Association Between Adherence to the Mediterranean Diet and Metabolic Syndrome and Its Components Among Polish Postmenopausal Women: A Cross-Sectional Study
by
, , , and
Joanna Bajerska
1,*
,
Aleksandra Skoczek-Rubińska
2
,
Magdalena Dębińska-Kubiak
1,
Wiktoria Stanisławska
1 and
Jarosław Walkowiak
3 1
Department of Human Nutrition and Dietetics, Poznań University of Life Sciences, Wojska Polskiego 31, 60-624 Poznań, Poland
2
Department of Dietetics, Faculty of Physical Culture, Poznań University of Physical Education, Estkowskiego 13, 66-400 Gorzów Wielkopolski, Poland
3
Department of Pediatric Gastroenterology and Metabolic Diseases, Poznań University of Medical Sciences, Szpitalna 27/33, 60-572 Poznań, Poland
*
Author to whom correspondence should be addressed.
Nutrients 2025, 17(17), 2727; https://doi.org/10.3390/nu17172727
Submission received: 14 July 2025
/
Revised: 14 August 2025
/
Accepted: 19 August 2025
/
Published: 22 August 2025
(This article belongs to the Section Nutrition in Women)
Abstract
Background/Objectives: The decrease in estrogen levels during menopause is associated with an increase in visceral fat accumulation, which can contribute to the development of metabolic syndrome (MetS). While some studies have suggested a link between the Mediterranean diet (MedDiet) and the reduced incidence of MetS and its components in the general population, these findings have not been confirmed among postmenopausal women. Therefore, this study investigated the association between the adherence to the MedDiet and the odds of having MetS, and established the food groups responsible for this effect in postmenopausal women. Methods: This cross-sectional study involved 312 postmenopausal women who underwent anthropometric measurements and blood parameter assessment. Adherence to the MedDiet was assessed using the Alternate Mediterranean Diet score (the aMED score), and MetS was defined based on the updated 2022 criteria. Results: After adjusting for potential confounders, adherence to the MedDiet was inversely associated with central obesity and hypertension. For each one-point increase in the aMED score (indicating a better adherence to the MedDet), the odds of central obesity and hypertension were significantly reduced by 33% (OR = 0.669, 95% CI: 0.518; 0.866, p = 0.002) and by 18% (OR = 0.817, 95% CI: 0.689; 0.969, p = 0.020), respectively. A greater consumption of nuts and fish was associated with lower odds of central obesity (OR = 0.972, 95% CI: 0.950; 0.995; p = 0.016) and (OR = 0.989, 95%CI: 0.979; 1.000; p = 0.043), respectively, whereas high processed red meat consumption was associated with hypertension (OR = 1.004, 95% CI: 1.000; 1.008, p = 0.048). Conclusions: A greater adherence to the MedDiet was associated with lower odds of central obesity and hypertension among postmenopausal women; however, it did not translate to a reduced likelihood of having MetS. A higher consumption of nuts and fish was associated with lower odds of central obesity, whereas a higher consumption of red, processed meats was associated with higher odds of hypertension. Longitudinal studies are needed to determine the causality of these relationships.
1. Introduction
The number of women entering menopause, typically aged 45–54, in the coming decades is set to increase significantly, with 1.65 billion projected by 2050 [1]. From a physiological point of view, menopause is the cessation of ovarian function, with the loss of reproductive hormone production and irreversible loss of fertility [2]. Hormone changes in menopause affect lipid metabolism, energy consumption, insulin resistance, and body fat composition, with a transition from a gynecoid to an android body shape and increased abdominal and visceral fat accumulation associated with increased risks of metabolic syndrome (MetS) [2]. The new definition of MetS proposed by Dobrowolski et al., 2022 encompasses the presence of obesity (abdominal obesity or obesity prescribed by BMI) and two of the three following criteria: hypertension, impaired glucose metabolism, and elevated non-HDL cholesterol [3]. The prevalence of MetS in postmenopausal women is significantly higher than in premenopausal women, with reported prevalence rates ranging from 32 to 58% [4].
