Despite the region’s reputation for healthy living, new research reveals that ultra-processed foods are increasingly prevalent in the diets of Mediterranean youth, linking poor eating habits with excessive screen time and modern lifestyle shifts.
Study: Unhealthy Ultra-Processed Food Consumption in Children and Adolescents Living in the Mediterranean Area: The DELICIOUS Project. Image Credit: Rimma Bondarenko / Shutterstock
In a recent study published in the International Journal of Public Health, researchers leveraged an extensive cross-sectional study to investigate the consumption of unhealthy UPF items among youth in the Mediterranean region.
The study surveyed 2,011 families across five countries and found that about 95% of children and adolescents consumed at least one unhealthy UPF item daily.
This high intake was strongly linked to obesity, older adolescent age, and suboptimal lifestyle factors, including increased screen time and exposure to food advertising, with additional links to frequent eating out of home and snacking.
High parental education was associated with high consumption but not with daily consumption, while having an older or female responding parent was inversely associated. Younger parental age was identified as a risk factor for higher UPF consumption.
These findings suggest that UPF consumption is part of a complex, modern, and unhealthy lifestyle that has taken root even in this traditionally healthy region.
In this study, “daily consumption” referred to eating at least one of the listed unhealthy UPF items daily.
Mediterranean Diet and the Nutrition Transition
The traditional Mediterranean Diet (MeDi) has historically been considered one of the most optimal extant dietary patterns, famously associated with longevity and health. However, recent decades have witnessed a global "nutrition transition." In many areas, including the Mediterranean region, traditional dietary patterns are reported as being progressively abandoned in favor of "Westernized" products that are high in energy but low in nutritional density.
The primary constituents of these "unhealthy" diets are often ultra-processed foods (UPFs), industrial formulations containing little to no whole foods. Nutritional research has revealed that these foods prioritize convenience and hyper-palatability, frequently using cosmetic additives and high levels of added sugar, sodium, and unhealthy fats.
A growing body of research links high UPF consumption to numerous health problems, including metabolic disorders, type 2 diabetes (T2D), cardiovascular disease (CVD), and even mental health issues like depression.
Studies specifically focused on children and adolescents have associated UPFs with food addiction in the former cohort, and faster increases in body mass index (BMI) and body fat percentage during adolescence. While this trend is globally recognized, data specifically focusing on unhealthy UPFs in Mediterranean youth remain limited.
Study Design and DELICIOUS Project Overview
The present study addressed this knowledge gap by using a cross-sectional analysis of the DELICIOUS (UnDErstanding consumer food choices & promotion of healthy and sustainable Mediterranean diet and LIfestyle in Children and adolescents through behavIOUral change actionS) project, an initiative aimed at understanding food choices and promoting a healthy Mediterranean lifestyle in children and adolescents.
The study cohort consisted of 2,011 parents of children and adolescents aged 6 to 17 from five Mediterranean countries: Italy, Spain, Portugal, Egypt, and Lebanon. Study data were collected via a parent-completed, detailed electronic survey that covered demographics, eating habits, and lifestyle factors for both parents and their children.
Assessment Tools and Data Collection Methods
The survey included a 13-item food frequency questionnaire (FFQ) measuring the consumption of soft drinks, fast food, salty snacks, commercial sauces, and sweets. These items operationalized “unhealthy” UPFs; frequency, rather than quantity or total UPF intake, was assessed, and the data were parent-reported. FFQ data were used to categorize participants based on their respective consumption frequencies.
Additionally, children's Body Mass Index (BMI) was collected and used to classify participants into normal weight, overweight, or obese (Centers for Disease Control and Prevention [CDC] criteria).
Lifestyle habits were assessed using validated tools, including the International Physical Activity Questionnaire-Short Form (IPAQ) and a lifestyle score derived from the Electronic Kids Dietary Index (E-KINDEX), which allowed for multivariate analysis and the identification of statistical associations between unhealthy UPF consumption and a wide range of demographic and lifestyle variables.
Key Findings on UPF Consumption Patterns
Study findings revealed that approximately 95% of included children and adolescents consumed unhealthy UPFs daily, with the median intake across the entire cohort computed to be about 1.8 servings per day. Multivariate analyses revealed key factors strongly associated with higher consumption.
Firstly, older children and those with obesity were found to demonstrate the most significant risk. Compared to 6–8-year-olds, adolescents aged 15–17 were 2.74 times more likely to have high consumption (p < 0.001) and 3.78 times more likely to be daily consumers (p < 0.001). Children with obesity were 1.97 times more likely to have high consumption (p < 0.001) and 2.02 times more likely to be daily consumers (p < 0.05) than their normal-weight peers.
Secondly, high parental education was associated with 2.23 times higher odds of high UPF consumption (p < 0.05) but not with daily consumption.
Thirdly, lifestyle was highlighted as a significant contributor to poor dietary habits. Specifically, compared to those with less than 2 hours of screen time a day, children with 2–4 hours of screen time were 2.61 times more likely to be daily consumers (p < 0.001), and those with over 4 hours were 2.64 times more likely (p < 0.05).
Eating out of home showed some of the largest effects: consuming meals out at least 2 times per week was associated with 20.73 times higher odds of daily consumption and 4.42 times higher odds of high consumption. Eating advertised foods was also associated with 5.03 times higher odds of daily consumption.
Snacking was associated with both high (OR = 1.95) and daily (OR = 2.88) consumption. A higher E-KINDEX lifestyle score was inversely associated with both high and daily consumption.
Implications and Public Health Recommendations
The present study highlights the alarming prevalence of daily UPF consumption among Mediterranean youth, finding these unhealthy dietary patterns deeply enmeshed in an overall unhealthy lifestyle characterized by high screen time, sedentary behavior, and specific eating habits, such as snacking and eating out.
While the study's cross-sectional design precludes causation, the convenience sampling via a consumer database limits national representativeness, and parent-reported FFQ frequency for selected “unhealthy” UPF items does not quantify total UPF or portion sizes, introducing potential misclassification.
The findings underscore the urgent need for a comprehensive, multi-pronged approach involving parents, educators, and healthcare professionals to foster healthier, more active lifestyles for children, even in regions with a rich history of healthy eating habits. Given the strong associations with eating out and advertising exposure, family- and environment-level strategies may be especially relevant targets.
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