The Mediterranean diet (MedDiet) is recommended by the current Dietary Guidelines for Americans, yet little is known about the perceived barriers and benefits to the diet in the U.S., particularly in the Stroke Belt (SB). Thus, the purpose of this study was to examine MedDiet adherence and perceived knowledge, benefits, and barriers to the MedDiet in the U.S. A cross-sectional study was conducted on 1447 participants in the U.S., and responses were sorted into geographic groups: the SB, California (CA), and all other US states (OtherUS). Linear models and multivariable linear regression analysis was used for data analysis. Convenience, sensory factors, and health were greater barriers to the MedDiet in the SB group, but not the OtherUS group (p < 0.05). Weight loss was considered a benefit of the MedDiet in the SB (p < 0.05), while price and familiarity were found to be less of a benefit (p < 0.05). Respondents with a bachelor’s degree or greater education had greater total MEDAS scores (p < 0.05) and obese participants had a lower MedDiet adherence score (p < 0.05). Our results identify key barriers and benefits of the MedDiet in the SB which can inform targeted MedDiet intervention studies.

Approximately one in four Australian children aged 5-17 years are overweight or obese. Most of the health effects of overweight and obesity in childhood do not eventuate until into adulthood; therefore, motivation for children to have a healthy diet may be low. This scoping review examined the literature for associations between diet quality in 5-18 year olds and 'school-valued' outcomes including student attendance, academic performance, behaviour at school and mental health. A literature search for studies that assessed dietary intake and at least one 'school-valued' outcome in schoolchildren, in highly developed countries was conducted. After applying selection criteria, 35 studies were included examining academic performance (46%), behaviour (11%), mental health (31%) and 11% examining two of these outcomes each. No relevant studies addressed attendance. In general, dietary factors including consumption of fruit and vegetables, discretionary foods and/or beverages, or overall diet quality, were suggested to be correlates of the 'school-valued' outcomes. However, the evidence is not comprehensive. This review elucidates the extent and nature of available literature, and provides a basis for future research where the potential benefits of diet on 'school-valued' outcomes can be thoroughly explored.

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).