{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T15:18:24Z","timestamp":1769527104019,"version":"3.49.0"},"reference-count":47,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T00:00:00Z","timestamp":1693353600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia","award":["NORTE-01-0145-FEDER-000010"],"award-info":[{"award-number":["NORTE-01-0145-FEDER-000010"]}]},{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia","award":["NORTE2020"],"award-info":[{"award-number":["NORTE2020"]}]},{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia","award":["EXALAR 21 02\/SAICT\/2017"],"award-info":[{"award-number":["EXALAR 21 02\/SAICT\/2017"]}]},{"name":"Programa Operacional Regional do Norte","award":["NORTE-01-0145-FEDER-000010"],"award-info":[{"award-number":["NORTE-01-0145-FEDER-000010"]}]},{"name":"Programa Operacional Regional do Norte","award":["NORTE2020"],"award-info":[{"award-number":["NORTE2020"]}]},{"name":"Programa Operacional Regional do Norte","award":["EXALAR 21 02\/SAICT\/2017"],"award-info":[{"award-number":["EXALAR 21 02\/SAICT\/2017"]}]},{"name":"Fundo Europeu de Desenvolvimento Regional (FEDER)","award":["NORTE-01-0145-FEDER-000010"],"award-info":[{"award-number":["NORTE-01-0145-FEDER-000010"]}]},{"name":"Fundo Europeu de Desenvolvimento Regional (FEDER)","award":["NORTE2020"],"award-info":[{"award-number":["NORTE2020"]}]},{"name":"Fundo Europeu de Desenvolvimento Regional (FEDER)","award":["EXALAR 21 02\/SAICT\/2017"],"award-info":[{"award-number":["EXALAR 21 02\/SAICT\/2017"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>An adequate sodium intake is related to various health benefits. Parallelly, the Mediterranean diet (MD) is a dietary pattern known for its many positive impacts on health. Nonetheless, the association between adherence to the MD and sodium urinary excretion is scarce, even more in children. This study aimed to assess the association between MD adherence and the excretion of sodium, as a proxy of intake. This cross-sectional analysis comprised 295 children (46.8% females, aged 7\u201311 years, mean age: 8.53 \u00b1 0.73 years) from 20 schools within Porto, Portugal. MD adherence was evaluated utilizing the alternate Mediterranean score (aMED). Higher scores denote a healthier dietary pattern (0\u20138). Sodium excretion was estimated by 24-h urine collection. The association between adherence to MD and Na excretion was estimated by logistic regression, adjusting for confounders. Children in the higher sodium excretion group had a higher intake of legumes, a higher body mass index and parents with lower education levels compared to children in the lower sodium excretion group. In logistic regression analysis, sodium urinary excretion was not associated with higher MD adherence, even after adjustment for confounders. High MD adherence could not be associated with lower sodium excretion in children.<\/jats:p>","DOI":"10.3390\/children10091478","type":"journal-article","created":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T09:44:46Z","timestamp":1693388686000},"page":"1478","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Does the Mediterranean Dietary Pattern Promote Lower Sodium Urinary Excretion in Children?"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7932-9460","authenticated-orcid":false,"given":"M\u00f3nica","family":"Rodrigues","sequence":"first","affiliation":[{"name":"Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2400-8408","authenticated-orcid":false,"given":"Francisca de","family":"Castro Mendes","sequence":"additional","affiliation":[{"name":"Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Epidemiology Research Unit, Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6310-4956","authenticated-orcid":false,"given":"Patr\u00edcia","family":"Padr\u00e3o","sequence":"additional","affiliation":[{"name":"Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal"},{"name":"Epidemiology Research Unit, Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2375-9071","authenticated-orcid":false,"given":"Lu\u00eds","family":"Delgado","sequence":"additional","affiliation":[{"name":"Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Immuno-Allergology Department, Centro Hospitalar S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"},{"name":"Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3043-1720","authenticated-orcid":false,"given":"Renata","family":"Barros","sequence":"additional","affiliation":[{"name":"Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal"},{"name":"Epidemiology Research Unit, Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal"}]},{"given":"Jo\u00e3o