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Pediatrics

High adherence to a mediterranean diet at age 4 reduces overweight, obesity and abdominal obesity incidence in children at the age of 8

International Journal of Obesity volume 44, pages 1906–1917 (2020)Cite this article

Subjects

Abstract

Background/objectives

A higher adherence to a Mediterranean diet has been shown to be protective against obesity in adults, but the evidence is still inconclusive in children at early ages. Our objective was to explore the association between adherence to Mediterranean Diet at the age of 4 and the prevalence of overweight, obesity, and abdominal obesity at 4 years of age, and incidence at the age of 8.

Subjects/methods

We analyzed data from children of the INMA cohort study who attended follow-up visits at age 4 and 8 years (n = 1801 and n = 1527, respectively). Diet was assessed at the age of 4 using a validated food frequency questionnaire. The adherence to MD was evaluated by the relative Mediterranean diet (rMED) score, and categorized as low (0–6), medium (7–10), and high (11–16). Overweight and obesity were defined according to the age-sex specific BMI cutoffs proposed by the International Obesity Task Force, and abdominal obesity as waist circumference >90th percentile. We used Poisson regression models to estimate prevalence ratios at 4 years of age, and Cox regression analysis to estimate hazard ratios (HR) from 4–8 years of age.

Results

In cross-sectional analyses at the age of 4 no association was observed between adherence to MD and overweight, obesity, or abdominal obesity. In longitudinal analyses, a high adherence to MD at age 4 was associated with lower incidence of overweight (HR = 0.38; 95% CI: 0.21–0.67; p = 0.001), obesity (HR = 0.16; 95% CI: 0.05–0.53; p = 0.002), and abdominal obesity (HR = 0.30; 95% CI: 0.12–0.73; p = 0.008) at the age of 8.

Conclusion

This study shows that a high adherence to MD at the age of 4 is associated with a lower risk of developing overweight, obesity, and abdominal obesity at age 8. If these results are confirmed by other studies, MD may be recommended to reduce the incidence of obesity at early ages.

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Fig. 1: Flowchart of the mothers and their children from the INMA study.

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Acknowledgements

We like to acknowledge Emily Felt for providing assistance with the English revision of the paper; she received compensation.

Funding

This study was funded by grants from Instituto de Salud Carlos III and the Spanish Ministry of Health (Red INMA G03/176; CB06/02/0041; FIS 97/0588; 00/0021-2; PI061756; PS0901958; FIS-FEDER 03/1615; 04/1509; 04/1112; 04/1931; 05/1079; 05/1052; 06/1213; 07/0314; 09/02647; FIS-FEDER 18/00909; FIS-PI041436; FIS-PI081151; FIS-PI06/0867; FIS-PS09/00090; FIS-PI04/2018; FIS-PI09/02311; FIS PI11/01007; FIS-PI13/02429; MS13/00054, CPII18/00018; PI12/01890; CP13/00054; PI18/00825) University of Oviedo, Conselleria de Sanitat Generalitat Valenciana, Generalitat de Catalunya-CIRIT 1999SGR 00241, Generalitat de Catalunya-AGAUR 2009 SGR 501 and 2014 SGR 822. Department of Health of the Basque Government (2005111093, 2009111069, and 201311089) the Provincial Government of Gipuzkoa (DFG06/004 and DFG08/001), annual agreements with the municipalities of the study area of Gipuzkoa (Zumarraga, Urretxu, Legazpi, Azkoitia y Azpeitia y Beasain), Fundació Marató TV3 (20162210 and 090430). ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya. Spanish Ministry of Economy and Competitiveness (SAF2012-32991 incl. FEDER funds), Agence Nationale de Securite Sanitaire de l’Alimentation de l’Environnement et du Travail (1262C0010), EU Commission (261357, 308333, 603794, and 634453). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the paper; and decision to submit the paper for publication.

Author information

Author notes

  1. These authors contributed equally: Leyre Notario-Barandiaran, Desirée Valera-Gran

Authors and Affiliations

  1. Department of Public Health, History of Medicine and Gynaecology, Universidad Miguel Hernández, Alicante, Spain

    Leyre Notario-Barandiaran, Sandra Gonzalez-Palacios, Manuela Garcia-de-la-Hera, Jesús Vioque & Eva Mª Navarrete-Muñoz

  2. Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain

    Leyre Notario-Barandiaran, Desirée Valera-Gran, Sandra Gonzalez-Palacios, Manuela Garcia-de-la-Hera, Jesús Vioque & Eva Mª Navarrete-Muñoz

  3. Department of Pathology and Surgery, Universidad Miguel Hernández, Alicante, Spain

    Desirée Valera-Gran & Eva Mª Navarrete-Muñoz

  4. Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain

    Manuela Garcia-de-la-Hera, Silvia Fernández-Barrés, Ana Fernández-Somoano, Mònica Guxens, Carmen Iñiguez, Martine Vrijheid, Adonina Tardón, Loreto Santa-Marina, Jesús Vioque & Eva Mª Navarrete-Muñoz

  5. ISGlobal, Barcelona, Spain

    Silvia Fernández-Barrés, Mònica Guxens, Dora Romaguera & Martine Vrijheid

  6. Universitat Pompeu Fabra (UPF), Barcelona, Spain

    Silvia Fernández-Barrés, Mònica Guxens, Dora Romaguera & Martine Vrijheid

  7. Faculty of Psychology, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Spain

    Eva Pereda-Pereda

  8. Biodonostia Health Research Institute, Donostia-San Sebastián, Spain

    Eva Pereda-Pereda & Loreto Santa-Marina

  9. IUOPA-Departamento de Medicina, University of Oviedo, Oviedo, Spain

    Ana Fernández-Somoano & Adonina Tardón

  10. Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre—Sophia Children’s Hospital, Rotterdam, The Netherlands

    Mònica Guxens

  11. Departamento de estadística e I.O. Universitat de València, València, Spain

    Carmen Iñiguez

  12. Balearic Islands Health Research Institute (IdISBa), Palma, Spain

    Dora Romaguera

  13. CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain

    Dora Romaguera

  14. Department of Health, Basque Government, Donostia-San Sebastián, Spain

    Loreto Santa-Marina

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  1. Leyre Notario-Barandiaran
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Correspondence to Jesús Vioque.

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Notario-Barandiaran, L., Valera-Gran, D., Gonzalez-Palacios, S. et al. High adherence to a mediterranean diet at age 4 reduces overweight, obesity and abdominal obesity incidence in children at the age of 8. Int J Obes 44, 1906–1917 (2020). https://doi.org/10.1038/s41366-020-0557-z

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