Regional variations in Mediterranean diet adherence: a sociodemographic and lifestyle analysis across Mediterranean and non-Mediterranean regions within the MEDIET4ALL project
Mohamed Ali Boujelbane, Achraf Ammar, Atef Salem, Mohamed Kerkeni, Khaled Trabelsi, Bassem Bouaziz, Liwa Masmoudi, Juliane Heydenreich, Christiana Schallhorn, Gabriel Müller, Ayse Merve Uyar, Hadeel Ghazzawi, Adam Tawfiq Amawi, Bekir Erhan Orhan, Giuseppe Grosso, Osama Abdelkarim, Tarak Driss, Kaïs El Abed, Piotr Żmijewski, Frédéric Debeaufort, Nasreddine Benbettaïeb, Clément Poulain, Laura Reyes-Uribe, Amparo Gamero, Marta Cuenca-Ortolá, Antonio Cilla, Nicola Francesca, Concetta María Messina, Enrico Viola, Bent Lorenzen, Stefania Filice, Aadil Bajoub, El-Mehdi Ajal, El Amine Ajal, Majdouline Obtel, Sadjia Lahiani, Taha Khaldi, Nafaa Souissi, Omar Boukhris, Haitham Jahrami, Waqar Husain, Evelyn Frías-Toral, Walid Mahdi, Hamdi Chtourou, Wolfgang I. Schöllhorn
Abstract
Introduction: The Mediterranean diet (MedDiet) is acknowledged for its health advantages; however, compliance with its principles differs by region and is influenced by geographical, cultural, economic, and life-style factors. This research examines regional differences in sociodemographic and lifestyle factors between Mediterranean (MC) and non-Mediterranean (NMC) countries, with a particular focus on adherence to the Mediterranean diet and lifestyle, as well as the associated barriers in each region. Methods: The MEDIET4ALL international survey was conducted across 10 countries, and data were collected from 4,010 participants. Dietary adherence was assessed via the MedLife Index, and additional lifestyle measures included physical activity (IPAQ-SF), sleep patterns (PSQI), mental health (DASS-21), and social participation (SSPQL). Statistical analyses included chi-square tests, Mann-Whitney U tests, and standardized residual analyses to identify significant regional variations. Results: The study revealed distinct dietary patterns, with MC participants showing stronger adherence to traditional MedDiet components (legumes, fish) while NMC participants favored modern adaptations (whole grains). Both regions exhibited low physical activities dominance (60%-62%), although MC participants engaged more (21.1% vs. 18.5%) in moderate physical activity. MC maintained higher proportions of "sometimes socially active" individuals, NMC showed greater representation in the "always socially active" category. Sleep quality was poorer in MC (45% below recommended duration vs. 40% in NMC), while NMC reported higher insomnia rates. Mental health symptoms were comparable (33%-35% moderate depression/anxiety in both), reflecting post-pandemic global trends. Barriers differed regionally with MC faced economic/access constraints while NMC struggled with knowledge gaps and time limitations. Conclusion: Our findings highlight that while Mediterranean regions maintain traditional dietary patterns, globalization and modern lifestyle shifts are narrowing regional health behaviors. Public health strategies should address region-specific barriers, including economic constraints in MC regions and knowledge gaps in NMC regions, while promoting MedDiet adherence. Future research should explore the impact of cultural, socio-economic, and digital factors on dietary behaviors and mental health to develop tailored, effective interventions for improving overall well-being.