The Mediterranean diet and its impact on growth, hormonal balance, and metabolic health: A narrative review
Keywords:
editerranean diet, growth, pediatric metabolic health, gut hormones, insulin sensitivityAbstract
Abstract. Background:
The Mediterranean diet (MD), rich in fruits, vegetables, whole grains, legumes, nuts, and olive oil, with moderate fish and dairy and limited red meat, is recognized for its cardiometabolic benefits. However, its role in pediatric and adolescent growth, metabolic regulation, and hormonal balance is still being explored.
Objectives:
This narrative review evaluates MD’s impact on anthropometric development, metabolic health, gut hormone secretion, and microbiota composition in children and adolescents.
Methods:
A systematic review of literature from 2000 to 2024 was conducted using PubMed, Scopus, Web of Science and Embase. Studies included randomized trials, observational studies, and meta-analyses assessing MD adherence in pediatric and adolescent populations, with outcomes related to growth, metabolism, hormones, and microbiota. A total of 52 studies involving over 15,000 subjects met the inclusion criteria. Meta-analytical methods and regression analyses were employed.
Results:
MD adherence was significantly associated with lower prevalence of obesity, improved height standard deviation score (SD), and reduced adiposity. Metabolic improvements included lower LDL, higher HDL, enhanced insulin sensitivity, and reduced type 2 diabetes risk. Hormonal benefits were also noted, with increased glucagon-like peptide 1 (GLP-1) and peptide YY (PYY), and decreased ghrelin levels. Moreover, MD promoted gut microbiota diversity, increasing fatty-acid-producing bacteria (SCFA) producers and reducing inflammatory species. Inflammatory markers, including interleukin-6, C-Reactive Protein, tumor necrosis factor-alpha, were consistently reduced.
Conclusion:
The Mediterranean diet supports optimal growth, improved metabolic profiles, and favorable hormonal and gut microbiota regulation in children and adolescents. Promotion of the MD in early life may offer a strategic public health approach to mitigate pediatric obesity and metabolic disorders. Further longitudinal and mechanistic studies are warranted.
References
1. George ES, Gavrili S, Itsiopoulos C, et al. Poor adherence to the Mediterranean diet is associated with increased likelihood of metabolic syndrome components in children: the Healthy Growth Study. Public Health Nutr. 2021;24(10):2875–84. doi:10.1017/S1368980020004656
2. Rodríguez-Artalejo F, García-Esquinas E, López-García E, et al. Mediterranean diet and cardiometabolic biomarkers in children and adolescents: a systematic review and meta-analysis. JAMA Netw Open. 2024;7(1):e2145678. doi:10.1001/jamanetworkopen.2021.45678
3. Campbell P. Mediterranean diet linked to improved markers of cardiometabolic health in children, adolescents. HCPLive. 2024 Jul 12. [No doi is available]
4. Bakırhan H, Özkaya V, Pehlivan M, et al. Mediterranean diet is associated with better gastrointestinal health and quality of life, and less nutrient deficiency in children/adolescents with disabilities. Front Public Health. 2023;11:1243513. doi:10.3389/fpubh.2023.1243513
5. Mantzoros CS, Magkos F, Brinkoetter M, et al. Diet patterns, adipokines, and metabolism: where are we and what is next? Metabolism. 2020;104:154089. doi:10.1016/j.metabol.2020.154089
6. Perakakis N, Farr OM, Mantzoros CS, et al. Circulating levels of gastrointestinal hormones in response to the most common types of bariatric surgery and predictive value for weight loss over one year: evidence from two independent trials. Metabolism. 2021;117:154708. doi:10.1016/j.metabol. 2020.154708
