Mediterranean Diet Linked to Improved Markers of Cardiometabolic Health in Children, Adolescents

Even in children, promoting adherence to a Mediterranean diet contributes to improved biomarkers of cardiometabolic health, according to a new study.

An analysis of 9 randomized clinical trials assessing the effects of Mediterranean diet-based interventions, results suggest such an approach was associated with decreases in blood pressure, triglycerides, total cholesterol, and LDL-C as well as increases in HDL-C among children and adolescents, highlighting early life as an ideal intervention period to prevent long-term cardiovascular event risk.¹

“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,” wrote investigators.¹ “Specifically, [Mediterranean diet]-based interventions in different contexts (eg, schools, hospitals) may be a valuable tool for optimizing cardiometabolic health in the younger population.”

As US public health systems grapple with a growing prevalence of cardiovascular-kidney-metabolic syndrome, a renewed emphasis has grown on identifying meaningful interventions to stem the tide of this concerning trend. The cornerstone of management and prevention of almost all chronic diseases, nutrition and lifestyle management are often focal points of these discussions.^1,2

Led by Fernando Rodríguez-Artalejo PhD, professor and chairman of the Department of Preventive Medicine and Public Health at the Universidad Autónoma de Madrid, the systematic review and meta-analysis were launched with the intent of filling an apparent knowledge gap related to the effects of the Mediterranean diet on biomarkers of cardiometabolic health among younger populations. With this in mind, investigators performed a search of the PubMed, Cochrane Library, Web of Science, and Scopus databases from inception through April 25, 2024 for trials related to the subject.¹

Studies included in the meta-analysis met the following criteria:

• Included participants aged 18 years or younger
• Assessed biomarkers as outcomes based on standardized tests
• Were designed as randomized controlled trials
• Examined Mediterranean Diet-based interventions

In total, 9 trials, with a total population of 577 participants and mean duration of 17 (range, 8 to 40) weeks, were identified for inclusion. Of the 9 trials included, 6 focused on children and adolescents with excess weight, 1 focused on children with prediabetes, and 2 focused on apparently healthy children. The minimum duration of Mediterranean diet-based interventions was 8 weeks.¹

The primary outcomes of interest for the systematic review and meta-analysis were changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides, total cholesterol, HDL-C, LDL-C, glucose, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR).¹

Results of the systematic review and meta-analysis demonstrated Mediterranean diet-based interventions were associated with a significant benefit on SBP(mean difference,−4.75 mmHg; 95% CI, −8.97 to −0.52 mmHg), triglycerides (mean difference, −16.42 mg/dL; 95% CI,−27.57 to −5.27mg/dL), total cholesterol (mean difference, −9.06 mg/dL; 95% CI,−15.65 to −2.48 mg/dL), LDL-C (mean difference, −10.48 mg/dL; 95% CI,−17.77 to −3.19 mg/dL), and increases in HDL-C (mean difference, 2.24mg/dL; 95% CI,0.34 to 4.14mg/dL). However, no significant effect was observed on DBP, glucose, insulin, or HOMA-IR.¹

Investigators highlighted multiple limitations within their study to consider. These included those inherent with the design of a meta-analysis, risk of bias concern within the trials of interest, lack of data on prior knowledge of or adherence to the dietary interventions, and publication bias may have overestimated the associations.¹

“Even though the reductions may seem modest, decreases in SBP during childhood and adolescence may be important, since elevated blood pressure in childhood or adolescence has been consistently associated with several intermediate CVD markers in adulthood,” investigators explained.¹ “Decreases in SBP may lead to substantial reductions in the risk of [cardiovascular disease] and mortality in adulthood. Furthermore, elevated levels of [triglycerides], [total cholesterol], and LDL-C are associated with a higher risk of atherosclerosis and [cardiovascular diseases], while higher levels of HDL-C are considered protective.”

References:

Brooks A. Nearly 90% of US adults meet cardiovascular-kidney-metabolic syndrome criteria. HCP Live. May 13, 2024. Accessed July 11, 2024. https://www.hcplive.com/view/nearly-90-us-adults-meet-cardiovascular-kidney-metabolic-syndrome-criteria.