Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Epidemiology

Poor dietary habits in Greek schoolchildren are strongly associated with screen time: results from the EYZHN (National Action for Children’s Health) Program

European Journal of Clinical Nutrition volume 72, pages 572–580 (2018)Cite this article

Subjects

Abstract

Background/objectives

To investigate adherence to the Mediterranean diet (MD) and the relationship between MD and lifestyle factors in a representative sample of Greek school children.

Subjects/methods

The data derived from 232,401 (51% boys) children aged 8 to 17 years old who participated in a health survey (2015). Physical fitness (PF) and anthropometric estimations were obtained by trained investigators. Physical activity (PA) status, sedentary activities and sleeping hours were assessed through self-completed questionnaires. Mediterranean diet was evaluated via KIDMED test.

Results

Forty percent of participants presented an optimal adherence to MD (≥8), while one to ten incorporated a low adherence to MD (≤3), in both genders. Participants with optimal adherence to MD presented a more favourable status in anthropometric and lifestyle characteristics. Adjusting for several potential confounders, increased screen time (<2 h/d) augmented odds of low adherence by 135% (95% CI: 2.216–2.491) and 150% (95% CI: 2.346–2.687), in boys and girls, respectively. For each 1-year enlarge in the age of children the odds of low adherence to MD enlarged by almost 11% (95%CI: 1.101–1.138) in both genders, while, boys had almost 6% increased probabilities to the low adherence (95%CI: 1.039, 1.102) than girls. Furthermore, insufficient sleeping hours (>2 h/d) and inadequate PA status were connected to higher odds of low adherence to MD.

Conclusions

Support a modest adherence to the MD and an enhancement considered necessary to adjust dietary intake to current guidelines. However, screen time presented a strong association with low adherence to MD.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Serra-Majem L, Ribas L, Ngo J, Ortega RM, Garcia A, Perez-Rodrigo C, et al. Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr. 2004;7:931–5.

    Article  PubMed  Google Scholar 

  2. Craigie AM, Lake AA, Kelly SA, Adamson AJ, Mathers JC. Tracking of obesity-related behaviours from childhood to adulthood: A systematic review. Maturitas. 2011;70:266–84.

    Article  PubMed  Google Scholar 

  3. Martinez-Gonzalez MA, Bes-Rastrollo M. Dietary patterns, Mediterranean diet, and cardiovascular disease. Curr Opin Lipidol. 2014;25:20–6.

    Article  CAS  PubMed  Google Scholar 

  4. Giugliano D, Esposito K. Mediterranean diet and metabolic diseases. Curr Opin Lipidol. 2008;19:63–8.

    CAS  PubMed  Google Scholar 

  5. Psaltopoulou T, Sergentanis TN, Panagiotakos DB, Sergentanis IN, Kosti R, Scarmeas N. Mediterranean diet, stroke, cognitive impairment, and depression: A meta-analysis. Ann Neurol. 2013;74:580–91.

    Article  PubMed  Google Scholar 

  6. Schroder H. Protective mechanisms of the Mediterranean diet in obesity and type 2 diabetes. J Nutr Biochem. 2007;18:149–60.

    Article  PubMed  Google Scholar 

  7. Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act. 2011;8:98.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Costarelli V, Koretsi E, Georgitsogianni E. Health-related quality of life of Greek adolescents: the role of the Mediterranean diet. Qual Life Res. 2013;22:951–6.

    Article  CAS  PubMed  Google Scholar 

  9. Farajian P, Risvas G, Karasouli K, Pounis GD, Kastorini CM, Panagiotakos DB, et al. Very high childhood obesity prevalence and low adherence rates to the Mediterranean diet in Greek children: the GRECO study. Atherosclerosis . 2011;217:525–30.

    Article  CAS  PubMed  Google Scholar 

  10. Mazaraki A, Tsioufis C, Dimitriadis K, Tsiachris D, Stefanadi E, Zampelas A, et al. Adherence to the Mediterranean diet and albuminuria levels in Greek adolescents: data from the Leontio Lyceum ALbuminuria (3L study). Eur J Clin Nutr. 2011;65:219–25.

    Article  CAS  PubMed  Google Scholar 

  11. Vassiloudis I, Yiannakouris N, Panagiotakos DB, Apostolopoulos K, Costarelli V. Academic performance in relation to adherence to the Mediterranean diet and energy balance behaviors in Greek primary schoolchildren. J Nutr Educ Behav. 2014;46:164–70.

    Article  PubMed  Google Scholar 

  12. Lydakis C, Stefanaki E, Stefanaki S, Thalassinos E, Kavousanaki M, Lydaki D. Correlation of blood pressure, obesity, and adherence to the Mediterranean diet with indices of arterial stiffness in children. Eur J Pediatr. 2012;171:1373–82.

    Article  CAS  PubMed  Google Scholar 

  13. Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0.5 could be a suitable global boundary value. Nutr Res Rev. 2010;23:247–69.

    Article  PubMed  Google Scholar 

  14. Research CoECoEoS. Eurofit: handbook for the Eurofit tests of Physical fitness 1993. 1-75 p.

  15. Grigorakis DA, Georgoulis M, Psarra G, Tambalis KD, Panagiotakos DB, Sidossis LS. Prevalence and lifestyle determinants of central obesity in children. Eur J Nutr. 2016;55:1923–31.

