The aim of this work was to assess ten-year trends (1999–2010) of adherence to the Mediterranean dietary pattern (MDP) among the Balearic Islands’ adult population. Two independent cross-sectional dietary surveys (1999–2000, n
= 1200 and 2009–2010 n
= 1388, including participants aged 16–65 years) were carried out in the Balearic Islands, Spain. Dietary habits were assessed by means of two 24 h diet recalls and a validated semi-quantitative food-frequency questionnaire that covers 145 food items. Adherence to the MDP was defined according to a score constructed considering the consumption of nine MDP characteristic components: high monounsaturated fatty acids:saturated fatty acids (MUFA:SFA) ratio, moderate ethanol consumption, high legumes, cereals and roots, fruits, vegetables, and fish consumption, and low consumption of meat and milk. Socio-economic status, education level, lifestyle factors and health status were also assessed. Adherence to the MDP was 43.1% (SD 5.8) in 1999–2000 and 44.6% (SD 8.3) in 2009–2010. Higher age was directly associated with higher adherence to the MDP, and this association was stronger in males than in females. Young generations and smokers showed the lowest adherence to MDP, whereas people with higher educational and socio-economic level, and who were physically active showed the highest adherence. According to the place of birth, the increase in the percentage of the adherence to the MDP was observed to be smaller among the Balearic Island’s natives than among people born abroad. In 2009–2010, individuals in the MDP’s fourth quartile were more likely to be older (aged 46–65 years), and were less likely to have a low occupational level, to have a light physical activity level and to be smoker than in 1999–2000. The adherence to the MDP has been stabilized and slightly recovered among the Balearic Islands’ adult population in the last decade.
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