Next Article in Journal
Defatted Flaxseed Flour as a New Ingredient for Foodstuffs: Comparative Analysis with Whole Flaxseeds and Updated Composition of Cold-Pressed Oil
Previous Article in Journal
Positive Effects of Aerobic-Resistance Exercise and an Ad Libitum High-Protein, Low-Glycemic Index Diet on Irisin, Omentin, and Dyslipidemia in Men with Abdominal Obesity: A Randomized Controlled Trial
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Nutrients
Volume 16
Issue 20
10.3390/nu16203481
nutrients-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Media Usage and Adherence to the Mediterranean Diet in Children

by
Alessandra Buja
*,
Andrea Miatton
,
Anna Zanovello
,
Filippo Brocadello
,
Tatjana Baldovin
,
Marian Nur Muhiddin
and
Ilaria Spreghini
Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131 Padua, Italy
*
Author to whom correspondence should be addressed.
Nutrients 2024, 16(20), 3481; https://doi.org/10.3390/nu16203481
Submission received: 26 September 2024 / Revised: 8 October 2024 / Accepted: 9 October 2024 / Published: 14 October 2024
(This article belongs to the Section Pediatric Nutrition)
Browse Figure
Versions Notes

Abstract

:
Background: Increased screen time in children is significantly associated with lower adherence to the Mediterranean diet (MD). The purpose of this study was to explore the association between different types of media use and the adherence to the MD in children. Methods: The study sample included 332 children aged 10–11 years attending the fifth year of primary school in Veneto, north-east Italy. The children’s mothers were surveyed on their children’s adherence to the MD, using the KidMed questionnaire, and on the time of media use, using the Media Activity Form-Parent (MAF-P). A multivariable backward stepwise linear regression was applied, adjusting the association for other potential confounding factors. Results: Children’s primary digital activities were watching TV or streaming platforms (5.0 h/week) and video content (2.5 h/week), followed by digital games (2.3 h/week). Lower adherence to the Mediterranean diet was associated with digital games (regression coefficient −0.65, SE 0.29, p = 0.026) and time spent watching TV or streaming platforms (regression coefficient −0.60, SE 0.29, p = 0.04). Conclusion: Interventions to promote healthier diets justify an approach that includes media education. Providing parents with recommendations on children’s use of digital media devices can empower them to improve their children’s well-being.

1. Introduction

In recent years, the growing presence of digital media has revolutionized several aspects of daily life, particularly for children and adolescents [1,2]. The proliferation of smartphones, tablets, and other digital devices has facilitated unprecedented access to a vast array of content, including video games, social media, and streaming services [3,4]. This surge in digital consumption has sparked concerns among researchers, educators, and health professionals regarding its potential impacts on children’s health and well-being [5,6].
One area of significant concern is the relationship between screen time and dietary habits [7]. Children who spend more time engaged in digital activities often exhibit poorer eating habits, marked by higher energy intake and frequent consumption of processed foods that are high in unhealthy sugars and fats but low in essential nutrients [8,9]. This association can be attributed to several factors, including increased exposure to food advertisements promoting unhealthy foods [10] and the development of irregular meal patterns, such as skipping breakfast and having late-night snacks [11,12]. In addition, the sedentary nature of digital engagement contributes to the development of unhealthy habits, which may continue into adulthood [13].
According to the Dietary Guidelines for Americans 2020–2025, by the age of two, children’s dietary recommendations largely align with those of adults [14]. However, the transition between late childhood and adolescence is a critical period for establishing the dietary patterns that will support the increased nutritional needs of puberty. During this stage, children gain more independence in their food choices as the number of meals eaten away from home increases [15]. This shift often leads to a preference for foods high in fat and added sugars [16]. Consequently, dietary patterns in late childhood show deficiencies in the intake of fruit, vegetables, and dairy products, while the recommended amounts of added sugars (10% of total energy), saturated fat (10% of total energy), and sodium (1.8 g) are often exceeded [14].
The Mediterranean diet (MD) is well known for its health benefits, including a reduced risk of metabolic diseases, immunological deficiencies, and neurological disorders [17,18,19,20]. It is characterized by a high consumption of fruits, vegetables, whole grains, and healthy fats, as well as a low intake of processed foods and sugars, and it is a benchmark for evaluating healthy eating patterns [21,22]. The Mediterranean diet also helps overall well-being by encouraging shared family time and a positive approach to mealtimes [23,24]. Adherence to this diet is especially important during childhood, a critical period for growth and development [25,26]. Emerging evidence suggests that excessive screen time may be inversely associated with adherence to the dietary recommendations of the Mediterranean diet in children [27]. The results of several studies are consistent with the fact that increased screen time reduces the intake of fruits, vegetables, and whole grains in both females and males, as well as increasing the consumption of energy-dense foods, such as energy-dense drinks and snacks, which results in increased energy intake from fat [8,28,29].
The present study aims to explore the association between consumption of a variety of digital contents and adherence to the Mediterranean diet in children. Understanding the role of emerging trends in children’s use of digital media is crucial for developing effective public health strategies and educational programs to promote healthier lifestyles.

