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The Prevalence of Adherence to Prudent Dietary Patterns and Their Association with Physical and Mental Health

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Dear Colleagues,

This Special Issue explores the links of adherence to prudent diets (e.g., Mediterranean, MIND, DASH) and time-restricted eating (TRE) or fasting with physical and mental health. Modern shifts toward processed foods have worsened chronic disease risks, while evidence suggests that balanced diets and structured eating regimens can enhance metabolic, cognitive, and psychological well-being. However, long-term adherence remains low due to socioeconomic, cultural, and behavioral barriers.

We invite studies on the following topics:

Prevalence and determinants of dietary adherence across populations;
Health impacts, including bidirectional diet–gut–brain interactions;
Strategies to promote compliance (e.g., personalized nutrition, policy changes);
Synergies between diet, exercise, sleep, and stress management.

Original research, reviews, and interventions are welcome, particularly the following:

Epidemiological and clinical studies on the prevalence of adherence to prudent diets and their associations with physical/mental health;
Interventional trials testing novel approaches to enhance dietary compliance (e.g., personalized nutrition, community programs);
Mechanistic insights into how prudent diets and fasting regimens modulate inflammation, oxidative stress, and the gut–brain axis;
Barriers and facilitators of long-term adherence, including cultural, economic, and psychological factors;
Synergistic effects of diet combined with exercise, sleep, and stress management in general and athletic populations.

This Special Issue will inform tailored public health strategies, clinical guidelines, and personalized interventions to counteract unhealthy dietary trends and optimize holistic health outcomes in diverse populations, including athletes and high-stress groups.

Dr. Achraf Ammar
Guest Editor

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31 pages, 799 KiB

Open AccessArticle

Exploring Determinants of Mediterranean Lifestyle Adherence: Findings from the Multinational MEDIET4ALL e-Survey Across Ten Mediterranean and Neighboring Countries

by Achraf Ammar, Mohamed Ali Boujelbane, Atef Salem, Khaled Trabelsi, Bassem Bouaziz, Mohamed Kerkeni, Liwa Masmoudi, Juliane Heydenreich, Christiana Schallhorn, Gabriel Müller, Ayse Merve Uyar, Hadeel Ali Ghazzawi, Adam Tawfiq Amawi, Bekir Erhan Orhan, Giuseppe Grosso, Osama Abdelkarim, Mohamed Aly, Tarak Driss, Kais El Abed, Wassim Moalla, Piotr Zmijewski, Frédéric Debeaufort, Nasreddine Benbettaieb, Clément Poulain, Laura Reyes, Amparo Gamero, Marta Cuenca-Ortolá, Antonio Cilla, Nicola Francesca, Concetta Maria Messina, Enrico Viola, Björn Lorenzen, Stefania Filice, Aadil Bajoub, El-Mehdi Ajal, El Amine Ajal, Majdouline Obtel, Sadjia Lahiani, Taha Khaldi, Nafaa Souissi, Omar Boukhris, Waqar Husain, Evelyn Frias-Toral, Walid Mahdi, Hamdi Chtourou, Haitham Jahrami and Wolfgang I. Schöllhorn Show full author list Hide full author list

Nutrients 2025, 17(14), 2280; https://doi.org/10.3390/nu17142280 - 10 Jul 2025

Viewed by 452

Abstract

Background/Objectives: Despite its well-established health benefits, adherence to the Mediterranean lifestyle (MedLife) has declined globally, including in its region of origin, alongside a significant shift toward ultra-processed food consumption. Understanding the factors associated with MedLife adherence is essential for developing targeted interventions and tailored policy recommendations. As part of the MEDIET4ALL PRIMA project, this cross-sectional study aimed to comprehensively examine geo-demographic, socio-economic, psychological, behavioral, and barrier-related factors associated with and potentially contributing to MedLife adherence. Methods: Data were collected from 4010 participants aged 18 years and above across ten Mediterranean and neighboring countries using the multinational MEDIET4ALL e-survey, which included the validated MedLife index, along with various other questionnaires. Results: Results indicate that only 22% of respondents demonstrated high adherence to the Mediterranean lifestyle (MedLife), with significant variability observed across countries, age groups, education levels, and health statuses. Spain had the highest proportion of participants with high adherence (38%). Factors associated with significantly higher adherence rates include older age, living in the Mediterranean region, higher education levels, a greater awareness of MedLife principles, lower perceived barriers, normal BMI, better health status, and stable economic and marital conditions (p-values ranging from 0.04 to <0.001). Additionally, individuals with high MedLife adherence exhibited more socially and physically active lifestyles and experienced less psychological strain (p < 0.001). Regression analyses identified MedLife awareness as the strongest positive predictor of adherence (β = 0.206), followed by social participation (β = 0.194) and physical activity (β = 0.096). Additional positive contributors include life satisfaction, sleep quality, living in the Mediterranean region, age, and education (β ranging from 0.049 to 0.093). Conversely, factors that are negatively associated with adherence include sedentary behavior, living environment, and barriers such as low motivation, taste dislike, price unaffordability, limited availability, and the time-consuming nature of preparing Mediterranean food (MedFood; β ranging from −0.036 to −0.067). Conclusions: These findings indicate that fewer than one in four adults across Mediterranean and neighboring countries demonstrate high adherence to MedLife, supporting prior evidence of suboptimal adherence even within Mediterranean regions. This study identified a range of behavioral, socio-demographic, and environmental factors—both positive and negative predictors—that can help guide the design of targeted, culturally adapted interventions to promote MedLife behavior. Future research should incorporate objective measurements and longitudinal monitoring to better understand underlying mechanisms, establish causality, and develop sustainable strategies for enhancing MedLife adherence in diverse populations. Full article

(This article belongs to the Special Issue The Prevalence of Adherence to Prudent Dietary Patterns and Their Association with Physical and Mental Health)

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