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Biggi C, Biasini B, Ogrinc N, Strojnik L, Endrizzi I, Menghi L, Khémiri I, Mankai A, Slama FB, Jamoussi H, Riviou K, Elfazazi K, Rehman N, Scazzina F, Menozzi D. Drivers and Barriers Influencing Adherence to the Mediterranean Diet: A Comparative Study across Five Countries. Nutrients 2024; 16:2405. [PMID: 39125289 PMCID: PMC11313691 DOI: 10.3390/nu16152405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/15/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
Given the global decline in adherence to the Mediterranean Diet (MD), even within its native region, it is key to identify the factors influencing this trend to mitigate the negative health outcomes associated with westernized diets. To this end, 4025 individuals (49.6% women, 42.6 ± 14.2 y/o) from Greece, Italy, Morocco, Slovenia, and Tunisia remotely completed a series of measures assessing motives, attitudes, and psychosocial factors related to MD adherence, which was evaluated using the MEDAS questionnaire. The results suggested medium-to-low adherence across all countries, with the highest adherence in Italy and Morocco and the lowest in Slovenia. Structural equation modeling revealed that positive attitudes toward the healthiness of food were the strongest predictors of adherence, whereas picky eating was a significant negative predictor in all countries except Greece. Adherence to the MD was positively influenced by health motivations in Morocco and weight control in Slovenia and Greece, while sensory appeal negatively influenced adherence in Italy. Additionally, price and convenience were significant barriers in Tunisia and Greece, whereas a preference for local and seasonal foods promoted adherence in Morocco and Greece. Overall, our findings underscore the need for country-specific interventions and policies that address distinct local factors and motivations to ease favorable shifts in dietary patterns toward MD principles.
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Affiliation(s)
- Chiara Biggi
- Department of Food and Drug, University of Parma, Parco Area delle Scienze, 27/A, 43124 Parma, Italy; (C.B.); (B.B.); (F.S.)
| | - Beatrice Biasini
- Department of Food and Drug, University of Parma, Parco Area delle Scienze, 27/A, 43124 Parma, Italy; (C.B.); (B.B.); (F.S.)
| | - Nives Ogrinc
- Jožef Stefan Institute (JSI), Jamova 39, 1000 Ljubljana, Slovenia; (N.O.); (L.S.)
| | - Lidija Strojnik
- Jožef Stefan Institute (JSI), Jamova 39, 1000 Ljubljana, Slovenia; (N.O.); (L.S.)
| | - Isabella Endrizzi
- Research and Innovation Center, Edmund Mach Foundation, Via Edmund Mach 1, 38098 San Michele all’Adige, Italy;
| | - Leonardo Menghi
- Center Agriculture Food Environment, University of Trento, Via Edmund Mach 1, 38098 San Michele all’Adige, Italy;
| | - Ikram Khémiri
- Tunisian Association of Nutritional Sciences, National Institute of Nutrition and Food Technology, 11 Rue Jebel Lakhdar, Bab Saadoun, Tunis 1007, Tunisia; (I.K.); (A.M.); (F.B.S.); (H.J.)
- Laboratory of Mycology, Pathologies and Biomarkers (LR16/ES05), Faculty of Sciences of Tunis, University of Tunis El Manar, Campus Universitaire, Tunis 2092, Tunisia
| | - Amani Mankai
- Tunisian Association of Nutritional Sciences, National Institute of Nutrition and Food Technology, 11 Rue Jebel Lakhdar, Bab Saadoun, Tunis 1007, Tunisia; (I.K.); (A.M.); (F.B.S.); (H.J.)
- Higher School of Health Sciences and Techniques, University of Tunis El Manar, B.P. 176–Bab Souika, Tunis 1007, Tunisia
| | - Fethi Ben Slama
- Tunisian Association of Nutritional Sciences, National Institute of Nutrition and Food Technology, 11 Rue Jebel Lakhdar, Bab Saadoun, Tunis 1007, Tunisia; (I.K.); (A.M.); (F.B.S.); (H.J.)
- Higher School of Health Sciences and Techniques, University of Tunis El Manar, B.P. 176–Bab Souika, Tunis 1007, Tunisia
| | - Henda Jamoussi
- Tunisian Association of Nutritional Sciences, National Institute of Nutrition and Food Technology, 11 Rue Jebel Lakhdar, Bab Saadoun, Tunis 1007, Tunisia; (I.K.); (A.M.); (F.B.S.); (H.J.)
