Poor adherence to the Mediterranean diet is associated with increased likelihood of metabolic syndrome components in children: the Healthy Growth Study

Public Health Nutr. 2021 Jul;24(10):2823-2833. doi: 10.1017/S1368980021001701. Epub 2021 Apr 19.


Objective: To examine the associations between the level of adherence to the Mediterranean diet (MedDiet) with obesity, insulin resistance (IR), metabolic syndrome (MetS) and its components in schoolchildren.

Design: The Healthy Growth Study was a large epidemiological cross-sectional study.

Setting: School children who were enrolled in primary schools in four counties covering the northern, southern, western and central part of Greece were invited to participate.

Participants: The study was conducted with a representative sample of 9-13-year-old schoolchildren (n 1972) with complete data. This study applied the KIDMed score to determine 'poor' (≤3), 'medium' (4-7) and 'high' (≥8) adherence of children to the MedDiet. The research hypothesis was examined using multivariate logistic regression models, controlling for potential confounders.

Results: The percentage of children with 'poor', 'medium' and 'high' adherence to the MedDiet was 64·8 %, 34·2 % and 1 %, respectively. Furthermore, the prevalence of obesity, IR and MetS was 11·6 %, 28·8 % and 3·4 %, respectively. Logistic regression analyses revealed that 'poor' adherence to the MedDiet was associated with an increased likelihood for central obesity (OR 1·31; 95 % CI 1·01, 1·73), hypertriglyceridaemia (OR 2·80; 95 % CI 1·05, 7·46) and IR (OR 1·31; 95 % CI 1·05, 1·64), even after adjusting for several potential confounders.

Conclusions: The present study showed that approximately two-thirds of the examined sample of schoolchildren in Greece have 'poor' adherence to the MedDiet, which also increases the likelihood for central obesity, hypertriglyceridaemia and IR. Prospective studies are needed to confirm whether these are cause-effect associations.

Keywords: Mediterranean diet; children; insulin resistance; metabolic syndrome; obesity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Cross-Sectional Studies
  • Diet, Mediterranean*
  • Humans
  • Logistic Models
  • Metabolic Syndrome* / epidemiology
  • Metabolic Syndrome* / etiology
  • Obesity