Persistent Moderate-to-Weak Mediterranean Diet Adherence and Low Scoring for Plant-Based Foods across Several Southern European Countries: Are We Overlooking the Mediterranean Diet Recommendations?

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.

The Role of Socioeconomic Status in Adherence to the Mediterranean Diet and Body Mass Index Change: A Follow-Up Study in the General Population of Southern Croatia

“…Unfortunately, many Mediterranean societies are moving away from their traditional dietary pattern, while some countries in Northern Europe and around the world are adopting a Mediterranean-like dietary pattern [25]. For example, previous studies have indicated a persistent moderate-to-weak adherence to the MD across several southern European countries, including Spain, Portugal, Italy, Greece, and Cyprus [58]. Some variations can be expected, probably due to the applied methodological framework and different instru-ments used for assessing adherence to the MD [55].…”

Exploring Hedonic and Eudaimonic Items of Well-Being in Mediterranean and Non-Mediterranean Countries: Influence of Sociodemographic and Lifestyle Factors

“…The current study is part of a research project carried out under the frame of MeDiWeB (Mediterranean Diet and Well-Being) consortium [29][30][31] which was designed to assess MD adherence and other Mediterranean lifestyle characteristics across participants of three MED (Spain, SP; Italy IT; Portugal PT) and two non-MED countries (Bulgaria, BG; Republic of North Macedonia, NMK), and to explore their association with SWB. For this purpose, we developed and applied an online questionnaire (MeDiWeB questionnaire) with 57 questions divided into three sections [29].…”

“…After consenting to fill the questionnaire, the participants proceeded to the second section which included a number of questions about sociodemographic characteristics, lifestyle habits, health related characteristics (BMI and diagnosed pathology), and SWB. The third section was devoted to dietary habits and included, among others, the 14 items used to calculate MD adherence (14-MEDAS score) [31]. The questions were structured following the OECD recommendations regarding subjective self-reporting, specifically, inclusion of subjective evaluation questions at or near the beginning of the survey, to avoid any potential bias effects [3].…”

“…[18,27,28]. To study MD adherence and other lifestyle components across different European Mediterranean (MED) and non-Mediterranean (non-MED) countries, as well as its association with some hedonic and eudaimonic indicators of well-being, we designed a questionnaire (MeDiWeB, Mediterranean Diet and Well-Being [29,30]) containing questions about: (i) sociodemographic factors; (ii) Mediterranean lifestyle and MD adherence, using a cross-national validated version of the 14-MEDAS (Mediterranean Diet Adherence Screener) [31], and (iii) hedonic and eudaimonic indicators of well-being. In a first step, we used the dietary habits section of the MeDiWeB survey to assess and compare MD adherence across different European MED and non-MED countries.…”

Enough to Feed Ourselves!—Food Plants in Bulgarian Rural Home Gardens

“…Our interest in food plants was additionally shaped by household food consumption analyses before and shortly after the democratization of the country in 1989, which showed very low consumption of fruits and vegetables. These habits have not changed since then [41,42]. The current paper aimed to provide evidence about food, medicinal and fodder plants grown in home gardens in rural regions in Bulgaria and to discuss the importance of ethnobotanical and horticultural knowledge that backs up the provisional as well as conservational role of these gardens.…”