The Association Between Adherence to the Mediterranean Diet and Childhood Obesity; the Role of Family Structure: Results from an Epidemiological Study in 1728 Greek Students

Background: Childhood obesity is among the leading public health challenges, worldwide.

Aim: To examine the association between children's adherence to the Mediterranean diet (MD) and weight status taking into account family structure and related behaviors.

Methods: 1728 primary-school Greek students (46% males), from Athens metropolitan area, island of Crete, and the Peloponnese region, were enroled during school years 2014-2016. Children and their parents completed questionnaires which, among others, recorded family structure (i.e., married/cohabited, divorced, single parent, and widowed), dietary and lifestyle habits. Adherence to the MD was assessed through the KIDMED score (range - 4 to 12). Children's body mass index was calculated and classified as normal, overweight/obese, according to the International Obesity Task Force classification. The working sample was 1142 children (44% males) with a recorded family structure.

Results: The prevalence of overweight was 21.7% and obesity was 5.0%; overweight/obesity prevalence was higher among males than females (32.4% vs. 23.3%; < 0.001). Overweight/obese children had a lower KIDMED score compared to normal weight (median (range): 4 (-2, 11) vs. 5 (-1, 10), = 0.05). An inverse association between KIDMED score and children's weight status (odds ratio (OR) (95% confidence interval (CI)): 0.95 (0.89-0.99)) was observed. Interaction between family structure and KIDMED was observed ( < 0.001); stratified analysis revealed that in children from nuclear families the KIDMED score was inversely associated with the likelihood of overweight/obesity (OR (95% CI): 0.95 (0.88-1.00)), whereas in children from single-parent families it was not (OR (95% CI): 0.94 (0.79-1.12)).

Conclusion: Adherence to the MD plays a protective role against childhood overweight/obesity, particularly among children living in nuclear families.