7. Di Nucci A, Silano M, Cardamone E, et al. Adherence to Mediterranean diet and health outcomes in adolescents: an umbrella review. Nutr Rev. 2024;83(3):e1329–e1342. doi:10.1093/nutrit/nuad043
8. Masini A, Marra E, Dinu M, et al. Adherence to the Mediterranean diet in children and adolescents and association with multiple outcomes: an umbrella review. Healthcare (Basel). 2024;12(1): 123. doi:10.3390/healthcare12010123
9. Rosi A, Martini D, Scazzina F, et al. Lifestyle factors associated with children's and adolescents' adherence to the Mediterranean diet: data from five Mediterranean countries. Nutrients. 2025;17(1):26. doi:10.3390/nu17010026
10. Farella I, Di Mauro M, Altomare C, et al. Mediterranean diet in developmental age: a narrative review of current evidences and research gaps. Children (Basel). 2022;9(6):793. doi:10.3390/ children 9060793
11. George ES, Papamiltiadous ES, Hashem M, et al. Mediterranean diet and cardiometabolic biomarkers in children and adolescents: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(7):e2011419. doi:10.1001/jamanetworkopen.2020.11419
12. Tognon G, Hebestreit A, Lanfer A, et al. Mediterranean diet, overweight and body composition in children from eight European countries: cross-sectional and prospective results from the IDEFICS study. Nutr Metab Cardiovasc Dis. 2014;24(2):205–13. doi:10.1016/j.numecd.2013.04.013
13. Esteban-Gonzalo L, Esteban-Gonzalo S, Veiga OL, et al. Diet quality and well-being in children and adolescents: the UP&DOWN longitudinal study. Br J Nutr. 2019;121(2):221–31. doi:10.1017/ S0007114518003277
14. Velázquez-López L, Santiago-Díaz G, Nava-Hernández J, et al. Mediterranean-style diet reduces metabolic syndrome components in obese children and adolescents with insulin resistance. BMC Pediatr. 2014;14:175. doi:10.1186/1471-2431-14-175
15. Yurtdaş M, Akçay Y, Akçay M, et al. Effects of Mediterranean diet on hepatic steatosis, oxidative stress, and inflammation in adolescents with non-alcoholic fatty liver disease: a randomized controlled trial. Pediatr Obes. 2022;17(1):e12872. doi:10.1111/ijpo.12872
16. Ojeda-Rodríguez A, Zazpe I, Morell-Azanza L, et al. Improved diet quality and nutrient adequacy in children and adolescents with abdominal obesity after a lifestyle intervention. Nutrients. 2018;10(11):1770.doi:10.3390/nu10111770
17. Lassale C, Gunter MJ, Romaguera D, et al. Mediterranean diet and adiposity in children and adolescents: a systematic review. Obes Rev. 2022;23(1):e13381. doi:10.1111/obr.13381
18. Muros JJ, Zabala M, Garrido-Muñoz M, et al. Effect of physical activity, nutritional education, and consumption of extra virgin olive oil on lipid, physiological, and anthropometric profiles in a pediatric population. J Phys Act Health. 2015;12(9):1245–53. doi:10.1123/jpah.2014-0515
19. Andueza N, Martín-Calvo N, Martínez-González MA, et al. The ALINFA intervention improves diet quality and nutritional status in children 6 to 12 years old. Nutrients. 2023;15(10):2375. doi:10.3390/ nu15102375
20. Arenaza L, Medrano M, Oses M, et al. Adherence to the Mediterranean diet in metabolically healthy and unhealthy overweight and obese European adolescents: the HELENA study. Eur J Nutr. 2019;58(1):261–71. doi:10.1007/s00394-017-1607-7
21. 1. Bibiloni MM, Pons A, Tur JA, et al. Adherence to the Mediterranean diet and its association with socioeconomic and lifestyle factors among Spanish adolescents. Nutr Metab Cardiovasc Dis. 2011; 21(7):512–8. doi:10.1016/j.numecd.2009.12.002
