Next Article in Journal
Vitamin-D Deficiency and Supplementation Altered the Network of the Coronary Arteries in a Rodent Model—In Situ Video Microscopic Technique
Next Article in Special Issue
Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health
Previous Article in Journal
Catechins as a Potential Dietary Supplementation in Prevention of Comorbidities Linked with Down Syndrome
Previous Article in Special Issue
Impact of Mediterranean Diet Food Choices and Physical Activity on Serum Metabolic Profile in Healthy Adolescents: Findings from the DIMENU Project
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Nutrients
Volume 14
Issue 10
10.3390/nu14102040
nutrients-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Review

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

by
Elisa Mattavelli
1,
Elena Olmastroni
1,
Daniela Bonofiglio
2,3,
Alberico L. Catapano
1,4,
Andrea Baragetti
1,4,† and
Paolo Magni
1,4,*,†
1
Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milan, Italy
2
Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
3
Centro Sanitario, University of Calabria, 87036 Rende, Italy
4
IRCCS MultiMedica, Sesto San Giovanni, 20099 Milan, Italy
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Nutrients 2022, 14(10), 2040; https://doi.org/10.3390/nu14102040
Submission received: 28 February 2022 / Revised: 27 April 2022 / Accepted: 11 May 2022 / Published: 13 May 2022
(This article belongs to the Special Issue Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health)
Browse Figure
Review Reports Versions Notes

Abstract

:
The Mediterranean diet has emerged as a comprehensive lifestyle, including specific foods and meal composition and a set of behavioural and social features. Adherence to the Mediterranean diet has been shown to promote health and reduce the prevalence of chronic diseases. The actual implementation of the Mediterranean diet is affected by several sociocultural factors as well as geographical components. Indeed, the geographical location, such as a specific country or different areas in a country and specific latitude and climate, appears to be an important factor that may strongly affect the implementation of the Mediterranean diet or some of its principles as well as the adherence to it. Another 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. In this review, we discuss the current evidence on the impact of geographical location on adherence to the Mediterranean diet.

1. Introduction

Among the different nutritional approaches aimed at promoting and maintaining good health as well as preventing chronic diseases, the Mediterranean diet has emerged over the decades as a comprehensive lifestyle, that, in addition to specific foods [1] and meal composition [2,3], also includes a set of behavioural and social features such as the production of specific foods as well as social exchange and communication [4,5,6,7]. The Mediterranean diet reflects the food patterns typical of southern regions of Greece, Italy, Spain and France in the early 1960s, where adult life expectancy was quite high, and the prevalence of diet-related chronic diseases was low [4,5,6]. Such food patterns, based on fresh or minimally processed or refined foods, were more specifically present in rural areas with easier availability of such dietary components, compared to urban areas [8]. The nutritional characteristics of the Mediterranean diet have inspired institutions and experts in several regions of the world and, more specifically, in individual countries, to implement healthier approaches to food consumption into their specific nutritional guidelines [9]. Some examples of this approach include the New Nordic Diet [10] and the US Dietary Guidelines for Americans, 2020–2025, 9th ed. [11]. 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]. In the past, this aspect has been associated with local traditions and ethnic features and therefore remained rather stable over time within a specific population. However, over the last decades, due to the exponential diffusion of multiple communication media, the modifications of such traditional nutrition habits have been more frequent, leading to either a nutritional transition to unhealthy habits, especially in younger subjects [17,20,21,22] and in selected areas such as the Middle Eastern and North African (MENA) region [12], or a greater awareness of the health advantages of a good adherence to the Mediterranean diet, especially in middle/older age subjects, with improved nutrition patterns during their lifetime [23]. Thus, the epidemiological and experimental observations reporting adherence to the Mediterranean diet and its impact on health issues should also take into consideration another component: the time-related longitudinal changes within a specific population.
This narrative review discusses the current evidence on the potential impact of these two important factors, geographical location and time-related life-long change, on adherence to the Mediterranean diet. To this aim, the PubMed and Excerpta Medica Database (Embase) were searched from inception until April 2022. The search was also extended to the gray literature. Used search terms, with a combination of MeSH terms if applicable in each database, included: “Mediterranean diet”, “geographical location”, “region”, “regional”, “adherence”, “Nordic diet”, and “age”.

2. Adherence to the Mediterranean Diet and Chronic Disease Prevention

Several epidemiological observations and intervention studies demonstrated that implementation of the Mediterranean diet, either as spontaneous adherence [24,25] or following specific intervention approaches (i.e., Lyon Diet Heart Study [26] and PREDIMED Study [27]), are associated with numerous health benefits. These include a reduced incidence of cardiovascular diseases [26,27,28,29,30], including peripheral artery disease [31], diabetes mellitus [32] and the metabolic syndrome [33] and type 2 diabetes mellitus [34,35]. Moreover, adherence to the Mediterranean diet has been found to show positive effects on cancer incidence [36], possibly thanks to the presence of natural compounds with protective effects [37]. Greater adherence to the Mediterranean diet has also been associated with a reduced incidence of neurodegenerative diseases (Parkinson’s and Alzheimer’s disease) [38,39] and, coherently, of cognitive dysfunction and physical impairment [40,41,42].

