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Peer-reviewedCC BY 4.0Nutrients

Adherence to the Mediterranean Diet and Body Composition in Children and Adolescents with Obesity: A Cross-Sectional Study

  • Mirna Begović1
  • Josipa Radić2,3
  • Marko Šimunović2,4
  • Marija Selak5
  • Adela Arapović2,6
6 affiliations
  1. 1Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia
  2. 2School of Medicine, University of Split, 21000 Split, Croatia
  3. 3Division of Nephrology and Haemodialysis, Department of Internal Medicine, University Hospital of Split, 21000 Split, Croatia
  4. 4Division of Pulmonology, Allergology, Endocrinology, Cardiology and Rheumatology, Department of Paediatrics, University Hospital of Split, 21000 Split, Croatia
  5. 5Section of Dietetics, Department of Nutrition and Dietetics, University Hospital of Split, 21000 Split, Croatia
  6. 6Division of Nefrology, Gastroenterology, Hereditary Metabolism Diseases and Eating Disorders, Department of Paediatrics, University Hospital of Split, 21000 Split, Croatia
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Abstract

Background/Objectives: Obesity in children and adolescents remains a major health challenge, while Mediterranean diet (MeDi) adherence among children and adolescents is often suboptimal. This study examined MeDi adherence and its association with anthropometric and body composition parameters in children and adolescents with obesity. Methods: This cross-sectional study included 132 participants aged 5–19 years with obesity and was conducted between February 2024 and September 2025 at the Department of Pediatrics, University Hospital Centre Split. MeDi adherence was assessed using the Mediterranean Diet Quality Index for children and adolescents (KIDMED), and body composition by multifrequency bioelectrical impedance analysis. Also, anthropometric measurements were recorded, and body mass index z-score adjusted for age and sex (BMI z-score) was calculated. Results: Based on the KIDMED score, 34.8% of participants showed optimal MeDi adherence, 49.2% moderate adherence, and 15.9% very low adherence. Significant inverse correlations were observed between KIDMED scores and body fat mass (kg) (ρ = −0.230, p = 0.008) and trunk fat mass (kg) (ρ = −0.234, p = 0.007), although these associations did not remain statistically significant after Benjamini–Hochberg correction (adjusted p = 0.06 for both). Multivariate linear regression analyses showed no statistically significant associations between KIDMED scores and the examined body fat parameters after adjustment for age and sex (all p > 0.05). Age was positively associated with body fat mass (kg), trunk fat mass (kg), and trunk fat (%) (all p < 0.001), whereas female sex was associated with higher body fat (%) (p < 0.001). Conclusions: Adherence to the MeDi was suboptimal in most children and adolescents with obesity. Our findings did not establish a statistically significant association between MeDi adherence and the examined body fat parameters after correction for multiple testing and adjustment for age and sex. Further prospective and intervention studies with a larger number of participants are needed to determine whether improving MeDi adherence can lead to favorable changes in body composition in this population.

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Cite

BibTeXRIS
BibTeX
@article{begovic2026adherence,
  title = {{Adherence to the Mediterranean Diet and Body Composition in Children and Adolescents with Obesity: A Cross-Sectional Study}},
  author = {Mirna Begović and Josipa Radić and Marko Šimunović and Marija Selak and Adela Arapović},
  journal = {Nutrients},
  year = {2026},
  month = oct,
  doi = {10.3390/nu18213576},
  url = {https://www.mdpi.com/2072-6643/18/21/3576},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Adherence to the Mediterranean Diet and Body Composition in Children and Adolescents with Obesity: A Cross-Sectional Study
AU  - Mirna Begović
AU  - Josipa Radić
AU  - Marko Šimunović
AU  - Marija Selak
AU  - Adela Arapović
PY  - 2026
DA  - 2026/10/29
JO  - Nutrients
DO  - 10.3390/nu18213576
UR  - https://www.mdpi.com/2072-6643/18/21/3576
AB  - Background/Objectives: Obesity in children and adolescents remains a major health challenge, while Mediterranean diet (MeDi) adherence among children and adolescents is often suboptimal. This study examined MeDi adherence and its association with anthropometric and body composition parameters in children and adolescents with obesity. Methods: This cross-sectional study included 132 participants aged 5–19 years with obesity and was conducted between February 2024 and September 2025 at the Department of Pediatrics, University Hospital Centre Split. MeDi adherence was assessed using the Mediterranean Diet Quality Index for children and adolescents (KIDMED), and body composition by multifrequency bioelectrical impedance analysis. Also, anthropometric measurements were recorded, and body mass index z-score adjusted for age and sex (BMI z-score) was calculated. Results: Based on the KIDMED score, 34.8% of participants showed optimal MeDi adherence, 49.2% moderate adherence, and 15.9% very low adherence. Significant inverse correlations were observed between KIDMED scores and body fat mass (kg) (ρ = −0.230, p = 0.008) and trunk fat mass (kg) (ρ = −0.234, p = 0.007), although these associations did not remain statistically significant after Benjamini–Hochberg correction (adjusted p = 0.06 for both). Multivariate linear regression analyses showed no statistically significant associations between KIDMED scores and the examined body fat parameters after adjustment for age and sex (all p > 0.05). Age was positively associated with body fat mass (kg), trunk fat mass (kg), and trunk fat (%) (all p < 0.001), whereas female sex was associated with higher body fat (%) (p < 0.001). Conclusions: Adherence to the MeDi was suboptimal in most children and adolescents with obesity. Our findings did not establish a statistically significant association between MeDi adherence and the examined body fat parameters after correction for multiple testing and adjustment for age and sex. Further prospective and intervention studies with a larger number of participants are needed to determine whether improving MeDi adherence can lead to favorable changes in body composition in this population.
SN  - 2072-6643
ER  -