Abstract / Summary
Childhood dietary patterns play a key role in shaping early cardiometabolic risk through effects on adiposity, lipid metabolism, inflammation, insulin sensitivity, and gut microbiota composition. Evidence indicates that atherosclerotic processes begin in early life and are strongly influenced by modifiable lifestyle factors, particularly diet quality. This narrative review aims to critically summarise current evidence on the relationships between dietary patterns, macronutrient intake, gut microbiota, and early cardiovascular risk markers in children and adolescents, while identifying potential targets for early prevention and future research. A non-systematic literature search was performed using PubMed/MEDLINE, Scopus, and Web of Science for articles published in English up to September 2026. The review was guided by the recommendations of the Scale for the Assessment of Narrative Review Articles (SANRA). Western dietary patterns, characterised by high intake of saturated fat, added sugars, salt, and ultra-processed foods, are associated with adverse lipid profiles, obesity, and early metabolic disturbances, whereas diets rich in fibre, unsaturated fats, fruits, vegetables, and whole grains are linked to more favourable cardiometabolic outcomes. Emerging evidence suggests that the gut microbiota may mediate the relationship between diet and cardiovascular health through metabolites such as short-chain fatty acids, bile acids, and trimethylamine N-oxide. However, mechanistic evidence in children remains limited, and most data linking gut microbiota with cardiovascular outcomes originate from adult studies. Early nutritional strategies, particularly improving overall diet quality, increasing dietary fibre intake, and promoting Mediterranean-style dietary patterns, may contribute to reducing long-term cardiometabolic risk. Further longitudinal and interventional paediatric studies are needed to clarify the relationships between diet, gut microbiota, and cardiovascular risk.