3. Adherence to the Mediterranean Diet and Geographic Location in Adults

As an extension of the above-reported observations, it is important to associate the term “Mediterranean diet” not only with the food quality and meal composition, but also with a particular way of cooking, eating and more. The Mediterranean diet indeed involves a series of skills, knowledge, symbols, rituals, and traditions related to crops, harvesting, animal husbandry, fishing, conservation, processing, and, more specifically, to the sharing and consumption of food [7]. Eating together is the basis of the cultural identity and continuity of communities throughout the Mediterranean area, representing an important moment of social exchange and communication, which results in the reinforcement of the relationships within family, groups, and community [43]. For these reasons, the Mediterranean diet was inscribed in 2013 in the Representative List of the Intangible Cultural Heritage of Humanity Countries: Greece, Italy, Spain, Morocco, Cyprus, Croatia, and Portugal [7]. Based on these considerations, it appears that the specific geographical location and all the related features strongly impact the implementation of the Mediterranean diet or some of its aspects, on the extent of awareness of its benefits and, ultimately, on the adherence of a population. 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.
The analysis of adherence to the Mediterranean diet in cross-sectional studies may be useful to unveil possible differences between populations living in the same country or even district, but in different geographical and socio-cultural conditions, such as, for example, in rural areas and in urban contexts, two quite diverse geographical settings. Table 1 reports the main outcomes of the studies conducted in adults and discussed in this section.
One example of this is offered by the comparison between two epidemiological studies recently conducted in northern Italy and rather far from the Mediterranean Sea. One study involved the PLIC cohort, conducted in the urban area of Milan, Italy, on 2500 adult volunteers [44,45] and the other involved the PLIC Chiesa cohort, conducted in about 800 adult subjects in an isolated village in the Italian Alps, at 1000 m above sea level [46]. These two populations, although living just 150 km apart, represent two socio-cultural heterogenous groups: one living in an urban context and the other being a rather homogeneous community with greater isolation and specific socio-cultural identity, respectively. A preliminary analysis of the adherence to the Mediterranean diet, assessed by the PREDIMED 14-item tool [56] (Table 2), was conducted in subgroups from the two studies, according to a case-control design (age- and sex-matched). It was found that PLIC-Chiesa individuals were less adherent to the Mediterranean diet than the corresponding PLIC subjects (mean PREDIMED score 7.38 vs. 8.22, respectively; p < 0.001), consistent with the traditional mountain diet, mostly consisting of food of animal origin. The full study will unveil whether this finding is associated with different health outcomes.
A regional variability of adherence to the Mediterranean diet (evaluated by the MD adherence score, Table 2) has also been reported in Spain, where a recent study conducted in all regions showed that southeastern Spain had the lowest score for adherence to the Mediterranean diet specifically related to low consumption of fish and plant products. A lower adherence score to the Mediterranean diet was also strongly associated with the prevalence of hypertension [47]. Studies on adherence to the Mediterranean diet and health outcomes in urban as well as rural areas have also been conducted in Greece. The ATTICA epidemiological study estimated the level of adherence to the Mediterranean diet in a sample (2749 participants) population of the Athens metropolitan area [48], by using the MedDietScore [57] (Table 2). Higher adherence to the Mediterranean diet was observed in areas with a greater proportion of women and older people with a lower unemployment rate and immigrant population, as well as in locations with more green areas and a higher frequency of supermarkets and street markets. On the contrary, adherence to the traditional Mediterranean diet, evaluated by the MedDietScore, in the population of the Elafonisos island, a small Greek island, was found to be moderate and associated with low physical activity and high prevalence of obesity and traditional risk factors for cardiovascular diseases, suggesting the need for lifestyle improvement programs in rural isolated areas of the Mediterranean basin [49]. Another study, conducted in the Republic of Cyprus, showed that adherence to the Mediterranean diet (assessed by the MedDietScore) in a sample of the general population was greater in males and residents of rural regions compared with females and residents of urban regions [50]. Interestingly, adherence to the Mediterranean diet, once consolidated, appears to be rather robust, even under challenging conditions, such as the recent COVID-19 pandemic. In this regard, studies reported that no major changes in Mediterranean diet adherence occurred in Spanish university students [51] and in a sample of the Italian population [52] during the recent COVID-19 lockdown, a major lifestyle challenge.
Outside the Mediterranean basin, certain data and experiences related to the Mediterranean diet are interesting. Longevity is a relevant advantage associated with adherence to the Mediterranean diet for a substantial part of life [62,63]. To address this issue in Australia, which is a country geographically and culturally quite far away from the Mediterranean area, a prospective cohort study including both Anglo-Celts and Greek-Australians was conducted in Melbourne, with the goal to evaluate whether adherence to the Mediterranean diet affected the survival of elderly people in this developed non-Mediterranean country. The authors reported that a diet that adheres to the principles of the Mediterranean diet was associated with longer survival among Australians of both Greek and Anglo-Celtic origin [53].
In the US, the Mediterranean diet, due to its palatability and its consequent high acceptability, is considered a good opportunity for dietary improvement, for example by increasing consumption of fresh vegetables, fruit, grains, and olive oil since the early 20th century [6]. Interestingly, improved awareness of and, consequently, adherence to the Mediterranean diet style in the US has also been promoted by populations that immigrated to the United States from Greece, Italy and Spain. In agreement with previous versions, the 2020–2025 version of the Dietary Guidelines for Americans [11] currently includes the Healthy Mediterranean-Style Dietary Pattern, which is considered a variation of the Healthy US-Style Dietary Pattern, based on the types and proportions of foods typically consumed by Americans, although in nutrient-dense forms and appropriate amounts. A very recent study conducted a geospatial analysis of Mediterranean diet adherence (assessed by the MD adherence score) in the US [54], collecting data across the US regions and exploring the predictive factors of such adherence among US adults (over 20,000 participants). High adherence was observed in 46.5% of the sample. Higher adherence clusters were mainly located in the western and northeastern coastal areas of the USA, whereas lower Mediterranean diet adherence clusters were observed in south and east-north-central regions. Being older, black, not a current smoker, having a college degree or above, an annual household income ≥USD US 75K, exercising ≥4 times/week and watching TV/video <4 h/d were each associated with higher odds of high adherence. The authors concluded that across the US regions there is a significant geospatial and population disparity in adherence to the Mediterranean diet, possibly leading to the greater prevalence of chronic diseases. In the US, although recommended by the current Dietary Guidelines for Americans, as indicated above, the Mediterranean diet is still poorly associated with its benefits, particularly in the Stroke Belt, a large 11-state region in the southeast part of the country with an unusually high incidence of stroke and other forms of cardiovascular disease. A recent study examined Mediterranean diet adherence (assessed by the PREDIMED score) and perceived knowledge, benefits, and barriers in the US [55]. Convenience, sensory factors and health were greater barriers to the Mediterranean diet in the Stroke Belt group, but not in the other groups/regions. Participants with a bachelor’s degree or higher showed greater adherence to the Mediterranean diet, whereas obese participants had a lower adherence.
When considering the geographical location and Mediterranean diet, it is worthwhile to mention an important European experience, represented by the New Nordic Diet, developed in some northern Europe countries (Denmark, Sweden and Finland), characterized by a markedly colder climate. Here, the plant-based nutrition present in the Mediterranean diet is translated into the consumption of healthy regional-specific foods, such as vegetables available in that area (pears, apples, berries, root and cruciferous vegetables, cabbages, rye bread and whole grain) as well as potatoes, a high intake of fish, low-fat dairy products, and vegetable fats, among other dietary lipid sources [10,64,65]. Moreover, it contains 35% less meat than the average Danish diet and appears to be effective in sustainability terms [66]. Rather little research has been conducted so far on the long-term health effects of adherence to the New Nordic Diet. A recent study found a non-significant inverse association with the overall incidence of myocardial infarction and of stroke in men [67], whereas no association was observed with the incidence of type 2 diabetes mellitus. These findings suggest the need for further studies to highlight which components of the Mediterranean diet provide the well-established cardioprotective effect. In this context, one may speculate about the effects of the different fats used for cooking: olive oil in the Mediterranean diet vs. rapeseed oil in the New Nordic diet [68,69].
Figure 1 reports the main geographical features reported for adults and is discussed in this section.