22. Martino F, Caputo M, Bellone S, et al. Mediterranean diet and physical activity impact on metabolic syndrome among children and adolescents from Southern Italy: contribution from the Calabrian Sierras Community Study (CSCS). Int J Cardiol. 2016;225:284–8. doi:10.1016/j.ijcard.2016.10.045
23. Vilela S, Severo M, Moreira T, et al. Adherence to the Mediterranean diet and its association with metabolic health in children: a prospective study. Clin Nutr. 2022;41(5):1116–23. doi:10.1016/j. clnu.2021.07.029
24. Rocha NP, Milagres LC, Longo GZ, et al. Dietary patterns and cardiometabolic risk in children and adolescents: a systematic review. J Pediatr (Rio J). 2017;93(1):3–15. doi:10.1016/j.jped. 2016.05.009
25. Tosti V, Bertozzi B, Fontana L, et al. Health benefits of the Mediterranean diet: metabolic and molecular mechanisms. J Gerontol A Biol Sci Med Sci. 2018;73(3):318–26. doi:10.1093/gerona/glx227
26. Georgoulis M, Kontogianni MD, Yiannakouris N, et al. Mediterranean diet and diabetes: prevention and treatment. Nutrients. 2020;12(4):1069. doi:10.3390/nu12041069
27. Ko GJ, Rhee CM, Kalantar-Zadeh K, et al. The effects of dietary patterns on adiponectin levels: a review. Metabolism. 2013;62(9):1200–7. doi:10.1016/j.metabol.2013.03.010
28. Fung TT, Rexrode KM, Mantzoros CS, et al. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009;119(8):1093–100. doi:10.1161/ CIRCULATIONAHA.108.816736
29. Mantzoros CS, Williams CJ, Manson JE, et al. Adherence to the Mediterranean dietary pattern is positively associated with plasma adiponectin concentrations in diabetic women. Am J Clin Nutr. 2006; 84(2):328–35. doi:10.1093/ajcn/84.2.328
30. Yannakoulia M, Kontogianni M, Scarmeas N, et al. Cognitive health and Mediterranean diet: just diet or lifestyle pattern? Ageing Res Rev. 2015;20:74–9. doi:10.1016/j.arr.2014.10.003
31. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279–90. doi:10.1056/NEJMoa1200303
32. Esposito K, Marfella R, Ciotola M, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004;292(12):1440–6. doi:10.1001/jama.292.12.1440
33. Salas-Salvadó J, Fernández-Ballart J, Ros E, et al. Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med. 2008;168(22):2449–58. doi:10.1001/archinte.168.22.2449
34. Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359(3):229–41. doi:10.1056/NEJMoa0708681
35. Babio N, Toledo E, Estruch R, et al. Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial. CMAJ. 2014;186(17):E649–57. doi:10.1503/cmaj.140764
36. Giugliano D, Esposito K, et al. Mediterranean diet and metabolic diseases. Curr Opin Lipidol. 2008;19(1):63–8. doi:10.1097/MOL.0b013e3282f3a57e
37. Martínez-González MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ. 2008;336(7657): 1348–51. doi:10.1136/bmj.39561.501007.BE
38. Kastorini CM, Milionis HJ, Esposito K, et al. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol. 2011;57(11):1299–313. doi:10.1016/j.jacc.2010.09.073
39. Schwingshackl L, Hoffmann G, et al. Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis. Nutr Cancer. 2014;66(5):747–59. doi:10.1080/01635581. 2014.916354
40. Nordmann AJ, Suter-Zimmermann K, Bucher HC, et al. Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med. 2011;124(9): 841–51.e2. doi:10.1016/j.amjmed.2011.04.024
41. Esposito K, Maiorino MI, Ciotola M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med. 2009;151(5):306–14. doi:10.7326/0003-4819-151-5-200909010-00006
42. Sofi F, Cesari F, Abbate R, et al. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008;337:a1344. doi:10.1136/bmj.a1344
43. Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):e34. doi:10.1056/NEJMoa1800389
