The mediating effect of parents' educational status on the association between adherence to the Mediterranean diet and childhood obesity: the PANACEA study

To investigate the potential mediating effect of parental education on the association between adherence to the Mediterranean diet and obesity, in 10-12 years old children. A cross-sectional survey was performed among 1,125 (529 male) children in Greece. Children and their parents completed standardized questionnaires, which evaluated parents' educational level and dietary habits. Body mass index was calculated and children were classified as normal, overweight or obese (IOTF classification). Adherence to the Mediterranean diet was assessed using the KIDMED score. 27.7% of the children were overweight and 6.3% were obese; 12.3% of children reported high adherence to the Mediterranean diet. Multi-adjusted analysis, stratified by parental education, revealed that adherence to the Mediterranean diet was inversely associated with children's obesity status only in families in which at least one parent was of higher educational level (stratum-specific adjusted odds ratio: 0.41; 95% CI 0.17-0.98), but not those in which both parents were of low educational level. Parental education status seems to play a mediating role in the beneficial effect of Mediterranean diet on children's obesity status.