- Research Unit “Obesity: Etiopathology and Treatment, UR18ES01”, Faculty of Medicine, University of Tunis El Manar, 15 Rue Jebel Lakhdar, Bab Saadoun, Tunis 1007, Tunisia
| | - Katerina Riviou
- Ellinogermaniki Agogi Scholi Panagea Savva AE (EA), Dimitriou Panagea Str., 15351 Pallini, Greece;
| | - Kaoutar Elfazazi
- Agri-Food Technology and Quality Laboratory, Regional Center of Agricultural Research of Tadla, National Institute of Agricultural Research, Morocco (INRA), Avenue de la Victoire, B.P. 415 RP, Rabat 10090, Morocco;
| | - Nayyer Rehman
- WRG Europe Ltd., 26-28 Southernhay East, Exeter EX1 1NS, UK;
| | - Francesca Scazzina
- Department of Food and Drug, University of Parma, Parco Area delle Scienze, 27/A, 43124 Parma, Italy; (C.B.); (B.B.); (F.S.)
| | - Davide Menozzi
- Department of Food and Drug, University of Parma, Parco Area delle Scienze, 27/A, 43124 Parma, Italy; (C.B.); (B.B.); (F.S.)
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Tranby BN, Sia IG, Clark MM, Novotny PJ, Lohr AM, Pardo LS, Patten CA, Iteghete SO, Zeratsky KA, Rieck TM, Molina L, Capetillo GP, Ahmed Y, Dirie H, Wieland ML. Negative mood is associated with sociobehavioral factors contributing to cardiovascular risk in an immigrant population. BMC Public Health 2024; 24:1911. [PMID: 39014369 PMCID: PMC11253367 DOI: 10.1186/s12889-024-19402-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND After settling in the United States (US), immigrants often accumulate obesity and cardiovascular risk factors. As mood is often associated with health behaviors in the US population, mood may be an important mediating factor in immigrant populations. METHODS The Healthy Immigrant Community (HIC) study, set in southeast Minnesota, enrolled 475 adult participants in a weight loss intervention designed to reduce cardiovascular risk. Baseline questionnaires assessed mood, nutrition, physical activity, self-efficacy for healthy eating and physical activity, social support, and cohesion. A single-item mood rating of poor or fair was considered "negative", while ratings of good, very good, or excellent were considered "positive". RESULTS Hispanic/Latino (n = 268) and Somali (n = 181) adults enrolled in HIC completed baseline measures and were included in this analysis. Participants endorsing negative mood compared to positive mood had lower healthy eating scores (p = 0.02), lower physical activity levels (p = 0.03), lower confidence in eating a healthy diet (p = 0.001), and felt less of a sense of belonging to their community (p = 0.01). Those endorsing negative mood reported receiving less social support to eat healthy (p = < 0.001) and be physically active (p = 0.01). They also accessed community resources for healthy eating (p = 0.001) and physical activity (p = < 0.01) less frequently than participants endorsing positive mood. CONCLUSIONS On self-report, negative mood was associated with less healthy nutrition, lower confidence in eating healthy, sedentary lifestyle, and perceived lack of belonging to the community. Integrating mood management and self-efficacy strategies may enhance the effectiveness of lifestyle interventions to reduce obesity and cardiovascular risk among immigrants who report negative mood. TRIAL REGISTRATION ClinicalTrials.gov registration: NCT05136339; April 23, 2022.
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Affiliation(s)
- Brianna N Tranby
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Irene G Sia
- Rochester Healthy Community Partnership, Rochester, MN, USA
- Division of Public Health, Infectious Diseases, & Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew M Clark
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Rochester Healthy Community Partnership, Rochester, MN, USA
| | - Paul J Novotny
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Abby M Lohr
- Rochester Healthy Community Partnership, Rochester, MN, USA
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Laura Suarez Pardo
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Christi A Patten
- Department of Psychiatry & Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sheila O Iteghete
- Rochester Healthy Community Partnership, Rochester, MN, USA
- Community Based Research Unit, Mayo Clinic, Rochester, MN, USA
| | | | | | - Luz Molina
- Rochester Healthy Community Partnership, Rochester, MN, USA
- Community Based Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Graciela Porraz Capetillo
- Rochester Healthy Community Partnership, Rochester, MN, USA
- Department of Language Services, Mayo Clinic, Rochester, MN, USA
| | - Yahye Ahmed
- Rochester Healthy Community Partnership, Rochester, MN, USA
- Somali American Social Service Association, Rochester, MN, USA
| | - Hana Dirie
- Rochester Healthy Community Partnership, Rochester, MN, USA
- Community Based Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Mark L Wieland
- Rochester Healthy Community Partnership, Rochester, MN, USA
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN, USA
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Sam-Yellowe TY. Nutritional Barriers to the Adherence to the Mediterranean Diet in Non-Mediterranean Populations. Foods 2024; 13:1750. [PMID: 38890978 PMCID: PMC11171913 DOI: 10.3390/foods13111750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/16/2024] [Accepted: 05/29/2024] [Indexed: 06/20/2024] Open
Abstract
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.
