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Cretan diet: Nutritional pattern for children

The Cretan-Mediterranean diet as a nutritional pattern for children and adolescents.

ksp_412 Findings on the beneficial effects of the adoption of a diet of the Cretan or the Mediterranean type can also be extended to children and adolescents. In general it has been shown that children and adolescents whose nutritional habits are closer to this nutritional pattern present larger intakes of several beneficial nutrient substances, while the quality of the diet is significantly degraded in those who are not so close to this pattern   (Serra-Majem et al. 2003). Nevertheless, data from Greek population demonstrate low rates in the adoption of Mediterranean diet, both by children and adolescents (Kontogianni et al. 2008).

Several recent studies have demonstrated that the adoption of the Mediterranean diet in the early childhood reduces the possibility of asthma and allergy occurrence (Chatzi & Kogevinas 2009), while it also improves control of the disease in children with an onset of  asthma  (Barros et al. 2008). Moreover, it is particularly interesting that the frequency of asthma and allergic symptoms is lower in children whose mothers were close the Mediterranean diet pattern during their pregnancy (Chatzi et al. 2008).

As far as childhood and adolescence obesity is concerned, there is not sufficient data to lead in definite conclusions. Nevertheless, it has been showed that the nutritional habits of adolescents who can be characterized as obese diverge by far from the traditional Mediterranean nutrition (Hassapidou et al. 2006), while according to another study obese children appeared to adopt the Mediterranean diet in a lower degree compared to children of normal body weight.   (Lazarou et al. 2009). However, there are also other factors, apart from nutrition, such as physical activity, parents’ body weight, as well as views and attitudes regarding nutrition, which seemed to affect significantly the body weight of children, a fact that suggests the complexity of the problem regarding childhood and adolescence obesity, which has now taken dimensions of an epidemic.

The problem of childhood obesity

During the last 3 decades, the rates of childhood and adolescence obesity have increased significantly. Almost 110 children up to 18 years old worldwide can be characterized as hyperbaric or obese (Haslam & James 2005) and the problem reaches even the less developed societies as a consequence of  sedentary life and the consumption of food which is easily available and has a low cost and a high calorific (Wang & Lobstein 2006). Obesity rates in these ages have been increased in almost every country, while in Europe almost 1 out of 4 children is hyperbaric or obese. Statistic data from Greece, and particularly from Crete, are disappointing. Crete holds the 5th position in Europe in the rates of hyperbaric and obese children aged 7-11 and the 1st position in the 13-17 age group featuring a ten rates difference from England, which holds the 2nd position. In Crete, 1 out of 3 children is (

Childhood obesity and complications

ksp_415 As the rates of obesity increase, helath complications become more and more obvious (Sinha et al. 2002;Daniels 2006). Hyperbaric and obese children run an increased risk of presenting different health problems not only in their childhood but also in their later life, while it is also possible that they will also be obese children in their adulthood. According to a study, children which were obese in the age of 10-15 had an 80% possibility of being obese as adults in the age of 25 (Freedman et al. 1999). A different study showed that children who are obese before the age of 8, present a more severe type of obesity as adults (Whitaker et al. 1997).

A lot of obese children present, already from this age, implications due to increased fat storage in the body, which include insulin disorders (often reflected by increased sugar or insulin blood levels), increased blood pressure levels, increased cholesterol and triglycerides levels, fatty liver infiltration and increased levels of systemic inflammatory markers (Cali & Caprio 2008).  All these conditions, which increase the risk for diabetes and cardiovascular diseases, do not present symptoms and often remain undiagnosed. These disorders can also appear in less obese children, as they seem to be related not only with the total fat rate, but also with the part of the body in which fat is accumulated (Cali & Caprio 2008). Apart from the already mentioned problems, obese children may present asthma and sleep apnea, while in the long term they run an increased risk for stroke, breast, kidney and large intestine cancer, myoskeletal problems as well as gall-bladder problems   (Daniels et al. 2009).

Other than its impact on physical health, obesity also seems to affect other parameters which are related to the psychology and the quality of life of a child. Obese children sometimes present reduced school performance, while in certain studies it has been demonstrated that they are prone to addictive habits such as smoking and alcohol, have a low self esteem, feel uncomfortable about their appearance, and occasionally have dysfunctional relationships with their peers (Daniels 2009).

