Adherence to Mediterranean Diet and Its Association with Metabolic Health Status in Overweight and Obese Adolescents

Abstract

Background. Obesity is becoming more prevalent around the world and greatly contributes to chronic disease progression. Previous studies have investigated individual food groups in relation to metabolic health status of adolescents, mainly in Western countries. Limited data are available on the association between dietary patterns and metabolic health in Middle East nations, where childhood overweight/obesity is increasing drastically. Therefore, we investigated the relationship between the Mediterranean diet and metabolic health status among Iranian adolescents. Methods. This cross-sectional study was conducted on 203 overweight/obese adolescents. Dietary intakes were evaluated by a validated food frequency questionnaire. Anthropometric parameters and blood pressure were measured. Fasting blood samples were obtained to determine circulating insulin, glucose, and lipid profile. Two different methods were applied to classify participants as metabolically healthy obese (MHO) or unhealthy obese (MUO): International Diabetes Federation (IDF) criteria and IDF along with insulin resistance (HOMA-IR) criteria. Results. A total of 79 (38.9%) and 67 (33.0%) adolescents were, respectively, categorized as MUO, based on IDF and IDF/HOMA definitions. Considering IDF criteria, higher adherence to the Mediterranean diet was related to lower odds of being MUO, both in the crude (OR: 0.17; 95%CI: 0.08–0.37) and fully adjusted model (OR: 0.33; 95% CI: 0.13–0.84). Excluding each component from the score made the association insignificant, except for two components of meat and dairy products. Based on the IDF/HOMA-IR criteria, there was no significant association between Mediterranean diet score and MUO, after considering all potential confounders (OR: 0.47; 95% CI: 0.17–1.30). Conclusions. We found an inverse association between the Mediterranean diet and odds of MUO among Iranian adolescents, based on IDF criteria. No significant relation was found when MUO was defined based on HOMA-IR/IDF criteria. Further prospective cohort studies are needed to confirm these findings.

Adherence to the Mediterranean diet as a possible additional tool to be used for screening the metabolically unhealthy obesity (MUO) phenotype

“…Interestingly, they found that in post-menopausal state but not in premenopausal, higher adherence to MD was associated with a lower risk of MUO phenotype [ 33 ]. Also in adolescence, this association has been confirmed [ 34 ]. Indeed, a cross-sectional study was carried out in 203 adolescents with overweight/obesity.…”

“…Indeed, a cross-sectional study was carried out in 203 adolescents with overweight/obesity. A validated food frequency questionnaire was administered in order to investigate dietary intakes, and an inverse association between MD and odds of MUO phenotype was found among Iranian adolescents [ 34 ]. The same results were found in the HELENA study, which was carried out in 137 adolescents with obesity or overweight in order to investigate the association of MUO phenotype with MD [ 35 ].…”

Dietary Inflammatory Potential in Pediatric Diseases: A Narrative Review

“…The MD, rich in nutrients and phytochemicals known for their anti-inflammatory role, including vitamins C and E, epigallocatechin gallate, lycopene, and polyphenols, could modulate inflammatory components such as NF-KB, mitogen-activated protein kinases, and IL-1β signaling [55]. Lastly, the high fiber content of the MD could have an antiinflammatory role due to the major production of SCFAs by gut bacteria, which could improve glucose and lipid metabolism in many tissues [64,65]. The changes in the gut microbiota are strictly related to the type of fatty acids ingested: the altered n-6/n-3 PUFAs ratio was found to promote the development of Enterobacteriaceae and Clostridia spp., leading to a pro-inflammatory environment that could be attenuated by the introduction of n-3 PUFAs [66,67].…”

“…For diseases re ing a specific diet, there are few and heterogeneous studies available for children. F research should focus more on the specific nutritional changes required to enable di control, both in terms of dietary patterns and specific nutrients' intake, and how these influence the risk of occurrence of other diseases or the composition of the gut micro Eight studies on both children and adolescents [43,47,48,50,57,58,64,65] Nutrition is an environmental factor that ences inflammatory pathways. Several av ble studies evaluate not only individual n ents or foods, but investigate nutrition c plexity through dietary pattern analys…”

The Effect of Healthy Lifestyle Strategies on the Management of Insulin Resistance in Children and Adolescents with Obesity: A Narrative Review

“…Among dietary patterns, over the last decades great attention has been paid to the Mediterranean diet (MedDiet), as a balanced nutritional pattern associated with increased metabolic health status in children and adolescents [ 120 ]. MedDiet is characterized by the high intake of vegetables, fruits, legumes, and cereals (mainly in unprocessed forms); the low intake of meat and meat products and low to moderate intake of dairy products; the moderate to high intake of fish; and the high intake of unsaturated added lipids, particularly in the form of olive oil [ 121 ].…”