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The Mediterranean Diet Quality Index (KIDMED Index) is frequently used to evaluate adherence to the Mediterranean Dietary Pattern among children and adolescents, through sixteen questions with the associated total score ranging from −4 to 12. However, in the authors’ best knowledge, the psychometric properties of this index had not yet been investigated in Portugal. Thus, the main purpose of the present study was to investigate the reproducibility and the validity of the KIDMED Index in a sample of 185 Portuguese adolescents. The reproducibility was tested by comparing the application of the KIDMED Index at two different times (2-week interval), using McNemar test and Kappa statistics. There was moderate agreement (κw = 0·591; 95 % CI 0·485, 0·696) and no significant change (P-value = 0·201) in the KIDMED Index classification, between the two applications. The validity was explored by comparing the results obtained by the KIDMED Index and by the average of 3-d Dietary-Record (DR), using Spearman’s correlation coefficient and Kappa statistics. There was weak correlation (ρ = 0·317; P-value < 0·001) and slight agreement (κw = 0·167; 95 % CI 0·071, 0·262) between the KIDMED Index classification and the 3-d DR-derived KIDMED score, and moderate correlation (ρ = 0·423; P-value < 0·001) and fair agreement (κw = 0·344; 95 % CI 0·202, 0·486) between the terciles of the KIDMED Index and the Mediterranean Adequacy Index scores. The results suggested an acceptable reproducibility and validity of the Portuguese version of the KIDMED Index, in alignment with the few studies investigating psychometric properties of this index in other countries.

High adherence to the Mediterranean diet (MD) has been associated with a lower prevalence of Metabolic Syndrome (MetS). The present study aimed to investigate the impact of MD adherence on parameters of MetS. A systematic literature search was performed in PubMed, Cochrane Central Registry of Clinical Trials (CENTRAL), Scopus, EMBASE, Web of Science and Google Scholar databases. Observational studies that recorded adherence to MD and components/measures of the MetS, such as waist circumference (WC), blood pressure (BP), fasting blood glucose (FBG), high-density lipoprotein (HDL) cholesterol and triglycerides (TG), were included in this study. A total of 58 studies were included in our study. WC and TG were significantly lower in the high adherence MD group (SMD: −0.20, (95%CI: −0.40, −0.01), SMD: −0.27 (95%CI: −0.27, −0.11), respectively), while HDL cholesterol was significantly higher in the same group (SMD: −0.28 (95%CI: 0.07, 0.50). There was no difference in FBG and SBP among the two groups (SMD: −0.21 (95%CI: −0.54, 0.12) & SMD: −0.15 (95%CI: −0.38, 0.07), respectively). MD may have a positive impact on all parameters of MetS. However, further research is needed in this field.

PurposePrevious meta-analyses assessed the association of adherence to the Mediterranean dietary pattern (MedDiet) with the risk of type 2 diabetes (T2D). Since then, new large-scale cohort studies have been published. In addition, dose–response relation was not previously investigated and the certainty of evidence was not assessed. We aimed to explore the dose–response relationship between adherence to the MedDiet and the risk of T2D.MethodsWe did a systematic search using PubMed, Scopus, and ISI Web of Science upto April 2021 for prospective cohort studies of the relationship between adherence to the MedDiet and the risk of T2D in the general population. The summary relative risks (RR) and 95%CI were estimated by applying a random-effects model.ResultsFourteen prospective cohort studies (410,303 participants and 41,466 cases) were included. There was an inverse association for the highest versus lowest category of adherence to the MedDiet (RR: 0.79, 95%CI 0.72, 0.88; I2 = 82%, n = 14; Risk difference:  – 21 per 1000 person, 95%CI  – 28,  – 12; GRADE = moderate certainty), and for a 2-point increment in the MedDiet adherence score (RR: 0.86, 95%CI 0.82, 0.91; n = 13). The RR remained significant after controlling for important confounders and in almost all subgroups, especially subgroups defined by geographical region. We observed an inverse linear association between MedDiet adherence score and T2D incidence.ConclusionAdherence to the MedDiet was inversely related to T2D risk in a dose–response manner. Adherence to a Mediterranean-style diet may be a good advice for the primary prevention of T2D.Registry and registry numberPROSPERO (CRD42021246589).

