Nutrition Education Program and Physical Activity Improve the Adherence to the Mediterranean Diet: Impact on Inflammatory Biomarker Levels in Healthy Adolescents From the DIMENU Longitudinal Study

Catia Morelli; Ennio Avolio; Angelo Galluccio; Giovanna Caparello; Emanuele Manes; Simona Ferraro; Antonella Caruso; Daniela De Rose; Ines Barone; Carlo Adornetto; Gianluigi Greco; Stefania Catalano; Sebastiano Andò; Diego Sisci; Cinzia Giordano; Daniela Bonofiglio

doi:10.3389/fnut.2021.685247

Nutrition Education Program and Physical Activity Improve the Adherence to the Mediterranean Diet: Impact on Inflammatory Biomarker Levels in Healthy Adolescents From the DIMENU Longitudinal Study

Front Nutr. 2021 Jul 19:8:685247. doi: 10.3389/fnut.2021.685247. eCollection 2021.

Authors

Catia Morelli^{1

2}, Ennio Avolio^{3

4}, Angelo Galluccio^{3

5}, Giovanna Caparello^{3

4}, Emanuele Manes³, Simona Ferraro^{3

4}, Antonella Caruso², Daniela De Rose^{1

2}, Ines Barone^{1

2}, Carlo Adornetto⁶, Gianluigi Greco⁶, Stefania Catalano^{1

2}, Sebastiano Andò^{1

2}, Diego Sisci^{1

2}, Cinzia Giordano^{1

2}, Daniela Bonofiglio^{1

2}

Affiliations

¹ Department of Pharmacy, Health, and Nutritional Sciences, University of Calabria, Arcavacata di Rende, Italy.
² Centro Sanitario, University of Calabria, Arcavacata di Rende, Italy.
³ Health Center SRL, Cosenza, Italy.
⁴ School of Specialization in Food Sciences, University of Rome Tor Vergata, Rome, Italy.
⁵ Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy.
⁶ Department of Mathematics, University of Calabria, Arcavacata di Rende, Italy.

Abstract

Adherence to Mediterranean diet (MD) and physical activity (PA) in adolescence represent powerful indicators of healthy lifestyles in adulthood. The aim of this longitudinal study was to investigate the impact of nutrition education program (NEP) on the adherence to the MD and on the inflammatory status in healthy adolescents, categorized into three groups according to their level of PA (inactivity, moderate intensity, and vigorous intensity). As a part of the DIMENU (Dieta Mediterranea & Nuoto) study, 85 adolescents (aged 14-17 years) participated in the nutrition education sessions provided by a team of nutritionists and endocrinologists at T0. All participants underwent anthropometric measurements, bio-impedentiometric analysis (BIA), and measurements of inflammatory biomarkers such as ferritin, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels. Data were collected at baseline (T0) and 6 months after NEP (T1). To assess the adherence to the MD, we used KIDMED score. In our adolescents, we found an average MD adherence, which was increased at T1 compared with T0 (T0: 6.03 ± 2.33 vs. T1: 6.96 ± 2.03, p = 0.002), with an enhanced percentage of adolescents with optimal (≥8 score) MD adherence over the study period (T0: 24.71% vs. T1: 43.52%, p = 0.001). Interestingly, in linear mixed-effects models, we found that NEP and vigorous-intensity PA levels independently influenced KIDMED score (β = 0.868, p < 0.0001 and β = 1.567, p = 0.009, respectively). Using ANOVA, NEP had significant effects on serum ferritin levels (p < 0.001), while either NEP or PA influenced ESR (p = 0.035 and 0.002, respectively). We also observed in linear mixed-effects models that NEP had a negative effect on ferritin and CRP (β = -14.763, p < 0.001 and β = -0.714, p = 0.02, respectively). Our results suggest the usefulness to promote healthy lifestyle, including either nutrition education interventions, or PA to improve MD adherence and to impact the inflammatory status in adolescence as a strategy for the prevention of chronic non-communicable diseases over the entire lifespan.

Keywords: C-reactive protein; Mediterranean diet; body composition parameters; ferritin; healthy lifestyle; physical activity.