2. Materials and Methods

2.1. Study Design

The present cross-sectional study derives from a survey administered in March–May 2023 as part of an educational intervention called “Le Buone Abitudini” [Healthy Habits], running since the academic year 2018/2019 at primary schools in the province of Padua (north-east Italy) [30]. This project promotes the adoption of a varied, healthy, and nutritionally balanced diet during childhood. Further details about the intervention are available elsewhere [31].
Of the 69 state primary schools in the province, 38 were invited to take part and 14 agreed, participating with at least one class. Participation in this study was offered to all children attending one of the classes selected for the intervention. Children whose parents did not provide signed informed consent were excluded from this study. No other exclusion or inclusion criteria were applied.
Our study sample included a total of 332 fifth-grade children (10–11 years old) attending 22 different classes. The children’s mothers were asked to answer a self-administered ad hoc online questionnaire. This study was conducted on anonymized data.

2.2. Materials

The questionnaire contained 34 multiple-choice items relating to both the children and their parents and touched on a number of factors considered to be potentially associated with the risk of poor adherence to the MD, i.e., social sphere and demographics, family setting, lifestyles (apart from nutrition), and behavioral traits.
The lifestyle factors considered in this study include the variable ”hours of sleep”, which encompassed both night-time sleep and daytime naps, the amount of time dedicated to homework (none, less than 1 h, or 1 h or more), and whether the children participated in sports or other out-of-school activities.
The “adherence to the MD” variable was derived from the Italian version of the KidMed Test [32]. Its development took into consideration aspects sustaining Mediterranean dietary patterns and also those undermining it. Previous studies showed that the KidMed questionnaire is a reliable instrument for assessing adherence to the Mediterranean diet, with a Cronbach’s alpha coefficient of 0.72 according to a Brazilian study [33,34]. The KidMed index ranges from 0 to 12 based on a 16-question test. Questions were assigned a value of −1 if they had a negative connotation towards adherence to the MD and +1 if they had a positive connotation. Children with scores of 3 or less were classified as having poor adherence to the MD, while those with scores of 4 or more were classified as having moderate-to-good adherence.
Children’s behavioral traits were measured on the basis of their mothers’ reports, using the Italian version of the Strengths and Difficulties Questionnaire (SDQ) [35]. The internal consistency of the SDQ was evaluated in a previous study that demonstrated a Cronbach’s alpha value of 0.70 in a large sample of Italian children [36]. The SDQ uses a 3-point Likert scale (from 0 = “not true” to 2 = “very true”) and consists of five subscales investigating emotional symptoms, hyperactivity/inattention, peer relationship problems, conduct problems, and prosocial behavior. Risk tertiles are identified for each behavioral trait: the first tertile identifies the children who exhibit a certain behavioral trait less, the second and third those who exhibit it more.
The use of media (“media” refers to all devices used to access the network such as smartphones, tablets, computers, video games, etc.) and its effect on the children were investigated in a dedicated section of the questionnaires using the Italian translation of the Media Activity Form-Parent (MAF-P) (T.M. Achenbach; reproduced under License 2606-02-02-23). Thirteen questions were used to gather information about parents’ perceptions of their children’s habits. A 3-point Likert scale (ranging from 0 = “not true” to 2 = “very true”) was used, and an individual’s final score was calculated by summing up the scores of each question, calculating an overall media use score. The survey also requested information on the amount of time spent on media-related activities during both weekdays and weekends. The total time spent on each activity per week was calculated by adding up the values for each day.
To categorize the variables, the tertiles of the distributions for media use score and time spent on online and digital activities were identified. The first and second tertiles were grouped together, while the third tertile was considered separately.
The second part of the questionnaire covered socio-economic aspects referring to parents and family environments, including the parent’s citizenship (Italian or other); the parent’s education (middle school or less, high school diploma, university degree); the parent’s marital status (married/cohabiting or unmarried/separated/divorced/widow); the parent’s need for help in understanding material provided by the doctor or pharmacist (never/rarely or occasionally/frequently/always); and the family’s disposable income. This last item was measured with the question “How do you make ends meet with your finances?” (very easily, quite easily or with some/great difficulty).

