Adherence to Mediterranean Diet in Children and Adolescents With Obesity and Association With Anthropometrics as well as Cardiometabolic Risk Factors

Background Childhood obesity increases worldwide and is associated with cardiovascular and metabolic comorbidities of the Metabolic Syndrome, which already start in childhood. Preliminary data suggest an association between diets, rich in minimally processed, plant-based foods, fibre and unsaturated fats, such as the Mediterranean diet (MD) and lower incidence of obesity and related comorbidities; however, evidence remains limited. Our study aimed to assess adherence to the MD and its association with anthropometrics and cardiometabolic risk (CMR) in children and adolescents with obesity in Germany. Methods In this cross-sectional study, 221 children (6–18 years) with BMI-SDS ≥ 90th percentile were included. Anthropometric and biochemical parameters were collected and applied to define existing CMR factors, including abdominal obesity, low high-density lipoprotein-cholesterol, hypertriglyceridemia, elevated blood pressure and insulin resistance. The sum of present risk factors resulted in a CMR score, with a higher score indicating higher CMR. Adherence to the MD was classified using the KIDMED index as low (-4-3 points), moderate (4–7 points) and optimal (8–12 points). Association between MD adherence and CMR score was examined using regression analysis, taking into account the influence of gender, pubertal stage and BMI-SDS. Results The mean KIDMED score was 2.3 ± 2.0. Low MD adherence was present in 71% of children, moderate adherence in 29%. No participant achieved optimal adherence. Children with moderate MD adherence had lower mean BMI-SDS (2.54 ± 0.53 vs. 2.84 ± 0.57; p < 0.001), WHtR (0.59 ± 0.06 vs. 0.63 ± 0.08; p < 0.001) and HOMA-IR (4.58 ± 2.66 vs. 6.10 ± 3.14; p < 0.001) compared to those with low MD adherence. Mean CMR score was on average 0.4 points lower with moderate MD adherence (β=-0.37; 95% CI:[-0.67,-0.07]; p = 0.017). The effect remained after adjustment for gender, pubertal stage and BMI-SDS (β=-0.28; 95% CI:[-0.59,0.03]; p = 0.079). Conclusion Children with obesity and poor adherence to a MD seem to have higher general and abdominal obesity as well as cardiometabolic risk. These findings suggest that a MD may provide protective effects on cardiometabolic health already in pediatric patients with obesity. Trial registration Clinical trial number: not applicable.