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

Abstract

The Mediterranean diet (MD) is one of the most healthful dietary patterns, beneficial for humans and the environment. However, the MD has recently exhibited a declining trend, especially in younger and less affluent people. This study investigated the association between socioeconomic indicators and adherence to the MD in 4671 adult subjects from Dalmatia, Croatia (age range 18–98 years; 61.9% were women). Additionally, in the follow-up we examined the change in adherence to the MD and in BMI (subsample, N = 1342; 62.5% were women; mean follow-up time of 5.8 years). The adherence to the MD was based on the Mediterranean Diet Serving Score (range 0–24 points, cut-off value ≥ 14 points), with a prevalence in the overall sample of 28.5%. Higher odds of adherence to the MD were recorded in women, older subjects, and those with higher level of objective material status, while it was less likely in the period after economic crisis of 2007–2008. Additionally, we detected no change in adherence to the MD in the follow-up subsample (−8.5%, p = 0.056), but there was an increase in BMI (+6.5%, p < 0.001). We recorded an increase in adherence for nuts (+127.5%), sweets (+112.6%), red meat (+56.4%), and wine (+50.0%), unlike the reduction in adherence for vegetables (−35.1%), fish (−23.4%), white meat (−11.6%), cereals (−10.9%), and dairy products (−9.6%). Similar results were obtained across all quartiles of objective material status. Over time, the absolute change in the MD score was positively associated with female gender, age, higher education, and moderate physical activity, but it was negatively associated with adherence to the MD at baseline. BMI change was positively associated with female gender, and negatively with initial BMI, initial adherence to the MD, and MD change. Our findings point towards a less than ideal adherence to the MD in the general population of southern Croatia, and identify important characteristics associated with adherence change over time, informing necessary interventions aimed at increasing MD uptake.

Determinants for adherence to the Mediterranean diet beyond the boundaries: A cross-sectional study from Sharjah the United Arab Emirates

“…In the current study, no association was noticed with the participant weight status in contrast to the Gulf study where high adherence was associated with lower risk of obesity indicators BMI, and waist/ hip circumference) among participants (OR: -0.57; 95% CI:0.56-0.38). The powerful determinants ndings of the current study are also comparable to those reported, from cross-sectional studies on healthy individuals in Italy, Croatia, and Casablanca City (North Africa ), where adherence to MD was positively associated with age, being married, and higher engagement in physical activities [33][34][35] and none smokers were independently associated with greater adherence to the MD [33]. A promising result from the current study is the association of increasing age with MD adherence.…”

Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health

“…Another Croatian group of research [12] found that MD adherence, evaluated by MDSS, had a prevalence of 28.5% in 4671 adult subjects, with higher odds in women, older subjects, and people with a higher level of objective material status. Over the study period, the absolute change in the MD score positively associated with female gender, age, higher education, and moderate physical activity, but it was negatively correlated with adherence to the MD at baseline, suggesting that these factors can be potentially targeted in order to increase MD adherence.…”

Factors associated with Mediterranean diet adherence in a sample of high socio-economic status children from southern Spain

“…SES has long been recognised as a predictor of MD adherence (31) and is still deemed to be highly important (32)(33)(34) . Studies agree that the higher the SES, the greater the MD adherence, regardless of age.…”