    Article  PubMed  Google Scholar 

  16. Colley RC, Wong SL, Garriguet D, Janssen I, Connor Gorber S, Tremblay MS. Physical activity, sedentary behaviour and sleep in Canadian children: parent-report versus direct measures and relative associations with health risk. Health Rep. 2012;23:45–52.

    PubMed  Google Scholar 

  17. Paruthi S, Brooks LJ, D’Ambrosio C, Hall WA, Kotagal S, Lloyd RM, et al. Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion. J Clin Sleep Med. 2016;12:1549–61.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kontogianni MD, Vidra N, Farmaki AE, Koinaki S, Belogianni K, Sofrona S, et al. Adherence rates to the Mediterranean diet are low in a representative sample of Greek children and adolescents. J Nutr. 2008;138:1951–6.

    Article  CAS  PubMed  Google Scholar 

  19. Garcia Cabrera S, Herrera Fernandez N, Rodriguez Hernandez C, Nissensohn M, Roman-Vinas B, Serra-Majem L. Kidmed test; prevalence of low adherence to the Mediterranean diet in children and young; a systematic review. Nutr Hosp. 2015;32:2390–9.

    CAS  PubMed  Google Scholar 

  20. Kyriacou A, Evans JM, Economides N, Kyriacou A. Adherence to the Mediterranean diet by the Greek and Cypriot population: a systematic review. Eur J Public Health. 2015;25:1012–8.

    Article  PubMed  Google Scholar 

  21. Hare-Bruun H, Nielsen BM, Kristensen PL, Moller NC, Togo P, Heitmann BL. Television viewing, food preferences, and food habits among children: a prospective epidemiological study. BMC Public Health. 2011;11:311.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Avery A, Anderson C, McCullough F. Associations between childrenas diet quality and watching television during meal or snack consumption: A systematic review. Matern Child Nutr. 2017;13:e12428

    Article  Google Scholar 

  23. Pettigrew S, Jongenelis M, Miller C, Chapman K. A path analysis model of factors influencing children’s requests for unhealthy foods. Eat Behav. 2017;24:95–101.

    Article  PubMed  Google Scholar 

  24. Ferranti R, Marventano S, Castellano S, Giogianni G, Nolfo F, Rametta S, et al. Sleep quality and duration is related with diet and obesity in young adolescent living in Sicily, Southern Italy. Sleep Sci. 2016;9:117–22.

    Article  PubMed  PubMed Central  Google Scholar 

  25. McDonald L, Wardle J, Llewellyn CH, Fisher A. Night time sleep duration and hedonic eating in childhood. Int J Obes (Lond). 2015;39:1463–6.

    Article  CAS  Google Scholar 

  26. Weiss A, Xu F, Storfer-Isser A, Thomas A, Ievers-Landis CE, Redline S. The association of sleep duration with adolescents’ fat and carbohydrate consumption. Sleep. 2010;33:1201–9.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Iaccarino Idelson P, Scalfi L, Valerio G. Adherence to the Mediterranean Diet in children and adolescents: a systematic review. Nutr Metab Cardiovasc Dis. 2017;27:283–99.

    Article  CAS  PubMed  Google Scholar 

  28. Thivel D, Aucouturier J, Isacco L, Lazaar N, Ratel S, Dore E, et al. Are eating habits associated with physical fitness in primary schoolchildren? Eat Behav. 2013;14:83–6.

    Article  PubMed  Google Scholar 

  29. Cuenca-Garcia M, Ruiz JR, Ortega FB, Labayen I, Gonzalez-Gross M, Moreno LA, et al. Association of breakfast consumption with objectively measured and self-reported physical activity, sedentary time and physical fitness in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr. 2014;17:2226–36.

    Article  PubMed  Google Scholar 

  30. Yannakoulia M, Lykou A, Kastorini CM, Saranti Papasaranti E, Petralias A, Veloudaki A, et al. Socio-economic and lifestyle parameters associated with diet quality of children and adolescents using classification and regression tree analysis: the DIATROFI study. Public Health Nutr. 2016;19:339–47.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Hellenic Ministry of Education and Religious Affairs, Secretariat General of Sports, OPAP S.A., Nestlé Hellas S.A., and the Department of Nutrition and Dietetics Graduate Program, Harokopio University of Athens supported this study.

Author information

Authors and Affiliations

  1. Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece. 70 Eleftheriou Venizelou Avenue, Athens, 17671, Greece

    Konstantinos D Tambalis, Demosthenes B Panagiotakos, Glykeria Psarra & Labros S Sidossis

  2. Hellenic Ministry of Culture and Athletics, Secretariat General of Sports, Athens, Greece

    Ioanna Moraiti

  3. Department of Exercise Sciences, Rutgers University, New Brunswick, NJ, 08901, USA

    Labros S Sidossis

Authors
  1. Konstantinos D Tambalis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Demosthenes B Panagiotakos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ioanna Moraiti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Glykeria Psarra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Labros S Sidossis
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

and the ΕΥΖΗΝ Study Group

Corresponding author

Correspondence to Labros S Sidossis.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tambalis, K.D., Panagiotakos, D.B., Moraiti, I. et al. Poor dietary habits in Greek schoolchildren are strongly associated with screen time: results from the EYZHN (National Action for Children’s Health) Program. Eur J Clin Nutr 72, 572–580 (2018). https://doi.org/10.1038/s41430-018-0119-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-018-0119-9

This article is cited by

Search

Advanced search

Quick links