Adherence to the Mediterranean Diet Among Croatian Children with Parent-Reported Adverse Food-Related Reaction: Cross-Sectional Study on Diet Quality, Regional and Socioeconomic Differences

Background: Food-related reactions can significantly impact children’s dietary choices, health, and nutritional status. This study evaluated adherence to the Mediterranean diet and explored its associations with regional and family socioeconomic status among Croatian children whose parents reported adverse food-related reactions. Methods: The cross-sectional study analyzed data on 193 children aged 2–9 years with parent-reported food-related reactions, collected from the Croatian National Food Consumption Survey, which included 1820 children aged 3 months to 9 years, based on the EU Menu methodology (OC/EFSA/DATA/2016/02 CT3). Parents completed standardized questionnaires on food-related reactions, lifestyle, dietary patterns, and socioeconomic indicators. Regional differences were assessed, and adherence to the Mediterranean diet was evaluated using the KIDMED index. Results: This survey found an 11% prevalence of parent-reported adverse food-related reactions among children aged 2 to 9 years. Milk, eggs, and tree nuts were the most commonly reported allergens. Adherence to the Mediterranean diet was moderate (36%) to low (41%; p = 0.011), with higher KIDMED scores associated with greater fruit, vegetable, legume, fish, and olive oil intake and lower adherence associated with more ultra-processed foods and obesity. Children from coastal and urban areas had better diet quality and socioeconomic indicators. Maternal education was strongly associated with Mediterranean diet adherence (OR = 1.88, p < 0.001), while maternal employment and household income showed no significant relationship. Conclusions: The findings highlight significant nutritional challenges among Croatian children with adverse food-related reactions, driven by regional and socioeconomic disparities. An adherence to a low Mediterranean diet indicates a need for a personalized approach to the diet management of children with food-related reactions. Addressing these through targeted, equitable public health strategies may improve outcomes for affected children.