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The mediating effect of parents’ educational status on the association between adherence to the Mediterranean diet and childhood obesity: the PANACEA study

International Journal of Public Health volume 58, pages 401–408 (2013)Cite this article

Abstract

Objectives

To investigate the potential mediating effect of parental education on the association between adherence to the Mediterranean diet and obesity, in 10–12 years old children.

Methods

A cross-sectional survey was performed among 1,125 (529 male) children in Greece. Children and their parents completed standardized questionnaires, which evaluated parents’ educational level and dietary habits. Body mass index was calculated and children were classified as normal, overweight or obese (IOTF classification). Adherence to the Mediterranean diet was assessed using the KIDMED score.

Results

27.7% of the children were overweight and 6.3% were obese; 12.3% of children reported high adherence to the Mediterranean diet. Multi-adjusted analysis, stratified by parental education, revealed that adherence to the Mediterranean diet was inversely associated with children’s obesity status only in families in which at least one parent was of higher educational level (stratum-specific adjusted odds ratio: 0.41; 95% CI 0.17–0.98), but not those in which both parents were of low educational level.

Conclusions

Parental education status seems to play a mediating role in the beneficial effect of Mediterranean diet on children’s obesity status.

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References

  • Antonogeorgos G, Grigoropoulou D, Papadimitriou A, Priftis KN, Anthracopoulos M, Nicolaidou P, Panagiotakos DB (2011) Validation of a semi-quantitative Food Frequency Questionnaire designed for children aged 10–12 years: The PANACEA-FFQ. In: 52nd Annual Meeting of the European Society for Paediatric Research, Newcastle, UK

  • Antonogeorgos G, Panagiotakos DB, Papadimitriou A, Priftis KN, Anthracopoulos M, Nicolaidou P (2012) Breakfast consumption and meal frequency interaction with childhood obesity. Pediatr Obes 7(1):65–72. doi:10.1111/j.2047-6310.2011.00006.x

    PubMed  Article  CAS  Google Scholar 

  • Argiropoulou E, Michalopoulou M, Aggelousis N, Avgerinos A (2004) Validity and reliability of physical activity measures in Greek high school age children. J Sports Sci Med 3:147–159

    Google Scholar 

  • Bonaccio M, Iacoviello L, de Gaetano G, Moli-Sani Investigators (2011) The Mediterranean diet: the reasons for a success. Thromb Res. doi:10.1016/j.thromres.2011.10.018

    PubMed  Google Scholar 

  • Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243

    PubMed  Article  CAS  Google Scholar 

  • Cullen KW, Baranowski T, Owens E, Marsh T, Rittenberry L, de Moor C (2003) Availability, accessibility, and preferences for fruit, 100 % fruit juice, and vegetables influence children’s dietary behavior. Health Educ Behav 30(5):615–626

    PubMed  Article  Google Scholar 

  • Dattilo AM, Birch L, Krebs NF, Lake A, Taveras EM, Saavedra JM (2012) Need for early interventions in the prevention of pediatric overweight: a review and upcoming directions. J Obes 2012:123023. doi:10.1155/2012/123023

    PubMed  Google Scholar 

  • Esposito K, Ciotola M, Giugliano D (2006) Mediterranean diet, endothelial function and vascular inflammatory markers. Public Health Nutr 9(8A):1073–1076. doi:10.1017/S1368980007668529

    PubMed  Article  Google Scholar 

  • Farajian P, Risvas G, Karasouli K, Pounis GD, Kastorini CM, Panagiotakos DB, Zampelas A (2011) Very high childhood obesity prevalence and low adherence rates to the Mediterranean diet in Greek children: the GRECO study. Atherosclerosis 217(2):525–530. doi:10.1016/j.atherosclerosis.2011.04.003

    PubMed  Article  CAS  Google Scholar 

  • Farajian P, Panagiotakos DB, Risvas G, Karasouli K, Bountziouka V, Voutzourakis N, Zampelas A (2012) Socio-economic and demographic determinants of childhood obesity prevalence in Greece: the GRECO (Greek Childhood Obesity) study. Public Health Nutr 25:1–8. doi:10.1017/S1368980012002625