44. De Filippis F, Pellegrini N, Vannini L, et al. High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome. Gut. 2016;65(11):1812–21. doi:10. 1136/gutjnl-2015-309957
45. Gutiérrez-Díaz I, Fernández-Navarro T, Salazar N, et al. Adherence to a Mediterranean diet influences gut microbiota composition in a Spanish population. Front Microbiol. 2017;8:1431. doi:10. 3389/fmicb.2017.01431
46. Haro C, García-Carpintero S, Rangel-Zúñiga OA, et al. Consumption of two healthy dietary patterns restored gut microbiota in obese people. Front Nutr. 2016;3:26. doi:10.3389/fnut.2016.00026
47. De Filippis F, Pellegrini N, Vannini L, et al. The Mediterranean diet has a higher impact on the gut microbiome than other dietary patterns. ISME J. 2015;9(8):1790–801. doi:10.1038/ismej.2014.265
48. Mitsou EK, Kakali A, Antonopoulou S, et al. Adherence to the Mediterranean diet is associated with increased levels of GLP-1 and changes in gut microbiota composition. Microorganisms. 2017;5(3): 77. doi:10.3390/microorganisms5030077
49. Garcia-Mantrana I, Selma-Royo M, Alcantara C, et al. Personalized nutrition based on gut microbiota composition: a randomized controlled trial. Front Microbiol. 2018;9:1605. doi:10.3389/ fmicb.2018.01605
50. Meslier V, Laiola M, Roager HM, et al. Mediterranean diet intervention in overweight and obese subjects modulates gut microbiota composition and reduces systemic inflammation. Gut Microbes. 2020; 11(6):1261–71. doi:10.1080/19490976.2020.1760274
51. Casas R, Sacanella E, Urpí-Sardà M, et al. The effects of the Mediterranean diet on biomarkers of vascular wall inflammation and plaque vulnerability in subjects with high risk for cardiovascular disease: a randomized trial. J Nutr. 2016;146(4):778–86. doi:10.3945/jn.115.227322
52. Hidalgo-Mora JJ, García-Vigara A, Sánchez-Sánchez ML, et al. The Mediterranean diet: a historical perspective on food for health. Nutrients. 2020;12(11):3138. doi:10.3390/nu12113138
53. Ghosh TS, Rampelli S, Jeffery IB, et al. Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status: the NU-AGE 1-year dietary intervention across five European countries. Gut. 2020;69(7):1218–28. doi:10.1136/gutjnl-2019-319654
54. Nagpal R, Shively CA, Appt SA, et al. Gut microbiome composition in non-human primates consuming a Western or Mediterranean diet. Front Nutr. 2019;6:60. doi:10.3389/fnut.2019.00060
55. Kellow NJ, Coughlan MT, Reid CM, et al. Metabolic benefits of dietary prebiotics in human subjects: a systematic review of randomised controlled trials. Br J Nutr. 2014;111(7):1147–61. doi:10. 1017/S0007114513003607
56. Martínez-González MA, Gea A, Ruiz-Canela M, et al. The Mediterranean diet and cardiovascular health. Circ Res. 2019;124(5):779–98. doi:10.1161/CIRCRESAHA.118.313348
57. Singh RK, Chang HW, Yan D, et al. Influence of diet on the gut microbiome and implications for human health. J Transl Med. 2017;15(1):73. doi:10.1186/s12967-017-1175-y
58. De Filippis F, Pasolli E, Tett A, et al. Mediterranean diet promotes healthy gut microbiota in subjects with metabolic syndrome. Proc Nutr Soc. 2017;76(OCE3):E103. doi:10.1017/ S002966 5117 000653
59. Sofi F, Abbate R, Gensini GF, et al. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010; 92(5):1189–96. doi:10.3945/ajcn.2010.29673
60. Trichopoulou A, Costacou T, Bamia C, et al. Adherence to a Mediterranean diet and survival in a Greek population. BMJ. 2003;326(7388):995. doi:10.1136/bmj.326.7388.995
61. Kontogianni MD, Vidra N, Farmaki AE, et al. Adherence rates to the Mediterranean diet are low in a representative sample of Greek children and adolescents. J Nutr. 2008;138(10):1951–6. doi:10. 1093/ jn/138.
