Mediterranean Diet Good for Kids, Teens Too

The Mediterranean diet improved cardiometabolic health among kids and teens, a meta-analysis of randomized clinical trials affirmed.

Interventions following the diet’s characteristic emphasis on fruit, vegetables, olive oil, and fish, rather than ultraprocessed foods significantly improved systolic blood pressure, triglycerides, and total and LDL cholesterol, reported José Francisco López-Gil, PhD, of the Universidad de Las Américas in Quito, Ecuador, and colleagues.

HDL cholesterol also improved, although diastolic blood pressure, glucose, insulin, and insulin resistance did not, they noted in JAMA Network Open.

“Clinicians should consider incorporating dietary counseling and Mediterranean diet-based interventions into their practice, particularly for young patients at risk of cardiometabolic issues,” López-Gil told MedPage Today in an email.

Prevention of cardiovascular disease (CVD) “needs to start early in life,” he added, pointing to evidence linking atherosclerotic plaque buildup and cardiovascular risk factors in childhood and adulthood to subsequent cardiovascular disease later in life. “The prevalence of metabolic syndrome in children and adolescents highlights the urgent need for interventions to improve cardiometabolic health in this population,” he said.

While the Mediterranean diet has well-known benefits for adults, López-Gil and colleagues aimed to raise the level of evidence for its impact on youth.

Their meta-analysis of nine randomized clinical trials included 577 participants ages 3-18 years (mean 11). Nearly 60% of participants were female. The mean study duration was 17 weeks, with a range of 8 to 40 weeks.

The trials randomized 322 participants to Mediterranean diet interventions. Six studies focused on children and adolescents with excess weight, and two of these studies focused on participants with nonalcoholic fatty liver disease. One study enrolled children with prediabetes, and the other two studies involved apparently healthy children.

Adherence to the Mediterranean diet (based on the Mediterranean Diet Quality Index for Children and Adolescents) was assessed in only four studies, López-Gil and colleagues noted. Seven studies issued the intervention group a Mediterranean diet prescription, while two studies provided them nutritional education based on the diet.

In five studies, the control group consisted of usual care. The control group consisted of a standard diet in two and a low-fat diet in another two.

Compared with the control group, Mediterranean diet-based interventions were associated with reductions in the following:

• Systolic blood pressure (mean difference −4.75 mm Hg, 95% CI −8.97 to −0.52)
• Triglycerides (−16.42 mg/dL, 95% CI −27.57 to −5.27)
• Total cholesterol (−9.06 mg/dL, 95% CI −15.65 to −2.48)
• LDL cholesterol (−10.48 mg/dL, 95% CI −17.77 to −3.19)

Mediterranean diet-based interventions were also associated with increases in high-density lipoprotein cholesterol (mean difference 2.24 mg/dL, 95% CI 0.34-4.14).

The findings suggest that “while the diet is effective in improving lipid profiles and blood pressure, its impact on insulin resistance and glucose metabolism may be less pronounced or require longer intervention periods to manifest,” López-Gil told MedPage Today.

Limitations of the meta-analysis included that some trials had risk-of-bias concerns and that not all interventions focused solely on the Mediterranean diet, with some incorporating physical activity or exercise as well, López-Gil and colleagues noted.

Additionally, not all trials provided data on participants’ prior knowledge of or adherence to the Mediterranean diet, they continued. Publication bias also may have overestimated associations, and it was not possible to conduct subgroup analyses or meta-regressions due to the scarcity of studies. The research team was not able to determine whether outcomes were consistent across different subgroups, such as sex or race or ethnicity, or whether variables like duration of the intervention, mean age, and BMI at baseline may have substantially influenced estimates obtained.

Furthermore, there was a low number of non-Mediterranean countries represented by the trials, and this could have contributed to limited generalizability of the results, they added.

López-Gil acknowledged that, “given the mixed results for some biomarkers, it is essential to continue monitoring and researching the comprehensive effects of the [Mediterranean diet] in this population to provide more tailored recommendations.”

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