    Google Scholar 

  • Fisher JO, Mitchell DC, Smiciklas-Wright H, Birch LL (2002) Parental influences on young girls’ fruit and vegetable, micronutrient, and fat intakes. J Am Diet Assoc 102(1):58–64

    PubMed  Article  Google Scholar 

  • Gopinath B, Baur LA, Burlutsky G, Robaei D, Mitchell P (2012) Socio-economic, familial and perinatal factors associated with obesity in Sydney schoolchildren. J Paediatr Child Health 48(1):44–51. doi:10.1111/j.1440-1754.2011.02181.x

    PubMed  Article  Google Scholar 

  • Haug E, Rasmussen M, Samdal O, Iannotti R, Kelly C, Borraccino A, Vereecken C, Melkevik O, Lazzeri G, Giacchi M, Ercan O, Due P, Ravens-Sieberer U, Currie C, Morgan A, Ahluwalia N (2009) Overweight in school-aged children and its relationship with demographic and lifestyle factors: results from the WHO-collaborative health behaviour in school-aged children (HBSC) study. Int J Public Health 54(Suppl 2):167–179. doi:10.1007/s00038-009-5408-6

    PubMed  Article  Google Scholar 

  • Hesketh K, Crawford D, Salmon J, Jackson M, Campbell K (2007) Associations between family circumstance and weight status of Australian children. Int J Pediatr Obes 2(2):86–96. doi:10.1080/17477160601148554

    PubMed  Article  Google Scholar 

  • Jackson-Leach R, Lobstein T (2006) Estimated burden of paediatric obesity and co-morbidities in Europe. Part 1. The increase in the prevalence of child obesity in Europe is itself increasing. Int J Pediatr Obes 1(1):26–32

    PubMed  Article  Google Scholar 

  • Jennings A, Welch A, van Sluijs EM, Griffin SJ, Cassidy A (2011) Diet quality is independently associated with weight status in children aged 9–10 years. J Nutr 141(3):453–459. doi:10.3945/jn.110.131441

    PubMed  Article  CAS  Google Scholar 

  • Kontogianni MD, Vidra N, Farmaki AE, Koinaki S, Belogianni K, Sofrona S, Magkanari F, Yannakoulia M (2008) Adherence rates to the Mediterranean diet are low in a representative sample of Greek children and adolescents. J Nutr 138(10):1951–1956 138/10/1951 [pii]

    PubMed  CAS  Google Scholar 

  • Kosti RI, Panagiotakos DB (2006) The epidemic of obesity in children and adolescents in the world. Cent Eur J Public Health 14(4):151–159

    PubMed  Google Scholar 

  • Lajunen HR, Kaprio J, Rose RJ, Pulkkinen L, Silventoinen K (2012) Genetic and environmental influences on BMI from late childhood to adolescence are modified by parental education. Obesity (Silver Spring) 20(3):583–589. doi:10.1038/oby.2011.304

    Article  Google Scholar 

  • Lazarou C, Kalavana T (2009) Urbanization influences dietary habits of Cypriot children: the CYKIDS study. Int J Public Health 54(2):69–77. doi:10.1007/s00038-009-8054-0

    PubMed  Article  Google Scholar 

  • Marques-Vidal P, Vollenweider P, Waeber G, Paccaud F (2012) The prevalence and management of cardiovascular risk factors in immigrant groups in Switzerland. Int J Public Health 57(1):63–77. doi:10.1007/s00038-011-0297-x

    PubMed  Article  Google Scholar 

  • McCrory C, Layte R (2012) Breastfeeding and risk of overweight and obesity at nine-years of age. Soc Sci Med 75(2):323–330. doi:10.1016/j.socscimed.2012.02.048

