In a recent study published in the journal Frontiers in Nutrition, researchers assessed the adherence to the Mediterranean Diet (AMD) and its influencing factors among the Italian adult population.
Study: Adherence to Mediterranean Diet and its main determinants in a sample of Italian adults: results from the ARIANNA cross-sectional survey. Image Credit: MaraZe / Shutterstock
Background
The Mediterranean Diet (MD), celebrated for its health, environmental, economic, and cultural benefits since the 1950s, emphasizes plant-based foods, moderate fish and wine consumption, and minimal meat intake. Despite its recognition by the United Nations Educational, Scientific and Cultural Organization (UNESCO) and proven advantages in preventing chronic diseases and promoting sustainability, adherence in Mediterranean regions, including Italy, is declining due to "Westernized" diets, contributing to rising obesity rates. Further research is needed to understand the evolving dietary patterns, identify barriers to adherence, and develop targeted interventions to promote the MD among diverse populations for improved public health outcomes.
About the study
The ARIANNA project conducted a cross-sectional survey among Italians aged 17 and above from March to April 2023. Utilizing an electronic questionnaire developed by Zeta Research Ltd. and disseminated through media, the study ensured voluntary and anonymous participation across Italy. This questionnaire, divided into sections on demographic, socioeconomic, health, lifestyle factors, and dietary habits, required participants to provide detailed information about their food consumption patterns over the past year. The survey uniquely incorporated the Mediterranean Diet Serving Score (MDSS) to quantify AMD among participants, employing a scoring system that reflects the intake frequency of specific food groups.
This approach facilitated the categorization of respondents into low, medium, and high adherence groups based on their MDSS scores, aiming to distinguish between different adherence levels. Upon completing the questionnaire, participants received immediate feedback on their AMD score, along with guidance for improving diet quality or encouragement to maintain healthy eating habits. Statistical analysis involved categorizing collected data and employing χ2 tests and ordered logistic regression to explore associations between AMD and various sociodemographic and health-related variables.
Study results
In the present survey, 3,732 adults from Italy participated voluntarily through an online platform. The majority, 87.70% or 3,273 individuals, were females, while males accounted for 12.30% or 459 participants. Age distribution showed 71.28% of the respondents were between 17 to 40 years old, leaving 28.72% over 40 years. The survey saw a notable rate of missing data for annual income, an optional question, with 22.75% not providing this information.
Geographical analysis of participants revealed a skew towards northern Italy, with 36.60% residing in the Northwest and 18.78% in the Northeast. Central Italy was home to 26.21%, whereas the South and Islands had 12.08% and 6.32% respectively. Comparatively, these demographics did not align with the national population distribution as per the Italian National Institute of Statistics (ISTAT), indicating a statistical deviation in the sample (p < 0.001).
Demographic factors like sex, health conditions, special diet adherence, and physical activity levels showed no significant differences across geographical areas. However, Central Italy had a higher proportion of individuals over 40 years of age and those with more than 13 years of education. The South and Islands predominantly consisted of younger participants. Income and employment status varied significantly across regions, with higher incomes and employment rates in the Northwest and Central areas, contrasted by lower figures in the South and Islands, which also had a larger prevalence of families with four or more members.
AMD varied within the sample; 83.82% exhibited medium adherence, 11.33% low, and only 4.85% high adherence. No significant correlation was found between AMD and variables like annual income, family size, birthplace, residence, or health conditions. Lower adherence rates were significantly more common among males, those older than 40, less educated individuals, and full-time workers. Conversely, vegans and vegetarians showed a notably higher prevalence of high AMD, with none in the low adherence category.
The univariate ordered logistic regression analysis indicated that education, employment status, gender, age, and special diet adherence significantly influenced AMD levels. Specifically, being male, older, employed, or unemployed was linked to lower AMD, while veganism or vegetarianism correlated with higher AMD. Socioeconomic status, represented by education level, income, and family size, also showed a significant association with AMD, although education was excluded from the final multivariate model due to its correlation with other socioeconomic factors.
Conclusions
To summarize, the ARIANNA study assessed AMD among Italian adults, revealing a general medium adherence level with a notable deviation from higher adherence. It identified female gender, younger age, students, and individuals following vegan or vegetarian diets as having higher AMD. Contrary to expectations, older adults and employed individuals showed lower AMD, challenging previous assumptions and highlighting a broader trend of declining traditional dietary patterns.
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