4. Adherence to the Mediterranean Diet and Geographic Location in Adolescents

Although several reports are available regarding adherence to the Mediterranean diet in the adult population, little information is available regarding children and adolescents, spontaneously adhering to this nutrition pattern early in life. Table 3 reports the main outcomes of the studies conducted in adolescents and discussed in this section.
In the context of younger age, education and awareness about the Mediterranean diet and its principles are very important, as shown by a study conducted in Greece and showing that Greek adolescents consume a more westernized diet, which is quite detached from the traditional Mediterranean diet, although actual knowledge about the Mediterranean diet was associated with greater adherence to it [70], according to the evaluation by KIDMED scoring [58] (Table 2). Data from different Italian regions [71] (obtained using the Mediterranean diet scale (MDS) according to [59], revised by [60], Table 2) in a sample of 565 adolescents aged 12–19 years indicate that 38.6% of subjects had low adherence to the Mediterranean diet, whereas only 14% had high adherence. In this study, adolescents from the southern region of Italy showed the highest adherence, compared with those from the northeast and northwest Italy, which are mostly far from the Mediterranean Sea. Recently, in the DIMENU cross-sectional study, carried out in adolescents from the southern Italy area, a medium adherence to the Mediterranean diet assessed by the KIDMED score was reported (medium adherence 60.87%) with no significant differences according to gender [72]. Similar data were also reported by other authors among adolescents living in the Mediterranean region [73], and in the adult population from the same Mediterranean area in which a direct association with age was found [76]. Specifically, Caparello et al. reported that in adulthood the percentage of adherers to recommendations for fruit, nuts, and fish, estimated by the PREDIMED score, was below the dietary guidelines [76]. Supporting this concept, in adolescence, higher consumers of nuts, olive oil and fish showed a better serum metabolic profile, underlining the need to improve the consumption of distinctive components of the Mediterranean diet pattern and to encourage people to change their eating behaviour [77]. In addition, optimal Mediterranean diet adherence (assessed by KIDMED) in adolescents performing vigorous intensity levels of physical activity was found to be associated with lower lipid profile markers and reduced insulin concentrations, reinforcing the healthy benefits of the Mediterranean-style diet pattern [72]. Moreover, serum from adolescents who follow an optimal adherence to the Mediterranean diet (KIDMED) displayed anti-inflammatory and antioxidant properties which may provide chances for the prevention of metabolic and chronic diseases in adulthood [74]. However, a better knowledge of the composition of the healthy Mediterranean diet pattern, in terms of food sources of macro- and micronutrients through nutrition education programs is necessary to improve the adherence to the Mediterranean diet (KIDMED) in the young population. Indeed, the awareness towards the promotion of the Mediterranean diet as a global nutritionally balanced and healthy dietary pattern led to a decreased inflammatory status in adolescents of southern Italy [75].
An interesting “generation shift” from a Mediterranean diet pattern to a more “westernized” type of diet has also been observed in Dalmatia, the Mediterranean coastal part of Croatia, highlighting that younger women, although having a higher education and socioeconomic status, showed a lower adherence to the Mediterranean diet (assessed by the Mediterranean Diet Serving Score [61], Table 2) and a healthier lifestyle than older women from the same region [17].

5. Conclusions

This paper highlights the relevance of the geographical location and related social features in the actual adherence to the Mediterranean diet, thereby promoting (or not) several health advantages. 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. Importantly, several critical issues are present when adapting the Mediterranean diet to non-Mediterranean populations [78]. The approach to studying diet–health relationships has progressively moved from individual dietary components to overall dietary patterns that affect the interaction and balance of personal metabolome (low-molecular-weight metabolites) and microbiome (host-enteric microbial ecology). Future studies will be needed to address this complexity, unveiling how metabolome and microbiome profiles are modulated by high adherence to the Mediterranean diet in the different populations and regions to promote health and longevity [79,80].

Author Contributions

Conceptualization, P.M.; methodology, E.M., E.O.; software, E.O.; validation, P.M., D.B., A.L.C.; formal analysis, P.M., A.B.; investigation, P.M.; resources, P.M., A.L.C.; data curation, P.M., E.M.; writing—original draft preparation, P.M.; writing, review and editing, P.M., D.B., A.B., A.L.C.; project administration, P.M.; funding acquisition, P.M. All authors have read and agreed to the published version of the manuscript.

Funding

The work of A.L.C., A.B. and P.M. has been supported by Ministry of Health—Ricerca Corrente—IRCCS MultiMedica. The work of P.M. and A.L.C. is supported by the Ministry of Health-IRCCS MultiMedica GR-2016-02361198. The work of P.M. is also supported by the Universita’ degli Studi di Milano (Transition grant PSR2015-1720PMAGN_01). The work of A.L.C. is supported by the Fondazione Cariplo 2015-0524 and 2015-0564; H2020 REPROGRAM PHC-03-2015/667837-2; ERANET ER-2017-2364981; PRIN 2017H5F943; Ministry of Health-IRCCS MultiMedica GR-2011-02346974; SISA Lombardia and Fondazione SISA. The work of A.B. is supported by a research grant from the Peanut Institute Foundation (2021). The authors are supported by the MIUR Progetto di Eccellenza.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest relevant to the topic of the paper.

