Erosion of the Mediterranean diet among adolescents: evidence from an Eastern Mediterranean Country

Abstract

At the time when the health benefits of the Mediterranean diet (MD) are pervasively recognized, a paradoxical observation is the decreasing adherence to this dietary pattern in its native countries. This study aims to investigate temporal trends in adherence to the MD among adolescents (10-19 years old) in Lebanon. Data were drawn from three national cross-sectional surveys conducted at three points in time: 1997 (n = 2004), 2009 (n = 3656), and 2015 (n = 1204). Dietary intake was assessed using 24-hr dietary recalls; and adherence to the MD was assessed using two country-specific indexes: composite Mediterranean (c-MED) index and Lebanese Mediterranean Diet (LMD) index. Significant decreases in c-MED and LDM scores and in the proportion of adolescents adhering to the MD were observed between 1997 and 2015, with more consistent results among females (p<0.05). Projections for year 2030 showed further decreases, with less than a quarter of adolescents remaining adherent to the MD. Based on linear regression analyses, belonging to year 2009 was associated with significantly lower MD scores compared to year 1997, even after adjustment for potential covariates (c-MED : β= -0.16, 95%CI: -0.30;-0.01; LMD: β= -0.42, 95%CI: -0.67;-0.17). Similar results were obtained when comparing survey year 2015 with 1997 (c-MED score: β= -0.20, 95% CI: -0.33;-0.06; LMD score: β= -0.60, 95%CI: -0.82;-0.37). Findings highlight the erosion of the MD among Lebanese adolescents, and underline the need for a comprehensive food system approach that fosters the promotion of the MD as a nutritionally balanced and sustainable dietary pattern.

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“…More alarming is the observed trend in SSB consumption in Lebanon. A recent national study documented an increase in SSB among Lebanese adolescents, from 241.4 g/day in 1997 to 321.7 g/day in 2009 and 301.6 g/day in 2015 (Naja et al, 2021).…”

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“…This interesting finding may be due to the fact that our sample showed low MD adherence according to the MDSS, even in those countries known for their traditional MD patterns, such as Spain and Italy, in agreement with previous findings of low MD adherence and food knowledge among healthcare students from Italy [ 41 ], Spain [ 42 ], and Turkey [ 43 ]. A decline in MD adherence of the general population in the Mediterranean area, and especially of younger generations, is widely recognized [ 44 , 45 , 46 ]. It has been reported that potential factors resulting in moving away from the MD model include globalization, a transition to Western habits, modernization and changes in lifestyle and environment [ 46 ].…”

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“…A recent study by Naja et al (2020) noted a significant decline in adherence to the Mediterranean diet among Lebanese adolescents between 1997 and 2015, from 35.03% to 27.63% respectively, using country-specific indices. This decline in adherence to the Mediterranean diet was shown to be largely driven by the decreasing consumption of whole fruits and vegetables from around 6% and 6.5% of total energy intake respectively in 1997 to around 3.4% and 3.8% respectively in 2015, and the increasing intake in parallel of "unhealthy" foods such as salty snacks and sugar sweetened beverages contributing respectively to 7.6% and 7% of adolescents' total energy intake [22]. Gulf countries have also reported a rapid change in dietary habits and lifestyle over the past 3 decades whereby the traditional diet consisting of dates, milk, rice, brown bread, fish, and vegetables shifted to a more westernized type of diet [20].…”