The study was conducted by Gülsevim Oda of the Department of Pediatric Dentistry at Ankara Yildirim Beyazit University and Emine Merve Ekici of the Department of Nutrition and Dietetics at the University of Health Sciences in Ankara. Their work set out to answer a deceptively simple question: do family-level lifestyle practices, dietary quality, and body weight leave a visible signature in a child’s mouth? To find out, the researchers recruited children aged six to thirteen years and combined clinical dental examinations with validated questionnaires assessing diet and household habits, along with anthropometric measurements of body composition.

Adherence to the Mediterranean dietary pattern was measured using the Mediterranean Diet Quality Index for Children and Adolescents, widely known by its abbreviation KIDMED. This instrument evaluates consumption of foods considered protective, such as fruit, vegetables, fish, and olive oil, alongside items considered detrimental, including sweets, sugary drinks, and regularly skipping breakfast. The family environment was assessed with the Family Nutrition and Physical Activity Screening Tool, or FNPA, which captures household practices such as meal patterns, food availability, screen time limits, and opportunities for physical activity. Together, these tools allowed the investigators to look beyond the individual child and examine the family context in which eating and activity behaviors are formed.

The clinical side of the study was equally rigorous. Each child underwent a dental examination in which researchers recorded caries experience using the standard indices: dmft and dmfs for primary teeth, and DMFT and DMFS for permanent teeth, counting decayed, missing, and filled teeth or surfaces. Periodontal status was evaluated with the gingival index and the plaque index, which quantify gum inflammation and bacterial biofilm accumulation, respectively. Body weight status was expressed as a BMI-for-age z-score, a measure that accounts for a child’s age and sex when comparing body mass index against population reference data. All statistical analyses were performed using SPSS software, version 27.0.

The descriptive results painted a familiar but sobering picture of contemporary pediatric lifestyles. Just over half of the participants, 52.5 percent, showed moderate adherence to the Mediterranean diet, while 29.4 percent of the children were classified as obese. That nearly one in three children in the sample carried excess weight underscores the double burden facing pediatric health systems, where overnutrition and poor dietary quality coexist with preventable dental disease. The researchers note that the study was registered as a clinical trial, NCT06130189, on November 13, 2023, and received ethics approval from the Ankara Medipol University Local Ethics Committee, with written informed consent obtained from parents and assent from the children themselves.

When the researchers examined the correlations between their measures, a coherent pattern emerged. KIDMED scores, reflecting Mediterranean diet adherence, were positively correlated with FNPA scores, indicating that children whose families practiced healthier nutrition and activity habits also tended to eat better themselves. More strikingly, higher KIDMED scores were negatively correlated with both the gingival index and the plaque index, meaning that children eating a more Mediterranean-style diet had less gum inflammation and less plaque on their teeth. FNPA scores, in turn, showed negative correlations with dmft and dmfs, suggesting that supportive family environments were associated with less caries experience in the primary dentition.

Body weight told the opposite story. The BMI-for-age z-score was positively correlated with DMFT, DMFS, gingival index, and plaque index, indicating that children with higher body mass index carried more caries burden in their permanent teeth and showed worse periodontal indicators. This convergence of metabolic and oral health markers in childhood is significant because it mirrors associations documented in adult populations, where obesity and periodontal disease frequently travel together, possibly through shared inflammatory pathways, dietary patterns high in processed foods and sugars, and behavioral factors that influence both conditions simultaneously.

The most important results came from the multivariable analyses, in which the researchers adjusted for age, sex, BMI-for-age z-score, family nutrition and physical activity practices, and toothbrushing frequency. Even after accounting for these potential confounders, higher Mediterranean diet adherence remained independently associated with lower DMFT scores and lower gingival index values. In other words, the apparent protective effect of the Mediterranean diet on permanent-tooth caries and gum health was not simply explained by children brushing more often, weighing less, or coming from healthier households. Conversely, higher BMI-for-age z-scores remained independently associated with poorer periodontal health, reinforcing the link between excess weight and gum inflammation in children.

The biological plausibility behind these associations is worth unpacking. The Mediterranean diet is rich in antioxidants, fiber, vitamins, and anti-inflammatory compounds from olive oil, fresh produce, legumes, and fish, all of which may support immune function and reduce the inflammatory burden that drives gingival disease. Whole foods requiring chewing also stimulate saliva production, which buffers acids and helps remineralize enamel, while the diet’s characteristic low intake of free sugars deprives cariogenic bacteria of their preferred substrate. By contrast, diets dominated by ultra-processed foods provide a steady supply of fermentable carbohydrates that fuel acid production by oral bacteria, eroding enamel and promoting the dysbiosis associated with both caries and periodontal inflammation.

The authors are careful to emphasize the limits of their design. Because the study is cross-sectional, capturing a single moment in time, no causal inferences can be drawn; it remains possible that children with painful or diseased mouths alter their diets, or that unmeasured factors such as socioeconomic status, access to dental care, or fluoride exposure shape both diet and oral health. The researchers call for longitudinal and interventional studies to confirm whether improving dietary quality actually protects children’s teeth and gums. Even so, the findings carry a practical message for families, pediatricians, and dentists alike: oral health may be another beneficiary of the Mediterranean eating pattern, and the dinner table, alongside the bathroom sink, may be one of the most powerful tools for keeping children’s smiles healthy. The research received no specific grant funding, and the authors declare no competing interests.

Subject of Research: Associations between Mediterranean diet adherence, family nutrition and physical activity practices, BMI, and oral health in children

Article Title: The relationship of mediterranean diet adherence, family nutrition and physical activity practices, and BMI with oral health in children

Article References: Oda, G., & Ekici, E. M. (2026). The relationship of mediterranean diet adherence, family nutrition and physical activity practices, and BMI with oral health in children. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07477-z

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07477-z

Keywords: Mediterranean diet, children, oral health, dental caries, BMI, obesity, periodontal health, KIDMED, family nutrition, physical activity, pediatric dentistry, cross-sectional study