Cavaleiro","family":"Rufo","sequence":"additional","affiliation":[{"name":"Epidemiology Research Unit, Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal"}]},{"given":"Diana","family":"Silva","sequence":"additional","affiliation":[{"name":"Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Epidemiology Research Unit, Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7294-9296","authenticated-orcid":false,"given":"Andr\u00e9","family":"Moreira","sequence":"additional","affiliation":[{"name":"Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal"},{"name":"Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal"},{"name":"Epidemiology Research Unit, Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal"},{"name":"Immuno-Allergology Department, Centro Hospitalar S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7035-7799","authenticated-orcid":false,"given":"Pedro","family":"Moreira","sequence":"additional","affiliation":[{"name":"Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal"},{"name":"Epidemiology Research Unit, Laboratory for Integrative and Translational Research in Population Health, Institute of Public Health, University of Porto, 4050-600 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"W\u00f3jcik, M., and Kozio\u0142-Kozakowska, A. (2021). Obesity, Sodium Homeostasis, and Arterial Hypertension in Children and Adolescents. Nutrients, 13.","DOI":"10.3390\/nu13114032"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/jch.12615","article-title":"Reducing Sodium Intake in Children: A Public Health Investment","volume":"17","author":"Appel","year":"2015","journal-title":"J. Clin. Hypertens."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1001\/jamapediatrics.2019.3310","article-title":"Global Prevalence of Hypertension in Children: A Systematic Review and Meta-analysis","volume":"173","author":"Song","year":"2019","journal-title":"JAMA Pediatr."},{"key":"ref_4","unstructured":"World Health Organization (2012). Guideline: Sodium Intake for Adults and Children, WHO."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA), Turck, D., Castenmiller, J., de Henauw, S., Hirsch-Ernst, K.-I., Kearney, J., Knutsen, H.K., Maciuk, A., and Mangelsdorf, I. (2019). Dietary reference values for sodium. EFSA J., 17, e05778.","DOI":"10.2903\/j.efsa.2019.5778"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1097\/HCO.0000000000000532","article-title":"The role of diet for prevention and management of hypertension","volume":"33","author":"Ozemek","year":"2018","journal-title":"Curr. Opin. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"De Pergola, G., and D\u2019Alessandro, A. (2018). Influence of Mediterranean Diet on Blood Pressure. Nutrients, 10.","DOI":"10.3390\/nu10111700"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/j.numecd.2020.12.020","article-title":"The Mediterranean diet from past to future: Key concepts from the second \u201cAncel Keys\u201d International Seminar","volume":"31","author":"Russo","year":"2021","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.maturitas.2019.12.002","article-title":"The Mediterranean diet: A historical perspective on food for health","volume":"132","author":"Cano","year":"2020","journal-title":"Maturitas"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Koumpagioti, D., Boutopoulou, B., Moriki, D., Priftis, K.N., and Douros, K. (2022). Does Adherence to the Mediterranean Diet Have a Protective Effect against Asthma and Allergies in Children? A Systematic Review. Nutrients, 14.","DOI":"10.3390\/nu14081618"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2599","DOI":"10.1056\/NEJMoa025039","article-title":"Adherence to a Mediterranean diet and survival in a Greek population","volume":"348","author":"Trichopoulou","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Mentella, M.C., Scaldaferri, F., Ricci, C., Gasbarrini, A., and Miggiano, G.A.D. (2019). Cancer and Mediterranean Diet: A Review. Nutrients, 11.","DOI":"10.3390\/nu11092059"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"9139","DOI":"10.3390\/nu7115459","article-title":"Definition of the Mediterranean Diet: A Literature Review","volume":"7","author":"Davis","year":"2015","journal-title":"Nutrients"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Finicelli, M., Di Salle, A., Galderisi, U., and Peluso, G. (2022). The Mediterranean Diet: An Update of the Clinical Trials. Nutrients, 14.","DOI":"10.3390\/nu14142956"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Katidi, A., Vlassopoulos, A., Noutsos, S., and Kapsokefalou, M. (2023). Ultra-Processed Foods in the Mediterranean Diet according to the NOVA Classification System: A Food Level Analysis of Branded Foods in Greece. Foods, 12.","DOI":"10.3390\/foods12071520"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40001-020-00476-5","article-title":"Urinary sodium-to-potassium ratio: A simple and useful indicator of diet quality in population-based studies","volume":"26","author":"Mirmiran","year":"2021","journal-title":"Eur. J. Med. Res."