Can a Mediterranean-style diet help obese kids' metabolic health?
Obese children who followed a Mediterranean-style diet for four months showed improved blood lipids, lower glucose and fewer metabolic syndrome features, while those on a standard healthy diet mainly saw lower glucose.
Source
Mediterranean-style diet reduces metabolic syndrome components in obese children and adolescents with obesity
Study at a glance
- Design
- Human experiment — Open-label, two-arm 16-week dietary intervention in a Mexican family medicine unit; allocation method is not described (no randomisation stated), and each arm was analysed only with before-after paired tests.
- N
- N=49 · 49 children and adolescents enrolled (24 Mediterranean-style diet, 25 standard diet); 7 were later excluded for missing visits (4 and 3 respectively), so fewer were analysed.
- Population
- Obese children and adolescents (BMI at or above the 95th percentile) with at least one metabolic syndrome component, attending a Mexican Social Security Institute family medicine unit.
- Outcome
- Change in BMI, body composition, fasting glucose, lipid profile, blood pressure and frequency of metabolic syndrome and its components over 16 weeks.
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What they did
The researchers enrolled 49 obese children and adolescents in Mexico who had at least one feature of metabolic syndrome. After a month of training families to plan healthy menus, 24 were given a Mediterranean-style diet rich in fibre, olive and other unsaturated oils, oily fish, nuts and antioxidant-rich fruit and vegetables, and 25 were given a standard healthy diet with similar general advice. Both groups were seen every three weeks for 16 weeks, with 24-hour diet recalls, body measurements and blood tests before and after.
What they found
In the Mediterranean-style group, BMI, fat mass, glucose, total cholesterol, triglycerides and LDL cholesterol fell and HDL cholesterol rose, and the proportion with metabolic syndrome dropped by 45%. The standard-diet group showed lower fasting glucose but gained about 1.7 kg on average and had no significant change in metabolic syndrome or lipids. The Mediterranean group reported eating more fibre, protein, omega-9 fats and antioxidant nutrients and less saturated fat. Waist circumference and blood pressure did not change significantly.
The limits
What it doesn't show
The paper does not say how children were allocated to the two diets, and the analysis compared each group only with its own baseline rather than testing the difference between groups, so it does not directly show that the Mediterranean diet beat the standard diet. The sample was small, the trial open-label, and children who missed appointments were dropped rather than analysed by intention to treat. Physical activity was not measured, diet was self-reported by 24-hour recall, and 16 weeks says nothing about whether benefits last.
Key terms
- Metabolic syndrome (MetS)
- A cluster of risk factors - abdominal obesity, high triglycerides, low HDL cholesterol, high blood pressure and raised glucose - that together predict type 2 diabetes and heart disease.
- Mediterranean-style diet
- An eating pattern emphasising olive and other unsaturated oils, fish, whole grains, legumes, fruit, vegetables and nuts, with little saturated fat and refined sugar.
- HOMA-IR
- An index of insulin resistance calculated from fasting insulin and fasting glucose; higher values mean the body responds less well to insulin.
- Open-label study
- A trial in which participants and researchers know which intervention each person receives, which can bias behaviour and reporting.
- Within-group versus between-group comparison
- Testing whether one group changed from its own baseline, as opposed to testing whether the change differed between groups; only the latter shows one intervention outperformed another.
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Quiz yourself
How many weeks did the dietary intervention last?
Common questions
Was this a randomised controlled trial?
The paper calls it an open-label study and does not describe randomisation, so we cannot assume the groups were randomly assigned, even though they looked similar at baseline.
Why is it a problem that each group was only compared with its own starting point?
A significant change in one group and a non-significant change in the other does not prove the groups differ; a direct between-group test is needed to claim the Mediterranean diet was better.
Did children on the Mediterranean-style diet lose weight?
Not significantly. Their BMI fell mainly because they grew taller without gaining weight, while the standard-diet group gained about 1.7 kg.
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