Research Research and Professional Briefs| Volume 114, ISSUE 4, P583-589, April 2014

Download started.


Factors Associated with Adherence to the Mediterranean Diet in the Adult Population

Published:October 24, 2013DOI:


      Our aim was to analyze the variables associated with adherence to the Mediterranean diet in the adult population. We conducted a cross-sectional study in an established cohort of 1,553 healthy study participants (mean age=55±14 years; 60.3% women). Mediterranean diet adherence was evaluated based on a 14-item questionnaire and the Mediterranean diet adherence screener, which defines adequate adherence as a score of ≥9. Physical activity was evaluated using the 7-day physical activity record. Sociodemographic, biological, and anthropometric variables were also evaluated. The differences between Mediterranean diet compliers and noncompliers are defined by the consumption of fruit, red meats, carbonated beverages, wine, fish/shellfish, legumes, pasta, and rice (P<0.01). Adherence was lower among individuals younger than 49 years of age. In the first age tertile, adherence was greater in women and in nonobese individuals, and the triglyceride levels were lower among compliers. In the second age tertile, the compliers exercised more and had a lower body fat percentage. In the third age tertile, the compliers also possessed less body fat. The logistic regression analysis revealed the following factors associated with improved Mediterranean diet adherence: more physical exercise (odds ratio=1.588), older age (odds ratio=2.162), and moderate alcohol consumption (odds ratio=1.342). The factors associated with improved Mediterranean diet adherence included female sex, age older than 62 years, moderate alcohol consumption, and more than 17 metabolic equivalents (METs)/h/wk of physical exercise. Poorer adherence was associated with males and obesity.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hu F.B.
        Dietary pattern analysis: A new direction in nutritional epidemiology.
        Curr Opin Lipidol. 2002; 13: 3-9
        • van den Brandt P.A.
        The impact of a Mediterranean diet and healthy lifestyle on premature mortality in men and women.
        Am J Clin Nutr. 2011; 94: 913-920
        • Martinez-Gonzalez M.A.
        • Guillen-Grima F.
        • De Irala J.
        • et al.
        The Mediterranean diet is associated with a reduction in premature mortality among middle-aged adults.
        J Nutr. 2012; 42: 1672-1678
        • Kontou N.
        • Psaltopoulou T.
        • Soupos N.
        • et al.
        The role of number of meals, coffee intake, salt and type of cookware on colorectal cancer development in the context of the Mediterranean diet.
        Public Health Nutr. 2013; 16: 928-935
        • Sofi F.
        • Cesari F.
        • Abbate R.
        • Gensini G.F.
        • Casini A.
        Adherence to Mediterranean diet and health status: Meta-analysis.
        BMJ. 2008; 337: a1344
        • Beunza J.J.
        • Toledo E.
        • Hu F.B.
        • et al.
        Adherence to the Mediterranean diet, long-term weight change, and incident overweight or obesity: The Seguimiento Universidad de Navarra (SUN) cohort.
        Am J Clin Nutr. 2010; 92: 1484-1493
        • Vadivel V.
        • Kunyanga C.N.
        • Biesalski H.K.
        Health benefits of nut consumption with special reference to body weight control.
        Nutrition. 2012; 28: 1089-1097
        • Di Daniele N.
        • Petramala L.
        • Di Renzo L.
        • et al.
        Body composition changes and cardiometabolic benefits of a balanced Italian Mediterranean Diet in obese patients with metabolic syndrome.
        Acta Diabetol. 2013; 50: 409-416
        • Van Diepen S.
        • Scholten A.M.
        • Korobili C.
        • et al.
        Greater Mediterranean diet adherence is observed in Dutch compared with Greek university students.
        Nutr Metab Cardiovasc Dis. 2011; 21: 534-540
        • Serra-Majem L.
        • Trichopoulou A.
        • Ngo de la Cruz J.
        • et al.
        Does the definition of the Mediterranean diet need to be updated?.
        Public Health Nutr. 2004; 7: 927-929
        • Schroder H.
        • Elosua R.
        • Vila J.
        • Marti H.
        • Covas M.I.
        • Marrugat J.
        Secular trends of obesity and cardiovascular risk factors in a Mediterranean population.
        Obesity (Silver Spring). 2007; 15: 557-562
        • Sanchez-Villegas A.
        • Delgado-Rodriguez M.
        • Martinez-Gonzalez M.A.
        • De Irala-Estevez J.
        Gender, age, socio-demographic and lifestyle factors associated with major dietary patterns in the Spanish Project SUN (Seguimiento Universidad de Navarra).
        Eur J Clin Nutr. 2003; 57: 285-292
        • Zazpe I.
        • Estruch R.
        • Toledo E.
        • et al.
        Predictors of adherence to a Mediterranean-type diet in the PREDIMED trial.
        Eur J Nutr. 2010; 49: 91-99
        • Tinker L.F.
        • Rosal M.C.
        • Young A.F.
        • et al.
        Predictors of dietary change and maintenance in the Women's Health Initiative Dietary Modification Trial.
        J Am Diet Assoc. 2007; 107: 1155-1166
        • di Giuseppe R.
        • Bonanni A.
        • Olivieri M.
        • et al.
        Adherence to Mediterranean diet and anthropometric and metabolic parameters in an observational study in the 'Alto Molise' region: The MOLI-SAL project.
        Nutr Metab Cardiovasc Dis. 2008; 18: 415-421
        • Gonzalez C.A.
        • Argilaga S.
        • Agudo A.
        • et al.
        [Sociodemographic differences in adherence to the Mediterranean dietary pattern in Spanish populations].
        Gac Sanit. 2002; 16: 214-221
        • Sanchez-Villegas A.
        • Martinez J.A.
        • De Irala J.
        • Martinez-Gonzalez M.A.
        Determinants of the adherence to an “a priori” defined Mediterranean dietary pattern.
        Eur J Nutr. 2002; 41: 249-257
        • Leon-Munoz L.M.
        • Guallar-Castillon P.
        • Graciani A.
        • et al.
        Adherence to the Mediterranean diet pattern has declined in Spanish adults.
        J Nutr. 2012; 142: 1843-1850
        • Garcia-Ortiz L.
        • Recio-Rodriguez J.I.
        • Martin-Cantera C.
        • et al.
        Physical exercise, fitness and dietary pattern and their relationship with circadian blood pressure pattern, augmentation index and endothelial dysfunction biological markers: EVIDENT study protocol.
        BMC Public Health. 2010; 10: 233
        • World Medical Association declaration of Helsinki
        Recommendations guiding physicians in biomedical research involving human subjects.
        JAMA. 1997; 277: 925-926
        • Schroder H.
        • Fito M.
        • Estruch R.
        • et al.
        A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women.
        J Nutr. 2011; 141: 1140-1145
        • Martinez-Gonzalez M.A.
        • Fernandez-Jarne E.
        • Serrano-Martinez M.
        • Wright M.
        • Gomez-Gracia E.
        Development of a short dietary intake questionnaire for the quantitative estimation of adherence to a cardioprotective Mediterranean diet.
        Eur J Clin Nutr. 2004; 58: 1550-1552
        • Zazpe I.
        • Sanchez-Tainta A.
        • Estruch R.
        • et al.
        A large randomized individual and group intervention conducted by registered dietitians increased adherence to Mediterranean-type diets: The PREDIMED study.
        J Am Diet Assoc. 2008; 108 (discussion 1145): 1134-1144
        • Haskell W.L.
        • Lee I.M.
        • Pate R.R.
        • et al.
        Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.
        Med Sci Sports Exerc. 2007; 39: 1423-1434
        • Mancia G.
        • De Backer G.
        • Dominiczak A.
        • et al.
        2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension.
        J Hypertens. 2007; 25: 1751-1762
        • Kontogianni M.D.
        • Vidra N.
        • Farmaki A.E.
        • et al.
        Adherence rates to the Mediterranean diet are low in a representative sample of Greek children and adolescents.
        J Nutr. 2008; 138: 1951-1956
        • El Rhazi K.
        • Nejjari C.
        • Romaguera D.
        • et al.
        Adherence to a Mediterranean diet in Morocco and its correlates: Cross-sectional analysis of a sample of the adult Moroccan population.
        BMC Public Health. 2012; 12: 345
        • Llorent-Bedmar V.
        Scholar/familiar education and Maroccan couples. Diachronic study of Casablanca región.
        Foro de Educación. 2011; 13: 139-153
        • Spring B.
        • Schneider K.
        • McFadden H.G.
        • et al.
        Multiple behavior changes in diet and activity: A randomized controlled trial using mobile technology.
        Arch Intern Med. 2012; 172: 789-796
        • Bautista-Castano I.
        • Molina-Cabrillana J.
        • Montoya-Alonso J.A.
        • Serra-Majem L.
        Variables predictive of adherence to diet and physical activity recommendations in the treatment of obesity and overweight, in a group of Spanish subjects.
        Int J Obes Relat Metab Disord. 2004; 28: 697-705
        • Brien S.E.
        • Ronksley P.E.
        • Turner B.J.
        • Mukamal K.J.
        • Ghali W.A.
        Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: Systematic review and meta-analysis of interventional studies.
        BMJ. 2011; 342: d636