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Vasara, E., Marakis, G., Breda, J., Skepastianos, P., Hassapidou, M., Kafatos, A., Rodopaios, N., Koulouri, A.A., and Cappuccio, F.P. (2017). Sodium and Potassium Intake in Healthy Adults in Thessaloniki Greater Metropolitan Area-The Salt Intake in Northern Greece (SING) Study. Nutrients, 9.","DOI":"10.20944\/preprints201703.0079.v2"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1097\/HJH.0b013e328345ef35","article-title":"High sodium intake of children through \u2018hidden\u2019 food sources and its association with the Mediterranean diet: The GRECO study","volume":"29","author":"Magriplis","year":"2011","journal-title":"J. Hypertens."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"32172","DOI":"10.3402\/fnr.v60.32172","article-title":"Development of a Mediterranean diet score adapted to Japan and its relation to obesity risk","volume":"60","author":"Kanauchi","year":"2016","journal-title":"Food Nutr. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1080\/09637486.2017.1350941","article-title":"Higher adherence to the Mediterranean diet is inversely associated with having hypertension: Is low salt intake a mediating factor?","volume":"69","author":"Privitera","year":"2018","journal-title":"Int. J. Food Sci. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1111\/pai.13446","article-title":"Higher diversity of vegetable consumption is associated with less airway inflammation and prevalence of asthma in school-aged children","volume":"32","author":"Mendes","year":"2021","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1038\/s41430-017-0029-2","article-title":"The validity of dietary assessment methods to accurately measure energy intake in children and adolescents who are overweight or obese: A systematic review","volume":"72","author":"Walker","year":"2018","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1111\/j.1398-9995.2008.01665.x","article-title":"Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma control","volume":"63","author":"Barros","year":"2008","journal-title":"Allergy"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.3945\/ajcn.2010.29367","article-title":"Trends in 24-h urinary sodium excretion in the United States, 1957\u20132003: A systematic review","volume":"92","author":"Bernstein","year":"2010","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/ajcn\/75.3.561","article-title":"Anthropometry-based reference values for 24-h urinary creatinine excretion during growth and their use in endocrine and nutritional research","volume":"75","author":"Remer","year":"2002","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Chen, S.L., Dahl, C., Meyer, H.E., and Madar, A.A. (2018). Estimation of Salt Intake Assessed by 24-Hour Urinary Sodium Excretion among Somali Adults in Oslo, Norway. Nutrients, 10.","DOI":"10.3390\/nu10070900"},{"key":"ref_27","unstructured":"Kuczmarski, R.J., Ogden, C.L., Grummer-Strawn, L.M., Flegal, K.M., Guo, S.S., Wei, R., Mei, Z., Curtin, L.R., Roche, A.F., and Johnson, C.L. (2000). CDC Growth Charts: United States, Department of Health and Human Services."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e146","DOI":"10.1016\/S2468-2667(21)00275-9","article-title":"Mediation of the parental education gradient in early adult mortality by childhood adversity: A population-based cohort study of more than 1 million children","volume":"7","author":"Elsenburg","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Viroli, G., Gon\u00e7alves, C., Pinho, O., Silva-Santos, T., Padr\u00e3o, P., and Moreira, P. (2021). High Adherence to Mediterranean Diet Is Not Associated with an Improved Sodium and Potassium Intake. Nutrients, 13.","DOI":"10.3390\/nu13114151"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1017\/S0007114509990559","article-title":"Dietary patterns and nutritional adequacy in a Mediterranean country","volume":"101","author":"Pfrimer","year":"2009","journal-title":"Br. J. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1038\/s41371-019-0210-2","article-title":"Prediction of 24-hour sodium excretion from spot urine samples in South African adults: A comparison of four equations","volume":"34","author":"Charlton","year":"2020","journal-title":"J. Human. Hypertens."