Preliminary results of the MEDIETALL's survey on Mediterranean Diet Adherence

Introduction

The MEDIET4ALL project conducted a multicenter survey aimed at assessing adherence to the Mediterranean Diet (MEDIET) across Mediterranean and non-Mediterranean countries, including Tunisia, Algeria, Morocco, France, Spain, Germany, Luxembourg, and Italy. Developed by experts at JGU Mainz, this survey explored participants’ dietary habits, lifestyle factors, and mental health parameters associated with the Mediterranean Diet. The study targeted variations in diet adherence influenced by regional, cultural, and socio-demographic factors.

The Mediterranean Diet, known for its health benefits, emphasizes plant-based foods, whole grains, and olive oil, with limited red meat and processed foods [1]. However, shifts toward processed foods and convenience diets are contributing to declining adherence, particularly among younger populations [2]. The MEDIET4ALL survey aimed to provide insights into these trends by exploring both dietary adherence and related lifestyle behaviors.

Methodology

The MEDIET4ALL survey, accessible in multiple languages, gathered responses from over 8,000 participants, with 4010 valid responses included in the final analysis. It measured adherence to the Mediterranean Diet using the Medlife Index and examined lifestyle aspects such as physical activity (International Physical Activity Questionnaire Short Form – IPAQ-SF), social participation (Social Support and Participation Questionnaire – SSPQ), sleep quality (Pittsburgh Sleep Quality Index – PSQI, Insomnia Severity Index – ISI), and psychological aspects (Depression Anxiety Stress Scales – DASS-21), along with life satisfaction (Satisfaction with Life Scale – SWLS). The survey included questions on socio-demographic factors, dietary habits, and health-related behaviors, ensuring a comprehensive understanding of diet adherence across different regions and populations.

Figure 1. Geographical Distribution and Sample Sizes of Study Participants from Selected Mediterranean and Non-Mediterranean Countries

Preliminary Findings – Dietary Patterns and the Medlife Index

The Medlife Index, which quantifies MEDIET adherence, revealed significant differences across regions and continents. Mediterranean countries scored higher in Block 1, emphasizing greater consumption of olive oil, processed meats, dairy, and spices. However, Block 2 showed that non-Mediterranean countries had higher scores, particularly in grain and low-sugar consumption. Block 3 indicated minimal differences between the regions but highlighted those Mediterranean participants tended to engage in more team sports and social activities.

When analyzing the Medlife Index across continents, Europe had the highest scores, with Africa and Asia exhibiting lower adherence levels. This distribution suggests that traditional Mediterranean dietary patterns are more strongly preserved within European countries compared to other continents.

Physical Activity Levels

Physical activity data illustrated that non-Mediterranean countries reported higher vigorous, moderate, and light physical activity levels than Mediterranean countries, with Europe leading across continents. Higher physical activity levels corresponded with higher Medlife Index adherence, especially in non-Mediterranean and European regions.

Mental Health, Life Satisfaction, and Sleep Quality

Mental health analysis showed that Mediterranean countries exhibited higher stress and anxiety scores compared to non-Mediterranean countries.

Life satisfaction was notably higher in non-Mediterranean countries, potentially reflecting varying socio-economic conditions across regions.

Sleep quality comparisons found non-Mediterranean participants reporting slightly better sleep than those in Mediterranean regions. Notably, sleep duration also varied significantly across continents, with African countries reporting the longest average sleep hours compared to Europe and Asia

Social Participation

Social participation was significantly higher in Mediterranean countries, indicating strong community engagement in these regions. When examining participation by continent, Africa showed the highest social engagement, followed by Asia, with Europe trailing. This aligns with the Mediterranean diet’s traditional emphasis on social and communal dining experiences.

Determinant variables of adherence to the MedLifestyle

Regarding the determinant variables of adherence to the MedLifestyle, preliminary results from multiple regression analyses revealed that various demographic factors — such as age, weight, employment status, region, and living environment — as well as health status and various lifestyle behaviors contribute to adherence to the MedLifestyle. Notably, social participation exhibited one of the highest standardized coefficients, indicating a strong relationship with MedLifestyle adherence. Additionally, physical activity also showed notable positive associations.

Conclusion

The MEDIET4ALL survey provided valuable insights into adherence to the Mediterranean Diet across diverse regions, highlighting the influence of cultural, lifestyle, and socio-demographic factors. Key differences in dietary patterns, physical activity, and social participation underscore the need for region-specific strategies to promote the Mediterranean Diet and its health benefits globally.

References

1.     Trichopoulou, A., et al. (2014). Definitions and potential health benefits of the Mediterranean diet: views from experts around the world. BMC Med, 12, 112.

2.     Lăcătușu, C. M., et al. (2019). The Mediterranean Diet: From an Environment-Driven Food Culture to an Emerging Medical Prescription. Int J Environ Res Public Health, 16(6), 942.

by Msc. Mohamed Ali Boujelbane of Johannes Gutenberg-University Mainz

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