      M. C. Patino-Alonso is an assistant professor, Statistics Department, University of Salamanca, Salamanca, Spain, and with The Alamedilla Health Center, Castilla-Leon Health Service-SACYL, Institute for Biomedical Research in Salamanca (IBSAL), Research Network on Preventive Activities and Health Promotion (redIAPP), Salamanca, Spain.


      J. I. Recio-Rodríguez is a nurse and dietitian, The Alamedilla Health Center, Castilla-Leon Health Service-SACYL, IBSAL, redIAPP, Salamanca, Spain.


      C. Agudo-Conde is a nurse, The Alamedilla Health Center, Castilla-Leon Health Service-SACYL, IBSAL, redIAPP, Salamanca, Spain.


      J. F. M. Belio is a medical doctor, Torre Ramona Health Center, Aragón Health Service, Zaragoza, Spain.


      R. Colominas-Garrido is a nurse, Passeig de Sant Joan Health Centre, Catalan Health Service, Barcelona, Spain.


      J. Lema-Bartolomé is a medical doctor, Cuenca III Health Center, Castilla La Mancha Health Service (SESCAM), Cuenca, Spain.


      A. G. Arranz is a medical doctor, Casa de Barco Health Center, Castilla y León Health Service-SACYL, Valladolid, Spain.


      M. A. Gomez-Marcos is a medical doctor, Primary Care Research Unit, La Alamedilla Health Center, SACYL, redIAPP, IBSAL, and with the Department of Medicine, University of Salamanca, Salamanca, Spain.


      L. García-Ortiz is a medical doctor, Primary Care Research Unit, La Alamedilla Health Center, SACYL, redIAPP, IBSAL, and with the Department of Medicine, University of Salamanca, Salamanca, Spain.