Substitution Modeling Shows Simple Dietary Changes Increase Mediterranean-Style Diet Pattern Scores for U.S. Adults

OBJECTIVES: The Mediterranean-Style Diet (MedD) pattern is associated with lower risk for chronic diseases. This diet pattern is abundant in plant foods, lean fish, whole grains, legumes, nuts, fresh fruits/vegetables, and is relatively high in fat from olive oil, low in refined/added sugars, and includes wine in moderation. The purpose of this study is to assess the impact of honey-pairing food substitutions on adherence to the MedD style pattern in U.S. adults. METHODS: Using a nationally representative sample (n = 19,978) of adults ages 25–66 with 2 complete and reliable 24-hr recalls from the National Health and Nutrition Examination Survey (2007–2018), alignment to a Mediterranean style dietary pattern was determined by calculation of a validated MedD score (0–100 points for the total score, with higher scores indicating greater adherence to the MedD). The sample was divided into two groups: high-scoring population (HP) vs. general population (GP). Differentiating food groups by adherence level were determined and used to create isocaloric food substitution modeling within the GP. Multiple regression analyses were used to determine food selections that have greatest impact on optimizing MedD score among the GP. RESULTS: The GP had lower total MedD score (7.1 ± 0.05) compared to the HP 16.7 ± 0.09 (P < 0.0001). Increasing olive oil (OO) from non-use to partial use would increase MedD score 2.1 ± 0.04 among the GP (P < 0.0001). Other isocaloric substitutions improved mean MedD Score among the GP: 4 oz of fish for 4 oz of red meat (P < 0.0001); 4.9 cups of kale for 2 cups of starchy/root vegetable (P < 0.0001); 1 oz of whole grain for 1 oz of refined grain, whole fruit in place of fruit juice (P < 0.0001). Paired with honey, these substitutions result in an optimized model that would increase MedD score greater than 3 points (10.5 ± 0.05) among the GP (P < 0.0001). CONCLUSIONS: Simple dietary substitutions or “swaps” can help a diet more closely align with a Mediterranean Style Dietary Pattern. The addition of honey may help increase the palatability of the substitutions without sacrificing overall nutritional value. FUNDING SOURCES: National Honey Board.