References

  1. Ros, E.; Singh, A.; O’Keefe, J.H. Nuts: Natural Pleiotropic Nutraceuticals. Nutrients 2021, 13, 3269. [Google Scholar] [CrossRef] [PubMed]
  2. Petrella, C.; Di Certo, M.G.; Gabanella, F.; Barbato, C.; Ceci, F.M.; Greco, A.; Ralli, M.; Polimeni, A.; Angeloni, A.; Severini, C.; et al. Mediterranean Diet, Brain and Muscle: Olive Polyphenols and Resveratrol Protection in Neurodegenerative and Neuromuscular Disorders. Curr. Med. Chem. 2021, 28, 7595–7613. [Google Scholar] [CrossRef] [PubMed]
  3. Schwingshackl, L.; Morze, J.; Hoffmann, G. Mediterranean diet and health status: Active ingredients and pharmacological mechanisms. Br. J. Pharmacol. 2020, 177, 1241–1257. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  4. Willett, W.C.; Sacks, F.; Trichopoulou, A.; Drescher, G.; Ferro-Luzzi, A.; Helsing, E.; Trichopoulos, D. Mediterranean diet pyramid: A cultural model for healthy eating. Am. J. Clin. Nutr. 1995, 61, 1402S–1406S. [Google Scholar] [CrossRef] [PubMed]
  5. Nestle, M. Mediterranean diets: Historical and research overview. Am. J. Clin. Nutr. 1995, 61, 1313S–1320S. [Google Scholar] [CrossRef]
  6. Haber, B. The Mediterranean diet: A view from history. Am. J. Clin. Nutr. 1997, 66, 1053S–1057S. [Google Scholar] [CrossRef] [Green Version]
  7. Bonaccio, M.; Iacoviello, L.; Donati, M.B.; de Gaetano, G. The tenth anniversary as a UNESCO world cultural heritage: An unmissable opportunity to get back to the cultural roots of the Mediterranean diet. Eur. J. Clin. Nutr. 2022, 76, 179–183. [Google Scholar] [CrossRef]
  8. Scali, J.; Richard, A.; Gerber, M. Diet profiles in a population sample from Mediterranean southern France. Public Health Nutr. 2001, 4, 173–182. [Google Scholar] [CrossRef] [Green Version]
  9. Magni, P.; Bier, D.M.; Pecorelli, S.; Agostoni, C.; Astrup, A.; Brighenti, F.; Cook, R.; Folco, E.; Fontana, L.; Gibson, R.A.; et al. Perspective: Improving Nutritional Guidelines for Sustainable Health Policies: Current Status and Perspectives. Adv. Nutr. 2017, 8, 532–545. [Google Scholar] [CrossRef]
  10. Mithril, C.; Dragsted, L.O.; Meyer, C.; Blauert, E.; Holt, M.K.; Astrup, A. Guidelines for the New Nordic Diet. Public Health Nutr. 2012, 15, 1941–1947. [Google Scholar] [CrossRef] [Green Version]
  11. U.S. Department of Agriculture; U.S. Department of Health and Human Services. ietary Guidelines for Americans, 2020–2025. Available online: https://dietaryguidelines.gov (accessed on 24 February 2022).
  12. Hwalla, N.; Jaafar, Z.; Sawaya, S. Dietary Management of Type 2 Diabetes in the MENA Region: A Review of the Evidence. Nutrients 2021, 13, 1060. [Google Scholar] [CrossRef] [PubMed]
  13. Doustmohammadian, A.; Clark, C.C.T.; Maadi, M.; Motamed, N.; Sobhrakhshankhah, E.; Ajdarkosh, H.; Mansourian, M.R.; Esfandyari, S.; Hanjani, N.A.; Nikkhoo, M.; et al. Favorable association between Mediterranean diet (MeD) and DASH with NAFLD among Iranian adults of the Amol Cohort Study (AmolCS). Sci. Rep. 2022, 12, 2131. [Google Scholar] [CrossRef] [PubMed]
  14. Matana, A.; Franić, I.; Radić Hozo, E.; Burger, A.; Boljat, P. Adherence to the Mediterranean Diet among Children and Youth in the Mediterranean Region in Croatia: A Comparative Study. Nutrients 2022, 14, 302. [Google Scholar] [CrossRef] [PubMed]
  15. Rubini, A.; Vilaplana-Prieto, C.; Flor-Alemany, M.; Yeguas-Rosa, L.; Hernández-González, M.; Félix-García, F.J.; Félix-Redondo, F.J.; Fernández-Bergés, D. Assessment of the Cost of the Mediterranean Diet in a Low-Income Region: Adherence and Relationship with Available Incomes. BMC Public Health 2022, 22, 58. [Google Scholar] [CrossRef]
  16. Papadimitriou, A.; Foscolou, A.; Itsiopoulos, C.; Thodis, A.; Kouris-Blazos, A.; Brazionis, L.; Sidossis, A.C.; Polychronopoulos, E.; Kokkinos, P.; Panagiotakos, D.; et al. Adherence to the Mediterranean Diet and Successful aging in Greeks living in Greece and abroad: The epidemiological Mediterranean Islands Study (MEDIS). Nutr. Health 2022, 2601060211072363. [Google Scholar] [CrossRef]
  17. Šarac, J.; Havaš Auguštin, D.; Lovrić, M.; Stryeck, S.; Šunić, I.; Novokmet, N.; Missoni, S. A Generation Shift in Mediterranean Diet Adherence and Its Association with Biological Markers and Health in Dalmatia, Croatia. Nutrients 2021, 13, 4564. [Google Scholar] [CrossRef]
  18. Obeid, C.A.; Gubbels, J.S.; Jaalouk, D.; Kremers, S.P.J.; Oenema, A. Adherence to the Mediterranean diet among adults in Mediterranean countries: A systematic literature review. Eur. J. Nutr. 2022, 1–18. [Google Scholar] [CrossRef]
  19. Magni, P.; Dozio, E.; Ruscica, M.; Celotti, F.; Masini, M.A.; Prato, P.; Broccoli, M.; Mambro, A.; Morè, M.; Strollo, F. Feeding behavior in mammals including humans. Ann. N. Y. Acad Sci. 2009, 1163, 221–232. [Google Scholar] [CrossRef]
  20. Archero, F.; Ricotti, R.; Solito, A.; Carrera, D.; Civello, F.; Di Bella, R.; Bellone, S.; Prodam, F. Adherence to the Mediterranean Diet among School Children and Adolescents Living in Northern Italy and Unhealthy Food Behaviors Associated to Overweight. Nutrients 2018, 10, 1322. [Google Scholar] [CrossRef] [Green Version]
