Level of adherence to the Mediterranean diet among children from Cyprus: the CYKIDS study

Background:: The Mediterranean diet (MD) prototype is widely used as an educational tool in public health programmes; few studies, however, have been conducted on the adherence of children to this diet. Objective: To evaluate the quality of Cypriot children's diet by assessing the degree of adherence to the MD. Methods: A national cross-sectional study among 1140 children (mean age = 10.7 (SD 0.98) years), using stratified multistage sampling design, was conducted in primary schools of Cyprus. Dietary assessment was based on a 154-item semi-quantitative FFQ and the two supplementary questionnaires (a Food Groups Frequency Questionnaire and a Short Eating Habits Questionnaire). Adherence to the MD was assessed by the KIDMED index. The association between the frequencies of consumption of various food groups and the level of adherence to the MD (poor v. average v. good KIDMED score) was also evaluated. Multiple logistic regression analyses were used to adjust for potential confounders. Results: Only 6.7% of the sample was classified as high adherers of MD, whereas 37% had a poor KIDMED score. Multiple logistic regression analysis has shown that children with at least an average KIDMED score were more likely to eat frequently seafood and fish, legumes, nuts, bread, fruits, leafy vegetables, olives, low glycaemic index foods and unrefined foods. Effect size of associations was from medium to high. Conclusion: Higher adherence to MD is associated with better diet quality in children. The MD prototype may thus represent a useful educational tool for promotion of healthy eating habits in children.