Associations of ultra-processed food consumption and mediterranean diet adherence with weight status among Lebanese children: a cross-sectional study

Childhood obesity, increased consumption of ultra-processed foods (UPFs), and low adherence to traditional dietary practices such as the Mediterranean diet (MD) have become major public health concerns worldwide. Evidence regarding their interrelationships in Middle Eastern pediatric populations remains limited. To investigate the associations between UPF consumption, adherence to the MD and weight status among Lebanese children and adolescents. A cross-sectional study was conducted among Lebanese children and adolescents, aged between 8 and 16 years, and recruited from pediatric clinics. Anthropometric measurements were conducted by trained researchers. Concerning the dietary habits, food intake was assessed using a culturally adapted food frequency questionnaire, while UPF consumption was classified according to the NOVA system, and adherence to the MD was evaluated using the KIDMED 2.0 (Mediterranean Diet Quality Index for children and adolescents) index. Multivariable logistic regression analyses were performed to assess the associations of UPF consumption and MD adherence with overweight and obesity in this sample, adjusting for prespecified potential confounders. A total of 525 children and adolescents were enrolled in the study (mean age: 12.71 ± 2.53 years), with a balanced distribution between girls (49.7%) and boys (50.3%). The combined prevalence of overweight and obesity in this sample was 29.7%. Furthermore, UPFs contributed 44.2% of total daily energy intake, while most participants exhibited moderate adherence to the MD. In the primary energy-adjusted multivariable model, the percentage contribution of NOVA-4 foods to the total energy intake was not associated with being overweight/obese (aOR = 0.994, 95% CI: 0.971–1.017, p = 0.607), whereas a higher total caloric intake was positively associated with the measured outcome (aOR = 1.002, 95% CI: 1.001–1.002, p < 0.001). In parallel, higher KIDMED 2.0 scores were associated with lower odds of being overweight/obese (aOR = 0.853, 95% CI: 0.776–0.938, p = 0.001). Furthermore, in the secondary analysis using the ROC-derived cutoff, a NOVA-4 intake of 1280 kcal/day or more was found to be associated with higher odds of being overweight or obese (aOR = 3.624, 95% CI: 2.231–5.886, p < 0.001). Greater adherence to the MD was associated with lower odds of overweight and obesity after adjustment for potential confounders among this sample of Lebanese children and adolescents. The proportion of energy derived from UPFs was not associated with weight status after adjustment for total energy intake, whereas a high absolute UPF intake was associated with higher odds in a secondary analysis, suggesting that UPFs may exert a role in excess weight mainly through higher overall energy intake. These findings support early nutritional interventions that limit UPF consumption and promote healthy traditional dietary patterns such as the MD.