Boujelbane Mohamed Ali, Ammar Achraf, Salem Atef, Kerkeni Mohamed, Trabelsi Khaled, Bouaziz Bassem, Masmoudi Liwa, Heydenreich Juliane, Schallhorn Christiana, Müller Gabriel, Merve Uyar Ayse, Ghazzawi Hadeel Ali, Amawi Adam Tawfiq, Orhan Bekir Erhan, Grosso Giuseppe, Abdelkarim Osama, Driss Tarak, El Abed Kais, Zmijewski Piotr, Debeaufort Frédéric, Benbettaieb Nasreddine, Poulain Clément, Reyes Laura, Gamero Amparo, Cuenca-Ortolá Marta, Cilla Antonio, Francesca Nicola, Messina Concetta Maria, Viola Enrico, Lorenzen Björn, Filice Stefania, Bajoub Aadil, Ajal El-Mehdi, Ajal El Amine, Obtel Majdouline, Lahiani Sadjia, Khaldi Taha, Souissi Nafaa, Boukhris Omar, Jahrami Haitham, Husain Waqar, Frias-Toral Evelyn, Mahdi Walid, Chtourou Hamdi, Schöllhorn Wolfgang I
Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany.
High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia.
Front Public Health. 2025 Jun 10;13:1596681. doi: 10.3389/fpubh.2025.1596681. eCollection 2025.
The Mediterranean diet (MedDiet) is acknowledged for its health advantages; however, compliance with its principles differs by region and is influenced by geographical, cultural, economic, and life-style factors. This research examines regional differences in sociodemographic and lifestyle factors between Mediterranean (MC) and non-Mediterranean (NMC) countries, with a particular focus on adherence to the Mediterranean diet and lifestyle, as well as the associated barriers in each region.
The MEDIET4ALL international survey was conducted across 10 countries, and data were collected from 4,010 participants. Dietary adherence was assessed via the MedLife Index, and additional lifestyle measures included physical activity (IPAQ-SF), sleep patterns (PSQI), mental health (DASS-21), and social participation (SSPQL). Statistical analyses included chi-square tests, Mann-Whitney U tests, and standardized residual analyses to identify significant regional variations.
The study revealed distinct dietary patterns, with MC participants showing stronger adherence to traditional MedDiet components (legumes, fish) while NMC participants favored modern adaptations (whole grains). Both regions exhibited low physical activities dominance (60%-62%), although MC participants engaged more (21.1% vs. 18.5%) in moderate physical activity. MC maintained higher proportions of "sometimes socially active" individuals, NMC showed greater representation in the "always socially active" category. Sleep quality was poorer in MC (45% below recommended duration vs. 40% in NMC), while NMC reported higher insomnia rates. Mental health symptoms were comparable (33%-35% moderate depression/anxiety in both), reflecting post-pandemic global trends. Barriers differed regionally with MC faced economic/access constraints while NMC struggled with knowledge gaps and time limitations.
Our findings highlight that while Mediterranean regions maintain traditional dietary patterns, globalization and modern lifestyle shifts are narrowing regional health behaviors. Public health strategies should address region-specific barriers, including economic constraints in MC regions and knowledge gaps in NMC regions, while promoting MedDiet adherence. Future research should explore the impact of cultural, socio-economic, and digital factors on dietary behaviors and mental health to develop tailored, effective interventions for improving overall well-being.
地中海饮食因其对健康有益而闻名；然而，不同地区对其原则的遵循情况存在差异，并且受到地理、文化、经济和生活方式等因素的影响。本研究考察了地中海国家（MC）和非地中海国家（NMC）在社会人口统计学和生活方式因素方面的区域差异，特别关注对地中海饮食和生活方式的坚持情况，以及每个地区相关的障碍。
在10个国家开展了MEDIET4ALL国际调查，收集了4010名参与者的数据。通过地中海生活指数评估饮食依从性，其他生活方式指标包括身体活动（国际体力活动问卷简表，IPAQ-SF）、睡眠模式（匹兹堡睡眠质量指数，PSQI）、心理健康（抑郁焦虑压力量表-21，DASS-21）和社会参与（社会支持与参与质量量表，SSPQL）。统计分析包括卡方检验、曼-惠特尼U检验和标准化残差分析，以确定显著的区域差异。
研究揭示了不同的饮食模式，MC地区的参与者对传统地中海饮食成分（豆类、鱼类）的依从性更强，而NMC地区的参与者则更倾向于现代改良版（全谷物）。两个地区都以低身体活动为主（60%-62%），不过MC地区参与中度身体活动的参与者更多（21.1%对18.5%）。MC地区“有时社交活跃”的个体比例更高，NMC地区在“总是社交活跃”类别中的占比更大。MC地区的睡眠质量较差（45%低于推荐时长，而NMC地区为40%），而NMC地区报告的失眠率更高。心理健康症状相当（两个地区中33%-35%有中度抑郁/焦虑），反映了疫情后的全球趋势。不同地区面临的障碍有所不同，MC地区面临经济/获取方面的限制，而NMC地区则在知识差距和时间限制方面存在困难。
我们的研究结果表明，虽然地中海地区保持着传统饮食模式，但全球化和现代生活方式的转变正在缩小区域健康行为的差异。公共卫生策略应解决特定区域的障碍，包括MC地区的经济限制和NMC地区的知识差距，同时促进对地中海饮食的依从性。未来的研究应探索文化、社会经济和数字因素对饮食行为和心理健康的影响，以制定针对性强、有效的干预措施来改善整体幸福感。