    PubMed  Article  Google Scholar 

  • Moschonis G, Tanagra S, Vandorou A, Kyriakou AE, Dede V, Siatitsa PE, Koumpitski A, Androutsos O, Grammatikaki E, Kantilafti M, Naoumi A, Farmaki AE, Siopi A, Papadopoulou EZ, Voutsadaki E, Chlouveraki F, Maragkopoulou K, Argyri E, Giannopoulou A, Manios Y (2010) Social, economic and demographic correlates of overweight and obesity in primary-school children: preliminary data from the healthy growth study. Public Health Nutr 13:1693–1700. doi:10.1017/S1368980010002247

    PubMed  Article  Google Scholar 

  • Panagiotakos DB, Tzima N, Pitsavos C, Chrysohoou C, Zampelas A, Toussoulis D, Stefanadis C (2007) The association between adherence to the Mediterranean diet and fasting indices of glucose homoeostasis: the ATTICA Study. J Am Coll Nutr 26(1):32–38 26/1/32 [pii]

    PubMed  Google Scholar 

  • Patel R, Lawlor DA, Kramer MS, Smith GD, Bogdanovich N, Matush L, Martin RM (2011) Socio-economic position and adiposity among children and their parents in the Republic of Belarus. Eur J Public Health 21(2):158–165. doi:10.1093/eurpub/ckq041

    PubMed  Article  Google Scholar 

  • Priftis KN, Panagiotakos DB, Anthracopoulos MB, Papadimitriou A, Nicolaidou P (2007) Aims, methods and preliminary findings of the physical activity, nutrition and allergies in children examined in Athens (PANACEA) epidemiological study. BMC Public Health 7:140. doi:10.1186/1471-2458-7-140

    PubMed  Article  Google Scholar 

  • Prince SA, Kristjansson EA, Russell K, Billette JM, Sawada MC, Ali A, Tremblay MS, Prud’homme D (2012) Relationships between neighborhoods, physical activity, and obesity: a multilevel analysis of a large Canadian city. Obesity (Silver Spring). doi:10.1038/oby.2011.392

    Google Scholar 

  • Raine KD (2012) Obesity epidemics: inevitable outcome of globalization or preventable public health challenge? Int J Public Health 57(1):35–36. doi:10.1007/s00038-011-0322-0

    PubMed  Article  Google Scholar 

  • Ritchie LD, Spector P, Stevens MJ, Schmidt MM, Schreiber GB, Striegel-Moore RH, Wang MC, Crawford PB (2007) Dietary patterns in adolescence are related to adiposity in young adulthood in black and white females. J Nutr 137(2):399–406 137/2/399 [pii]

    PubMed  CAS  Google Scholar 

  • Romaguera D, Norat T, Mouw T, May AM, Bamia C, Slimani N, Travier N, Besson H, Luan J, Wareham N, Rinaldi S, Couto E, Clavel-Chapelon F, Boutron-Ruault MC, Cottet V, Palli D, Agnoli C, Panico S, Tumino R, Vineis P, Agudo A, Rodriguez L, Sanchez MJ, Amiano P, Barricarte A, Huerta JM, Key TJ, Spencer EA, Bueno-de-Mesquita HB, Buchner FL, Orfanos P, Naska A, Trichopoulou A, Rohrmann S, Kaaks R, Bergmann M, Boeing H, Johansson I, Hellstrom V, Manjer J, Wirfalt E, Uhre Jacobsen M, Overvad K, Tjonneland A, Halkjaer J, Lund E, Braaten T, Engeset D, Odysseos A, Riboli E, Peeters PH (2009) Adherence to the Mediterranean diet is associated with lower abdominal adiposity in European men and women. J Nutr 139(9):1728–1737. doi:10.3945/jn.109.108902

    PubMed  Article  CAS  Google Scholar 

  • Sahingoz SA, Sanlier N (2011) Compliance with Mediterranean diet quality index (KIDMED) and nutrition knowledge levels in adolescents. A case study from Turkey. Appetite 57(1):272–277. doi:10.1016/j.appet.2011.05.307

