Lifestyle Factors Associated with Children’s and Adolescents’ Adherence to the Mediterranean Diet Living in Mediterranean Countries: The DELICIOUS Project

<b>Background/Objectives.</b> Traditional dietary patterns are being abandoned in Mediterranean countries, especially among younger generations. This study aimed to investigate the potential lifestyle determinants that can increase adherence to the Mediterranean diet in children and adolescents. <b>Methods.</b> This study is a cross-sectional analysis of data from five Mediterranean countries (Italy, Spain, Portugal, Egypt, and Lebanon) within the context of the EU-funded project DELICIOUS (UnDErstanding consumer food choices & promotion of healthy and sustainable Mediterranean Diet and LIfestyle in Children and adolescents through behavIOUral change actionS). This study comprised information on 2011 children and adolescents aged 6-17 years old collected during 2023. The main background characteristics of both children and parents, including age, sex, education, and family situation, were collected. Children's eating (i.e., breakfast, place of eating, etc.) and lifestyle habits (i.e., physical activity level, sleep, and screen time) were also investigated. The level of adherence to the Mediterranean diet was assessed using the KIDMED index. Logistic regression analyses were performed to test for likelihood of higher adherence to the Mediterranean diet. <b>Results.</b> Major determinants of higher adherence to the Mediterranean diet were younger age, higher physical activity level, adequate sleep duration, and, among dietary habits, having breakfast and eating with family members and at school. Parents' younger age and higher education were also determinants of higher adherence. Multivariate adjusted analyses showed that an overall healthier lifestyle and parents' education were the factors independently associated with higher adherence to the Mediterranean diet. <b>Conclusions.</b> Higher adherence to the Mediterranean diet in children and adolescents living in the Mediterranean area is part of an overall healthy lifestyle possibly depending on parents' cultural background.