Although research has generally shown a negative association between depression and adherence to the Mediterranean diet (MeDi), the literature related to older adults is controversial, perhaps partially due to the fact that cognitive status has not been considered. The aim of the current work was to investigate the association between MeDi and incident depression in a representative cohort of people, taking into account their cognitive status in multiple ways. The sample was drawn from the HELIAD study, a longitudinal study including a follow-up of 3 years after the baseline assessment. In total, 879 participants without depression at baseline were included (55.4% women, mean age ± Standard Deviation: 73.3 ± 5.0 years). Depression was determined as a score in the Geriatric depression scale ≥6 and/or antidepressant medication and/or clinical diagnosis of depression. Cox proportional hazard models adjusted for age, sex and education were employed. In the basic model, adherence to the MeDi was negatively associated with depression. In the most conservative model, excluding participants with dementia and Mild Cognitive Impairment, and after controlling for the baseline Cognitive Status, each unit (range 0–55) increase in MeDi was associated with a 6.2% decrease in the risk for depression (p < 0.001). These findings indicate that MeDi is negatively associated with depression longitudinally in older adults, above and beyond cognitive status.

Broadly consumed dietary patterns, such as the European and Western ones, are exerting pressures on biodiversity both in Europe and globally, and shifting toward a sustainable dietary pattern has thus become a must. This paper constitutes a preliminary communication of the results of a research project on the issue. In this study, the pressures of three dietary patterns (European, Western, and Mediterranean) on biodiversity are addressed in terms of land use, water use, greenhouse gas emissions, and eutrophication impact indicators. The environmental impacts are calculated based on a compositional analysis of each dietary pattern and the environmental footprints of the corresponding food groups. Food balance sheets published by the FAO are used as a basis for the compositional analysis, while the environmental footprints of each of the representative food products are retrieved from related life cycle assessment (LCA) studies. The results show that a shift from the European to the Mediterranean dietary pattern would lead to 10 m2/capita/day land savings, 240 L/capita/day water savings, 3 kg CO2/capita/day reduction in greenhouse gas emissions, and 20 gPO4eq/capita/day reductions in eutrophication potential. Likewise, a shift from the Western to the Mediterranean dietary pattern would lead to 18 m2/capita/day land savings, 100 L/capita/day water savings, 4 kg CO2/capita/day reduction in greenhouse gas emissions, and 16 gPO4eq/capita/day reduction in eutrophication potential. Based on these findings, it is clear that this shift is urgently needed as a step toward environmentally sustainable dietary patterns, such as the Mediterranean one, to preserve biodiversity for future generations.

The metabolic syndrome is common in older adults and may be modified by the diet. The aim of this study was to examine associations between a posteriori dietary patterns and the metabolic syndrome in an older New Zealand population. The REACH study (Researching Eating, Activity, and Cognitive Health) included 366 participants (aged 65–74 years, 36 % male) living independently in Auckland, New Zealand. Dietary data were collected using a 109-item FFQ with demonstrated validity and reproducibility for assessing dietary patterns using principal component analysis. The metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III. Associations between dietary patterns and the metabolic syndrome, adjusted for age, sex, index of multiple deprivation, physical activity, and energy intake were analysed using logistic regression analysis. Three dietary patterns explained 18 % of dietary intake variation – ‘Mediterranean style’ (salad/leafy cruciferous/other vegetables, avocados/olives, alliums, nuts/seeds, shellfish and white/oily fish, berries), ‘prudent’ (dried/fresh/frozen legumes, soya-based foods, whole grains and carrots) and ‘Western’ (processed meat/fish, sauces/condiments, cakes/biscuits/puddings and meat pies/hot chips). No associations were seen between ‘Mediterranean style’ (OR = 0·75 (95 % CI 0·53, 1·06), P = 0·11) or ‘prudent’ (OR = 1·17 (95 % CI 0·83, 1·59), P = 0·35) patterns and the metabolic syndrome after co-variate adjustment. The ‘Western’ pattern was positively associated with the metabolic syndrome (OR = 1·67 (95 % CI 1·08, 2·63), P = 0·02). There was also a small association between an index of multiple deprivation (OR = 1·04 (95 % CI 1·02, 1·06), P < 0·001) and the metabolic syndrome. This cross-sectional study provides further support for a Western dietary pattern being a risk factor for the metabolic syndrome in an older population.

