Abstract
The Mediterranean diet (MD) has been sponsored worldwide as a healthy and sustainable diet. Our aim was to update and compare MD adherence and food choices across several Southern European countries: Spain (SP), Portugal (PT), Italy (IT), Greece (GR), and Cyprus (CY) (MED, Mediterranean), and Bulgaria (BG) and the Republic of North Macedonia (NMK) (non-MED, non-Mediterranean). Participants (N = 3145, ≥18 y) completed a survey (MeDiWeB) with sociodemographic, anthropometric, and food questions (14-item Mediterranean Diet Adherence Screener, 14-MEDAS). The MED and non-MED populations showed moderate (7.08 ± 1.96) and weak (5.58 ± 1.82) MD adherence, respectively, with significant yet small differences across countries (SP > PT > GR > IT > CY > BG > NMK, p-value < 0.001). The MED participants scored higher than the non-MED ones for most of the Mediterranean-typical foods, with the greatest differences found for olive oil (OO) and white meat preference. In most countries, ≥70% of the participants reported quantities of red meat, butter, sweet drinks, and desserts below the recommended cutoff points, whereas <50% achieved the targets for plant-based foods, OO, fish, and wine. Being a woman and increasing age were associated with superior adherence (p-value < 0.001), but differences were rather small. Our results suggest that the campaigns carried out to support and reinforce the MD and to promote plant-based foods have limited success across Southern Europe, and that more hard-hitting strategies are needed.
Highlights
The Mediterranean diet (MD) has been designated as an intangible cultural heritage with a particular lifestyle and eating habits around the Mediterranean Basin
We report the results of the analyses of the following subset of variables for each of the participant countries and for the Mediterranean countries (MED) group and non-MED groups: sociodemographic data, health-related information (self-reported diagnosed pathology, weight, and height (m), used to calculate body mass index (BMI, kg/m2 )), and food choices
We explored the differences in food choices between sexes, age ranges, BMI categories, and disease status (Tables S3–S6)
Summary
The Mediterranean diet (MD) has been designated as an intangible cultural heritage with a particular lifestyle and eating habits around the Mediterranean Basin. The MD dietary pattern is characterized by the preferred use of olive oil (OO; rich in monounsaturated fatty acids); a high intake of plant-based foods (fruits, vegetables, legumes, nuts); a preference for white lean meat; and a moderate consumption of fish, whole-grain cereals, and red wine. The rise in obesity and related chronic cardio-metabolic disorders continues to be a major public health problem worldwide, reflecting the failure of the current dietary models and supporting the urgent need to pursue and attain healthier lifestyle and dietary patterns [2]. A large amount of evidence has been gathered regarding the association between the MD and, especially, the consumption of plant-based foods, with significant benefits against obesity and associated disorders [3,4]. Despite the recognized benefits associated with the MD, populations living around the Mediterranean Sea have progressively abandoned many of their traditional dietary habits, adopting instead a more
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