    PubMed  Article  Google Scholar 

  • Schroder H (2007) Protective mechanisms of the Mediterranean diet in obesity and type 2 diabetes. J Nutr Biochem 18(3):149–160. doi:10.1016/j.jnutbio.2006.05.006

    PubMed  Article  Google Scholar 

  • Schroder H, Mendez MA, Ribas-Barba L, Covas MI, Serra-Majem L (2010) Mediterranean diet and waist circumference in a representative national sample of young Spaniards. Int J Pediatr Obes 5(6):516–519. doi:10.3109/17477161003777417

    PubMed  Article  Google Scholar 

  • Serra-Majem L, Ribas L, Perez-Rodrigo C, Garcia-Closas R, Pena-Quintana L, Aranceta J (2002) Determinants of nutrient intake among children and adolescents: results from the enKid Study. Ann Nutr Metab 46(Suppl 1):31–38 66398 [pii]

    PubMed  Article  CAS  Google Scholar 

  • Serra-Majem L, Ribas L, Ngo J, Ortega RM, Garcia A, Perez-Rodrigo C, Aranceta J (2004) Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr 7(7):931–935 S136898000400117X [pii]

    PubMed  Google Scholar 

  • Spence JC, Cutumisu N, Edwards J, Evans J (2008) Influence of neighbourhood design and access to facilities on overweight among preschool children. Int J Pediatr Obes 3(2):109–116. doi:10.1080/17477160701875007

    PubMed  Article  Google Scholar 

  • Wachs TD, Creed-Kanashiro H, Cueto S, Jacoby E (2005) Maternal education and intelligence predict offspring diet and nutritional status. J Nutr 135(9):2179–2186 135/9/2179 [pii]

    PubMed  CAS  Google Scholar 

  • Wijlaars LP, Johnson L, van Jaarsveld CH, Wardle J (2011) Socioeconomic status and weight gain in early infancy. Int J Obes (Lond) 35(7):963–970. doi:10.1038/ijo.2011.88

    Article  CAS  Google Scholar 

  • Martinez E, Llull R, Del Mar Bibiloni M, Pons A, Tur JA (2010) Adherence to the Mediterranean dietary pattern among Balearic Islands adolescents. Br J Nutr 103(11):1657–1664. doi:10.1017/S0007114509993576

    PubMed  Article  CAS  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Affiliations

  1. Department of Nutrition and Dietetics, Harokopio University, 70 Eleftheriou Venizelou Str., PC 17671, Athens, Greece

    George Antonogeorgos, Demosthenes B. Panagiotakos & Dimitra Grigoropoulou

  2. Third Department of Pediatrics, Attikon Hospital, Medical School, University of Athens, Rimini 1, PC 12462, Athens, Greece

    Anastasios Papadimitriou, Polyxeni Nicolaidou & Kostas N. Priftis

  3. Respiratory Unit, Department of Paediatrics, University of Patras, Rio, PC 26504, Patras, Greece

    Michael Anthracopoulos

Authors
  1. George Antonogeorgos
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  2. Demosthenes B. Panagiotakos
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  3. Dimitra Grigoropoulou
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  4. Anastasios Papadimitriou
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  5. Michael Anthracopoulos
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  6. Polyxeni Nicolaidou
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  7. Kostas N. Priftis
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Corresponding author

Correspondence to Demosthenes B. Panagiotakos.

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Antonogeorgos, G., Panagiotakos, D.B., Grigoropoulou, D. et al. The mediating effect of parents’ educational status on the association between adherence to the Mediterranean diet and childhood obesity: the PANACEA study. Int J Public Health 58, 401–408 (2013). https://doi.org/10.1007/s00038-012-0424-3

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  • DOI: https://doi.org/10.1007/s00038-012-0424-3

Keywords

  • Obesity
  • Mediterranean diet
  • Parent education
  • Mediation
  • Overweight
  • Children