  21. Chacón-Cuberos, R.; Badicu, G.; Zurita-Ortega, F.; Castro-Sánchez, M. Mediterranean Diet and Motivation in Sport: A Comparative Study Between University Students from Spain and Romania. Nutrients 2018, 11, 30. [Google Scholar] [CrossRef] [Green Version]
  22. Tsakiraki, M.; Grammatikopoulou, M.G.; Stylianou, C.; Tsigga, M. Nutrition transition and health status of Cretan women: Evidence from two generations. Public Health Nutr. 2011, 14, 793–800. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  23. La Fauci, V.; Alessi, V.; Assefa, D.Z.; Lo Giudice, D.; Calimeri, S.; Ceccio, C.; Antonuccio, G.M.; Genovese, C.; Squeri, R. Mediterranean diet: Knowledge and adherence in Italian young people. Clin. Ter. 2020, 171, e437–e443. [Google Scholar] [CrossRef] [PubMed]
  24. Sofi, F.; Cesari, F.; Abbate, R.; Gensini, G.F.; Casini, A. Adherence to Mediterranean diet and health status: Meta-analysis. BMJ 2008, 337, a1344. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  25. Guasch-Ferré, M.; Willett, W.C. The Mediterranean diet and health: A comprehensive overview. J. Intern. Med. 2021, 290, 549–566. [Google Scholar] [CrossRef]
  26. de Lorgeril, M.; Salen, P.; Martin, J.L.; Monjaud, I.; Delaye, J.; Mamelle, N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: Final report of the Lyon Diet Heart Study. Circulation 1999, 99, 779–785. [Google Scholar] [CrossRef]
  27. Estruch, R.; Ros, E.; Salas-Salvadó, J.; Covas, M.I.; Corella, D.; Arós, F.; Gómez-Gracia, E.; Ruiz-Gutiérrez, V.; Fiol, M.; Lapetra, J.; et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N. Engl. J. Med. 2018, 378, e34. [Google Scholar] [CrossRef]
  28. Keys, A. Coronary heart disease, serum cholesterol, and the diet. Acta Med. Scand. 1980, 207, 153–160. [Google Scholar] [CrossRef]
  29. Keys, A. Wine, garlic, and CHD in seven countries. Lancet 1980, 315, 145–146. [Google Scholar] [CrossRef]
  30. Shikany, J.M.; Safford, M.M.; Soroka, O.; Brown, T.M.; Newby, P.K.; Durant, R.W.; Judd, S.E. Mediterranean Diet Score, Dietary Patterns, and Risk of Sudden Cardiac Death in the REGARDS Study. J. Am. Heart Assoc. 2021, 10, e019158. [Google Scholar] [CrossRef]
  31. Wan, D.; Li, V.; Banfield, L.; Azab, S.; de Souza, R.J.; Anand, S.S. Diet and Nutrition in Peripheral Artery Disease: A Systematic Review. Can. J. Cardiol. 2022, 38, 672–680. [Google Scholar] [CrossRef]
  32. Schwingshackl, L.; Missbach, B.; König, J.; Hoffmann, G. Adherence to a Mediterranean diet and risk of diabetes: A systematic review and meta-analysis. Public Health Nutr. 2015, 18, 1292–1299. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  33. Kastorini, C.M.; Milionis, H.J.; Esposito, K.; Giugliano, D.; Goudevenos, J.A.; Panagiotakos, D.B. The effect of Mediterranean diet on metabolic syndrome and its components: A meta-analysis of 50 studies and 534,906 individuals. J. Am. Coll. Cardiol. 2011, 57, 1299–1313. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  34. Martínez-González, M.A.; de la Fuente-Arrillaga, C.; Nunez-Cordoba, J.M.; Basterra-Gortari, F.J.; Beunza, J.J.; Vazquez, Z.; Benito, S.; Tortosa, A.; Bes-Rastrollo, M. Adherence to Mediterranean diet and risk of developing diabetes: Prospective cohort study. BMJ 2008, 336, 1348–1351. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  35. Mirabelli, M.; Chiefari, E.; Arcidiacono, B.; Corigliano, D.M.; Brunetti, F.S.; Maggisano, V.; Russo, D.; Foti, D.P.; Brunetti, A. Mediterranean Diet Nutrients to Turn the Tide against Insulin Resistance and Related Diseases. Nutrients 2020, 12, 1066. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  36. Bradbury, K.E.; Appleby, P.N.; Key, T.J. Fruit, vegetable, and fiber intake in relation to cancer risk: Findings from the European Prospective Investigation into Cancer and Nutrition (EPIC). Am. J. Clin. Nutr. 2014, 100 (Suppl. S1), 394S–398S. [Google Scholar] [CrossRef] [Green Version]
  37. Augimeri, G.; Bonofiglio, D. The Mediterranean Diet as a Source of Natural Compounds: Does It Represent a Protective Choice against Cancer? Pharmaceuticals 2021, 14, 920. [Google Scholar] [CrossRef]
  38. Panza, F.; Solfrizzi, V.; Colacicco, A.M.; D’Introno, A.; Capurso, C.; Torres, F.; Del Parigi, A.; Capurso, S.; Capurso, A. Mediterranean diet and cognitive decline. Public Health Nutr. 2004, 7, 959–963. [Google Scholar] [CrossRef] [Green Version]
  39. Solch, R.J.; Aigbogun, J.O.; Voyiadjis, A.G.; Talkington, G.M.; Darensbourg, R.M.; O’Connell, S.; Pickett, K.M.; Perez, S.R.; Maraganore, D.M. Mediterranean diet adherence, gut microbiota, and Alzheimer’s or Parkinson’s disease risk: A systematic review. J. Neurol. Sci. 2022, 434, 120166. [Google Scholar] [CrossRef]
  40. Valls-Pedret, C.; Lamuela-Raventós, R.M.; Medina-Remón, A.; Quintana, M.; Corella, D.; Pintó, X.; Martínez-González, M.; Estruch, R.; Ros, E. Polyphenol-rich foods in the Mediterranean diet are associated with better cognitive function in elderly subjects at high cardiovascular risk. J. Alzheimer’s Dis. 2012, 29, 773–782. [Google Scholar] [CrossRef] [Green Version]
