Mediterranean Diet May Optimize Heart Health Among Children, Adolescents

Mediterranean diet–based interventions were modestly associated with cardiometabolic biomarkers in children and adolescents, suggesting these interventions may serve as a useful tool to optimize heart health, a study finds.¹

The Mediterranean diet is based on the traditional and healthy eating choices of people in countries that border the Mediterranean Sea, including France, Greece, Italy, Portugal, and Spain.

This systematic review and meta-analysis study is published in JAMA Network Open.

“Indeed, to our knowledge, no systematic review of the literature has been conducted to assess the association of MedDiet-based interventions on biomarkers of cardiometabolic health specifically in this population,” wrote the researchers of the study. “Therefore, our objective was to review and analyze the randomized clinical trials (RCTs) that have assessed MedDiet interventions among children and adolescents.”

The Mediterranean diet is based on the traditional and healthy eating choices of people in countries that border the Mediterranean Sea, including France, Greece, Italy, Portugal, and Spain.² This diet includes high intake of whole grains, vegetables, fruits, legumes, olive oil, and fish, as well as low consumption of butter and other saturated fats, red meat, poultry, and dairy products, and drinking red wine in moderation.

For the current study, databases PubMed, Cochrane Library, Web of Science, and Scopus were searched from inception to April 25, 2024.¹ RCTs that investigated the effect of the Mediterranean diet on cardiometabolic biomarkers among participants aged 18 years and younger were included.

The main study outcome was effect size of each trial computed by unstandardized mean differences (MDs) of changes in biomarker levels between the intervention and the control groups. Additionally, these effects were assessed for quality using the Grading Recommendations, Assessment, Development, and Evaluations approach.

A total of 9 RCTs were included, involving 577 participants. Participants in the Mediterranean diet group had significant reductions in systolic blood pressure (MD, −4.75 mm Hg; 95% CI, −8.97 to −0.52), triglycerides (MD, −16.42 mg/dL; 95% CI, −27.57 to −5.27), total cholesterol (MD, −9.06 mg/dL; 95% CI, −15.65 to −2.48), and low-density lipoprotein cholesterol (MD, −10.48 mg/dL; 95% CI, −17.77 to −3.19). Additionally, participants in this group had increases in high-density lipoprotein cholesterol (MD, 2.24 mg/dL; 95% CI, 0.34-4.14).

No associations were identified with other biomarkers, including studies for diastolic blood pressure, glucose, insulin, and homeostatic model assessment for insulin resistance.

However, the researchers acknowledged some limitations to the study, including concerns about risk of bias in some RCTs, not all interventions were solely focused on the Mediterranean diet, not all RCTs had data on participants’ prior knowledge of or adherence to the diet, publication bias may have overestimated the associations, it was possible to conduct subgroup analyses or meta-regressions due to scarcity of studies, and that there was a low number of non-Mediterranean countries represented, which may have limited the generalizability of the results.

Despite these limitations, the researchers believe the study supports the use of the Mediterranean diet to optimize cardiometabolic health among children and adolescents.

“These results underscore the importance of promoting healthy eating habits in youths, as these habits may lead to substantially improved cardiometabolic health, even during the early stages of life,” wrote the researchers. “Specifically, MedDiet-based interventions in different contexts (eg, schools, hospitals) may be a valuable tool for optimizing cardiometabolic health in the younger population.”

References

1. López-Gil JF, García-Hermoso A, Martínez-González MÁ, et al. Mediterranean diet and cardiometabolic biomarkers in children and adolescents: a systematic review and meta-analysis. JAMA Netw Open. 2024;7(7):e2421976. doi:10.1001/jamanetworkopen.2024.21976

2. Mediterranean diet and MS. Bionews. Accessed July 25, 2024. https://multiplesclerosisnewstoday.com/living-with-ms/ms-diet-nutrition/mediterranean-diet-and-ms/