Adherence to Mediterranean diet associated with health-related quality of life in children and adolescents: a systematic review

Abstract

Background Health-related quality of life (HRQoL) has become a significant outcome in assessing interventions in the pediatric population and could be influenced by diet patterns. The Mediterranean diet (MD) pattern has been related to multiple positive health outcomes, including decreased cardiovascular risk and better mental health. We aimed to evaluate the association between MD adherence and HRQoL in children and adolescents. Methods The literature search was conducted in PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Ovid-MEDLINE databases from inception to May 2022. Two researchers independently checked titles and abstracts, evaluated full-text studies, extracted data, and appraised the risk of bias using the Newcastle–Ottawa Scale (NOS). Results Eleven studies (1 longitudinal and 10 cross-sectional), totaling 6,796 subjects, were included. Ten studies assessed MD adherence with KIDMED index, and one assessed MD adherence with Krece Plus test, while all included studies assessed HRQoL with a KIDSCREEN test. All studies analyzed the association between MD adherence and HRQoL with linear regression, and eight used adjusted models. Five studies found a significant positive association of MD adherence with HRQoL, with β-values ranging from 0.13 to 0.26. Two found a nonsignificant positive relationship, while one found a negative association. According to the NOS criteria, the risk of bias assessment showed four studies with a low risk of bias and seven with a high risk of bias. Conclusion Our findings suggest a positive correlation of MD adherence with HRQoL in children and adolescents. However, future research is needed to strengthen the evidence of this relationship. Trial registration CRD42021236188 (PROSPERO)

Adherence to the Mediterranean Diet and Health-Related Quality of Life during the COVID-19 Lockdown: A Cross-Sectional Study including Preschoolers, Children, and Adolescents from Brazil and Spain

“…Our findings depict that a high adherence to the MD was linked with higher HRQoL scores. This result is in accordance with most of the studies conducted on this matter, both before [ 27 ] and after the COVID-19 lockdown [ 44 ]. Nevertheless, divergent results have also been found [ 27 ].…”

“…Although another did not report a comparison between the pre-pandemic period and during the COVID-19 pandemic, a reduction in the HRQoL can be observed. Relevant HRQoL factors include dietary habits (i.e., frequency, composition, and amount of beverages/food consumed), which are associated with higher HRQoL scores in mental and physical dimensions [ 27 ]. In addition, these dietary habits have been associated with overweight and obesity in this population [ 28 ], which are related to lower HRQoL [ 29 ].…”

“…Furthermore, some systematic reviews have concluded that the COVID-19 pandemic has led to a decline in the HRQoL of children and adolescents [ 26 , 32 ]. A recent systematic review analyzed the association of adherence to the MD with the HRQoL in young people [ 27 ]. However, all studies included in that review were conducted before [ 33 , 34 , 35 , 36 ] and other was performed after [ 37 ] the COVID-19 lockdown, indicating an association between a greater adherence to the MD and a higher HRQoL among young populations [ 27 , 37 ].…”

“…A recent systematic review analyzed the association of adherence to the MD with the HRQoL in young people [ 27 ]. However, all studies included in that review were conducted before [ 33 , 34 , 35 , 36 ] and other was performed after [ 37 ] the COVID-19 lockdown, indicating an association between a greater adherence to the MD and a higher HRQoL among young populations [ 27 , 37 ]. To our knowledge, this is the first study that has analyzed this relationship in young people during the situation of social isolation (i.e., lockdown) due to the COVID-19 pandemic.…”

Is there any association between dietary inflammatory index and quality of life? A systematic review

“…Wu et al reported that diet quality and dietary behavior were positively associated with various aspects of QOL, including physical, psychosocial, school, and emotional functioning in children and adolescents ( 43 ). Results of a most recent study showed that adherence to the Mediterranean diet was positively associated with quality of life in children and adolescents ( 44 ). Moreover, adhering to the DASH pattern led to the improvement of QOL in patients with heart failure (HF) during 3 months ( 45 ).…”