2.3. Statistical Analyses

Categorical variables were described by their absolute frequency and percentage. Quantitative variables were described with the median and interquartile range (IQR) because the Shapiro–Wilk normality test was rejected. Violin plots or boxplots were used for the representation of score-based variables and durations.
Differences in frequency distribution in the Mediterranean adherence group were assessed using the chi-square test or the Fisher test. The latter was only used when there were fewer than five absolute frequencies in the contingency tables. The Mann–Whitney test was used when one of the two variables was continuous or discrete.
Finally, a multivariable stepwise backward linear regression of the KidMed score was performed with a backward selection of the independent variables including all the lifestyle factors and the socio-economic factors referring to parents and family environments.
The missing values were treated in different ways according to the variable. When possible, the KidMed category (poor, medium, high) was deduced when a single answer of the KidMed questionnaire was missing. When there was more than one missing value, the subject was excluded from the analysis. The same approach was used for the parental style. For missing values in other variables, complete case analysis was used.
Results were deemed statistically significant when p < 0.05. The R software (ver. 14) was used for all the statistical analyses.

3. Results

A summary of sample characteristics is presented in Table 1. The sample included 332 children aged 10 to 11 years (mean 10.25, SD 0.45). Most mothers reported that their children had a medium or high adherence to the MD (86.2% of the sample). Based on the anthropometric measures provided, 66.6% of the children were regular weight, 18.4% were overweight, 10.7% were obese, and 4.3% were underweight.
Figure 1 reports the sample’s distributions relative to media usage score and time spent on online and digital activities. Children’s main digital activities involved watching TV or streaming platforms (average 5.0 h per week, IQR 2.0–8.0) and watching video content (average 2.5 h, IQR 0.1–5.0), followed by digital games (average 2.3 h, IQR 0.0–5.8).
According to the bivariate analysis (Table 2), the media use score (median 6.5, IQR 3–11) was not associated with significant changes in children’s habits relative to the Mediterranean diet (p = 0.292). By contrast, children who spent more time playing digital games (p = 0.001) or watching TV and using streaming platforms (p = 0.002) were significantly associated with lower adherence to the MD.
The multivariable linear regression of the KidMed score (Table 3) showed similar associations with regard to digital games (regression coefficient −0.65, SE 0.29, p = 0.026) and time spent watching TV or using streaming platforms (regression coefficient −0.60, SE 0.29, p = 0.04).

4. Discussion

This study explored the association between the consumption of various forms of popular media among a sample of 10- to 11-year-old school-going children and adherence to the Mediterranean diet. The results indicated that playing electronic games and watching TV or streaming content are significantly associated with a lower adherence to the Mediterranean diet.
In recent years, the relationship between children’s eating habits and digital media has attracted interest in public health research. Most studies found that screen time was negatively associated with diet quality [8,9] and adherence to specific dietary patterns, such as the Mediterranean diet [37,38]. As van Sluijs and colleagues noted in their review of adolescent behavior [39], however, classic indicators such as television viewing and computer use are no longer adequate in representing the multitude of ways in which adolescents consume media. According to a recent report by Ofcom (the UK regulator for communications services) [4], although TV is still the most popular media device, with a household penetration rate of 97%, children now have access to a wide variety of connected devices, including tablets, laptops, video game consoles, smart speakers, and desktop computers.
In this study, the main form of digital entertainment for the sample of 10–11-year-old children was watching TV, which accounted for a large part of the time spent on the screen (5 h/week) and was found to be associated with a worsening of eating style. Television broadcasting and streaming platforms typically provide long and engaging material intended to capture the viewer’s attention within a dedicated time frame [40]. This format often stimulates a social aspect, as it is commonly shared with family and friends, and can become a modeling influence for children [41]. As a result, some frequently reported determinants of poor eating habits, including sedentary habits [39], mindless eating [11,42], and disruption of regular family meal planning [12], are likely to be found in association with consumption of TV/streaming content. Advertising might be another factor to consider, as food-related commercials could be enhanced by the sophisticated data analysis and tracking systems used by streaming services to deliver tailored advertisements to individual viewers [10], compared to traditional TV broadcasts [43].
A different interpretation should be sought for the associations between diet and time spent by children playing digital games (2.3 h/week). In previous research, digital games have been associated with reduced amounts of physical activity [44,45], reduced sleep duration and quality [46], and lower self-concept in children [47]. All these determinants, with their mutual influence, could potentially be seen as central factors in the association between digital games and adherence to the Mediterranean diet [47].
However, a gap still exists in existing research that has not been fully explored in the scientific literature. In fact, most previous studies on the association between digital media consumption and children’s health habits have focused primarily on overall screen time and television viewing. In contrast, the specific time spent using all other types of electronic devices, such as video game consoles, personal computers, and portable devices, has been addressed in only a limited number of studies [7,9,27,42]. Currently, neither the World Health Organization (WHO) nor the American Academy of Pediatrics (AAP) provide specific screen time limits for children over the age of six [48,49]. However, both organizations emphasize the importance of setting reasonable limits to screen time to promote the adoption of healthy habits by children [50,51].
As digital devices become more and more pervasive and begin to replace traditional means of performing everyday activities, such as doing homework or communicating with peers, parents need evidence-based information, specific for different digital devices, to promote healthier habits for future generations. Future research should delve deeper into these aspects to better understand the underlying mechanisms. Such investigations are essential to provide policymakers with robust evidence that can inform strategies and initiatives aimed at promoting healthy behaviors and improving dietary habits among children.

