Eating patterns, lifestyle and Mediterranean Diet in children and adolescents from the Campania region, Italy

It is known that unhealthy eating patterns and sedentary behaviour are linked with the onset of overweight and obesity and that obese children will probably become obese adults, with a shorter life expectancy and higher risk of contracting cardio-vascular diseases and cancer. The Campania region has the highest rate of childhood overweight and obesity in Italy, which is in turn one of the European countries with the highest rate of overweight and obesity in children and adolescents. Therefore, urgent need for effective strategies is required at all levels (educational, medical, legal and political) in order to face the multiple risks linked to unbalanced diet and sedentary lifestyle of children. The principal aim of this thesis is the analysis of eating patterns and lifestyle and adherence to the Mediterranean Diet of children and adolescents in Campania, in order to assess their association with different possible predictive factors and with adiposity indexes. The first study of the thesis is a cross-sectional survey on the clustering of eating and lifestyle behaviour in 478 adolescents (15-17 years old) from the Campania region. The aim was to assess the prevalence of meeting the international recommendations and the association between the cluster of recommended behaviour and abdominal adiposity. The systematic review presented in this thesis has aimed to analyse the level of adherence to the MD in children and adolescents and its possible predictive factors, its association with adiposity indexes, lifestyle and body composition variables and its nutritional adequacy. The third study is a cross-sectional survey on eating patterns, lifestyle attitudes and the adherence to the Mediterranean Diet in 389 adolescents (11-13 years old) in the Campania region. The aim was to assess the prevalence of healthy and unhealthy eating patterns, lifestyle attitudes and level of adherence to the Mediterranean Diet, though the KIDMED index, and their associations with predictive factors and adiposity indexes. The results of the three studies confirm the urgent need for effective prevention strategies. In particular, it is suggested to include WHtR in the screening methods because it is related to unhealthy clustered behaviour; that it is important to promote the Mediterranean Diet especially in low socio-economic families and to create specific strategies for adolescents, who are at major risk, as the adherence to the Mediterranean Diet declines with age; that the KIDMED index can be applied to better understand eating patterns of children and adolescents and that it gives specific indications of what food or food group has to be encouraged or discouraged. Finally, all the studies suggest that strategies are needed which strongly target the decrease of all sedentary beahviour, as all its components are associated with unhealthy eating patterns, poor adherence to the Mediterranean Diet and to adiposity indexes.