Obesity is one of the world’s most challenging public health problems. Youth obesity has more than quadrupled over the past 30 years, being its prevalence particularly higher in Mediterranean countries such as Italy (34-36%), Portugal (27-29%) and Spain (24-26%). The Mediterranean diet (MD) has been proposed as a suitable dietary model for the prevention and control of CNCD over the entire lifespan. Some cross-sectional studies showed that a high MD adherence is associated with decreased risk of being overweight, obese and affected by metabolic syndrome (MetS) in adolescents from Mediterranean countries.3,4 However, the health effects of MD through well-designed clinical-nutritional intervention studies, and its underlying mechanisms, have been scarcely evaluated in obese adolescents

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Period of Implementation

Dec 1, 2019 - Nov 30, 2023
Total Budget

EUR 1,088,515.00



The primary goal of MED4Youth is to achieve a decrease of the BMI z-score parameter46 of 0.20 in the MD group compared with the low-fat group, which is considered clinically important in children and adolescents, is comparable to a weight loss of approximately 5% and it is associated with improvements in cardiovascular and metabolic risk factors.47 For every 1-unit increase in BMI z-score the hazard ratio for boys and girls aged 13 years of a fatal coronary heart disease event in adulthood was 1.24 and 1.23, respectively. In second place MED4Youth also targets to achieve a decline of 2 cm in WC in the MD group compared with low-fat group. WC is a surrogate marker of abdominal obesity and is associated with higher CVD risk in youth. A 5-point increase in KidMed was associated with a mean decline of 1.54 cm in sex-, age- and heightadjusted WC in young Spaniards aged 10-24 years.


The main objective of MED4Youth is to strengthen the link between the MD and health benefits against youth obesity and associated CVD risk factors through the identification of evident positive effects exerted by an energy-restricted MD including healthy products from the Mediterranean basin (mixed nuts, pomegranate and hummus) and sourdough bread. The project also aims to elucidate whether the health effects of MD are associated with changes in the gut microbiota and gut-derived metabolites in order to shed light on the interplay between MD, gut microbiome, metabolome and youth obesity which, at present, remains poorly elucidated.

Problems and Needs Analysis

The high prevalence of youth obesity is associated with increasing rates of diabetes, hypercholesterolaemia, non-alcoholic fatty liver disease (NAFLD) and hypertension, which are risk factors for the development of cardiovascular disease (CVD) in adulthood, the leading cause of chronic non-communicable disease (CNCD) deaths (17.5 million in 2012) according to the World Health Organization. The South African-Eastern Mediterranean Regions are facing the same challenges due to rapid economic, demographic and lifestyle changes, including changes in food consumption, reduced physical activity and increased sedentary lifestyle.2 Hence, it is of primary importance to identify lifestyle factors, including the adoption of dietary patterns, to counteract this youth obesity epidemic

Intervention Strategy(ies)

1) to assess whether an energy-restricted Mediterranean-style diet intervention is more effective against obesity and associated CVD risk factors than a conventional low-fat diet carrying out a multicentre nutritional and clinical intervention study specifically targeting obese adolescents (13-16y) from different Mediterranean countries; all combined with an educational web-application designed to encourage healthy behaviours; 2) to elucidate whether the MD can shape the gut microbiota and gut-derived metabolites and gain knowledge about the mechanisms through which MD exerts its beneficial effects against youth obesity and associated CVD risk factors by means of the application of omics technologies and a system biology approach.