Mediterranean Diet Associated with Improved Cardiometabolic Health in Youth, According to First Meta-Analysis of its Kind

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Mediterranean diet (MedDiet)-based interventions may be useful tools to optimize cardiometabolic health among children and adolescents, according to recent findings published in JAMA Network Open.

Results from a systematic review and meta-analysis of 9 randomized clinical trials with a minimum duration of 8 weeks involving 577 participants aged younger than 18 years showed that compared with control groups, those who received MedDiet-based interventions demonstrated a significant association with reductions in:

• Systolic blood pressure (SBP; mean difference -4.75 mmHg, 95% CI -8.97 to -0.52)
• Triglycerides (TGs; mean difference -16.42 mg/dL, 95% CI -27.57 to -5.27)
• Total cholesterol (TC; mean difference -9.06 mg/dL, 95% CI -15.65 to -2.48)
• Low-density lipoprotein cholesterol (LDL-C; mean difference -10.48, 95% CI -17.77 to -3.19 mg/dL)

Investigators also reported increases in high-density lipoprotein cholesterol (HDL-C; mean difference 2.24 mg/dL, 95% CI 0.34-4.14) among participants in the intervention group compared to those in the control group.

There were no significant associations found between groups with the other cardiometabolic biomarkers studied:

• Diastolic blood pressure (DBP; mean difference -1.91 mmHg, 95% CI -3.98 to 0.17)
• Glucose (mean difference -2.61 mg/dL, 95% CI -5.87 to 0.66)
• Insulin (mean difference -1.26 µIU/mL, 95% CI -2.98 to 0.46)
• Homeostatic model assessment for insulin resistance (HOMA-IR; mean difference -0.14, 95% CI -0.74 to 0.46)

“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,” first author José Francisco López-Gil, PhD, of the Universidad de Las Américas in Quito, Ecuador, and colleagues wrote.

In particular, MedDiet-based interventions in various contexts, such as schools and hospitals, “may be a valuable tool for optimizing cardiometabolic health in the younger population,” researchers added.

In recent years, the Mediterranean diet has gained popularity due to its many health benefits including reducing the risk of cancer, hypertension, and cardiovascular disease (CVD). Adherence to this diet has also been linked to lower mortality rates and a reduction in the proportion of obesity in children and adolescents, according to the study.

No previous systematic review and meta-analysis, however, has verified the association of MedDiet-based interventions with cardiometabolic biomarkers in children and adolescents, researchers noted. For that reason, López-Gil and colleagues conducted the current meta-analysis of 9 RCTs that included 577 participants aged 3 to 18 years (mean age 11 years). The majority of participants (59.6%) were girls, and the mean study duration was 17 weeks with a range of 8 to 40 weeks.

A total of 322 participants received MedDiet-based interventions. Six studies focused on children and adolescents with excess weight, of which 2 focused on participants with nonalcoholic fatty liver disease. One study enrolled children with prediabetes, and the other 2 studies involved apparently healthy children.

Adherence to MedDiet-based interventions (based on the Mediterranean Diet Quality Index for Children and Adolescents) was assessed in only 4 studies, López-Gil and colleagues stated. Seven studies issued the intervention group a Mediterranean diet prescription, while 2 studies provided them nutritional education based on the diet. In 5 studies, the control group consisted of usual care, which was comprised of a standard diet in 2 of those studies and a low-fat diet in the other 2 trials.

Due to the limited number of RCTs included in the analysis, investigators advised that caution be exercised when interpreting the results. Additional limitations of the meta-analysis included the fact that some trials had risk-of-bias concerns and not all interventions focused solely on the Mediterranean diet.

Reference: López-Gil JF, García-Hermoso A, Martínez-González MÁ, Rodríguez-Artalejo F. Mediterranean diet and cardiometabolic biomarkers in children and adolescents: A systematic review and meta-analysis. JAMA Netw Open. Published online July 12, 2024. doi: 10.1001/jamanetworkopen.2024.21976