Limitations

Some limitations of the present study should be acknowledged.
First, this study employs a cross-sectional design, which examines associations between variables at a single point in time but lacks the temporal data necessary to establish the sequence of events. As a result, the present study can only identify associations between potential determinants and adherence to the Mediterranean diet, but it cannot explore causal relationships.
Second, this study could not find an association between children’s diet and social media utilization. Moreover, social media use in our sample was reported to be close to zero, probably due to the young age of the sample. Therefore, these results may not be representative of other realities or of an older sample.
Third, this study used a self-administered questionnaire directed to mothers, which could be subject to various biases, including sampling bias, non-response bias, acquiescence bias, and social desirability bias. Children’s habits may also vary in different contexts (e.g., at home vs. at school), which mothers may not fully capture when responding to the survey.
Despite these limitations, this study is significant given the limited literature on this topic, providing new insights into the emerging role of various types of digital media consumption in influencing children’s adherence to the Mediterranean diet.

5. Conclusions

Activities such as playing digital games and watching TV or streaming platforms are significantly associated with poorer adherence to the Mediterranean diet among primary school children. These findings suggest that recommendations for promoting healthy eating habits in children should differentiate between types of digital activities when advising against prolonged media use. Further research is needed to explore this area and enhance our understanding of the factors linking children’s media use to their dietary habits, which could help shape more effective health promotion strategies.

Author Contributions

Conceptualization, A.B.; methodology, A.B.; software, A.Z.; validation, A.B.; formal analysis, A.Z.; investigation, M.N.M. and I.S.; resources, A.B.; data curation, A.Z.; writing—original draft preparation, A.M.; writing—review and editing, A.M. and A.B.; visualization, A.Z. and A.M.; supervision, F.B. and T.B.; project administration, A.B.; funding acquisition, A.B. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by Despar Nordest.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki and the Italian National Research Committee and approved by the Ethical Committee for Clinical Trials of the province of Padua at Padua Teaching Hospital 17 December 2020, CESC 4526/U6/18, registered in protocol on 22 January 2021 with code 9959X.11.

Informed Consent Statement

Informed consent was obtained from the directors at the schools involved and the parents of all children participating in this study.

Data Availability Statement

The datasets analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

Acknowledgments

The authors thank Thomas M Achenbach for sharing the Italian translation of the Media Activity Form-Parent (MAF-P) questionnaire and all the schools, teachers, and mothers who participated in this study.

Conflicts of Interest

The authors declare no conflicts of interest. The funders had no role in the design of this study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