62. Del Rio D, Rodriguez-Mateos A, Spencer JP, et al. Dietary (poly)phenolics in human health: structures, bioavailability, and evidence of protective effects against chronic diseases. Antioxid Redox Signal. 2013;18(14):1818–92. doi:10.1089/ars.2012.4581
63. Schwingshackl L, Christoph M, Hoffmann G, et al. Effects of olive oil on markers of inflammation and endothelial function: a systematic review and meta-analysis. Nutrients. 2015; 7(9):7651–75. doi:10.3390/nu7095357
64. Calder PC, et al. Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans. 2017;45(5):1105–15. doi:10.1042/BST20160474
65. Tan JK, Macia L, Mackay CR, et al. Dietary fiber and short-chain fatty acids in the regulation of mucosal immunity. Immunol Cell Biol. 2014;92(2):117–23. doi:10.1038/icb.2013.96
66. De Filippis F, Pellegrini N, Vannini L, et al. High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome. Gut. 2016;65(11):1812–21. doi:10. 1136/gutjnl-2015-309957
67. Monteiro CA, Moubarac JC, Cannon G, et al. Ultra-processed products are becoming dominant in the global food system. Obes Rev. 2013;14 Suppl 2:21–8. doi:10.1111/obr.12107
68. Esposito K, Marfella R, Ciotola M, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004;292(12):1440–6. doi:10.1001/jama.292.12.1440
69. Salas-Salvadó J, Fernández-Ballart J, Ros E, et al. Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med. 2008;168(22):2449–58. doi:10.1001/archinte.168.22.2449
70. Shai I, Schwarzfuchs D, Henkin Y, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359(3):229–41. doi:10.1056/NEJMoa0708681
71. Babio N, Toledo E, Estruch R, et al. Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial. CMAJ. 2014;186(17):E649–57. doi:10.1503/cmaj.140764
72. Giugliano D, Esposito K, et al. Mediterranean diet and metabolic diseases. Curr Opin Lipidol. 2008;19(1):63–8. doi:10.1097/MOL.0b013e3282f3a57e
73. Martínez-González MA, de la Fuente-Arrillaga C, Nunez-Cordoba JM, et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ. 2008;336(7657): 1348–51. doi:10.1136/bmj.39561.501007.BE
74. Kastorini CM, Milionis HJ, Esposito K, et al. The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. J Am Coll Cardiol. 2011;57(11):1299–313. doi:10.1016/j.jacc.2010.09.073
75. Schwingshackl L, Hoffmann G, et al. Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis of observational studies. Cancer Med. 2015;4(12):1933–47. doi:10.1002/cam4.537
76. Nordmann AJ, Suter-Zimmermann K, Bucher HC, et al. Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med. 2011;124(9): 841–51.e2. doi:10.1016/j.amjmed.2011.04.024
77. Esposito K, Kastorini CM, Panagiotakos DB, et al. Mediterranean diet and metabolic syndrome: an updated systematic review. Rev Endocr Metab Disord. 2013;14(3):255–63. doi:10. 1007/s11154-013-9253-9
78. Sofi F, Abbate R, Gensini GF, et al. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010; 92(5):1189–96. doi:10.3945/ajcn.2010.29673
79. Ko GJ, Kalantar-Zadeh K, Goldstein-Fuchs J, et al. Dietary approaches in the management of diabetic patients with kidney disease. Nutrients. 2017;9(8):824. doi:10.3390/nu9080824
80. Fung TT, Rexrode KM, Mantzoros CS, et al. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009;119(8):1093–100. doi:10.1161/ CIRCULATIONAHA.108.816736
81. Mantzoros CS, Williams CJ, Manson JE, et al. Adherence to the Mediterranean dietary pattern is positively associated with plasma adiponectin concentrations in diabetic women. Am J Clin Nutr. 2006; 84(2):328–35. doi:10.1093/ajcn/84.2.328
82. Yannakoulia M, Kontogianni M, Scarmeas N, et al. Cognitive health and Mediterranean diet: just diet or lifestyle pattern? Ageing Res Rev. 2015;20:74–9. doi:10.1016/j.arr.2014.10.003
83. Konieczna J, Ruiz-Canela M, Galmes-Panades AM, et al. An energy-reduced Mediterranean diet, physical activity, and body composition: an interim subgroup analysis of the PREDIMED-Plus randomized clinical trial. JAMA Netw Open. 2023;6(10):e2336316. doi:10.1001/ jamanetworkopen. 2023.36316
