Mediterranean diet, physical activity, and family characteristics associated with cognitive performance in Italian primary school children: analysis of the I-MOVE project

Eur J Pediatr. 2023 Feb;182(2):917-927. doi: 10.1007/s00431-022-04756-6. Epub 2022 Dec 16.


Working memory (WM) is a multicomponent system that supports cognitive functioning. It has been linked to a wide variety of outcomes including academic success and general well-being. The present study examined the relations between adherence to the Mediterranean diet (MD) and WM among Italian children, adjusting for important parent characteristics and children's lifestyle habits. Data for this study was obtained from 106 children attending primary school in Imola (Italy) who were part of the I-MOVE study emphasizing school-based physical activity. Children's adherence to the MD was calculated using the KIDMED index (KI) based on the ZOOM-8 questionnaire. Physical activity (PA) levels were assessed using an actigraph accelerometer and WM using the backward digit span test. Univariate regression was used to select significant child-level and family measures associated with WM, which were then tested in a single multivariate regression model. Older age is positively associated with higher WM (β = 0.36; 95% CI 0.25, 0.47). Dietary adherence (KI) (β = 0.07; 95% CI 0.01, 0.14) and engagement in organized PA outside school hours (β = 0.58; 95% CI 0.09, 1.10) are positively related to WM. Among the family measures, father's education was positively associated with WM for high school education and for university vs. middle school or lower, respectively.

Conclusion: Adherence to the MD was associated with better WM capacity in primary school children. These findings can be used to guide policymakers in designing health promotion programs and instituting policies emphasizing healthy nutrition to improve physical health and boost cognitive functioning.

What is known: • The development of working memory involves the entire childhood with a rapid spurt between 2 and 8 years of age. • Working memory plays a critical role in children's learning and academic performance and underlies higher-order cognitive abilities.

What is new: • Adherence to the Mediterranean Diet was associated with higher working memory capacity in primary school children. • Health promotion interventions based on PA and sound nutrition involving children benefit not only physical and mental health, but also cognitive health.

Keywords: Lifestyle; Mediterranean diet; Parental education; Physical activity; Working memory.

MeSH terms

  • Child
  • Cognition
  • Diet, Mediterranean*
  • Exercise
  • Family Characteristics
  • Feeding Behavior
  • Humans
  • Italy
  • Schools
  • Surveys and Questionnaires