Background/Purpose: To our knowledge, no previous study has analyzed the associations between self-efficacy and adherence to the Mediterranean diet (MedDiet) in adolescents, nor have sex-based differences in this relationship been examined. The aim of the current study was to examine the relationship between self-efficacy and MedDiet adherence in Spanish adolescents. Methods: This research was cross-sectional and involved 619 adolescents (56.5% girls) who were part of the Eating Habits and Activities of Daily Living (EHDLA) project. Self-efficacy was assessed using a 10-item scale (general self-efficacy scale), which yielded scores ranging from 20 to 100 points. The Mediterranean Diet Quality Index for Children and Adolescents (KIDMED), which consists of a 16-item questionnaire with scores ranging from −4 to 12, was used to evaluate adherence to the MedDiet. Unhealthy behaviors related to the MedDiet were assigned a score of −1, whereas healthy behaviors received a score of +1. Results: Overall, for each 20-point increase in self-efficacy, boys had a greater non-significant likelihood of having optimal MedDiet adherence (1.33%, 95% confidence interval [CI] −5.15 to 7.82, p = 0.687). Conversely, girls had a greater significant likelihood of having optimal MedDiet adherence per further point in self-efficacy (7.40%, 95% CI 2.28 to 12.53, p = 0.005). Individually, among boys, a 20-point increase in self-efficacy was associated with a 4.8% higher probability of having a dairy product for breakfast (95% CI 0.2 to 9.4, p = 0.042). Among girls, the same increase in self-efficacy was linked to a greater probability of consuming fruit or fruit juice daily (6.8%, 95% CI 2.2 to 11.4, p = 0.004), eating a second fruit every day (8.6%, 95% CI 3.4 to 13.8, p = 0.001), consuming fish regularly (6.2%, 95% CI 1.1 to 11.2, p = 0.017), enjoying pulses and eating them more than once a week (4.5%, 95% CI 0.3 to 8.8, p = 0.035), having cereals or grains for breakfast (5.4%, 95% CI 0.4 to 10.5, p = 0.035), and regularly consuming nuts (5.2%, 95% CI 0.2 to 10.2, p = 0.041). Additionally, increases in self-efficacy was associated with a 5.0% lower probability of skipping breakfast (95% CI −8.8 to −1.1, p = 0.012). Conclusions: Our results revealed a significant association between self-efficacy and MedDiet adherence among girls, whereas the relationship between self-efficacy and the MedDiet in boys was not significant. These results suggest that interventions aimed at improving adolescent dietary patterns should consider incorporating strategies to increase self-efficacy, potentially with sex-specific approaches.

The Mediterranean diet has been reported to be inversely associated with incident metabolic syndrome (MetSyn) among older adults; however, this association has not been studied in young African American and white adults. The objective of the present study was to evaluate the association of a modified Mediterranean diet (mMedDiet) score with the 25-year incidence of the MetSyn in 4713 African American and white adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. A diet history questionnaire was used to assess dietary intake at baseline, year 7 and year 20 and a mMedDiet score was created. Cardiovascular risk factors were measured at multiple examinations over 25 years. The MetSyn was defined according to the National Cholesterol Education Program Adult Treatment Panel III (ATP III) criteria. Cox proportional-hazards regression analysis was use to evaluate associations for incident MetSyn across the mMedDiet score categories adjusting for demographic characteristics, lifestyle factors and BMI. Higher mMedDiet scores represented adherence to a dietary pattern rich in fruit, vegetables, whole grains, nuts and fish, but poor in red and processed meat and snack foods. The incidence of MetSyn components (abdominal obesity, elevated TAG concentrations and low HDL-cholesterol concentrations) was lower in those with higher mMedDiet scores than in those with lower scores. Furthermore, the incidence of the MetSyn was lower across the five mMedDiet score categories; the hazard ratios and 95 % CI from category 1 to category 5 were 1·0; 0·94 (0·76, 1·15); 0·84 (0·68, 1·04); 0·73 (0·58, 0·92); and 0·72 (0·54, 0·96), respectively (P trend= 0·005). These findings suggest that the risk of developing the MetSyn is lower when consuming a diet rich in fruit, vegetables, whole grains, nuts and fish.

This systematic review discusses data on the dietary intake of preschool children living in the Mediterranean countries of the European Union, including the comparison with a Mediterranean-like diet and the association with nutritional status. Specifically, data from the multinational European Identification and Prevention on Dietary and life style induced health effects in children and infants (IDEFICS) study and national studies, such as the Estudo do Padrão Alimentar e de Crescimento Infantil (EPACI) study and Geração XXI cohort in Portugal, ALimentando la SAlud del MAñana (ALSALMA) study in Spain, Étude des Déterminants pré-et postnatals précoces du développement et de la santé de l’ENfant (EDEN) cohort in France, Nutrintake 636 study in Italy, and Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) cohort in Greece, were analyzed. In the majority of countries, young children consumed fruit and vegetables quite frequently, but also consumed sugared beverages and snacks. High energy and high protein intakes mainly from dairy products were found in the majority of countries. The majority of children also consumed excessive sodium intake. Early high prevalence of overweight and obesity was found, and both early consumption of energy-dense foods and overweight seemed to track across toddler and preschool ages. Most children living in the analyzed countries showed low adherence to a Mediterranean-like diet, which in turn was associated with being overweight/obese. Unhealthier diets were associated with lower maternal educational level and parental unemployment. Programs promoting adherence of young children to the traditional Mediterranean diet should be part of a multi-intervention strategy for the prevention and treatment of pediatric overweight and obesity.