Adherence to the Mediterranean diet among adults in Mediterranean countries: a systematic literature review

Abstract

Background and aim While the Mediterranean diet (MD) is promoted in non-Mediterranean countries, inhabitants of Mediterranean countries seem to be shifting away from this healthy diet. The aim of this study is to provide an overview of MD adherence in the general adult population of Mediterranean countries. Methods A systematic review was conducted following the PRISMA 2020 (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines and registered in the Prospero database (CRD42020189337). Literature was searched in PubMed, Web of Science and PsycINFO databases for studies published from 2010 up to and including 2021. The following inclusion criteria were used: age 18 years and older, sample size > 1000 participants, and using a validated MD adherence score. Studies that only included participants with nutrition-related or other severe chronic disorders, as well as studies that only included specific subpopulations (e.g., pregnant women), were excluded in order to focus on the general adult population. A quality analysis of the included studies was done using the NCCMT scale. Results A total of 50 studies were included. The number of participants in the included studies ranged between 1013 and 94,113. Most of the included studies pertained to the European Mediterranean countries, with fewer studies from the Middle Eastern and North African Mediterranean countries. The vast majority of the included studies reported low or moderate MD adherence, both based on the mean adherence as well as the low or moderate adherence category often being the most prevalent. There were no clear differences noted between sex and age groups. The quality assessment generally showed weak or moderate scores. Conclusions Mediterranean populations have been showing moderate adherence to MD in the past 10 years, indicating room for improving adherence to the MD in countries of its origin.

Adherence to the Mediterranean Diet: Impact of Geographical Location of the Observations

“…Moreover, evidence is present that improved health and longevity results from prolonged exposure to this dietary pattern, emphasizing the time factor and the actual moment of its acquisition. However, in several instances, Mediterranean populations have been showing moderate adherence to the Mediterranean diet in the past 10 years [ 18 ], which suggests the need for improving adherence to the Mediterranean diet even in the countries of its origin. In the future, the ways in which a palatable and healthful dietary pattern, such as the Mediterranean diet, can be communicated and promoted need to be investigated beyond medical and nutrition authorities, for example, by employing culinary and marketing strategies.…”

“…Interestingly, the relevant change in the society features and the associated globalization that occurred in the last half-century and are still ongoing impacted and still impact the relationship between local habits and adherence to the Mediterranean diet, sometimes in opposite directions. A very recent systematic analysis of adherence to the Mediterranean diet among adults in a large set of Mediterranean countries reported that most available studies (in the 2010–2021 period) are from European Mediterranean countries, with fewer studies from Mediterranean countries in North African and Middle Eastern regions [ 18 ]. In general, low or moderate adherence was reported by the different studies, without major sex and age differences.…”

“…In this context, it is important to emphasize that, in order to be most effective, nutritional guidelines need to be developed according to several specific factors, such as local cultural, ethnic and traditional features, and geographic and socioeconomic components, as well as to the availability of specific local food products [ 9 ]. Among these features, the geographical location (i.e., a specific country, different areas in a country, such as seaside or mountainside or plains far from both, and specific latitude and climate, including climate changes, as well as the related social features) appears to be a crucial factor that may affect to a large extent the actual applicability of the Mediterranean diet or some of its principles as well as the actual adherence to it [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. An additional dynamic component affecting personal nutritional choices, also regarding adherence to the Mediterranean diet and its principles, is the individual life-long trajectory of food preference and nutrition habits and awareness, including feeding behavior aspects [ 19 ].…”

Association between Lebanese Mediterranean Diet and Frailty in Community-Dwelling Lebanese Older Adults—A Preliminary Study

“…In addition, dietitians conducting the interviews had completed a three-day workshop, and received training on proper data collection, which can reduce interviewing bias. Lastly, a recent systematic review aiming to characterize the adherence to the MeDi in the general adult population of Mediterranean countries observed that most identified studies related to MeDi pertained to European Mediterranean countries with fewer studies from the Middle Eastern and North African Mediterranean countries, showing a clear gap in this research area [ 70 ]. Therefore, the current study helps with the understanding of different MeDi types and allows the comparison of dietary habits between different countries around the Mediterranean basin.…”

Longitudinal Trends, Determinants, and Cardiometabolic Impact of Adherence to the Mediterranean Diet among Greek Adults

“…Despite the well-established health benefits of the Mediterranean diet, there is evidence of a gradual deviation from this dietary pattern within Mediterranean populations [ 13 , 14 , 15 ]. For instance, a longitudinal analysis of worldwide dietary data based on Food and Agriculture Organization Food Balance Sheets revealed that the mean Mediterranean Adequacy Index (computed by dividing the sum of the percentage of total energy from typical Mediterranean food groups by the sum of the percentage of total energy from non-typical Mediterranean food groups) decreased from 3.46 ± 1.28 in 1961–1965 to 2.03 ± 0.90 in 2000–2003 and 2.00 ± 0.93 in 2004–2011 within Mediterranean countries [ 13 ].…”