BACKGROUND: From the 1960s to the early 21st-century adherence to the Mediterranean diet (MD) declined around the world. This was partly due to the westernization of eating habits. However, in the last decade a new variable came into play, the economic crisis, which may have affected dietary patterns. OBJECTIVE: We analyzed worldwide trends of adherence to the MD between the periods 1961-1965, 2000-2003 and 2004-2011. METHODS: Data was obtained from the Food and Agriculture Organization Food Balance Sheets in three study periods: 1961-1965, 2000-2003 and 2004-2011. The Mediterranean Adequacy Index (MAI) was calculated for 41 selected countries using the averages of available energy intake for different food groups. Changes in MAI indicated the trends in adherence in the different periods. RESULTS: In many countries, MAI deteriorated from 1961 to 1965 and 2004 to 2011, yet an increase was observed in 16 countries. Between the last two observation periods, MAI values stabilized in 16 of the 41 selected countries. Regional rankings for the three study periods based on descending MAI scores were: Southern Mediterranean, Mediterranean Europe, Central Europe and Northern Europe. DISCUSSION AND CONCLUSIONS: Adherence to the MD significantly decreased between 1961-65 and 2000-03, whereas from 2004-2011 there was a stabilization of MAI values and even an increase among 16 countries. Efforts are needed to preserve the dietary traditions and lifestyle habits within the Mediterranean region in order to counteract increasing rates of chronic disease.