References

  1. Reid Chassiakos, Y.; Radesky, J.; Christakis, D.; Moreno, M.A.; Cross, C.; Council on Communications and Media; Hill, D.; Ameenuddin, N.; Hutchinson, J.; Levine, A.; et al. Children and Adolescents and Digital Media. Pediatrics 2016, 138, e20162593. [Google Scholar] [CrossRef]
  2. Coyne, S.M.; Radesky, J.; Collier, K.M.; Gentile, D.A.; Linder, J.R.; Nathanson, A.I.; Rasmussen, E.E.; Reich, S.M.; Rogers, J. Parenting and Digital Media. Pediatrics 2017, 140, S112–S116. [Google Scholar] [CrossRef]
  3. Gottfried, M.A. Michelle Faverio and Jeffrey Teens, Social Media and Technology 2023; Pew Research Center: Washington, DC, USA, 2023. [Google Scholar]
  4. Ofcom. Children and Parents: Media Use and Attitudes 2023; Ofcom: London, UK, 2023. [Google Scholar]
  5. Lauricella, A.R.; Wartella, E.; Rideout, V.J. Young Children’s Screen Time: The Complex Role of Parent and Child Factors. J. Appl. Dev. Psychol. 2015, 36, 11–17. [Google Scholar] [CrossRef]
  6. Livingstone, S.; Haddon, L.; Görzig, A.; Ólafsson, K. Risks and Safety on the Internet. The Perspective of European Children. Full Findings and Policy Implications from the EU Kids Online Survey of 9–16 Year Olds and Their Parents in 25 Countries; EU Kids Online Network: London, UK, 2011. [Google Scholar]
  7. Stiglic, N.; Viner, R.M. Effects of Screentime on the Health and Well-Being of Children and Adolescents: A Systematic Review of Reviews. BMJ Open 2019, 9, e023191. [Google Scholar] [CrossRef] [PubMed]
  8. Tambalis, K.D.; Panagiotakos, D.B.; Psarra, G.; Sidossis, L.S. Screen Time and Its Effect on Dietary Habits and Lifestyle among Schoolchildren. Cent. Eur. J. Public Health 2020, 28, 260–266. [Google Scholar] [CrossRef]
  9. Marsh, S.; Ni Mhurchu, C.; Maddison, R. The Non-Advertising Effects of Screen-Based Sedentary Activities on Acute Eating Behaviours in Children, Adolescents, and Young Adults. A Systematic Review. Appetite 2013, 71, 259–273. [Google Scholar] [CrossRef]
  10. Boyland, E.J.; Halford, J.C.G. Television Advertising and Branding. Effects on Eating Behaviour and Food Preferences in Children. Appetite 2013, 62, 236–241. [Google Scholar] [CrossRef] [PubMed]
  11. Savige, G.; MacFarlane, A.; Ball, K.; Worsley, A.; Crawford, D. Snacking Behaviours of Adolescents and Their Association with Skipping Meals. Int. J. Behav. Nutr. Phys. Act. 2007, 4, 36. [Google Scholar] [CrossRef] [PubMed]
  12. Van den Bulck, J.; Eggermont, S. Media Use as a Reason for Meal Skipping and Fast Eating in Secondary School Children. J. Hum. Nutr. Diet. Off. J. Br. Diet. Assoc. 2006, 19, 91–100. [Google Scholar] [CrossRef]
  13. Kelder, S.H.; Perry, C.L.; Klepp, K.I.; Lytle, L.L. Longitudinal Tracking of Adolescent Smoking, Physical Activity, and Food Choice Behaviors. Am. J. Public Health 1994, 84, 1121–1126. [Google Scholar] [CrossRef]
  14. Snetselaar, L.G.; de Jesus, J.M.; DeSilva, D.M.; Stoody, E.E. Dietary Guidelines for Americans, 2020–2025. Nutr. Today 2021, 56, 287–295. [Google Scholar] [CrossRef] [PubMed]
  15. Savarino, G.; Corsello, A.; Corsello, G. Macronutrient Balance and Micronutrient Amounts through Growth and Development. Ital. J. Pediatr. 2021, 47, 109. [Google Scholar] [CrossRef] [PubMed]
  16. Birch, L.; Savage, J.S.; Ventura, A. Influences on the Development of Children’s Eating Behaviours: From Infancy to Adolescence. Can. J. Diet. Pract. Res. 2007, 68, s1–s56. [Google Scholar]
  17. Godos, J.; Zappalà, G.; Bernardini, S.; Giambini, I.; Bes-Rastrollo, M.; Martinez-Gonzalez, M. Adherence to the Mediterranean Diet Is Inversely Associated with Metabolic Syndrome Occurrence: A Meta-Analysis of Observational Studies. Int. J. Food Sci. Nutr. 2017, 68, 138–148. [Google Scholar] [CrossRef]
  18. Rees, K.; Takeda, A.; Martin, N.; Ellis, L.; Wijesekara, D.; Vepa, A.; Das, A.; Hartley, L.; Stranges, S. Mediterranean-style Diet for the Primary and Secondary Prevention of Cardiovascular Disease. Cochrane Database Syst. Rev. 2019, 3, CD009825. [Google Scholar] [CrossRef]
  19. Puri, S.; Shaheen, M.; Grover, B. Nutrition and Cognitive Health: A Life Course Approach. Front. Public Health 2023, 11, 1023907. [Google Scholar] [CrossRef] [PubMed]
  20. Nobs, S.P.; Zmora, N.; Elinav, E. Nutrition Regulates Innate Immunity in Health and Disease. Annu. Rev. Nutr. 2020, 40, 189–219. [Google Scholar] [CrossRef]
