Mediterranean diet adherence in pediatric familial Mediterranean fever: clinical and inflammatory correlates

Familial Mediterranean fever is an autoinflammatory disease characterized by recurrent episodes of fever and serositis, with subclinical inflammation that may persist between attacks. Although the Mediterranean diet has recognized anti-inflammatory properties, its clinical relevance in pediatric familial Mediterranean fever remains unclear. In this cross-sectional observational study, children aged 7-18 years with a confirmed diagnosis of familial Mediterranean fever who were followed at the Pediatric Rheumatology Clinic of Dokuz Eylül University between June 2022 and February 2023 were evaluated using standardized dietary questionnaires during outpatient visits. A total of 91 patients met the inclusion criteria. Associations between Mediterranean diet adherence, eating behaviors, attack frequency, disease severity, and selected clinical and inflammatory parameters were analyzed using appropriate comparative statistical tests. Eating behavior showed nominal associations with body mass index and exertional leg pain. Leukocyte count differed across the KIDMED categories in the overall comparison; however, no pairwise comparison remained statistically significant after Bonferroni correction. Neither dietary measure was associated with attack frequency or disease severity. In pediatric familial Mediterranean fever, Mediterranean diet adherence and eating behaviors showed nominal exploratory associations with selected clinical and inflammatory parameters but were not associated with attack frequency or overall disease severity. These findings suggest that dietary patterns may be more closely related to inter-attack clinical and inflammatory expression than to acute disease activity and may help inform future prospective studies on modifiable lifestyle factors in pediatric autoinflammatory disease.