Affiliation:
1. One Health Research Group, Universidad de Las Américas, Quito, Ecuador
2. Navarrabiomed, Hospital Universitario de Navarra, Universidad Pública de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
3. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
4. University of Navarra, Instituto de Investigación Sanitaria de Navarra, Spain
5. Department of Preventive Medicine and Public Health, Pamplona, Spain
6. CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
7. Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
8. CIBER of Epidemiology and Public Health, Madrid, Spain
9. IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
Abstract
ImportanceNo prior systematic review and meta-analysis has specifically verified the association of Mediterranean diet (MedDiet)–based interventions with biomarkers of cardiometabolic health in children and adolescents.ObjectiveTo review and analyze the randomized clinical trials (RCTs) that assessed the effects of MedDiet-based interventions on biomarkers of cardiometabolic health among children and adolescents.Data SourcesFour electronic databases were searched (PubMed, Cochrane Library, Web of Science, and Scopus) from database inception to April 25, 2024.Study SelectionOnly RCTs investigating the effect of interventions promoting the MedDiet on cardiometabolic biomarkers (ie, systolic blood pressure [SBP], diastolic blood pressure [DBP], triglycerides [TGs], total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], glucose, insulin, and homeostatic model assessment for insulin resistance [HOMA-IR]) among children and adolescents (aged ≤18 years) were included.Data Extraction and SynthesisA systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data were extracted from the studies by 2 independent reviewers. Results across studies were summarized using random-effects meta-analysis.Main Outcome and MeasuresThe effect size of each trial was computed by unstandardized mean differences (MDs) of changes in biomarker levels (ie, SBP, DBP, TGs, TC, HDL-C, LDL-C, glucose, insulin, HOMA-IR) between the intervention and the control groups. The quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations approach.ResultsNine RCTs were included (mean study duration, 17 weeks; range, 8-40 weeks). These studies involved 577 participants (mean age, 11 years [range, 3-18 years]; 344 girls [59.6%]). Compared with the control group, the MedDiet-based interventions showed a significant association with reductions in SBP (mean difference, −4.75 mm Hg; 95% CI, −8.97 to −0.52 mm Hg), TGs (mean difference, −16.42 mg/dL; 95% CI, −27.57 to −5.27 mg/dL), TC (mean difference, −9.06 mg/dL; 95% CI, −15.65 to −2.48 mg/dL), and LDL-C (mean difference, −10.48 mg/dL; 95% CI, −17.77 to −3.19 mg/dL) and increases in HDL-C (mean difference, 2.24 mg/dL; 95% CI, 0.34-4.14 mg/dL). No significant associations were observed with the other biomarkers studied (ie, DBP, glucose, insulin, and HOMA-IR).Conclusions and RelevanceThese findings suggest that MedDiet-based interventions may be useful tools to optimize cardiometabolic health among children and adolescents.
Publisher
American Medical Association (AMA)