Mediterranean diet in five Mediterranean countries: the DELICIOUS project

An abandonment of traditional dietary patterns is growingly observed in Mediterranean countries, especially among younger generations. This study aimed to explore determinants of Mediterranean diet (MD) adherence in 5 Mediterranean countries (Italy, Spain, Portugal, Egypt, and Lebanon) within the context of the EU funded project DELICIOUS (UnDErstanding consumer food choices & promotion of healthy and sustainable Mediterranean diet and LIfestyle in Children and adolescents through behavIOUral change actionS). The sample consisted of 2011 parents of children and adolescents aged 6-17 years old. The main background characteristics, including age, sex, education, family situation, weight status, physical activity levels, sleep and screen time duration, were collected. The level of adherence to the MD was assessed using the KIDMED index. Eating habits (i.e., breakfast, place of eating, etc.) were also investigated. Logistic regression analyses were performed to test for likelihood of higher adherence to the MD. The mean KIDMED score in the study sample was 6.1 [standard deviation (SD) 2.0] with significant differences across countries [Lebanon 5.7 (SD 2.0), Italy 5.8 (SD 2.1), Spain 6.3 (SD 2.1), Egypt 6.5 (SD 1.9), and Portugal 6.5 (SD 2.0)]. A total of 865 participants were deemed as highly adherent to the MD [highest tertile, mean KIDMED score = 8.0 (SD 0.9)]. Major determinants of higher adherence to the MD were the following: among background characteristics, younger age group, higher physical activity level and adequate sleep duration; regarding dietary habits, having breakfast, out-of-home eating, eating with family members and at school, and home-cooked meals were associated with higher MD adherence. Parents’ younger age and higher education were also determinants of higher adherence. In conclusion, a cluster of healthy lifestyle behaviors can be observed among Mediterranean children and adolescents as determinant of higher adherence to the MD. KEY MESSAGES: • Lifestyle habits tend to cluster into healthy behaviors. • Differences in Mediterranean diet adherence may occur across countries.