  41. Vlachos, G.S.; Yannakoulia, M.; Anastasiou, C.A.; Kosmidis, M.H.; Dardiotis, E.; Hadjigeorgiou, G.; Charisis, S.; Sakka, P.; Stefanis, L.; Scarmeas, N. The role of Mediterranean diet in the course of subjective cognitive decline in the elderly population of Greece: Results from a prospective cohort study. Br. J. Nutr. 2021, 1–11. [Google Scholar] [CrossRef]
  42. Coelho-Júnior, H.J.; Trichopoulou, A.; Panza, F. Cross-sectional and longitudinal associations between adherence to Mediterranean diet with physical performance and cognitive function in older adults: A systematic review and meta-analysis. Ageing Res. Rev. 2021, 70, 101395. [Google Scholar] [CrossRef] [PubMed]
  43. Bonaccio, M.; Iacoviello, L.; de Gaetano, G.; Moli-Sani Investigators. The Mediterranean diet: The reasons for a success. Thromb. Res. 2012, 129, 401–404. [Google Scholar] [CrossRef] [PubMed]
  44. Olmastroni, E.; Shlyakhto, E.V.; Konradi, A.O.; Rotar, O.P.; Alieva, A.S.; Boyarinova, M.A.; Baragetti, A.; Grigore, L.; Pellegatta, F.; Tragni, E.; et al. Epidemiology of cardiovascular risk factors in two population-based studies. Atheroscler. Suppl. 2018, 35, e14–e20. [Google Scholar] [CrossRef] [PubMed]
  45. Olmastroni, E.; Baragetti, A.; Casula, M.; Grigore, L.; Pellegatta, F.; Pirillo, A.; Tragni, E.; Catapano, A.L. Multilevel Models to Estimate Carotid Intima-Media Thickness Curves for Individual Cardiovascular Risk Evaluation. Stroke 2019, 50, 1758–1765. [Google Scholar] [CrossRef] [PubMed]
  46. Magni, P.; Baragetti, A.; Casula, M.; Grigore, L.; Olmastroni, E.; Pellegatta, F.; Catapano, A.L. Life-Style And Cardio-Metabolic Profile Of A Population Living In A Clustered Alpine Village (The Plic Chiesa Study): Comparison With An Urban Cohort (Plic Study). Atherosclerosis 2019, 287, e83–e84. [Google Scholar] [CrossRef]
  47. Abellán Alemán, J.; Zafrilla Rentero, M.P.; Montoro-García, S.; Mulero, J.; Pérez Garrido, A.; Leal, M.; Guerrero, L.; Ramos, E.; Ruilope, L.M. Adherence to the "Mediterranean Diet" in Spain and Its Relationship with Cardiovascular Risk (DIMERICA Study). Nutrients 2016, 8, 680. [Google Scholar] [CrossRef] [Green Version]
  48. Tsiampalis, T.; Faka, A.; Kouvari, M.; Psaltopoulou, T.; Pitsavos, C.; Chalkias, C.; Panagiotakos, D.B. The impact of socioeconomic and environmental determinants on Mediterranean diet adherence: A municipal-level spatial analysis in Athens metropolitan area, Greece. Int. J. Food Sci. Nutr. 2021, 72, 259–270. [Google Scholar] [CrossRef]
  49. Kapelios, C.J.; Kyriazis, I.; Ioannidis, I.; Dimosthenopoulos, C.; Hatziagelaki, E.; Liatis, S.; Group, P.S. Diet, life-style and cardiovascular morbidity in the rural, free living population of Elafonisos island. BMC Public Health 2017, 17, 147. [Google Scholar] [CrossRef] [Green Version]
  50. Kyprianidou, M.; Panagiotakos, D.; Faka, A.; Kambanaros, M.; Makris, K.C.; Christophi, C.A. Adherence to the Mediterranean diet in Cyprus and its relationship to multi-morbidity: An epidemiological study. Public Health Nutr. 2021, 24, 4546–4555. [Google Scholar] [CrossRef]
  51. Sumalla-Cano, S.; Forbes-Hernández, T.; Aparicio-Obregón, S.; Crespo, J.; Eléxpuru-Zabaleta, M.; Gracia-Villar, M.; Giampieri, F.; Elío, I. Changes in the Lifestyle of the Spanish University Population during Confinement for COVID-19. Int. J. Environ. Res. Public Health 2022, 19, 2210. [Google Scholar] [CrossRef]
  52. Di Renzo, L.; Gualtieri, P.; Pivari, F.; Soldati, L.; Attinà, A.; Cinelli, G.; Leggeri, C.; Caparello, G.; Barrea, L.; Scerbo, F.; et al. Eating habits and lifestyle changes during COVID-19 lockdown: An Italian survey. J. Transl. Med. 2020, 18, 229. [Google Scholar] [CrossRef] [PubMed]
  53. Kouris-Blazos, A.; Gnardellis, C.; Wahlqvist, M.L.; Trichopoulos, D.; Lukito, W.; Trichopoulou, A. Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia. Br. J. Nutr. 1999, 82, 57–61. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  54. Chen, M.; Creger, T.; Howard, V.; Judd, S.E.; Harrington, K.F.; Fontaine, K.R. Geospatial analysis of Mediterranean diet adherence in the United States. Public Health Nutr. 2021, 24, 2920–2928. [Google Scholar] [CrossRef] [PubMed]
  55. Knight, C.J.; Jackson, O.; Rahman, I.; Burnett, D.O.; Frugé, A.D.; Greene, M.W. The Mediterranean Diet in the Stroke Belt: A Cross-Sectional Study on Adherence and Perceived Knowledge, Barriers, and Benefits. Nutrients 2019, 11, 1847. [Google Scholar] [CrossRef] [Green Version]
  56. Martínez-González, M.A.; García-Arellano, A.; Toledo, E.; Salas-Salvadó, J.; Buil-Cosiales, P.; Corella, D.; Covas, M.I.; Schröder, H.; Arós, F.; Gómez-Gracia, E.; et al. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: The PREDIMED trial. PLoS ONE 2012, 7, e43134. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  57. Panagiotakos, D.B.; Pitsavos, C.; Stefanadis, C. Dietary patterns: A Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk. Nutr. Metab. Cardiovasc. Dis. 2006, 16, 559–568. [Google Scholar] [CrossRef]