  21. Davis, C.; Bryan, J.; Hodgson, J.; Murphy, K. Definition of the Mediterranean Diet; A Literature Review. Nutrients 2015, 7, 9139–9153. [Google Scholar] [CrossRef]
  22. Caretto, A.; Lagattolla, V. Non-Communicable Diseases and Adherence to Mediterranean Diet. Endocr. Metab. Immune Disord.—Drug Targets 2015, 15, 10–17. [Google Scholar] [CrossRef]
  23. De La Torre-Moral, A.; Fàbregues, S.; Bach-Faig, A.; Fornieles-Deu, A.; Medina, F.X.; Aguilar-Martínez, A.; Sánchez-Carracedo, D. Family Meals, Conviviality, and the Mediterranean Diet among Families with Adolescents. Int. J. Environ. Res. Public Health 2021, 18, 2499. [Google Scholar] [CrossRef]
  24. Bernardi, E.; Visioli, F. Fostering Wellbeing and Healthy Lifestyles through Conviviality and Commensality: Underappreciated Benefits of the Mediterranean Diet. Nutr. Res. 2024, 126, 46–57. [Google Scholar] [CrossRef] [PubMed]
  25. World Health Organization. Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation, Geneva, 28 January–1 February 2002; World Health Organization: Geneva, Switzerland, 2003; ISBN 978-92-4-120916-8. [Google Scholar]
  26. World Health Organization. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020; World Health Organization: Geneva, Switzerland, 2013; ISBN 978-92-4-150623-6. [Google Scholar]
  27. de Menezes, L.R.D.; e Souza, R.C.V.; Cardoso, P.C.; dos Santos, L.C. Factors Associated with Dietary Patterns of Schoolchildren: A Systematic Review. Nutrients 2023, 15, 2450. [Google Scholar] [CrossRef] [PubMed]
  28. Robinson, T.N.; Banda, J.A.; Hale, L.; Lu, A.S.; Fleming-Milici, F.; Calvert, S.L.; Wartella, E. Screen Media Exposure and Obesity in Children and Adolescents. Pediatrics 2017, 140, S97–S101. [Google Scholar] [CrossRef]
  29. Harris, C.; Flexeder, C.; Thiering, E.; Buyken, A.; Berdel, D.; Koletzko, S.; Bauer, C.-P.; Brüske, I.; Koletzko, B.; Standl, M. Changes in Dietary Intake during Puberty and Their Determinants: Results from the GINIplus Birth Cohort Study. BMC Public Health 2015, 15, 841. [Google Scholar] [CrossRef]
  30. Cos’è Le Buone Abitudini. Buone Abitudini Despar. Available online: https://www.lebuoneabitudini.despar.it/le-buone-abitudini-programma-di-educazione-alimentare (accessed on 22 June 2024).
  31. Buja, A.; Grotto, G.; Brocadello, F.; Sperotto, M.; Baldo, V. Primary School Children and Nutrition: Lifestyles and Behavioral Traits Associated with a Poor-to-Moderate Adherence to the Mediterranean Diet. A Cross-Sectional Study. Eur. J. Pediatr. 2020, 179, 827–834. [Google Scholar] [CrossRef]
  32. Serra-Majem, L.; Ribas, L.; Ngo, J.; Ortega, R.M.; García, A.; Pérez-Rodrigo, C.; Aranceta, J. Food, Youth and the Mediterranean Diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in Children and Adolescents. Public Health Nutr. 2004, 7, 931–935. [Google Scholar] [CrossRef]
  33. Štefan, L.; Prosoli, R.; Juranko, D.; Čule, M.; Milinović, I.; Novak, D.; Sporiš, G. The Reliability of the Mediterranean Diet Quality Index (KIDMED) Questionnaire. Nutrients 2017, 9, 419. [Google Scholar] [CrossRef]
  34. Simon, M.I.S.d.S.; Forte, G.C.; Marostica, P.J.C. Translation and cultural adaptation of the mediterranean diet quality index in children and adolescents. Rev. Paul. Pediatr. 2020, 38, e2018242. [Google Scholar] [CrossRef] [PubMed]
  35. Goodman, R. The Strengths and Difficulties Questionnaire: A Research Note. J. Child Psychol. Psychiatry 1997, 38, 581–586. [Google Scholar] [CrossRef]
  36. Riso, D.D.; Salcuni, S.; Chessa, D.; Raudino, A.; Lis, A.; Altoè, G. The Strengths and Difficulties Questionnaire (SDQ). Early Evidence of Its Reliability and Validity in a Community Sample of Italian Children. Personal. Individ. Differ. 2010, 49, 570–575. [Google Scholar] [CrossRef]
  37. Seral-Cortes, M.; Sabroso-Lasa, S.; Bailo-Aysa, A.; Gonzalez-Gross, M.; Molnár, D.; Censi, L.; Molina-Hidalgo, C.; Gottrand, F.; Henauw, S.D.; Manios, Y.; et al. Mediterranean Diet, Screen-Time-Based Sedentary Behavior and Their Interaction Effect on Adiposity in European Adolescents: The HELENA Study. Nutrients 2021, 13, 474. [Google Scholar] [CrossRef] [PubMed]
