Adherence to Mediterranean Diet: A Population-Based Longitudinal Cohort Study

Authors:

Open Access

12 April 2023

journal article
research article
Published by MDPI AG in Nutrients

Vol. 15 (8) , 1844
DOI:10.3390/nu15081844
PMID:37111063

Abstract

Adherence to the Mediterranean diet (MedDiet) is recommended for cardiovascular disease prevention. However, recent epidemiological studies report a shift toward lower adherence to MedDiet. We have conducted a prospective cohort study to evaluate changes in individual determinants of MedDiet adherence over time. Clinical information and MedDiet adherence score (MEDAS) were collected in 711 subjects (mean age 68 ± 10 years; 42% males), enrolled in the PLIC study (Progression of Intimal Atherosclerotic Lesions in Carotid arteries), during two visits conducted, on average, 4.5 years apart. MEDAS score worsening and improvements (absolute change, ΔMEDAS) and the variation in the proportion of subjects reporting to meet each MEDAS criteria were assessed. Overall, 34% of the subjects improved their MedDiet adherence (ΔMEDAS: +1.87 ± 1.13), by consuming more olive oil, legumes and fish and use of dishes seasoned with sofrito and 48% subjects worsened their MedDiet adherence (ΔMEDAS: −2.02 ± 1.14) by consuming less fruit, legumes, fish and nuts, with higher rates of worsening in women and subjects aged 50–65 years. Subjects who improved the score were more obese, had higher plasma glucose levels, and metabolic syndrome at the basal visit. In summary, we report an overall decrease in MedDiet adherence, evaluated during a timeframe heavily affected by the COVID-19 pandemic, underlining the need for better dietary interventions.

Keywords

Funding Information

European Union Framework Programmes for Research and Innovation Horizon 2020—Personalising Health and Care (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
Italian Ministry of Health-IRCCS MultiMedica (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
Fondazione Cariplo (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
H2020 REPROGRAM (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
PRIN (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
ERANET (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
RP-2017-ERACVD-OPERATION (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
SISA Lombardia (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
Fondazione SISA (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
Vini di Batasiolo S.p.A (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
University of Milan (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
Peanut Institute (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
PNRR M4C2-Investimento (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
European Union—NextGeneration EU (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
AtheroNET COST Action (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
HORIZON-MSCA-2021-SE-01-01-MSCA Staff Exchanges 2021 CardioSCOPE (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)
Italian Ministry of Health-Ricerca Corrente to IRCCS MultiMedica (H2020 REPROGRAM PHC-03-2015/667837-2, ERA-NET ER-2017-2364981, GR-2016-02361198, 2015-0524, 2015-0564, PHC-03-2015/667837-2, 2017H5F943, ER-2017-2364981, ERP-2017-23671155, GR-2011-02346974, AL_RIC19ABARA_01, PSR2021_ABARA, 1.4-CN00000041, CA21153, 101086397)

This publication has 38 references indexed in Scilit:

Decline of the Mediterranean diet at a time of economic crisis. Results from the Moli-sani study
Nutrition, Metabolism and Cardiovascular Diseases, 2014
Mediterranean diet adherence rates in Sicily, southern Italy
Public Health Nutrition, 2013
Adherence to the Mediterranean Diet Pattern Has Declined in Spanish Adults3
The Journal of Nutrition, 2012
A Short Screener Is Valid for Assessing Mediterranean Diet Adherence among Older Spanish Men and Women
The Journal of Nutrition, 2011
Trends in adherence to the Mediterranean diet in an Italian population between 1991 and 2006
European Journal of Clinical Nutrition, 2010
A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease
Archives of internal medicine (1960), 2009
Adherence to a Mediterranean-type diet and reduced prevalence of clustered cardiovascular risk factors in a cohort of 3204 high-risk patients
European Journal of Preventive Cardiology, 2008
Development of a short dietary intake questionnaire for the quantitative estimation of adherence to a cardioprotective Mediterranean diet
European Journal of Clinical Nutrition, 2004
Mediterranean diet and reduction in the risk of a first acute myocardial infarction: an operational healthy dietary score
European Journal of Nutrition, 2002
Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)
JAMA, 2001