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longevity nutrition

Mediterranean dietary pattern analysis combining two nutritional assessment tools in children aged 3 to 6 years in five European countries

15 April 2026

Triebswetter Alexander, Erhardt Julia, Totzauer Martina, Luque Verònica, Gispert-Llaurado Mariona, Verduci Elvira, Gruszfeld Dariusz, Xhonneux Annick, Koletzko Berthold, Grote Veit

Summary

1. Plain-language summary of what the study found

This research found that young children (aged 3-6) across Europe generally have poor to moderate adherence to the Mediterranean diet, with children in Mediterranean countries showing better adherence. Crucially, the dietary patterns observed during these early years tend to remain stable over time, highlighting early childhood as a key period for shaping lasting eating habits.

2. Key findings

  • Combining different dietary assessment methods (food diaries and questionnaires) provided a more comprehensive and accurate measure of children's Mediterranean diet adherence.
  • Children living in Mediterranean countries (Italy, Spain) showed significantly higher adherence to the Mediterranean diet compared to those in non-Mediterranean countries (Belgium, Germany, Poland).
  • This stronger adherence in Mediterranean countries was primarily driven by greater consumption of fruits, vegetables, fish, pulses (legumes), and olive oil.
  • Overall adherence to the Mediterranean diet remained relatively stable as children aged from 3 to 6 years, suggesting that early eating habits are quite persistent.

3. Practical takeaways for someone interested in nutrition and longevity

  • Prioritize Early Habits: Focus on establishing healthy eating patterns, especially those aligned with the Mediterranean diet principles, during a child's preschool years. These habits are likely to endure and influence their long-term health.
  • Embrace Core Foods: Actively encourage young children to regularly consume fruits, vegetables, fish, legumes, and olive oil, as these are foundational elements of the health-promoting Mediterranean dietary pattern.
  • Environmental Influence: Recognize the powerful role of family and cultural environment in shaping dietary choices. Creating a home environment rich in Mediterranean foods can significantly impact a child's diet.

4. Study limitations

While insightful, the study noted that individual children's adherence scores could fluctuate over time despite overall pattern stability, suggesting variability in daily intake. It also focused on a specific early childhood age range, so findings may not fully extend to older children or adults.

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 . Supplementary Information The online version contains supplementary material available at 10.1007/s00394-026-03930-y.
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