  38. Wärnberg, J.; Pérez-Farinós, N.; Benavente-Marín, J.C.; Gómez, S.F.; Labayen, I.; Zapico, A.G.; Gusi, N.; Aznar, S.; Alcaraz, P.E.; González-Valeiro, M.; et al. Screen Time and Parents’ Education Level Are Associated with Poor Adherence to the Mediterranean Diet in Spanish Children and Adolescents: The PASOS Study. J. Clin. Med. 2021, 10, 795. [Google Scholar] [CrossRef] [PubMed]
  39. van Sluijs, E.M.F.; Ekelund, U.; Crochemore-Silva, I.; Guthold, R.; Ha, A.; Lubans, D.; Oyeyemi, A.L.; Ding, D.; Katzmarzyk, P.T. Physical Activity Behaviours in Adolescence: Current Evidence and Opportunities for Intervention. Lancet 2021, 398, 429–442. [Google Scholar] [CrossRef]
  40. Volpe, A. The One Thing That Isn’t Evolving with Netflix & Hulu’s Takeover of TV. Available online: https://www.thrillist.com/entertainment/nation/netflix-episode-length-streaming-services-traditional-tv (accessed on 3 July 2024).
  41. Yee, A.Z.H.; Lwin, M.O.; Ho, S.S. The Influence of Parental Practices on Child Promotive and Preventive Food Consumption Behaviors: A Systematic Review and Meta-Analysis. Int. J. Behav. Nutr. Phys. Act. 2017, 14, 47. [Google Scholar] [CrossRef]
  42. Tabares-Tabares, M.; Moreno Aznar, L.A.; Aguilera-Cervantes, V.G.; León-Landa, E.; López-Espinoza, A. Screen Use during Food Consumption: Does It Cause Increased Food Intake? A Systematic Review. Appetite 2022, 171, 105928. [Google Scholar] [CrossRef] [PubMed]
  43. Kelly, B.; Halford, J.C.G.; Boyland, E.J.; Chapman, K.; Bautista-Castaño, I.; Berg, C.; Caroli, M.; Cook, B.; Coutinho, J.G.; Effertz, T.; et al. Television Food Advertising to Children: A Global Perspective. Am. J. Public Health 2010, 100, 1730–1736. [Google Scholar] [CrossRef]
  44. Forde, C.; Hussey, J. How Children Use Active Videogames and the Association Between Screen Time and Physical Activity. Games Health J. 2015, 4, 312–317. [Google Scholar] [CrossRef]
  45. Ferrari, G.L.d.M.; Araújo, T.L.; Oliveira, L.C.; Matsudo, V.; Fisberg, M. Association between Electronic Equipment in the Bedroom and Sedentary Lifestyle, Physical Activity, and Body Mass Index of Children. J. Pediatr. 2015, 91, 574–582. [Google Scholar] [CrossRef]
  46. Bartel, K.A.; Gradisar, M.; Williamson, P. Protective and Risk Factors for Adolescent Sleep: A Meta-Analytic Review. Sleep Med. Rev. 2015, 21, 72–85. [Google Scholar] [CrossRef]
  47. González-Valero, G.; Nobari, H.; Badicu, G.; López-Gutiérrez, C.J.; Moreno-Rosa, G.; Castro-Sánchez, M. Relationship of Physical Activity and Sleep Duration with Self-Concept, Mediterranean Diet and Problematic Videogame Use in Children: Structural Equation Analysis as a Function of Gender. Appl. Sci. 2022, 12, 2878. [Google Scholar] [CrossRef]
  48. Guidelines on Physical Activity, Sedentary Behaviour and Sleep for Children under 5 Years of Age; World Health Organization: Geneva, Switzerland, 2019; ISBN 978-92-4-155053-6.
  49. AACAP Screen Time and Children. Available online: https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-And-Watching-TV-054.aspx (accessed on 8 October 2024).
  50. What Do We Really Know about Kids and Screens? Available online: https://www.apa.org/monitor/2020/04/cover-kids-screens (accessed on 8 October 2024).
  51. To Grow Up Healthy, Children Need to Sit Less and Play More. Available online: https://www.who.int/news/item/24-04-2019-to-grow-up-healthy-children-need-to-sit-less-and-play-more (accessed on 2 July 2024).
Nutrients 16 03481 g001
Figure 1. The sample’s distribution of scores for media usage and time spent on online and digital activities.
Figure 1. The sample’s distribution of scores for media usage and time spent on online and digital activities.
Nutrients 16 03481 g001
Table 1. Descriptive statistics of the sample.
Table 1. Descriptive statistics of the sample.
Descriptive variableCategoryFrequency (%)
N = 332
Sex aMale161 (50.8%)
Female166 (49.2%)
Siblings bNone70 (21.2%)
One or more261 (78.9%)
Time dedicated to homeworkNo homework9 (2.7%)
<1 h 99 (29.8%)
≥1 h 224 (67.5%)
Out-of-school activities c None117 (35.6%)
One or more212 (64.4%)
Sports dNone55 (16.6%)
One or more276(83.4%)
Hours of sleep eMedian (Q1–Q3)9 (8–9)
Parent’s citizenship fItalian255 (79.9%)
Other64 (20.1%)
Parent’s marital status gMarried/cohabiting282 (89.5%)
Unmarried/divorced/widow33 (10.5%)
Parent’s education hMiddle school or less45 (14.1%)
