The Mediterranean Diet in the Stroke Belt: A Cross-sectional Study on Adherence and Perceived Knowledge, Barriers, and Benefits (P18-066-19)

Abstract

Objectives The Mediterranean diet (MD) is recommended by the current Dietary Guidelines for Americans, yet little is known about the diet in the US, particularly in areas of high chronic disease. Thus, we investigated MD adherence and perceived benefits and barriers to consumption of the MD in the US Stroke Belt. Methods A survey containing 44 validated MD knowledge, barriers, and benefits (KBB) questions, a validated 14-question MD adherence screener, 7 questions based on the Precaution Adoption Model (stages of change), and 7 demographic/anthropometric questions was distributed systematically to US residents using Amazon Mechanical Turk. Responses from the Stroke Belt (SB; n = 304), California (CA; n = 489), and all other US states (OtherUS; n = 439) were obtained. The CA group served as the reference group. A linear model was used to assess KBB question scores in the groups (Model 1), adjusted for sex and age (Model 2), and all other demographic variables (Model 3). Multivariable linear regression analysis was used to assess the differences in total MD adherence scores between the groups adjusted for all covariates. Simple logistic regression for having heard of the MD with demographic variables was examined. Statistical analyses were conducted in R v3.5.2. Results Barriers on MD knowledge, convenience, sensory factors, and health and familiarity with the MD diet were significantly greater in the SB group, but not the OtherUS group, in all models (P < 0.05). Weight loss was found to be a significantly greater benefit in the SB group in all models (P < 0.05). For each point increase in MD adherence, a reduction in 0.32 and 0.48 points (P < 0.05) was observed in the SB and otherUS groups, respectively. In the full cohort, the odds for participants having heard of the MD prior to taking the survey significantly increased 12.50 times (95%CI, 2.56–226) for 65–74 year olds. The odds were also significantly increased (OR 1.68; 95%CI, 1.13–2.47 and OR 2.47; 95%CI, 1.45–4.32) for those with Bachelor's and Master's or professional degrees, respectively, while no significant differences were found with sex or race. Conclusions Our results identify key barriers and benefits of the MD in the SB which can inform targeted MD intervention studies. Funding Sources USDA Hatch Funding Program (MWG) and Haggard Family Annual Award in Nutrition and Dietetics (OJ).