While numerous traditional dietary patterns play an important role in preventing and treating MetS and its constituents, the Mediterranean diet (MedDiet) is one of the most extensively researched. For example, Di Daniele et al. suggested in their review that the MedDiet can be used as a possible therapy for MetS, as it prevents excesses of adiposity and the obesity-related inflammatory response [5]. A meta-analysis of twelve cross-sectional and prospective cohorts showed that a higher adherence to the MedDiet was associated with a 19% lower risk of developing MetS [relative risk (RR): 0.81 (95% confidence interval (CI) 0.71 to 0.92]; its individual components, such as waist circumference and blood pressure, also became less likely [RR: 0.82 (95% CI 0.70 to 0.96); RR: 0.87 (95% CI 0.77 to 0.97), respectively [6]. However, adherence to the MedDiet in the sub-analysis, which included only women (two studies), was not significantly associated with a reduced risk of MetS [6]. Moreover, among the studies included in the meta-analysis, those conducted in non-Mediterranean countries reported no significant effects [6]. Leone et al. (2022) observed that a greater adherence to the MedDiet reduced the risk of metabolically unhealthy obesity in postmenopausal, but not in premenopausal, women living in Italy [7]. While the MedDiet can be beneficial for overall health, including cardiovascular health, there is little strong evidence that specifically links the MedDiet to a reduced incidence of MetS among postmenopausal women, especially those living far away from the Mediterranean region. Therefore, this study aimed to investigate the association between adherence to the MedDiet and the odds of having MetS and its components among Polish postmenopausal women, and to establish the food groups responsible for this effect.
2. Materials and Methods
2.1. Subjects
This cohort study recruited Polish postmenopausal women between 2016 and 2020 who had an absence of menses during the 12 months before the study. The exclusion criteria were as follows: unnatural menopause (e.g., due to surgery or radiation therapy for cervical cancer), use of hormonal replacement therapy, a history of heart disease, insulin-dependent diabetes, type-2 diabetes, hypothyreosis, chronic inflammatory disease, liver disease, or any type of cancer. The analysis included 312 menopausal women (Figure 1).
This study was approved by the Bioethics Committee of Poznan University of Medical Sciences (number 664/20 and 603/14), and was conducted as per the Declaration of Helsinki. All subjects provided written informed consent before study participation.
2.2. Metabolic Syndrome Definition
The diagnostic criteria for MetS are based on the guidelines published by Dobrowolski et al. [3] which take into account the presence of obesity, either a waist circumference in women ≥ 88 cm or BMI ≥ 30 kg/m2, and two of the following criteria: hypertension (systolic blood pressure ≥ 130, diastolic blood pressure ≥ 85 mm Hg), or antihypertensive treatment, impaired glucose metabolism (fasting glucose ≥ 100 mg/dL) or glucose lowering drug treatment, non-HDL cholesterol level ≥ 130 mg/dL, or lipid-lowering drug treatment.
2.3. Dietary Assessment
A three-day food diary was used to assess dietary intake, allowing respondents to record all foods and beverages consumed over a specific period of two weekdays and one weekend day. A dietitian provided twenty minutes of training to improve the accuracy of the food records. This training involved face-to-face education on how to accurately record real-time food intake, including the name of the food, amount of food consumed using standard household measurements, preparation methods, brand names of commercially available products, and recipes of composite dishes. Instructions on how to use paper-based or web-based (http://www.ilewazy.pl/) photographs of products and dishes were also provided, and the respondents were provided with comprehensive written instructions on how to collect dietary data. The dietitian reviewed the completed records with the respondent to clarify potential omissions and ambiguities or make necessary changes. The reported food and beverage quantities were converted into grams and milliliters, respectively, and then input into dietary analysis software Dieta 6.0 (National Food and Nutrition Institute, Warsaw, Poland) to calculate the energy and nutritional value of their daily food intake.
2.4. Anthropometry
The anthropometric data recorded included body weight (kg), height (cm), body mass index (BMI = weight/height2), fat mass (%), fat-free mass (kg), waist circumference (cm), and waist-to-height ratio (WHtR = waist circumference/height). Height was measured to the nearest 0.1 cm using a stadiometer (RadWag, Radom, Poland). Body weight was assessed to the nearest 0.1 kg after an overnight fast using the calibrated scale. Body composition was measured using dual-energy X-ray absorptiometry (DXA) with a Lunar Prodigy densitometer (GE Healthcare, Madison, WI, USA, 2013). Waist circumference (WC) was measured using nonelastic tape placed horizontally above the iliac crest with minimal respiration. The cutoff used for WC was that for women of European ethnicity (≥88 cm) [8]. Systolic and diastolic blood pressure were measured using a sphygmomanometer.
2.5. Biochemistry
Blood was drawn from all participants by qualified personnel in the morning after an overnight fast, and the serum was obtained by centrifugation at 1000 rpm for 10 min. The biological material was stored at −80 °C until further analysis. Biochemical parameters, including glucose (GLU), total cholesterol (T-C), high-density lipoprotein cholesterol HDL, and triglycerides (TG), were determined using a Beckman Coulter AU analyzer (Beckman Coulter, Inc., Brea, CA, USA). Low-density lipoprotein cholesterol (LDL) concentrations were calculated using the Friedewald formula, and non-HDL cholesterol was calculated by subtracting HDL-C from total cholesterol.