It is clear by the above mentioned that obesity is not a problem of aesthetics, as it is often considered, but a complex condition which sets a child’s health in serious danger and, in some cases, degrades its quality of life.

Etiology of childhood obesity and the role of the family

ksp_413 Childhood and adolescence obesity appears to be hereditary in a certain degree. Nevertheless, the upsurge observed in recent years suggests that the role of environmental factors is particularly important, since our genes have not altered in such a short time. There are several factors which are involved in the etiology of childhood obesity (Daniels et al. 2009), such as socioeconomic parameters, lack of physical activity and consumption of foods and drinks (such as refreshments and juices) of low quality and high calorific value. Furthermore, lactation appears to be helpful in the prevention of childhood obesity.

Apart form the above mentioned factors, the role of parents is of crucial importance (Gruber & Haldeman 2009). It is clear that the family environment is significantly responsible for the appearance of obesity, but it also plays an equally important role in the way of dealing with the problem.  Obese parents tend to have obese children, bequeathing to them not only their genes but also their nutritional habits. Parents are responsible for the kinds of food available in the house, as well as for the meal schedules, and at the same time they constitute an example for their children, both in nutritional and physical activity habits. It is also worth noticing that almost 50% of parents do not observe increased body weight in their children and therefore take a lot of time to look for an appropriate therapy or, in some cases, do not look for any therapy at all  (Parry et al. 2008).

Treatment of childhood and adolescence obesity

ksp_414 Treatment of obesity should initially include evaluation of the child’s body weight and its risk against complications of obesity, both in its health and in its psychology. The body weight of parents  should be evaluated, as well as thei current nutritional and physical activity habits of both the child and its family (Daniels et al. 2009).

In general, a cooperation with a specialized dietician is required, not only for the evaluation but also for the therapy, and in order for the treatment to be  effective, parents must have an active participation (Daniels et al. 2009;Gruber & Haldeman 2009). It is the parents that should create the appropriate conditions for a good nutrition within the house limits and support the increase of physical activity, while at the same time they might also have to reconsider the potentially unsuitable approach which they used in the past in order to transmit to their children the messages about the changes that have to take place.

The change of nutritional habits is a multiple and gradual procedure which requires time, patience and a big effort both by the children and their parents.


  • Cali AM, Caprio S. Obesity in children and adolescents. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S31-6. Review.
  • Chatzi L, Torrent M, Romieu I, et al. Mediterranean diet in pregnancy is protective for wheeze and atopy in childhood. Thorax. 2008;63(6):507-13.
  • Chatzi L, Kogevinas M. Prenatal and childhood Mediterranean diet and the development of asthma and allergies in children. Public Health Nutr. 2009;12(9A):1629-34.
  • Daniels S. The consequences of childhood overweight and obesity. Future Child. 2006;16:47–67.
  • Daniels SR, Jacobson MS, McCrindle BW, et al. American Heart Association Childhood Obesity Research Summit: executive summary. Circulation. 2009;119(15):2114-23.
  • Freedman DS, Dietz WH, Srinivasan SR, et al. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics. 1999;103:1175–1182.
  • Gruber KJ, Haldeman LA. Using the family to combat childhood and adult obesity. Prev Chronic Dis. 2009;6(3):A106.
  • Haslam DW, James WPT. Obesity. Lancet 2005;366:1197–1209.
  • Hassapidou M, Fotiadou E, Maglara E, et al. Energy intake, diet composition, energy expenditure, and body fatness of adolescents in northern Greece. Obesity (Silver Spring). 2006;14(5):855-62.
  • 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.
  • Lazarou C, Panagiotakos DB, Matalas AL. Physical activity mediates the protective effect of the Mediterranean diet on children’s obesity status: The CYKIDS study. Nutrition. 2009. [Epub ahead of print]
  • Parry LL, Netuveli G, Parry J, et al. A systematic review of parental perception of overweight status in children. J Ambul Care Manage. 2008;31(3):253-68.
  • Sinha R, Fisch G, Teague B, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002;346:802–810.
  • Wang Y, Lobstein T. Worldwide trends in childhood overweight and
  • obesity. Int J Pediatr Obes. 2006;1:11–25
  • Wang Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int J Pediatr Obes. 2006;1(1):11-25. Review.
  • Whitaker RC, Wright JA, Pepe MS, et al. Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;337:869–873.