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



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.


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.


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.


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


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.

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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).

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