  58. Serra-Majem, L.; Ribas, L.; Ngo, J.; Ortega, R.M.; García, A.; Pérez-Rodrigo, C.; Aranceta, J. Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Public Health Nutr. 2004, 7, 931–935. [Google Scholar] [CrossRef]
  59. Trichopoulou, A.; Kouris-Blazos, A.; Wahlqvist, M.L.; Gnardellis, C.; Lagiou, P.; Polychronopoulos, E.; Vassilakou, T.; Lipworth, L.; Trichopoulos, D. Diet and overall survival in elderly people. BMJ 1995, 311, 1457–1460. [Google Scholar] [CrossRef] [Green Version]
  60. Hu, F.B.; Bronner, L.; Willett, W.C.; Stampfer, M.J.; Rexrode, K.M.; Albert, C.M.; Hunter, D.; Manson, J.E. Fish and omega-3 fatty acid intake and risk of coronary heart disease in women. JAMA 2002, 287, 1815–1821. [Google Scholar] [CrossRef] [Green Version]
  61. Monteagudo, C.; Mariscal-Arcas, M.; Rivas, A.; Lorenzo-Tovar, M.L.; Tur, J.A.; Olea-Serrano, F. Proposal of a Mediterranean Diet Serving Score. PLoS ONE 2015, 10, e0128594. [Google Scholar] [CrossRef] [Green Version]
  62. Dominguez, L.J.; Di Bella, G.; Veronese, N.; Barbagallo, M. Impact of Mediterranean Diet on Chronic Non-Communicable Diseases and Longevity. Nutrients 2021, 13, 2028. [Google Scholar] [CrossRef] [PubMed]
  63. Bhattacharya, R.; Zekavat, S.M.; Uddin, M.M.; Pirruccello, J.; Niroula, A.; Gibson, C.; Griffin, G.K.; Libby, P.; Ebert, B.L.; Bick, A.; et al. Association of Diet Quality With Prevalence of Clonal Hematopoiesis and Adverse Cardiovascular Events. JAMA Cardiol. 2021, 6, 1069–1077. [Google Scholar] [CrossRef] [PubMed]
  64. Mithril, C.; Dragsted, L.O. Safety evaluation of some wild plants in the New Nordic Diet. Food Chem. Toxicol. 2012, 50, 4461–4467. [Google Scholar] [CrossRef] [PubMed]
  65. Mithril, C.; Dragsted, L.O.; Meyer, C.; Tetens, I.; Biltoft-Jensen, A.; Astrup, A. Dietary composition and nutrient content of the New Nordic Diet. Public Health Nutr. 2013, 16, 777–785. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  66. Saxe, H. The New Nordic Diet is an effective tool in environmental protection: It reduces the associated socioeconomic cost of diets. Am. J. Clin. Nutr. 2014, 99, 1117–1125. [Google Scholar] [CrossRef] [Green Version]
  67. Galbete, C.; Kröger, J.; Jannasch, F.; Iqbal, K.; Schwingshackl, L.; Schwedhelm, C.; Weikert, C.; Boeing, H.; Schulze, M.B. Nordic diet, Mediterranean diet, and the risk of chronic diseases: The EPIC-Potsdam study. BMC Med. 2018, 16, 99. [Google Scholar] [CrossRef]
  68. Klonizakis, M.; Bugg, A.; Hunt, B.; Theodoridis, X.; Bogdanos, D.P.; Grammatikopoulou, M.G. Assessing the Physiological Effects of Traditional Regional Diets Targeting the Prevention of Cardiovascular Disease: A Systematic Review of Randomized Controlled Trials Implementing Mediterranean, New Nordic, Japanese, Atlantic, Persian and Mexican Dietary Interventions. Nutrients 2021, 13, 3034. [Google Scholar] [CrossRef]
  69. Krznarić, Ž.; Karas, I.; Ljubas Kelečić, D.; Vranešić Bender, D. The Mediterranean and Nordic Diet: A Review of Differences and Similarities of Two Sustainable, Health-Promoting Dietary Patterns. Front. Nutr. 2021, 8, 683678. [Google Scholar] [CrossRef]
  70. Tsartsali, P.K.; Thompson, J.L.; Jago, R. Increased knowledge predicts greater adherence to the Mediterranean diet in Greek adolescents. Public Health Nutr. 2009, 12, 208–213. [Google Scholar] [CrossRef] [Green Version]
  71. Noale, M.; Nardi, M.; Limongi, F.; Siviero, P.; Caregaro, L.; Crepaldi, G.; Maggi, S.; Group, M.D.F.S. Adolescents in southern regions of Italy adhere to the Mediterranean diet more than those in the northern regions. Nutr. Res. 2014, 34, 771–779. [Google Scholar] [CrossRef]
  72. Morelli, C.; Avolio, E.; Galluccio, A.; Caparello, G.; Manes, E.; Ferraro, S.; De Rose, D.; Santoro, M.; Barone, I.; Catalano, S.; et al. Impact of Vigorous-Intensity Physical Activity on Body Composition Parameters, Lipid Profile Markers, and Irisin Levels in Adolescents: A Cross-Sectional Study. Nutrients 2020, 12, 741. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  73. Grosso, G.; Marventano, S.; Buscemi, S.; Scuderi, A.; Matalone, M.; Platania, A.; Giorgianni, G.; Rametta, S.; Nolfo, F.; Galvano, F.; et al. Factors associated with adherence to the Mediterranean diet among adolescents living in Sicily, Southern Italy. Nutrients 2013, 5, 4908–4923. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  74. Augimeri, G.; Galluccio, A.; Caparello, G.; Avolio, E.; La Russa, D.; De Rose, D.; Morelli, C.; Barone, I.; Catalano, S.; Andò, S.; et al. Potential Antioxidant and Anti-Inflammatory Properties of Serum from Healthy Adolescents with Optimal Mediterranean Diet Adherence: Findings from DIMENU Cross-Sectional Study. Antioxidants 2021, 10, 1172. [Google Scholar] [CrossRef] [PubMed]
  75. Morelli, C.; Avolio, E.; Galluccio, A.; Caparello, G.; Manes, E.; Ferraro, S.; Caruso, A.; De Rose, D.; Barone, I.; Adornetto, C.; et al. Nutrition Education Program and Physical Activity Improve the Adherence to the Mediterranean Diet: Impact on Inflammatory Biomarker Levels in Healthy Adolescents From the DIMENU Longitudinal Study. Front. Nutr. 2021, 8, 685247. [Google Scholar] [CrossRef]
