Data from studies in pediatric samples exploring adherence to the Mediterranean diet are scarce. The aim of the present work was to explore adherence to a Mediterranean diet pattern in a representative sample of Greek children and adolescents. The study sample (n = 1305, 3-18 y) was representative of the Greek pediatric population in terms of sex and age. Information on participants' sociodemographic, anthropometric, and lifestyle characteristics were collected through telephone interviews. Adherence to the Mediterranean diet guidelines for adults and to the general dietary guidelines for children was evaluated using KIDMED scores: the higher the score, the more favorable the dietary pattern. The Goldberg cut-off limits for the ratio of energy intake:basal metabolic rate were used to evaluate dietary underreporting and children were accordingly classified as low energy reporters (LER) or non-LER. Only 11.3% of children and 8.3% of adolescents had an optimal KIDMED score (>/=8). In adolescents, partial correlation analysis revealed a negative weak association between KIDMED and BMI (r = -0.092; P = 0.031), which remained significant in the non-LER subgroup (r = -0.137, P = 0.011). Multiple regression analysis revealed that higher KIDMED scores were associated, in non-LER children, with less time spent on sedentary activities (P = 0.002) and higher paternal education (P = 0.050), whereas in adolescents, with younger age (P = 0.001), less time spent on sedentary activities (P = 0.015), higher maternal education (P = 0.014), and higher eating frequency (P = 0.041). In conclusion, low adherence rates to the Mediterranean diet were observed in Greek children and adolescents; this evidence needs to be further explored regarding its impact on health and disease.

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Adhering to a Mediterranean Diet (MD) is associated with reduced cardiovascular disease (CVD) risk. This study aimed to explore methods of increasing MD adoption in a non-Mediterranean population at high risk of CVD, including assessing the feasibility of a developed peer support intervention. The Trial to Encourage Adoption and Maintenance of a MEditerranean Diet (TEAM-MED) was a 12-month pilot parallel group RCT involving individuals aged ≥40 y, with low MD adherence, who were overweight, and had an estimated CVD risk ≥20% over ten years. It explored three interventions, a peer support group, a dietician-led support group and a minimal support group to encourage dietary behaviour change and monitored variability in Mediterranean Diet Score (MDS) over time and between the intervention groups, alongside measurement of markers of nutritional status and cardiovascular risk. 118 individuals were assessed for eligibility, and 75 (64%) were eligible. After 12 months there was a retention rate of 69% (PSG 59%; DSG 88%; MSG 63%). For all participants, increases in MDS were observed over 12 months (p<0.001), both in original MDS data and when imputed data were used. Improvements in BMI, HbA1c levels, systolic and diastolic blood pressure in the population as a whole. This pilot study has demonstrated that a non-Mediterranean adult population at high CVD risk can make dietary behaviour change over a 12-month period towards a MD. The study also highlights the feasibility of a peer support intervention to encourage MD behaviour change amongst this population group and will inform a definitive trial.

Objective: To compare the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets in deterring 10-year CVD. Design: Prospective cohort (n 2020) with a 10-year follow-up period for the occurrence of combined (fatal or non-fatal) CVD incidence (International Classification of Diseases (ICD)-10). Baseline adherence to the Mediterranean and DASH diets was assessed via a semi-quantitative FFQ according to the MedDietScore and DASH scores, respectively. Setting: Attica, Greece. Participants: Two thousand twenty individuals (mean age at baseline 45·2 (sd 14·0) years). Results: One-third of individuals in the lowest quartile of Mediterranean diet consumption, as compared with 3·1 % of those in the highest quartile, developed 10-year CVD (P < 0·0001). In contrast, individuals in the lowest and highest DASH diet quartiles exhibited similar 10-year CVD rates (n (%) of 10-year CVD in DASH diet quartiles 1 v. 4: 79 (14·7 %) v. 75 (15·3 %); P = 0·842). Following adjustment for demographic, lifestyle and clinical confounding factors, those in the highest Mediterranean diet quartile had a 4-fold reduced 10-year CVD risk (adjusted hazard ratio (HR) 4·52, 95 % CI 1·76, 11·63). However, individuals with highest DASH diet quartile scores did not differ from their lowest quartile counterparts in developing such events (adjusted HR 1·05, 95 % CI 0·69, 1·60). Conclusions High adherence to the Mediterranean diet, and not to the DASH diet, was associated with a lower risk of 10-year fatal and non-fatal CVD. Therefore, public health interventions aimed at enhancing adherence to the Mediterranean diet, rather than the DASH diet, may most effectively deter long-term CVD outcomes particularly in Mediterranean populations.

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