2.6. Physical Activity Assessment
Physical activity was assessed using a short version of the International Physical Activity Questionnaire and was classified as low (≤600 metabolic equivalent [MET]/min/week), moderate (600–1499 MET/min/week), and high (≥1500 MET/min/week).
2.7. Mediterranean Diet Adherence
Adherence to the MedDiet was determined using the alternate Mediterranean Diet (aMED) score, originally described by Fung et al. [9]. Briefly, the aMED includes nine components: vegetables, legumes, fruits, nuts, whole grains, red and processed meats, fish, alcohol, and the ratio of monounsaturated to saturated fats. Median cut-points were calculated for all components, with one point awarded if the individual scored above the median for intake of vegetables, fruits, legumes, whole grain, nut, and fish intake, or if the monounsaturated:saturated fat ratio was above the median; one point was also awarded if the individual consumed median of less intake of red and processed meats. One point was given for consumption of 5–15 g of ethanol per day for women, which represents approximately 300 mL of regular beer, 150 mL of wine, or 35 mL of liquor, and zero points were awarded for consumption outside of these ranges. The total score ranged from zero to nine points, with higher scores indicating greater adherence to the MedDiet.
2.8. Statistical Analysis
Statistical analysis was performed using v. 13.0 Statistica software (TIBCO Software, Palo Alto, CA, USA). The Shapiro–Wilk test was used to verify whether a dataset follows a normal distribution. Since most variables did not meet the assumption of normality, non-parametric tests were used. Participants were grouped into tertiles based on aMED scores: tertile 1 (scores ≤ 3) represented those with the weakest adherence to the Mediterranean diet, whereas tertile 3 (scores ≥ 5) included those with the strongest adherence. Continuous variables are presented as medians with interquartile ranges (IQR), and categorical variables as counts and percentages (n, %). The Kruskal–Wallis test and Pearson’s chi-square test were applied to compare continuous and categorical variables across aMED tertiles, respectively.
Unadjusted and adjusted logistic regression analyses were conducted to examine the association between adherence to the Mediterranean diet (aMED score) and the odds of metabolic syndrome (MetS) and its individual components. The dependent variables were the presence of MetS and each of its components (dichotomous: 0 = no, 1 = yes), and the aMED score was treated as a continuous predictor. Covariates included total energy intake, years of education, years since menopause, physical activity level, and smoking status.
Additionally, unadjusted and adjusted logistic regression models were used to assess which individual food items typical of the Mediterranean diet were associated with the odds of MetS and its components. In these models, the dependent variables remained the same, while the consumption of specific food items (continuous) was used as the main predictor. The same set of covariates was included. A p-value < 0.05 (two sided) was considered statistically significant.
3. Results
The analysis included 312 menopausal women with a median age of 58 years (IQR: 53.0–63.0 years old) and a median aMED score of 4.0 (IQR: 3.0–5.0). Participants with a higher adherence to the MedDiet (tertile 3) generally exhibited a healthier diet, including a higher intake of vegetables, fruits, nuts, whole grains, legumes, and fish, while consuming less red and processed meats. Moreover, significantly more postmenopausal women with a higher adherence to the MedDiet stated that they consumed 5–15 g of ethanol in alcoholic drinks per day (Table 1). Significant differences were only observed in some of the MetS components, including the BMI, systolic blood pressure, and HDL-C levels. A higher aMED score was associated with a lower prevalence of central obesity (74% vs. 92%), hypertension (57% vs. 75%), and MetS (50% vs. 70%) in this study population (Table 1).
Table 2 shows the association between adherence to the MedDiet and the odds of MetS and its components. In the crude model, there was an association between adherence to the MedDiet and the odds of obesity, central obesity, hypertension, and MetS. However, after adjusting for relevant confounders, adherence to the MedDiet was associated only with lower odds of having central obesity and hypertension, although the prevalence of obesity and MetS in our population was as high as 52% and 61%, respectively (Table 1). In particular, for each one-point increase in the aMED score (indicating a better adherence to the MedDiet), the odds of central obesity and hypertension significantly reduced by 33% (OR = 0.669, 95% CI: 0.518; 0.866, p = 0.002) and by 18% (OR = 0.817, 95% CI: 0.689; 0.969, p = 0.020), respectively (Table 2).
In the fully adjusted model of how individual food items related to the odds of central obesity and hypertension (Table 3), a higher consumption of nuts and fish was associated with a lower odds of central obesity (OR = 0.972, 95% CI: 0.950; 0.995; p = 0.016) and (OR = 0.989, 95% CI: 0.979; 1.000; p = 0.043), respectively, whereas a higher consumption of red processed meats was associated with a greater odds of hypertension (OR = 1.004, 95% CI: 1.000; 1.008, p = 0.048). There were no associations between the incidence of central obesity and hypertension and the consumption of other food items, such as vegetables, legumes, fruit, whole grains, the monounsaturated to saturated fat ratio, or alcohol intake.
4. Discussion
This cross-sectional study was designed to investigate the association between adherence to the Mediterranean diet and the odds of having MetS and its components among Polish postmenopausal women. Based on the findings from our study, a greater adherence to the MedDiet was associated with lower odds of central obesity and hypertension among postmenopausal women, but it did not translate to a reduced likelihood of having MetS. More specifically, for each one-point increase in the aMED score (indicating a better adherence to the MedDiet), the odds of having central obesity and hypertension were significantly reduced by 33% and 18%, respectively.
The food groups associated with lower odds of central obesity were nuts and fish, whereas a higher consumption of processed red meat was associated with hypertension. To the best of our knowledge, this is the first complex study focused on this target population. Previously, Leone et al. reported that a greater adherence to the MedDiet reduced the risk of metabolically unhealthy obesity in postmenopausal but not in premenopausal women [7]. Overall, our findings regarding individual metabolic alterations are in line with those of previous articles, where adherence to the MedDiet is inversely associated with abdominal adiposity [10] and hypertension [11]. The beneficial effect of this diet in reducing central adiposity may be associated with its high content of polyunsaturated fatty acids (PUFAs) and MUFAs and low levels of saturated fatty acids (SFAs) [12]. Visceral adipose tissue consists predominantly of SFAs, whereas subcutaneous fat has deposits of PUFAs and MUFAs [13]. The main sources of n-3 PUFAs in the MedDiet are fish, seafood, and nuts, while olive oil is the main source of MUFAs [14]. Indeed, in our study, the food groups most significantly associated with lower odds of central obesity in postmenopausal women were nuts and fish. Specifically, the most prominent fatty acids in nuts are linoleic acid, oleic acid, and α-linolenic acid, the latter being especially abundant in walnuts [15]. Cubas-Basterrechea et al. observed that the consumption of less than the recommended 30 g of nuts at least three times a week was linked to a 19% higher prevalence of central obesity and a 61% higher prevalence of MetS compared to the recommended level in an older Spanish population [16]. A dose–response meta-analysis of prospective observational studies found an inverse association between nut consumption and abdominal obesity (RR: 0.42, 95% CI: 0.31, 0.57). However, the authors also indicated that the quality of the evidence was rather low [17]. Several studies have explored the effects of fish consumption on the risk of developing MetS. In the SEAFOODPlus study, in which 126 overweight adults were randomized to a calorie-restricted diet with or without 150 g/day of fish (cod), five times per week for eight weeks, participants who consumed fish lost 1.7 kg more body weight than the control group, and experienced a 3.4 cm reduction in WC and a 5.2 mmHg reduction in systolic blood pressure [18]. In a South Korean cohort study, an average daily fish consumption of between 40 and 70 g per day was associated with a 57% reduction in the risk of developing MetS, albeit only among men [19]. An earlier dose–response meta-analysis of prospective observational studies also found fish intake to be associated with reduced abdominal obesity [17].
In our study, processed red meat consumption was associated with higher odds of hypertension, consistent with findings from previous cross-sectional studies [20,21]. However, an increased risk of developing hypertension in a Brazilian population was associated with a moderate and high consumption of processed meats but not with the consumption of red meat [22]. It is of note that the available data also demonstrate that the intake of white meat (such as poultry) is associated with more favorable hypertension outcomes than the consumption of red meat [23]. Many hypotheses exist regarding the association of red meat with a higher risk of hypertension, particularly that of processed red meat. The higher risk associated with processed red meat may be related to its sodium content, additives, and their metabolism by the gut microbiome into deleterious metabolites [23]. Studies to date have outlined the potential mechanistic roles of SCFAs in mediating host–microbe communication in hypertension, often acting via host SCFA G-protein-coupled receptors. Similarly, there are clear roles for trimethylamine-N oxide (TMAO) in cardiovascular diseases [24].
Although the cross-sectional study conducted in 10 European countries, found an association between adherence to the Mediterranean diet (rich in plant-based foods and unsaturated fatty acids) and lower abdominal adiposity in men and women [25], we did not observe such an association with the plant-based components of the MedDiet (e.g., fruits and vegetables, olive oil, and legumes). The lack of an observed association may be attributed to methodological limitations, as focusing on individual food items does not take into account other dietary factors that may influence the results, nor the synergistic effects between foods and nutrients [26]. Although a recent meta-analysis of observational studies provided evidence that a greater adherence to the MedDiet was associated with reduced odds of having MetS [6], no such association was found in the present study, especially after adjusting for the relevant confounders. This suggests that the observed association was likely due to confounding variables rather than a direct causal link between the MedDiet and MetS. Indeed, it was suggested that women, non-smokers, and physically active with a higher educational level have a healthier dietary pattern [27]. In our study population, no associations were found also between adherence to the MedDiet and the odds of having hyperglycemia or elevated non-HDL cholesterol levels. Papadaki et al. (2020) in a meta-analysis of RCTs observed a greater effect of the MedDiet on blood glucose but only in studies conducted in Mediterranean countries compared to non-Mediterranean countries [28]. This may be due to the better availability of the required food items, and other eating-related behaviors such as the time of eating, the order of courses in each meal, or sun exposure in the Mediterranean region [29]. Indeed, Boujelbane et al., 2025 noted that those living in Mediterranean regions show a better adherence to traditional MedDiet components (legumes and fish) than those from non-Mediterranean regions [30]. These findings align with those of previous research showing that Mediterranean populations are more likely to adhere to the principles of the MedDiet [31]. Previously, we also showed the better effects of the Central European Diet in a group of postmenopausal women, possibly because of the native character of this diet for the target population [32,33].
The present study findings should be considered in light of some limitations. First, our study has an observational design, and cannot establish causal relationships between adherence to the MedDiet and MetS or its components, only associations. Second, as with all studies that use self-reported dietary assessment methods, the widely acknowledged underreporting of energy intake, especially among women with a higher BMI, may cause selection bias. For this reason, energy intake was used as a potential confounder. Moreover, the short time frame may not accurately represent an individual’s typical dietary intake, due to the daily variations in food and nutrient consumption. Third, only postmenopausal women were included; therefore, these findings cannot be generalized to other populations. Moreover, being diagnosed with MetS could lead to behavior changes in dietary intake, which could represent another potential limitation. A final limitation of the study is the omission of potential confounders, such as medication use, which may have influenced the observed associations.
Nonetheless, this study has several strengths, especially considering that only postmenopausal women were included in the study. Our findings that the Mediterranean dietary pattern may help prevent the development of central obesity and hypertension in postmenopausal women are, therefore, very strong. Moreover, the use of the aMED score as a tool for evaluating adherence to the MedDiet may be used even in populations outside the Mediterranean region [34].
5. Conclusions
Based on the findings from our study, a greater adherence to the MedDiet was associated with lower odds of having abdominal obesity and hypertension in a group of postmenopausal women, but it did not translate into a reduction in the odds of having MetS. For each one-point increase in the aMED score (indicating a better adherence to the MedDiet), the odds of having central obesity and hypertension were significantly reduced by 33% and 18%, respectively. The higher consumption of nuts and fish was associated with lower odds of central obesity, whereas a higher consumption of red, processed meats was associated with higher odds of hypertension. Longitudinal studies are needed in order to determine the causality of these relationships. It is recommended that adherence to the MedDiet be encouraged in non-Mediterranean populations. This should focus on education, cultural adaptation, and addressing practical barriers, highlighting the health benefits of the Mediterranean diet, and providing support through nutritional guidance and potentially by subsidizing access to key dietary components.
Author Contributions
Conceptualization, J.B., M.D.-K., W.S. and J.W.; methodology, J.B., M.D.-K. and W.S.; formal analysis, J.B., M.D.-K. and W.S.; investigation, J.B. and A.S.-R.; resources, J.B. and A.S.-R.; data curation, J.B., A.S.-R. and J.W.; writing—original draft preparation, J.B.; writing—review and editing, J.B., A.S.-R., M.D.-K., W.S. and J.W.; supervision, J.B. and J.W.; funding acquisition, J.B. and A.S.-R. All authors have read and agreed to the published version of the manuscript.
Funding
This work was co-financed by a Polish National Science Centre award (grant number No. DEC-2013/09/B/NZ9/02365 and UMO-2018/29/N/NZ9/01700).
Institutional Review Board Statement
The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the local ethics committee at Poznan University of Medical Sciences (No. 664/20—9 September 2020 and No. 603/14—12 June 2014).
Informed Consent Statement
Informed consent was obtained from all study subjects.
Data Availability Statement
The data presented in this study are available upon request from the corresponding author due to privacy and ethical restrictions.
Acknowledgments
The authors thank all the study participants and students who helped in data collection.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
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Figure 1.
STROBE flow chart.
Table 1.
Characteristics of the study participants.
| Participants by Mediterranean Diet Adherence Score | |||||
|---|---|---|---|---|---|
| Variables | All (n = 312) | T1: 0–3 (n = 149) | T2: 4 (n = 74) | T3: 5–9 (n = 90) | p-value * |
| Median (1st–3rd quartile) | Median (1st–3rd quartile) | Median (1st–3rd quartile) | Median (1st–3rd quartile) | ||
| Sociodemographic and Anthropometric Data | |||||
| Age [y] | 58.0 (53.0–63.0) | 58.0 (53.0–62.0) | 58.0 (54.0–63.0) | 57.0 (52.0–62.0) | 0.594 |
| Years since menopause [y] | 6.0 (2.0–11.0) | 7.0 (2.0–11.0) | 6.0 (2.0–12.0) | 5.0 (2.0–11.0) | 0.616 |
| Duration of education [y] | 17.0 (17.0–17.0) | 12.0 (12.0–17.0) | 17.0 (12.0–17.0) | 17.0 (17.0–17.0) | <0.001 |
| Current or former smoker (n, %) | 64 (20.5) | 38 (26) | 13 (18) | 38 (14) | 0.099 |
| Body weight [kg] | 78.6 (68.2–88.5) | 79.7 (72.4–88.6) | 79.8 (70.7–88.6) | 73.9 (63.6–87.0) | 0.057 |
| FAT [kg] | 36.0 (27.6–44.2) | 37.0 (30.8–44.3) | 36.4 (28.5–44.0) | 32.7 (24.0–44.0) | 0.100 |
| FFM [%] | 54.3 (49.2–59.3) | 53.7 (48.9–58.3) | 54.5 (49.8–59.9) | 54.9 (49.5–61.6) | 0.188 |
| WHtR | 0.62 (0.58–0.68) | 0.63 (0.59–0.68) | 0.62 (0.58–0.68) | 0.62 (0.54–0.68) | 0.100 |
| Dietary Intake | |||||
| Vegetables [g/d] | 318.8 (202.0–452.4) | 232.5 (158.4–361.8) | 378.2 (259.7–453.6) | 402.2 (321.4–520.6) | <0.001 |
| Legumes [g/d] | 0.0 (0.0–0.0) | 0.0 (0.0–0.0) | 0.0 (0.0–0.0) | 0.0 (0.0–10.0) | <0.001 |
| Fruit [g/d] | 224.6 (109.2–378.8) | 160.7 (81.3–269.2) | 271.9 (132.5–440.3) | 322.2 (184.8–423.0) | <0.001 |
| Nuts [g/d] | 0.0 (0.0–4.1) | 0.0 (0.0–0.0) | 0.0 (0.0–4.0) | 2.5 (0.0–10.0) | <0.001 |
| Whole grains [g/d] | 76.3 (36.5–121.7) | 53.3 (17.9–110.0) | 86.3 (47.0–121.6) | 100.0 (63.3–136.7) | <0.001 |
| Red and processed meats [g/d] | 60.2 (28.6–107.6) | 75.0 (41.9–121.5) | 54.3 (30.0–96.6) | 38.0 (12.8–77.5) | <0.001 |
| Fish [g/d] | 0.0 (0.0–30.0) | 0.0 (0.0–0.0) | 0.0 (0.0–36.7) | 24.5 (0.0–50.0) | <0.001 |
| MUFA:SFA | 1.0 (0.82–1.22) | 0.98 (0.82–1.26) | 0.99 (0.82–1.18) | 1.1 (0.84–1.26) | 0.302 |
| Alcohol intake [g/d] | 0.0 (0.0–2.8) | 0.0 (0.0–0.0) | 0.0 (0.0–3.9) | 0.0 (0.0–5.6) | 0.004 |
| Alcohol intake 5–15 g/day (n, %) | 46 (15) | 10 (7) | 12 (16) | 24 (27) | <0.001 |
| Energy intake [kcal/d] | 1596.8 (1311.7–1946.3) | 1544.9 (1268.2–1904.5) | 1498.5 (1291.7–1953.8) | 1731.5 (1453.8–2015.2) | 0.035 |
| %E protein | 16.4 (14.0–18.8) | 16.7 (14.4–19.1) | 15.9 (13.6–18.8) | 15.6 (13.6–18.5) | 0.125 |
| %E fat | 22.9 (12.9–32.8) | 22.0 (13.8–33.2) | 19.0 (11.2–30.0) | 27.5 (13.5–32.9) | 0.088 |
| %E carbohydrate | 53.3 (45.8–60.4) | 51.7 (44.8–59.7) | 53.0 (48.4–63.6 | 52.1 (46.4–58.6) | 0.165 |
