Article Dans Une Revue Nutrients Année : 2025

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

Mohamed Ali Boujelbane
  • Fonction : Auteur
Atef Salem
  • Fonction : Auteur
  • PersonId : 1563069
Khaled Trabelsi
Bassem Bouaziz
Mohamed Kerkeni
Juliane Heydenreich
Christiana Schallhorn
Ayse Merve Uyar
  • Fonction : Auteur
Hadeel Ali Ghazzawi
Adam Tawfiq Amawi
  • Fonction : Auteur
  • PersonId : 1563076
Bekir Erhan Orhan
Giuseppe Grosso
  • Fonction : Auteur
  • PersonId : 1563078
Mohamed Aly
Kais El Abed
  • Fonction : Auteur
  • PersonId : 1563081
Piotr Zmijewski
Marta Cuenca-Ortolá
  • Fonction : Auteur
Nicola Francesca
Enrico Viola
  • Fonction : Auteur
  • PersonId : 1563086
Björn Lorenzen
  • Fonction : Auteur
  • PersonId : 1563087
Stefania Filice
  • Fonction : Auteur
  • PersonId : 1563088
Aadil Bajoub
  • Fonction : Auteur
El-Mehdi Amine Ajal
  • Fonction : Auteur
  • PersonId : 1563089
El Amine Ajal
  • Fonction : Auteur
Majdouline Obtel
  • Fonction : Auteur
  • PersonId : 1563090
Sadjia Lahiani
  • Fonction : Auteur
  • PersonId : 1563091
Taha Khaldi
Nafaa Souissi
Omar Boukhris
  • Fonction : Auteur
  • PersonId : 1563094
Waqar Husain
Evelyn Frias-Toral
Walid Mahdi
  • Fonction : Auteur
  • PersonId : 1563097
Hamdi Chtourou
Haitham Jahrami
Wolfgang I Schöllhorn

Résumé

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.

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hal-05164995 , version 1 (16-07-2025)

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Achraf Ammar, Mohamed Ali Boujelbane, Atef Salem, Khaled Trabelsi, Bassem Bouaziz, et al.. Exploring Determinants of Mediterranean Lifestyle Adherence: Findings from the Multinational MEDIET4ALL e-Survey Across Ten Mediterranean and Neighboring Countries. Nutrients, 2025, 17 (14), pp.2280. ⟨10.3390/nu17142280⟩. ⟨hal-05164995⟩
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