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Affiliation(s)
- Tobili Y. Sam-Yellowe
- Graduate College, Canisius University, 2001 Main Street, Buffalo, NY 14208-1098, USA;
- Department of Biological, Geological and Environmental Sciences, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH 44115, USA
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Dobroslavska P, Silva ML, Vicente F, Pereira P. Mediterranean Dietary Pattern for Healthy and Active Aging: A Narrative Review of an Integrative and Sustainable Approach. Nutrients 2024; 16:1725. [PMID: 38892658 PMCID: PMC11174674 DOI: 10.3390/nu16111725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
The global population is on a trajectory of continuous growth, with estimates projecting an increase from 7.7 billion in 2019 to approximately 9.7 billion by 2050. Longevity is also expected to rise rapidly, with advancements in healthcare contributing to increased life expectancies and an increase in the maximum lifespan. The aging process is accompanied by different changes, often leading to a decline in daily life activities and an increased susceptibility to disease. Age-related changes can cause cellular damage and subsequent cellular death. Oxidative stress and inflammation play significant roles in this process contributing to molecular damage and mitochondrial dysfunction. Active aging has been associated with improved quality of life and a reduced risk of morbidity and premature mortality. In this context, the Mediterranean diet has emerged as a promising approach to promoting healthy aging and sustainability. The phytochemical compounds within the Mediterranean diet have been linked to a lower risk of developing cardiovascular disease, type 2 diabetes, obesity, cancer and neurodegenerative diseases. The findings of peer-reviewed articles regarding the use of the Mediterranean diet as a healthy and sustainable dietary pattern written in Portuguese, Spanish or English were included in this narrative literature review. This dietary pattern's emphasis on the consumption of fresh and local food aligns with both health and environmental sustainability goals. This work provides a comprehensive review of the benefits of the Mediterranean diet and its components in a healthy aging process and highlights the importance of this dietary pattern as a sustainable approach.
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Affiliation(s)
| | - Maria Leonor Silva
- Applied Nutrition Research Group (GENA), Nutrition Lab, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Monte de Caparica, 2829-511 Almada, Portugal; (P.D.); (F.V.); (P.P.)
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Tsofliou F, Vlachos D, Hughes C, Appleton KM. Barriers and Facilitators Associated with the Adoption of and Adherence to a Mediterranean Style Diet in Adults: A Systematic Review of Published Observational and Qualitative Studies. Nutrients 2022; 14:4314. [PMID: 36296998 PMCID: PMC9607475 DOI: 10.3390/nu14204314] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
The Mediterranean diet (MedDiet) has been linked with physical and mental health benefits. Previous research, however, suggests that adoption and adherence to a Mediterranean diet might be difficult for people who live outside of the Mediterranean region. The aim of this systematic review was to investigate the factors that influence adoption and adherence to a Mediterranean style diet in adults aged 18 years old and over, as identified in published observational and qualitative studies. Following registration of our protocol on PROSPERO (ID: CRD42018116515), observational and qualitative studies of adults' perceptions and experiences relevant to following a Mediterranean style diet were identified using systematic searches of databases: MEDLINE, the Cochane Library, CINAHL, Web of Science and Scopus, over all years of records until February 2022. A narrative synthesis was then undertaken. Of 4559 retrieved articles, 18 studies fulfilled our inclusion criteria and were included. Factors influencing adoption and adherence to a MedDiet were identified and categorized as: financial, cognitive, socio-cultural, motivational, lifestyle, accessibility & availability, sensory & hedonic and demographic. Similar barriers and facilitators are often reported in relation to healthy eating or the consumption of specific healthy foods, with a few exceptions. These exceptions detailed concerns with specific components of the MedDiet; considerations due to culture and traditions, and concerns over a cooler climate. Suggestions for overcoming these barriers and facilitators specific to adoption and adherence to the Mediterranean diet are offered. These data will inform the development of future studies of robust methodology in eating behaviour change which offer pragmatic approaches for people to consume and maintain healthy diets.
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Affiliation(s)
- Fotini Tsofliou
- Department of Rehabilitation and Sport Sciences, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK
| | - Dimitrios Vlachos
- Department of Rehabilitation and Sport Sciences, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK
| | - Christina Hughes
- Department of Rehabilitation and Sport Sciences, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth BH8 8GP, UK
| | - Katherine M. Appleton
- Department of Psychology, Faculty of Science and Technology, Talbot Campus, Bournemouth University, Fern Barrow, Bournemouth BH12 5BB, UK
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Bonofiglio D. Mediterranean Diet and Physical Activity as Healthy Lifestyles for Human Health. Nutrients 2022; 14:nu14122514. [PMID: 35745244 PMCID: PMC9228212 DOI: 10.3390/nu14122514] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Daniela Bonofiglio
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Cosenza, Italy; ; Tel.: +39-0984-496208; Fax: +39-0984-496203
- Centro Sanitario, University of Calabria, 87036 Rende, Cosenza, Italy
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