Mediterranean diet. Regarding central adiposity, 11 studies found no significant association, 30,32,34,46,49–51,55,57,72,73 whereas 5 found an inverse association 35,39,48,53,75 and 2 a positive association 39,52 . Regarding the statistical approaches, 17 studies only performed simple chi‐square, ANOVA, or Pearson correlation tests without adjustment, 42,43,45,49–51,55,57,58,63,64,66–68,70,74,77 of which only 5 found statistically significant differences in anthropometric markers according to Mediterranean diet adherence 42,43,64,66,77 .…”

Effectiveness of a Physical Education Program on the Motor and Pre-literacy Skills of Preschoolers From the Training-To-Health Project: A Focus on Weight Status

“…As reported by several researches, both physical inactivity and sedentary/unhealthy behaviors increase the risk of being overweight and obesity in childhood (Tucker, 2008;Han et al, 2010;Hills et al, 2011;Reilly et al, 2019). For this reason, the role of diet and physical activity in children has been investigated in previous studies (Obradovic Salcin et al, 2019;Tabacchi et al, 2020a). In support of the above, Tabacchi et al (2020a) suggest that raising children in an environment where both motor and cognitive skills are encouraged can improve food literacy and, furthermore, enhance school achievement.…”