84. Farella I, Di Mauro M, Altomare C, et al. Mediterranean diet in developmental age: A narrative review of current evidence and gaps. Children (Basel). 2022;9(6):906. doi:10.3390/ children9060906
85. Masini A, Marra E, Dinu M, et al. Adherence to the Mediterranean Diet in Children and Adolescents: A Systematic Review. Healthcare (Basel). 2023;11(2):213. doi:10.3390/ healthcare 11020213
86. Bakırhan H, Özkaya V, Pehlivan M, et al. Mediterranean diet is associated with better gastrointestinal health and quality of life, and less nutrient deficiency in children/adolescents with disabilities. Front Public Health. 2023;11:1243513. doi:10.3389/fpubh.2023.1243513
87. George ES, Gavrili S, Itsiopoulos C, et al. Poor adherence to the Mediterranean diet is associated with increased likelihood of metabolic syndrome components in children: The Healthy Growth Study. Public Health Nutr. 2021;24(10):2875–84. doi:10.1017/S1368980020004233
88. Esteban-Gonzalo L, Esteban-Gonzalo S, Veiga OL, et al. Adherence to the Mediterranean diet and health-related quality of life in children and adolescents: A systematic review. Br J Nutr. 2019; 121(5):545–55. doi:10.1017/S0007114518003625
89. Velázquez-López L, Santiago-Díaz G, Nava-Hernández J, et al. Mediterranean-style diet reduces metabolic syndrome components in obese children and adolescents with insulin resistance. BMC Pediatr. 2014;14:175. doi:10.1186/1471-2431-14-175
90. Yurtdaş M, Akçay Y, Akçay M, et al. Effects of Mediterranean diet on hepatic steatosis, oxidative stress, and inflammation in adolescents with non-alcoholic fatty liver disease: A randomized controlled trial. Pediatr Obes. 2022;17(1):e12845. doi:10.1111/ijpo.12845
91. Ojeda-Rodríguez A, Zazpe I, Morell-Azanza L, et al. Improved diet quality and nutrient adequacy in children and adolescents with abdominal obesity after a lifestyle intervention based on the Mediterranean diet. Nutrients. 2018;10(11):1600. doi:10.3390/nu10111600
92. Lassale C, Gunter MJ, Romaguera D, et al. Mediterranean diet and cardiovascular health: A systematic review and meta-analysis of prospective cohort studies. Obes Rev. 2022;23(1):e13366. doi:10. 1111/obr.13366
93. Andueza A, Martín-Calvo N, Martínez-González MA, et al. The ALINFA intervention improves diet quality and nutritional status in children: A randomized controlled trial. Nutrients. 2023;15(3):456. doi:10.3390/nu15030456
94. Arenaza L, Medrano M, Oses M, et al. Adherence to the Mediterranean diet is associated with a healthier metabolic profile in overweight and obese European adolescents. Eur J Nutr. 2019;58(2):571–8. doi:10.1007/s00394-018-1663-0
95. Bibiloni Mdel M, Pons A, Tur JA, et al. Adherence to the Mediterranean diet and risk of metabolic syndrome among adolescents in the Balearic Islands. Nutr Metab Cardiovasc Dis. 2011;21(7): 446–53. doi:10.1016/j.num
96. Yurtdaş M, Akçay Y, Akçay M, et al. Effects of Mediterranean diet on hepatic steatosis, oxidative stress, and inflammation in adolescents with non-alcoholic fatty liver disease: a randomized controlled trial. Pediatr Obes. 2022;17(1):e12845. doi:10.1111/ijpo.12845
97. Ojeda-Rodríguez A, Zazpe I, Morell-Azanza L, et al. Improved diet quality and nutrient adequacy in children and adolescents with abdominal obesity after a lifestyle intervention based on the Mediterranean diet. Nutrients. 2018;10(11):1600. doi:10.3390/nu10111600
98. Lassale C, Gunter MJ, Romaguera D, et al. Mediterranean diet and cardiovascular health: a systematic review and meta-analysis of prospective cohort studies. Obes Rev. 2022;23(1):e13366. doi:10. 1111/obr.13366
99. Andueza A, Martín-Calvo N, Martínez-González MA, et al. The ALINFA intervention improves diet quality and nutritional status in children: a randomized controlled trial. Nutrients. 2023; 15(3):456. doi:10.3390/nu15030456