High school diploma137 (42.9%)
University degree137 (42.9%)
Family’s disposable income iLow115 (35.8%)
Medium146 (45.5%)
High60 (18.7%)
Parent’s need for help in medical issues jNever/rarely223 (70.8%)
Occasionally/frequently/always92 (29.2%)
Family members k≤388 (27.2%)
477 (23.8%)
>4159 (49.1%)
Adherence to MD lPoor45 (13.8%)
Medium/high281 (86.2%)
BMI mUnderweight13 (4.3%)
Regular weight199 (66.6%)
Overweight55 (18.4%)
Obese32 (10.7%)
Data not available in a 5 (1.5%), b 1 (0.3%), c 3 (0.9%), d 1 (0.3%), e 7 (2.1%), f 13 (3.9%), g 17 (5.1%), h 13 (3.9%), i 11 (3.3%), j 17 (5.1%), k 8 (2.4%), l 6 (1.8%), m 33 (9.9%).
Table 2. Distributions of the media usage score, time spent on digital games, and time spent watching TV or streaming platforms by KidMed groups.
Table 2. Distributions of the media usage score, time spent on digital games, and time spent watching TV or streaming platforms by KidMed groups.
Adherence to the MDp-Value
PoorMedium–High
Time spent on social media1st and 2nd tertiles26 (12.4%)184 (87.6%)0.292
3rd tertile16 (17.8%)74 (82.2%)
Time spent on digital games 1st and 2nd tertiles19 (9.1%)190 (90.9%)0.001
3rd tertile21 (23.6%)68 (76.4%)
Time spent on watching TV or streaming platforms1st and 2nd tertiles22 (10.1%)197 (89.9%)0.002
3rd tertile20 (25.0%)60 (75.0%)
Time spent on messaging 1st and 2nd tertiles27 (13.4%)174 (86.6%)0.873
3rd tertile15 (14.9%)86 (85.1%)
Time spent on content creation1st and 2nd tertiles37 (14.2%)223 (85.8%)0.983
3rd tertile4 (16.7%)20 (83.3%)
Time spent on music1st and 2nd tertiles28 (13.3%)183 (86.7%)0.623
3rd tertile14 (16.3%)72 (83.7%)
Adult video games1st and 2nd tertiles31 (13.4%)200 886.6%)0.800
3rd tertile8 (16.0%)42 (84.0%)
Time spent on social media1st and 2nd tertiles35 (13.9%)216 (86.1%)0.899
3rd tertile5 (16.7%)25 (83.3%)
Time spent on phone or video calls1st and 2nd tertiles25 (12.2%)180 (87.8%)0.182
3rd tertile17 (18.9%)73 (81.1%)
Time spent on digital school assignments1st and 2nd tertiles28 (13.3%)183 (86.7%)0.614
3rd tertile13 (16.5%)66 (83.5%)
Time spent on web browsing in free time1st and 2nd tertiles30 (15.2%)168 (84.8%)0.666
3rd tertile12 (12.5%)84 (87.5%)
Time spent on watching video content1st and 2nd tertiles24 (11.8%)180 (88.2%)0.181
3rd tertile18 (18.2%)81 (81.8%)
Time spent on online gambling 1st and 2nd tertiles40 (15.2%)224 (84.8%)0.339
3rd tertile1 (100.0%)0 (0.0%)
Time spent on other online activities1st and 2nd tertiles34 (14.0%)209 (86.0%)0.835
3rd tertile2 (22.2%)7 (77.8%)
Table 3. Backward stepwise of linear regression of KidMed score.
Table 3. Backward stepwise of linear regression of KidMed score.
Regression CoefficientSEp Value
Digital games
(3rd vs. 1st and 2nd tertiles)		−0.640.290.028
Watching TV or streaming platforms (3rd vs. 1st and 2nd tertiles)−0.660.290.024
Variables entered: sex, siblings, time dedicated to homework, out-of-school activities, sport, hours of sleep, parent’s citizenship, parent’s marital status, parent’s education, family’s disposable income, parent’s need for help in medical issues, family members, prosocial behavior, hyperactivity/inattention, peer relational problems, emotional symptoms, conduct problems, use of social media time.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Buja, A.; Miatton, A.; Zanovello, A.; Brocadello, F.; Baldovin, T.; Muhiddin, M.N.; Spreghini, I. Media Usage and Adherence to the Mediterranean Diet in Children. Nutrients 2024, 16, 3481. https://doi.org/10.3390/nu16203481

AMA Style

Buja A, Miatton A, Zanovello A, Brocadello F, Baldovin T, Muhiddin MN, Spreghini I. Media Usage and Adherence to the Mediterranean Diet in Children. Nutrients. 2024; 16(20):3481. https://doi.org/10.3390/nu16203481

Chicago/Turabian Style

Buja, Alessandra, Andrea Miatton, Anna Zanovello, Filippo Brocadello, Tatjana Baldovin, Marian Nur Muhiddin, and Ilaria Spreghini. 2024. "Media Usage and Adherence to the Mediterranean Diet in Children" Nutrients 16, no. 20: 3481. https://doi.org/10.3390/nu16203481

APA Style

Buja, A., Miatton, A., Zanovello, A., Brocadello, F., Baldovin, T., Muhiddin, M. N., & Spreghini, I. (2024). Media Usage and Adherence to the Mediterranean Diet in Children. Nutrients, 16(20), 3481. https://doi.org/10.3390/nu16203481

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop