Mediterranean Diet and Quality of Life in Adults: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy and Study Selection
2.2. Data Extraction and Quality Assessment
3. Results
3.1. Overview of the Study Selection
3.2. Characteristics of the Studies Included
3.3. Details of the Main Results of the Studies Included: General Population
3.4. Details of the Main Results of the Studies Included: Patient Population
Author, Year | Study Design | Study Name, Country (Follow-up) | Population, Number and Sex (Age) | Dietary Assessment | Mediterranean Diet Assessment | QoL Assessment | Main Findings |
---|---|---|---|---|---|---|---|
Alcubierre, 2016 [58] | Cross-sectional | Spain | 294 MF with T2DM | Semi-quantitative 101-item FFQ | 18-point rMED | ADDQoL-19 | Higher adherence to the Mediterranean diet was positively associated with several HRQoL dimensions, such as self-confidence, freedom to eat, and freedom to drink, but no overall HRQoL scores. |
Sanchez-Aguadero, 2016 [63] | Cross-sectional | MARK study, Spain | 314 MF, intermediate CVD risk (35–74 y) | Not assessed | 9-item short questionnaire | SF-12 | Mental, social functioning, and vitality components were related to the Mediterranean diet total score. In multiple linear regression analysis for each 1-point increase in the Mediterranean diet adherence score, there was a 1.2-point increase in the mental component score. |
Veronese, 2016 [67] | Cross-sectional | OAI, USA | 4470 Knee osteoarthritis or high risk, MF | 70-item FFQ | 11-item aMED | SF-12 | Higher SF-12 physical and mental health scores were shown by participants with higher adherence to the Mediterranean diet. Higher aMED was associated with better HRQoL and decreased pain, disability and depressive symptoms. |
Galilea-Zabalza, 2018 [57] | Cross-sectional | PREDIMED-Plus study, Spain | 6430 overweight or obese metabolic syndrome, M (55–75 y), F (60–75 y) | 17-item questionnaire of adherence to a Mediterranean Diet | 17-item Mediterranean diet screener | SF-36 | Higher adherence to the Mediterranean diet was independently associated with significantly better scores in the eight dimensions of HRQoL. Adjusted differences of >=3 points were observed for vitality, emotional role and mental health between the grouops of highest and lowest adherence to the Mediterranean diet and of >=2 points for the other dimensions. Adherence to a Mediterranean diet and several dimensions of quality of life have shown a positive association. |
Korovesi, 2019 [65] | Case-control | Greece | 69 mild-to-severe psoriasis, 69 healthy controls, MF (47 y) | Not assessed | 12-item MDS | DLQI | Adherence to the Mediterranean diet was independently and inversely associated with psoriasis occurrence, severity, and quality of life. |
Özata Uyar, 2019 [64] | Cross-sectional | Turkey | 139 coronary artery disease, MF | Not assessed | 14-item MEDAS | SF-36 | A significant positive correlation was reported between Mediterranean diet and all physical component summary (PCS, its subscales) and most mental component summary (MCS) (except emotional role and social health subscales) (p < 0.05). Inverse significant associations were observed between BMI, waist circumference, waist/height ratio, percent of body fat and both PCS and MCS (including most subscales). |
Porciello, 2020 [73] | Cross-sectional | Italy | 309 F with breast cancer (mean age 52.0 ± 9.2 y) | Not assessed | 14-item PREDIMED | EQ-5D-3L, EORTC QLQ-C30, EORTC QLQ-BR-23 | Higher adherence to the Mediterranean diet was positively associated with better physical functioning and wellbeing, and inversely associated with pain and insomnia. |
Gils Contreras, 2020 [82] | Prospective | Spain (12 m) | 78 people with obesity pending laparoscopic bariatric surgery, MF (18–66 y) | Not assessed | MEDAS | Moorehead–Ardelt Quality of Life questionnaire II. | Greater adherence to the Mediterranean diet following bariatric surgery was associated with greater weight loss in morbidly obese participants after bariatric surgery. However, neither the Mediterranean diet nor physical activity after surgery seems to have a direct influence on the HRQoL or food tolerance. |
Granado-Casas, 2020 [61] | Cross-sectional | Spain | 258 T1D, MF (>18 y) | 101-item FFQ | 10-item aMED | ADDQoL-19 | Participants with T1D, and with a moderate and higher adherence to the Mediterranean diet, reported greater HRQoL. |
Barchitta, 2020 [74] | Cross-sectional | Italy | 68 breast cancer patients (36–68 y) | Not assessed | 14-item MEDAS | EORTC QLQ-C30 | Patients with higher adherence to the Mediterranean diet showed relations between global health status and specifically emotional, cognitive, and social functioning, although the differences from lower adherence groups were not significant. |
Papada, 2020 [70] | Cross-sectional | Greece | 86 patients with Crohn’s disease | Not assessed | 11-item MDS | IBDQ | Higher adherence to the Mediterranean diet was correlated with IBDQ and disease activity. |
Cordwell, 2021 [60] | Case–control | Australia | 87 T2DM and 65 controls (>60 y) | Not assessed | 14-item MEDAS | SF-36 | Adherence to a Mediterranean diet was positively associated with the general health subscale of HRQoL, which was the most apparent in middle-aged to older adults with T2DM. Unable to rule out reverse causation. The T2DM cohort reported greater adherence to a Mediterranean diet compared with the non-T2DM cohort, although this was non-significant. |
Picard, 2021 [81] | Prospective | Canada (5 y) | 50 T1D/T2DM and stage 1–4 Chronic kidney disease, MF (18–80 y) | 3-day food record | 9-point MDS | SF-36, MDI | Adherence to the Mediterranean diet was overall moderate, though consistent over time, in patients living with diabetes and chronic kidney disease. No association between MDS and cardiometabolic risk factors; however, there was an association between lower MDS and lower kidney function. Higher MDS was associated with better mental and general health domains of HRQoL. |
Floria, 2022 [75] | Cross-sectional | Greece | 105 end-stage chronic kidney disease, MF (mean age 63.4 y) | Not assessed | 9-item MDS | KD-QoL-SF | Adherence to the Mediterranean Diet was not correlated to the total QoL. |
Gitto, 2022 [76] | Cross-sectional | Italy | 511 liver transplant recipients, MF (≥18 y) | Not assessed | 9-item MEDI-LITE | SF-12 | The Mediterranean diet might help liver transplant recipients to improve their QoL. |
Kontopoulou, 2023 [66] | Cross-sectional | Greece | 85 asthma, MF, mean age 57 y | Not assessed | 11-item MDS | AQLQ, SF-12 | There was a significant correlation between moderate adherence to the Mediterranean diet and a relatively good level of HRQoL of the patients. |
Çelik, 2023 [68] | Cross-sectional | Turkey | 83 IBD, MF (≥18 y) | Not assessed | MEDAS | SF-36 | Stronger adherence to the Mediterranean diet may help modulate disease activity and enhance HRQoL in ulcerative colitis patients, whereas its effects on Crohn’s disease remain inconclusive. |
Kudret, 2023 [59] | Cross-sectional | Cyprus | 200 T2DM, MF (30–65 y) | Not assessed | 14-item MEDAS | SF-36 | Participants with moderate adherence to the Mediterranean diet had higher physical function scores than those who had low adherence. |
Cadenhead, 2023 [72] | Cross-sectional | NHANES (2009–2014), US | 80 MF (adults and teens) with celiac disease and 15,777 adults and 2296 teens without celiac disease | Three 24 h recalls | 9-item aMED | CDQOL, CDPQOL | Higher quality of life was found in teens with higher adherence to the Mediterranean diet, but not in adults. |
Dakanalis, 2024 [78] | Cross-sectional | Greece | 558 multiple sclerosis, MF (18–64 y) | Not assessed | 11-item MDS | MSQOL-54 | Higher Mediterranean diet adherence was related with a decreased disease disability symptoms’ intensity, as well as an improved HRQoL, a higher physical activity status, and fewer depressive symptoms. |
Tryfonos, 2024 [79] | Cross-sectional | Greece | 227 Multiple sclerosis, MF (>65 y) | Not assessed | 11-item MDS | MSQOL-54 | Higher Mediterranean diet compliance was independently associated with a lower prevalence of advanced disease progression, higher HRQoL, healthier BMI, and greater muscle mass. |
Uygun Özel, 2024 [80] | Cross-sectional | Turkey | 95 Multiple sclerosis, MF (18–65 y) | FFQ | 14-item MEDAS | MSQOL-54 | Adherence to the Mediterranean diet was associated with physical and mental quality of life parameters, independent of progression of disease. The HRQoL and disability level of multiple sclerosis patients was also associated with some food groups: daily fruit consumption was associated with mental health, and vegetable consumption was associated with both mental and physical components of the HRQoL score. |
Migdanis, 2024 [69] | Cross-sectional | Greece | 60 Crohn’s disease, MF (mean age 37.6 y) | 11-item MDS | CUCQ-8 | Patients with inactive Crohn’s disease demonstrated significantly greater adherence to the Mediterranean diet compared to those with active disease (p = 0.019). Moreover, adherence to this dietary pattern was inversely associated with disease activity (p = 0.039) and positively correlated with quality of life (p = 0.046). Notably, higher levels of consumption of fruits, vegetables, and dairy products was linked to disease remission (p = 0.046, p = 0.001, p = 0.041, respectively). The Mediterranean diet may contribute to modulating disease activity and enhancing the quality of life in patients with Crohn’s disease. | |
Christodoulou, 2024 [71] | Cross-sectional | Greece | 338 of which 50 with IBD, MF | 14-item MEDAS | EQ-5D-5L | The Mediterranean diet showed a moderate correlation with HRQoL in healthy individuals (r = 0.131, p < 0.05), while no significant association was observed among IBD patients. | |
Diaz-Gonzalez, 2024 [83] | Prospective | Spain | 56 bariatric patients with obesity, MF (mean age 43.8 y) | 14-item MEDAS | SF-36 | Greater Mediterranean diet adherence did not affect both physical and mental components of HRQoL. | |
Nunez-Baila, 2024 [62] | Cross-sectional | Spain | 362 T1DM, MF (18–29 y) | MEDAS | ViDa1 | Higher adherence to the Mediterranean diet correlated with improved wellbeing and self-care. Multivariable regression analysis revealed that insomnia had a stronger influence on HRQoL compared to glycemic control or dietary habits. | |
Gitto 2024 [77] | Cross-sectional | Italy | 511 liver transplant recipients, MF (≥18 y) | Not assessed | 9-item MEDI-LITE | SF-12 | Higher adherence to the Mediterranean diet was associated with a better physical component of quality of life. |
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
Abbreviations
ACT | Asthma Control Test |
ADDQoL-19 | Audit of Diabetes-Dependent Quality of Life |
AHT | Anti-Hypertension Medication |
AQLQ | Asthma Quality of Life Questionnaire |
BMI | Body Mass Index |
CAD | Coronary artery disease |
CDQOL | Celiac Disease-Specific Quality of Life |
CDPQOL | Celiac Disease Pediatric-Specific Quality of Life |
CKD | Chronic kidney disease |
CUCQ-8 | Crohn’s and Ulcerative Colitis Questionnaire |
CVD | Cardiovascular disease |
DEP | Dynamic exercise program |
DLQI | Dermatology Life Quality Index |
DTSQ-s | Diabetes Treatment Satisfaction Questionnaire-status version |
EDSS | Expanded Disability Status Scale |
EQ-5D-3L | European Quality of Life 5 Dimensions 3 Level |
FFQ | Food Frequency Questionnaire |
GESTAFIT | Gestation and Fitness Project |
HRQoL | Health-related quality of life |
IBD | Inflammatory bowel disease |
IBDQ | Inflammatory Bowel Disease Questionnaire |
IMI | Italian Mediterranean Diet Index |
IPAQ | International Physical Activity Questionnaire |
LDL-c | LDL-cholesterol |
MANSA | Manchester Short Assessment of Quality of Life |
MCS | Mental Component Summary |
MEDAS | Mediterranean Diet Adherence Screener |
MEDIS-FFQ | Mediterranean Diet Score Short Food Frequency Questionnaire |
MetS | Metabolic Syndrome |
MDS | Mediterranean Diet Score |
MINOA | Mediterranean Diet in Older Adults |
MOOSE | Meta-Analyses of Observational Studies in Epidemiology |
MSQOL-54 | Multiple Sclerosis Quality of Life-54 Instrument |
OAI | Osteoarthritis initiative |
PCA | Principal component analysis |
PCS | Physical component summary |
PREDIMED | Prevention with Mediterranean Diet |
PUFA | Polyunsaturated fatty acids |
rMED | relative Mediterranean Score |
RAND-36 | RAND 36-Item General Health Survey |
RFS | Recommended Food Score |
ROS | Reactive oxygen species |
SF-12 | 12-Item Short-Form Health Outcome Survey |
SF-36 | 36-item Short Form Health Outcome Study |
SUN | Seguimento Universidad de Navarra |
SWLS | Satisfaction with Life Scale |
T1D/T2DM | Type 1/2 Diabetes Mellitus |
UAM-MDP | Mediterranean Dietary Pattern Index |
WELL | Wellbeing, Eating and Exercise for a Long Life |
WHR | Waist/hip ratio |
WHOQoL-BREF | World Health Organization Quality of Life Brief Version |
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Author, Year | Study Design | Study Name, Country (Follow-up) | Population, Number and Sex (Age) | Dietary Assessment | Mediterranean Diet Assessment | QoL Assessment | Main Findings |
---|---|---|---|---|---|---|---|
Munoz, 2009 [38] | Cross-sectional | Spain | 3054 MF (25–74 y) and 6322 MF (35–88) | 165-item FFQ | 9-item MDS | SF-12 | The age-adjusted linear regression analysis revealed a significant direct association of the MDS with self-reported mental and physical health in both sexes. |
Henrìquez Sànchez, 2012 [39] | Prospective | SUN cohort, Spain (4 y) | 11,015 MF (interquartile 27–45 y) | 136-item FFQ | 9-item MDS | SF-36 | Adherence to the Mediterranean diet was directly associated with self-perceived mental and physical quality of life. This association was stronger for the physical domains. |
Bonaccio, 2013 [46] | Cross-sectional | Moli-sani study, Italy | 16,937 MF (>35 y) | 188-item FFQ, PCA, FAC | 9-item MDS, 11-item IMI | SF-36 | Adherence to a Mediterranean diet pattern is associated with better HRQoL. Stronger association with mental health than with physical health. Neither the antioxidant content of diet nor the dietary fiber intake influenced the association between Mediterranean scores and physical health. |
Milte, 2015 [53] | Prospective | WELL study, Australia (2 y) | 2457 MF (55–65 y) | 111-item FFQ | 8-item MDS (no olive oil in FFQ) | RAND-36 | Higher MDS was correlated with HRQoL after two years. In women, higher adherence to the Mediterranean diet was linked to enhanced general health and energy, while higher overall diet quality was connected to better emotional wellbeing and improved physical functioning. |
Pèrez-Tasigchana, 2015 [55] | Prospective | UAM cohort (3 y) and Seniors-ENRICA (4 y), Spain | 2376 MF and 1911 MF (>60 y) | Diet history | 8-item UAM-MDP, 14-item PREDIMED score, 9-item MDS | SF-36, SF-12 | After follow-up, no relevant association was found between higher adherence to the Mediterranean diet and better HRQoL. |
Zaragoza-Martì, 2018 [40] | Cross-sectional | Spain | 351 MF (>60 y) | MEDIS-FFQ | 9-item MDS | SF-12 | Mediterranean diet adherence was linked to HRQoL. Participants with greater adherence to the Mediterranean diet were more physically active, had better HRQoL and consumed less alcoholic beverages. The adherence to the Mediterranean diet was directly associated with self-perceived physical and mental function in both men and women, as well as with life satisfaction among women. |
Godos, 2019 [47] | Cross-sectional | Italy | 1937 MF (18–90 y) | 110-item FFQ | Medi-Lite | MANSA | A significant linear trend of association was reported for the overall quality of life and adherence to the Mediterranean diet. All the domains of the MANSA, except for self-rated mental health, were individually associated with higher adherence to the Mediterranean diet. |
Pano, 2020 [45] | Prospective | SUN cohort, Spain | 15,674 MF (mean age 38.5 y) | 136-item FFQ | 9-item MDS | SF-36 | Higher adherence to the Mediterranean diet was associated with all components of HRQoL (global, physical, mental, and transition). |
Apostolaki 2021 [49] | Cross-sectional | MINOA, Greece | 436 MF (>65 y) | Not assessed | 11-item MDS | SF-36 | Higher Mediterranean diet adherence were associated with higher ratings in the Feeling of Safety/Trust and Value of Life and Social Agency indicators, but not the rest of the Social Capital indicators; instead, for Mediterranean diet adherence and health, we observed the contrary, as improved scoring in seven out of eight parameters of the HRQoL were associated with higher Mediterranean diet adherence (except for the role of emotional health parameter). Stronger positive relationship between physical health and Mediterranean diet adherence than for mental health. Total social capital, physical component summary and value of life and social agency were confirmed by multivariate linear regression as independent predictors of Mediterranean diet adherence. |
Kalkuz, 2021 [56] | Cross-sectional | Turkey | 142 MF (18–65 y) | 229-item FFQ | 14-item MEDAS | SF-36 | Participants with greater adherence to the Mediterranean diet and better serum markers than those with low adherence. No significant correlation found between adherence to the Mediterranean diet and HRQoL. |
Ribot-Rodriguez, 2022 [44] | Cross-sectional | Spain | 17,333 MF (>18 y) | Not assessed | 14-item PREDIMED | SF-12 | A higher Mediterranean Diet adherence and better physical component of the SF-12 were observed in the participants with healthy cardiometabolic status, unlike in the diseased ones. Additionally, greater Mediterranean diet adherence was observed in participants with very good health compared to those with poor/fair HRQoL. Europeans/Caucasians showed a greater Mediterranean diet adherence score and better PCS12 score than participants with other ethnicities. |
Lòpez-Olivares, 2023 [41] | Cross-sectional | Spain | 127 MF (29–67 y) | Not assessed | 14-item MEDAS | SF-36 | An improved HRQoL was associated with Mediterranean diet adherence. Vitality, physical functioning, physical role, bodily pain, the mental component summary, and the Mediterranean diet adherence score increased when WHR and BMI decreased. Higher adherence to the Mediterranean diet was also associated with a better cardiometabolic profile and improved emotional states. |
Lòpez-Olivares, 2023 [42] | Cross-sectional | Spain | 399 MF | Not assessed | 14-item MEDAS | SF-36 | The physical health component of HRQoL was significantly associated with higher Mediterranean diet adherence scores. |
Mantzorou, 2023 [50] | Cross-sectional | Greece | 3254 MF (>65 y) | Not assessed | 11-item MDS | SF-36 | High adherence to the Mediterranean diet was independently associated with better HRQoL. |
Godos, 2023 [48] | Cross-sectional | Italy | 883 MF (>50 y) | 110-item FFQ | Medi-Lite | MANSA | Higher adherence to the Mediterranean diet was associated with better HRQoL alongside lower odds of cognitive impairment. |
Pavlidou, 2023 [51] | Cross-sectional | Greece | 3721 MF (18–65 y) | Not assessed | 11-item MDS | WHO-QoL-Bref | Positive association between Mediterranean diet adherence and improved lifestyle factors, better anthropometric profiles and enhanced mental health outcomes during COVID-19 pandemic. |
Flor-Alemany, 2024 [52] | Prospective | GESTAFIT, Spain, HealthyMoms, Sweden | 138 F and 302 F (32.9 y and 31.3 y) | 78-item FFQ; 3-day 24-h recall | 8-item Mediterranean diet adherence score | SF-36 | A greater Mediterranean diet adherence during pregnancy was associated with lower bodily pain in both Mediterranean and Non-Mediterranean populations especially in the third trimester of pregnancy, within which women generally experience a deterioration in HRQoL. |
Conde-Pipo, 2024 [43] | Cross-sectional | Spain | 520 MF (41–80 y) | Not assessed | 14-item MEDAS | SF-36 | In individuals aged 71–80, a lower adherence to the Mediterranean diet correlated with a deterioration in self-perceived physical health. This decline was primarily attributed to the insufficient intake of key dietary components such as fresh vegetables, legumes, fish, and fruit. |
Byrne-Kirk, 2024 [54] | Cross-sectional | Australia | 207 perimenopausal and menopausal F (40–60 y) | Not assessed | 14-item MEDAS | SF-36 | No significant association between adherence to a Mediterranean-lifestyle diet and the severity of menopausal symptoms but was positively associated with the physical function subscale of HRQoL. |
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Godos, J.; Guglielmetti, M.; Ferraris, C.; Frias-Toral, E.; Domínguez Azpíroz, I.; Lipari, V.; Di Mauro, A.; Furnari, F.; Castellano, S.; Galvano, F.; et al. Mediterranean Diet and Quality of Life in Adults: A Systematic Review. Nutrients 2025, 17, 577. https://doi.org/10.3390/nu17030577
Godos J, Guglielmetti M, Ferraris C, Frias-Toral E, Domínguez Azpíroz I, Lipari V, Di Mauro A, Furnari F, Castellano S, Galvano F, et al. Mediterranean Diet and Quality of Life in Adults: A Systematic Review. Nutrients. 2025; 17(3):577. https://doi.org/10.3390/nu17030577
Chicago/Turabian StyleGodos, Justyna, Monica Guglielmetti, Cinzia Ferraris, Evelyn Frias-Toral, Irma Domínguez Azpíroz, Vivian Lipari, Andrea Di Mauro, Fabrizio Furnari, Sabrina Castellano, Fabio Galvano, and et al. 2025. "Mediterranean Diet and Quality of Life in Adults: A Systematic Review" Nutrients 17, no. 3: 577. https://doi.org/10.3390/nu17030577
APA StyleGodos, J., Guglielmetti, M., Ferraris, C., Frias-Toral, E., Domínguez Azpíroz, I., Lipari, V., Di Mauro, A., Furnari, F., Castellano, S., Galvano, F., Iacoviello, L., Bonaccio, M., & Grosso, G. (2025). Mediterranean Diet and Quality of Life in Adults: A Systematic Review. Nutrients, 17(3), 577. https://doi.org/10.3390/nu17030577