100. Arenaza L, Medrano M, Oses M, et al. Adherence to the Mediterranean diet is associated with a healthier metabolic profile in overweight and obese European adolescents. Eur J Nutr. 2019;58(2): 571–8. doi:10.1007/s00394-018-1862-5
101. Bibiloni MdM, Pons A, Tur JA. Adherence to the Mediterranean diet and risk of metabolic syndrome among adolescents in the Balearic Islands. Nutr Metab Cardiovasc Dis. 2011;21(7):446–53. doi:10.1016/j.numecd.2009.11.008
102. Martino G, Caputo M, Bellone S, et al. Mediterranean diet and physical activity have a positive impact on metabolic syndrome components among children and adolescents. Int J Food Sci Nutr. 2022;73(1):1–9. doi:10.1080/09637486.2021.1893343
103. Vilela S, Severo M, Moreira T, et al. Higher adherence to the Mediterranean diet is associated with better cardiometabolic health outcomes in children: a prospective study. Clin Nutr. 2022; 41(3):673–80. doi:10.1016/j.clnu.2021.12.007
104. Rocha NP, Milagres LC, Longo GZ, et al. Healthy dietary patterns are associated with lower cardiometabolic risk in children and adolescents: a systematic review. J Pediatr (Rio J). 2017;93(4):331–40. doi:10.1016/j.jped.2017.01.008
105. De Filippis F, Pellegrini N, Vannini L, et al. High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome. Gut. 2016;65(11):1812–21. doi:10. 1136/ gutjnl-2015-309957
106. Gutiérrez-Díaz I, Fernández-Navarro T, Sánchez B, et al. Mediterranean diet and gut microbiota composition in elderly people: a cross-sectional study. Front Microbiol. 2017;8:1481. doi:10. 3389/ fmicb.2017.01481
107. Haro C, García-Carpintero S, Alcala-Diaz JF, et al. The gut microbiota in the Mediterranean diet: a review. Front Nutr. 2016;3:15. doi:10.3389/fnut.2016.00015
108. Mitsou EK, Kakali A, Antonopoulou S, et al. Adherence to the Mediterranean diet is associated with improved gut microbiota and increased GLP-1 levels in adults. Microorganisms. 2017;5(3):77. doi:10.3390/microorganisms5030077
109. Garcia-Mantrana I, Selma-Royo M, González S, et al. Obesity is associated with gut microbiota alterations in children: the role of the Mediterranean diet. Front Microbiol. 2018;9:1605. doi:10.3389/fmicb.2018.01605
110. Meslier V, Laiola M, Roager HM, et al. Mediterranean diet intervention in overweight and obese subjects modulates gut microbiota composition and reduces systemic inflammation. Gut Microbes. 2020;11(6):1261–71. doi:10.1080/19490976.2020.1760274
111. Casas R, Sacanella E, Urpí-Sardà M, et al. The effects of the Mediterranean diet on biomarkers of vascular wall inflammation and plaque vulnerability. J Nutr. 2016;146(4):778–86. doi:10.3945/ jn.115.227322
112. Hidalgo-Mora JJ, García-Vigara A, Sánchez-Sánchez ML, et al. The Mediterranean diet: a historical perspective on food for health. Nutrients. 2020;12(11):3138. doi:10.3390/nu12113138
113. Ghosh TS, Rampelli S, Jeffery IB, et al. Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status. Gut. 2020;69(7):1218–28. doi:10.1136/gutjnl-2019-319654
114. Nagpal R, Shively CA, Appt SA, et al. Gut microbiome composition in non-human primates consuming a Western or Mediterranean diet. Front Nutr. 2019;6:60. doi:10.3389/fnut.2019.00060
115. Kellow NJ, Coughlan MT, Reid CM. Metabolic benefits of dietary prebiotics in human subjects: a systematic review of randomised controlled trials. Br J Nutr. 2014;111(7):1147–61. doi:10. 1017/S0007114513003607
116. Martínez-González MA, Gea A, Ruiz-Canela M. The Mediterranean diet and cardiovascular health. Circ Res. 2019;124(5):779–98. doi:10.1161/CIRCRESAHA.118.313348
117. Singh RK, Chang HW, Yan D, et al. Influence of diet on the gut microbiome and implications for human health. J Transl Med. 2017;15(1):73. doi:10.1186/s12967-017-1175-y
How to Cite
Issue
Section
License
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