  76. Caparello, G.; Galluccio, A.; Giordano, C.; Lofaro, D.; Barone, I.; Morelli, C.; Sisci, D.; Catalano, S.; Andò, S.; Bonofiglio, D. Adherence to the Mediterranean diet pattern among university staff: A cross-sectional web-based epidemiological study in Southern Italy. Int. J. Food Sci. Nutr. 2020, 71, 581–592. [Google Scholar] [CrossRef]
  77. Ceraudo, F.; Caparello, G.; Galluccio, A.; Avolio, E.; Augimeri, G.; De Rose, D.; Vivacqua, A.; Morelli, C.; Barone, I.; Catalano, S.; et al. Impact of Mediterranean Diet Food Choices and Physical Activity on Serum Metabolic Profile in Healthy Adolescents: Findings from the DIMENU Project. Nutrients 2022, 14, 881. [Google Scholar] [CrossRef]
  78. Hoffman, R.; Gerber, M. Evaluating and adapting the Mediterranean diet for non-Mediterranean populations: A critical appraisal. Nutr. Rev. 2013, 71, 573–584. [Google Scholar] [CrossRef] [Green Version]
  79. Jin, Q.; Black, A.; Kales, S.N.; Vattem, D.; Ruiz-Canela, M.; Sotos-Prieto, M. Metabolomics and Microbiomes as Potential Tools to Evaluate the Effects of the Mediterranean Diet. Nutrients 2019, 11, 207. [Google Scholar] [CrossRef] [Green Version]
  80. Mitsou, E.K.; Kakali, A.; Antonopoulou, S.; Mountzouris, K.C.; Yannakoulia, M.; Panagiotakos, D.B.; Kyriacou, A. Adherence to the Mediterranean diet is associated with the gut microbiota pattern and gastrointestinal characteristics in an adult population. Br. J. Nutr. 2017, 117, 1645–1655. [Google Scholar] [CrossRef] [Green Version]
Nutrients 14 02040 g001 550
Figure 1. Geographical features of Mediterranean diet adherence in adults.
Figure 1. Geographical features of Mediterranean diet adherence in adults.
Nutrients 14 02040 g001
Table
Table 1. Adherence to the Mediterranean diet and geographic location in adults.
Table 1. Adherence to the Mediterranean diet and geographic location in adults.
Study NameCountryYearScoring System Adherence to Mediterranean DietReference
PLICItaly (urban)2017PREDIMEDhigher than PLIC-Chiesa[44,45]
PLIC-ChiesaItaly (mountain)2020PREDIMEDlower than PLIC[46]
DIMERICASpain (different regions)2016MD adherence scorelowest in Southestern Spain[47]
ATTICAGreece (urban)2021MedDietScore higher in women, older people[48]
PERSEASGreece (island)2017MedDietScore moderate, despite being in a small island[49]
Cyprus2021MedDietScore higher in males/rural areas[50]
Spain2022PREDIMEDno major changes during COVID-19 lockdown[51]
Italy2020PREDIMEDno major changes during COVID-19 lockdown[52]
Australia1999composite scorehigher was associated with longer survival[53]
USA (different regions)2020MD adherence scoresignificant geospatial/population disparities[54]
USA (Stroke Belt/other regions)2019PREDIMEDlower in Stroke Belt group[55]
Table
Table 2. Mediterranean diet score systems used in the reported studies.
Table 2. Mediterranean diet score systems used in the reported studies.
Scoring SystemRange for Classification in Categories
LowModerateHigh
PREDIMED (MEDAS) [56]≦5 6–9 ≧10
MD adherence score [47]<55–7>7
MedDietScore [57]<25/55 26–35/55 >35/55
KIDMED [58]≦3 4–78
Mediterranean diet scale (MDS) [59], [60]0–34–56–9
Mediterranean Diet Serving Score (MDSS) [61]0–9.910–13.9≧14 (24 max)
Mediterranean diet scores were assessed by direct administration by a trained dietician (PREDIMED) or by evaluating a food frequency questionnaire (all others). The related references are indicated.
Table
Table 3. Adherence to the Mediterranean diet and geographic location in adolescents.
Table 3. Adherence to the Mediterranean diet and geographic location in adolescents.
Study NameCountryYearScoring System Adherence to Mediterranean DietReference
Greece2009KIDMEDgreater if good knowledge of Med diet[70]
MDFS groupItaly2014Mediterr. diet scalelow: 38.6%; high: 14%. Higher in southern Italy[71]
DIMENUItaly (Southern)2020KIDMEDmedium: 60.9%[72]
Italy (Sicily)2013KIDMEDmoderate in general, lower in urban settings[73]
Italy2021KIDMEDhigher associates to antiinflammatory profile[74]
DIMENUItaly (Southern)2021KIDMEDhigher with education programs[75]
Croatia (Dalmatia)2021MDSSreduced in younger women[61]
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Mattavelli, E.; Olmastroni, E.; Bonofiglio, D.; Catapano, A.L.; Baragetti, A.; Magni, P. Adherence to the Mediterranean Diet: Impact of Geographical Location of the Observations. Nutrients 2022, 14, 2040. https://doi.org/10.3390/nu14102040

AMA Style

Mattavelli E, Olmastroni E, Bonofiglio D, Catapano AL, Baragetti A, Magni P. Adherence to the Mediterranean Diet: Impact of Geographical Location of the Observations. Nutrients. 2022; 14(10):2040. https://doi.org/10.3390/nu14102040

Chicago/Turabian Style

Mattavelli, Elisa, Elena Olmastroni, Daniela Bonofiglio, Alberico L. Catapano, Andrea Baragetti, and Paolo Magni. 2022. "Adherence to the Mediterranean Diet: Impact of Geographical Location of the Observations" Nutrients 14, no. 10: 2040. https://doi.org/10.3390/nu14102040

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop