Does Adherence to Mediterranean Diet Mediate the Association Between Food Environment and Obesity Among Non-Hispanic Black and White Older US Adults? A Path Analysis

Nutritional Barriers to the Adherence to the Mediterranean Diet in Non-Mediterranean Populations

Adherence to the Mediterranean diet has been shown to lower the risk of developing chronic non-communicable diseases like cardiovascular and neurodegenerative diseases and cancer. Improvements in depression, participation in daily activities in older individuals, weight loss and a reduction in adverse pregnancy outcomes are associated with adherence to the Mediterranean diet. The number of studies that have evaluated barriers to adherence to the Mediterranean diet in the US and, in particular, in racial and ethnic minority populations within the US are few. Among Native American and Alaskan Native populations, studies evaluating traditional or alternative Mediterranean diet adherence for chronic non-infectious diseases is unavailable. Mediterranean diet scoring instruments used in studies in European and Mediterranean countries and among white participants in the US fail to capture the dietary patterns of racial and ethnic minority populations. In this narrative review, the food components of the traditional Mediterranean diet are discussed, adherence to the Mediterranean diet is examined in Mediterranean and non-Mediterranean countries and barriers preventing adherence to the Mediterranean diet in the US and among racial and ethnic minority populations is reviewed. Recommendations for improving nutrition education and intervention and for increasing adherence and cultural adaptions to the Mediterranean diet are provided.

Adherence to the Mediterranean Diet in a Portuguese Immigrant Community in the Central Valley of California

The Mediterranean Diet (MedDiet) is a healthy eating pattern associated with a better quality of life among older adults and reduced risk of non-communicable diseases. Little is known about the MedDiet in immigrant communities from countries in which the MedDiet is a settled cultural heritage. Thus, we examined MedDiet adherence and perceived knowledge, benefits, and barriers to the MedDiet in a Portuguese immigrant community in Turlock, California. A cross-sectional study was conducted with 208 participants in Turlock and Livermore, California, which was used as a reference population. Univariate, multivariable, and logistic regression models were used for data analysis. Compared to the Livermore group, the Turlock group was younger and less educated, but had a higher average MedDiet score and active adherence to a MedDiet (p < 0.001 for both). In the Turlock group, convenience, sensory appeal, and health were observed to be significant barriers to the MedDiet (p < 0.05), while health, weight loss, natural content, familiarity, price, sensory appeal, and mood were significant benefit factors (p < 0.05). In conclusion, participants in Turlock had greater MedDiet adherence despite lower education attainment. Furthermore, the perceived benefits of the MedDiet were key factors in MedDiet perception and adherence in a Portuguese immigrant community.

Food Environments and Hepatocellular Carcinoma Incidence

Research into the potential impact of the food environment on liver cancer incidence has been limited, though there is evidence showing that specific foods and nutrients may be potential risk or preventive factors. Data on hepatocellular carcinoma (HCC) cases were obtained from the Surveillance, Epidemiology, and End Results (SEER) cancer registries. The county-level food environment was assessed using the Modified Retail Food Environment Index (mRFEI), a continuous score that measures the number of healthy and less healthy food retailers within counties. Poisson regression with robust variance estimation was used to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for the association between mRFEI scores and HCC risk, adjusting for individual- and county-level factors. The county-level food environment was not associated with HCC risk after adjustment for individual-level age at diagnosis, sex, race/ethnicity, year, and SEER registry and county-level measures for health conditions, lifestyle factors, and socioeconomic status (adjusted IRR: 0.99, 95% CI: 0.96, 1.01). The county-level food environment, measured using mRFEI scores, was not associated with HCC risk.