Determinants of Adherence to the Mediterranean Diet and Weight in Italian Adolescents: A Comprehensive Analysis

Adolescence, particularly early adolescence (10-14 years), is a crucial period for nutrition due to rapid growth, hormonal changes, and evolving independence in food choices influenced by peers, body image, and family. With regard to Italy, no synthesis of current evidence is available on adherence to a Mediterranean diet (MD) and determinants in this population. This narrative review aims to provide an overview of studies evaluating MD adherence among early adolescents in Italy. We identified 15 studies: 1 at the national level, 3 from northern Italy, 1 from central Italy, and 10 from southern regions. Regional differences emerged: in northern Italy, high adherence ranges from 15.8% to 28.0% and low adherence from 12.0% to 37.3%; in central Italy, 27.7% show low adherence, 47.8% moderate adherence, and 24.5% high adherence; while in southern Italy, low adherence spans from 18.4% to as high as 71.2%, particularly in Apulia. Weight status was the most frequently studied correlation of adherence, with higher adherence among normal-weight individuals. Positive associations were also seen with physical activity, socioeconomic status, parental educational level and occupation, and rural residence. Less consistently studied factors included gender, sleep, academic performance, screen time, smoking, and psychosocial health. This review highlights the lack of nationally representative data on MD adherence in Italian adolescents aged 10-14 years, with most studies conducted in southern Italy. Regional disparities were evident, suggesting that dietary habits are shaped by a combination of individual, familial, and environmental factors. Targeted, age-specific public health strategies to improve MD adherence among Italian early adolescents are required, particularly to increase physical activity and education on nutrition for both children and parents. Additional research, especially in northern and central Italy, is essential to guide effective interventions in this vulnerable population.