| Dietary fiber [g/d] | 21.4 (15.9–26.8) | 18.3 (13.3–23.7) | 22.9 (17.2–28.1) | 24.6 (19.9–30.1) | <0.001 |
| Physical Activity | |||||
| Low < 600 MET/min/wk (n, %) | 64 (20.5) | 28 (19) | 21 (28) | 15 (17) | 0.148 |
| Moderate 600–1499 MET/min/wk (n, %) | 222 (71) | 112 (75) | 45 (61) | 65 (72) | |
| High > 1499 MET/min/wk (n, %) | 26 (8.0) | 9 (6) | 8 (11) | 10 (11) | |
| MetS and Its Components | |||||
| BMI [kg/m2] | 30.3 (26.2–34.5) | 30.7 (27.6–34.6) | 30.4 (26.3–34.0) | 28.5 (23.2–34.9) | 0.024 |
| Obesity ≥ 30 kg/m2 (n, %) | 162 (52) | 84 (56) | 39 (93) | 40 (44) | 0.196 |
| Waist circumference [cm] | 101.0 (93.8–109.2) | 102.0 (96.0–109.0) | 101.0 (94.5–109.0) | 99.3 (87.5–110.0) | 0.209 |
| Central obesity ≥ 88 cm (n, %) | 273 (76) | 137 (92) | 69 (95) | 67 (74) | <0.001 |
| Systolic blood pressure [mmHg] | 133.5 (124.7–147.0) | 134.0 (129.7–147.0) | 137.0 (121–154.0) | 130.0 (122–140.0) | 0.118 |
| Diastolic blood pressure [mmHg] | 83.8 (79.0–92.0) | 84.0 (79.7–91.0) | 86.0 (78.3–94.7) | 81.5 (79.0–90.0) | 0.319 |
| Hypertension ≥ 130/85 mmHg (n, %) | 208 (66.7) | 112 (75) | 45 (62) | 51 (57) | 0.008 |
| Blood glucose [mg/dL] | 94.7 (86.0–100.8) | 94.1 (87.0–102.0) | 94.9 (86.0–100.0) | 94.5 (85.0–100.0) | 0.830 |
| Blood glucose ≥ 100 mg/dL (n, %) | 87 (28) | 47 (33) | 18 (26) | 23 (27) | 0.431 |
| Triglycerides [mg/dL] | 126.0 (86.8–170.0) | 128.3 (91.0–167.6) | 125.5 (89.0–167.0) | 118.9 (79.0–178.3) | 0.447 |
| Total Cholesterol [mg/dL] | 227.0 (198.2–255.0) | 226.0 (201.0–252.0) | 227.5 (196.3–253.3) | 227.5 (196.0–260.8) | 0.995 |
| HDL-C [mg/dL] | 58.0 (48.0–68.0) | 56.6 (47.0–66.0) | 60.5 (49.9–70.0) | 58.0 (50.0–69.0) | 0.256 |
| non-HDL [mg/dL] | 166.5 (136.0–196.0) | 169.2 (140.0–198.0) | 161.0 (135.0–195.7) | 160.4 (134.0–195.0) | 0.734 |
| Non-HDL ≥ 130 mg/dL (n, %) | 243 (78) | 117 (82) | 57 (81) | 69 (80) | 0.919 |
| LDL-C [mg/dL] | 139.0 (114.0–162.9) | 139.0 (115.3–165.0) | 137.5 (112.0–159.4) | 141.0 (110.0–162.9) | 0.899 |
| Metabolic syndrome (yes, %) | 191 (61) | 104 (70) | 42 (58) | 45 (50) | 0.007 |
The results are presented as medians with IQR. Categorical data as n (%). * The categorical data were analyzed using Chi-squared test, while Kruskal–Wallis test was applied to continuous data. Abbreviations: BMI: body mass index (calculated as weight in kilograms divided by height in meters squared); HDL: high-density lipoprotein; MUFA:SFA: monounsaturated fatty acids to saturated fatty acids; LDL: low-density lipoprotein; T: tertile; WHtR: waist-to-height ratio (calculated as waist circumference divided by height in centimeters).
Table 2.