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s00394-002-0372-4","article-title":"Relationship between diet and blood pressure in a representative Mediterranean population","volume":"41","author":"Schmelz","year":"2002","journal-title":"Eur. J. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1093\/ajcn\/80.4.1012","article-title":"Olive oil, the Mediterranean diet, and arterial blood pressure: The Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study","volume":"80","author":"Psaltopoulou","year":"2004","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1093\/pch\/pxz153","article-title":"Dietary intake of sodium by children: Why it matters","volume":"25","author":"Gowrishankar","year":"2020","journal-title":"Paediatr. Child Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1161\/HYPERTENSIONAHA.115.05948","article-title":"High salt intake: Independent risk factor for obesity?","volume":"66","author":"Ma","year":"2015","journal-title":"Hypertension"},{"key":"ref_36","first-page":"477","article-title":"Sodium and potassium content of some fresh, frozen and canned vegetables","volume":"36","author":"Zuccarelli","year":"1986","journal-title":"Arch. Latinoam. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1177\/0967772017727696","article-title":"Ancel Benjamin Keys (1904\u20132004): His early works and the legacy of the modern Mediterranean diet","volume":"28","author":"Puddy","year":"2020","journal-title":"J. Med. Biogr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e019033","DOI":"10.1136\/bmjopen-2017-019033","article-title":"Evaluation of Mediterranean diet adherence scores: A systematic review","volume":"8","year":"2018","journal-title":"BMJ Open"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e007467","DOI":"10.1136\/bmjopen-2014-007467","article-title":"Geographic and socioeconomic variation of sodium and potassium intake in Italy: Results from the MINISAL-GIRCSI programme","volume":"5","author":"Francesco","year":"2015","journal-title":"BMJ Open"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Moreira, S., Moreira, P., Sousa, A.S., Guerra, R.S., Afonso, C., Santos, A., Borges, N., Amaral, T.F., and Padr\u00e3o, P. (2021). Urinary Sodium Excretion and Adherence to the Mediterranean Diet in Older Adults. Nutrients, 14.","DOI":"10.3390\/nu14010061"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Ginos, B.N.R., and Engberink, R. (2020). Estimation of Sodium and Potassium Intake: Current Limitations and Future Perspectives. Nutrients, 12.","DOI":"10.3390\/nu12113275"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e2014009","DOI":"10.4178\/epih\/e2014009","article-title":"Dietary assessment methods in epidemiologic studies","volume":"36","author":"Shim","year":"2014","journal-title":"Epidemiol. Health"},{"key":"ref_43","first-page":"38","article-title":"Dietary assessment methods: Dietary records","volume":"31","author":"Ortega","year":"2015","journal-title":"Nutr. Hosp."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.nutres.2017.11.001","article-title":"Methodological considerations and future insights for 24-hour dietary recall assessment in children","volume":"51","author":"Foster","year":"2018","journal-title":"Nutr. Res."},{"key":"ref_45","unstructured":"Wolper, C.H.S., and Heymsfield, S.B. (1995). Handbook of Assessment Methods for Eating Behaviors and Weight-Related Problems: Measures, Theory, and Research, Sage Publications, Inc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s40292-021-00474-6","article-title":"Dietary Intervention to Improve Blood Pressure Control: Beyond Salt Restriction","volume":"28","author":"Cicero","year":"2021","journal-title":"High Blood Press. Cardiovasc. Prev."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Rodrigues, M., de Castro Mendes, F., Padr\u00e3o, P., Delgado, L., Paci\u00eancia, I., Barros, R., Rufo, J.C., Silva, D., Moreira, A., and Moreira, P. (2023). Mediterranean Diet and Airway Inflammation in School-Aged Children. Children, 10.","DOI":"10.23822\/EurAnnACI.1764-1489.301"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/9\/1478\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:42:51Z","timestamp":1760128971000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/9\/1478"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,30]]},"references-count":47,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["children10091478"],"URL":"https:\/\/doi.org\/10.3390\/children10091478","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,30]]}}}