Effects of lifestyle-based interventions to improve Mediterranean diet adherence among the young population: A meta-Analysis of randomized controlled trials

Context: Despite the large number of studies published to date, the effect of lifestyle-based interventions on improving adherence to the Mediterranean diet (MedDiet) in young people has not been meta-Analyzed. Objective: The aim of the present systematic review and meta-Analysis was two-fold: (1) to determine the pooled intervention effects of lifestyle-based interventions on improving adherence to the MedDiet in a young population aged 3 years-18 years and (2) to examine the potential factors related to those intervention effects. Data Sources: A systematic search of the MEDLINE (via PubMed), Scopus, Cochrane Library, and Web of Science databases was performed from their inception until June 15, 2023. Data Extraction: Different meta-Analyses were independently performed to observe the effect of lifestyle-based interventions on adherence to the MedDiet (according to the Mediterranean Diet Quality Index in children and adolescents [KIDMED]). Data Analysis: Compared with the control group, the intervention group showed a small increase in KIDMED score (d =. 27; 95% confidence interval [CI],. 11 to. 43; P <. 001; I2 = 89.7%). Similarly, participants in the lifestyle-based intervention groups had a 14% higher probability of achieving optimal adherence to the MedDiet (risk difference =. 14; 95% CI,. 02 to. 26; P =. 023; I2 = 96.8%). Greater improvements in achieving optimal adherence to the MedDiet were found in interventions delivered out of school (risk difference =. 24, 95% CI,. 04 to. 44; I2 = 88.4%), those aimed at parents or at both children and parents (risk difference =. 20, 95% CI,. 07 to. 34; I2 = 98.2%), and those including only participants with overweight/obesity (risk difference =. 34, 95% CI,. 15 to. 52; I2 =. 0%). Conclusion: Healthy lifestyle-based interventions seem to be effective in increasing adherence to the MedDiet and in achieving optimal adherence to this dietary pattern among children and adolescents.