Association between adherence to the MedDiet and odds of having MetS and its components.
| Variables | OR | 95% CI | p-Value |
|---|---|---|---|
| Obesity ≥ 30 kg/m2 | |||
| Crude model | 0.848 | 0.730; 0.986 | 0.032 |
| Adjusted model | 0.904 | 0.760; 1.074 | 0.250 |
| Central obesity ≥ 88 cm | |||
| Crude model | 0.633 | 0.500; 0.803 | <0.001 |
| Adjusted model | 0.669 | 0.518; 0.866 | 0.002 |
| Hypertension ≥ 130/85 mmHg | |||
| Crude model | 0.779 | 0.663; 0.915 | 0.002 |
| Adjusted model | 0.817 | 0.689; 0.969 | 0.020 |
| Non-HDL-C levels ≥ 130 mg/dL | |||
| Crude model | 1.080 | 0.887; 1.316 | 0.443 |
| Adjusted model | 1.086 | 0.879; 1.342 | 0.444 |
| Blood glucose ≥ 100 mg/dL | |||
| Crude model | 0.851 | 0.717; 1.009 | 0.064 |
| Adjusted model | 0.875 | 0.726; 1.055 | 0.163 |
| Presence of MetS (yes) | |||
| Crude model | 0.810 | 0.693; 0.945 | 0.008 |
| Adjusted model | 0.863 | 0.730; 1.019 | 0.082 |
Values are odds ratios (OR) and 95% CI obtained from logistic regression models. The multivariate model was adjusted for energy intake and years of education, years since menopause, category of physical activity, and smoking status.
Table 3.
Association of individual food items with the odds of central obesity and hypertension.
| Variables | Central Obesity | Hypertension | ||||
|---|---|---|---|---|---|---|
| OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
| Vegetables [g/d] | 0.998 | 0.996; 1.000 | 0.059 | 0.999 | 0.998; 1.000 | 0.137 |
| Legumes [g/d] | 1.011 | 0.979; 1.045 | 0.503 | 1.002 | 0.989; 1.016 | 0.725 |
| Fruit [g/d] | 0.999 | 0.998; 1.001 | 0.537 | 0.999 | 0.998; 1.001 | 0.290 |
| Nuts [g/d] | 0.972 | 0.950; 0.995 | 0.016 | 0.994 | 0.975; 1.014 | 0.558 |
| Whole grains [g/d] | 0.996 | 0.991; 1.002 | 0.203 | 1.003 | 0.999; 1.007 | 0.194 |
| Red and processed meats [g/d] | 1.004 | 0.998; 1.011 | 0.192 | 1.004 | 1.000; 1.008 | 0.048 |
| Fish [g/d] | 0.989 | 0.979; 1.000 | 0.043 | 0.995 | 0.987; 1.003 | 0.186 |
| MUFA:SFA | 1.070 | 0.314; 3.644 | 0.914 | 1.315 | 0.593; 2.919 | 0.500 |
| Alcohol intake [g/d] | 1.004 | 0.950; 1.061 | 0.891 | 0.994 | 0.954; 1.036 | 0.771 |
Values are odds ratios (OR) and 95% CI obtained from logistic regression models adjusted for energy intake and years of education, years since menopause, category of physical activity, and smoking status. MUFA:SFA: monounsaturated fatty acids to saturated fatty acids.
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Bajerska, J.; Skoczek-Rubińska, A.; Dębińska-Kubiak, M.; Stanisławska, W.; Walkowiak, J. Association Between Adherence to the Mediterranean Diet and Metabolic Syndrome and Its Components Among Polish Postmenopausal Women: A Cross-Sectional Study. Nutrients 2025, 17, 2727. https://doi.org/10.3390/nu17172727
AMA Style
Bajerska J, Skoczek-Rubińska A, Dębińska-Kubiak M, Stanisławska W, Walkowiak J. Association Between Adherence to the Mediterranean Diet and Metabolic Syndrome and Its Components Among Polish Postmenopausal Women: A Cross-Sectional Study. Nutrients. 2025; 17(17):2727. https://doi.org/10.3390/nu17172727
Chicago/Turabian StyleBajerska, Joanna, Aleksandra Skoczek-Rubińska, Magdalena Dębińska-Kubiak, Wiktoria Stanisławska, and Jarosław Walkowiak. 2025. "Association Between Adherence to the Mediterranean Diet and Metabolic Syndrome and Its Components Among Polish Postmenopausal Women: A Cross-Sectional Study" Nutrients 17, no. 17: 2727. https://doi.org/10.3390/nu17172727
APA StyleBajerska, J., Skoczek-Rubińska, A., Dębińska-Kubiak, M., Stanisławska, W., & Walkowiak, J. (2025). Association Between Adherence to the Mediterranean Diet and Metabolic Syndrome and Its Components Among Polish Postmenopausal Women: A Cross-Sectional Study. Nutrients, 17(17), 2727. https://doi.org/10.3390/nu17172727
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