Abstract
PURPOSE: While the Mediterranean diet (MD) is associated with numerous health benefits, in children there is limited information on effects of assessment methods, cross-country differences, and the tracking of MD adherence over time. We aimed to compare and combine dietary assessment tools in young children, to provide an informative method for scoring adherence to MD, and to examine cross-country variations. METHODS: 3-Day Food Diaries (3-DFD) and Food Frequency Questionnaires (FFQ) were assessed at 4 time points during the ages of 3 to 6 years across five European countries: Belgium, Germany, Italy, Poland, and Spain. Information from both tools was used to calculate the Mediterranean Diet Quality Index for children and adolescents (KIDMED), both independently and in combination. For the latter, country and time point differences were examined. Individual diet score variance per country across time points was determined using Intraclass Correlation Coefficient (ICC). RESULTS: The combined KIDMED score (3.76 ± 2.28) was higher compared to both the FFQ (3.31 ± 2.33) and the 3-DFD score (1.78 ± 2.45) across follow-ups. The combined KIDMED score was higher in Mediterranean countries (Italy 5.00 ± 1.60; Spain 4.54 ± 1.70) than non-Mediterranean countries (Belgium 1.96 ± 2.07; Germany 3.13 ± 2.01; Poland 1.65 ± 2.12) (p < 0.01), driven by more children from Mediterranean countries consuming fruits, vegetables, fish, pulses, and olive oil. The combined KIDMED score was rather stable over time. Intra-individual consistency over time was poor to moderate (Germany: 0.620, Belgium: 0.604, Italy: 0.429, Poland: 0.564, and Spain: 0.493). CONCLUSIONS: Combining FFQ and 3-DFD led to a higher KIDMED score reflecting more detected details of frequencies in food consumption. MD adherence was poor to moderate and remained stable over time in early childhood, suggesting that dietary patterns established at a young age are likely to persist. TRIAL REGISTRATION: This trial was registered at clinicaltrials.gov as NCT00338689.