Adherence to the Mediterranean diet in Cyprus and its relationship to multi-morbidity: an epidemiological study

Abstract Objective: To examine the adherence to the Mediterranean diet in the adult general population of Cyprus and assess its relationship with multi-morbidity. Design: A representative sample of the adult population of Cyprus was selected in 2018–2019 using stratified sampling. Demographics, Mediterranean diet, smoking and physical activity, as well as the presence of chronic, clinical and mental conditions, were collected using a validated questionnaire. Diseases were classified according to the International Classification of Diseases, 10th Revision. Setting: The five government-controlled municipalities of the Republic of Cyprus. Participants: A total of 1140 Cypriot men and women over 18 years. Results: The average Mediterranean diet score was 15·5 ± 4·0 with males and residents of rural regions being more adherent to the Mediterranean diet compared with females and residents of urban regions (P < 0·05). Being in the higher tertile of adherence to the Mediterranean diet was associated with lower odds of multi-morbidity compared with the lower tertile, and this result was statistically significant even after adjusting for age, gender, smoking habits and physical activity (OR = 0·68, 95 % CI 0·46, 0·99). Conclusions: The study provides evidence of the adherence to the Mediterranean diet in Cypriot population and its association with multi-morbidity. Adherence to the Mediterranean diet was associated with lower risk of multi-morbidity. Future research would attempt to replicate such results that could add solid pieces of evidence towards meeting some criteria of causality and severity tests; hence, prevention programmes and practice guidelines in Cyprus and elsewhere should take into account those beneficial effects.

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Multi-Morbidity and Mediterranean Diet in the Cypriot population

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1015 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Kyprianidou ◽

D Panagiotakos ◽

M Kambanaros ◽

K C Makris ◽

C A Christophi

Keyword(s):

Mediterranean Diet ◽

Meat Products ◽

Educational Status ◽

International Classification Of Diseases ◽

Beneficial Effects ◽

Lower Tertile ◽

Validated Questionnaire ◽

Classification Of Diseases ◽

Diet Pattern ◽

The Mediterranean

Abstract Introduction Knowledge about factors associated with multi-morbidity in a given population has important implications for prevention, diagnosis, treatment, and prognosis strategies. Objectives To examine the association of Mediterranean diet with multi-morbidity in the adult general population of Cyprus. Methods A representative sample of n = 1142 Cypriots over 18 years old was recruited during 2018-2019. Multi-morbidity was assessed using a validated questionnaire and diseases were classified according to the International Classification of Diseases, 11th Revision (ICD-11). Mediterranean diet was evaluated using the MedDiet score tool which included the weekly consumption of non-refined cereals, fruit, vegetables, legumes, potatoes, fish, meat and meat products, poultry, full fat dairy products, as well as olive oil and alcohol intake. Results The average Mediterranean diet score was 15.5 ± 4.0 with males adhering more to the Mediterranean diet compared to females (p < 0.001). Being in the higher tertile of adherence to the Mediterranean diet was associated with lower odds of multi-morbidity at α = 0.10, even after adjusting for age, gender, educational status, smoking habits, and physical activity (OR = 0.72, 95% CI: 0.49, 1.06, p = 0.09), compared to the lower tertile. Conclusions To the best to our knowledge, this is the first study which provides evidence of an association between Mediterranean diet and multi-morbidity. Adherence to Mediterranean diet was associated with lower risk of multi-morbidity. Future prevention programs and practice guidelines in Cyprus and elsewhere should take into account the beneficial effects of a Mediterranean diet on multi-morbidity. Key messages This study provides the first evidence of an association between Mediterranean diet and multi-morbidity. health benefits in terms of multiple chronic diseases in an individual can be gained from Mediterranean diet pattern.

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Adherence to the Mediterranean Lifestyle and Desired Body Weight Loss in a Mediterranean Adult Population with Overweight: A PREDIMED-Plus Study

Nutrients ◽

10.3390/nu12072114 ◽

2020 ◽

Vol 12 (7) ◽

pp. 2114 ◽

Cited By ~ 1

Author(s):

Cristina Bouzas ◽

Maria del Mar Bibiloni ◽

Alicia Julibert ◽

Miguel Ruiz-Canela ◽

Jordi Salas-Salvadó ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Body Weight ◽

Mediterranean Diet ◽

Longitudinal Research ◽

Adult Population ◽

Body Weight Loss ◽

Health Study ◽

Mediterranean Population ◽

The Mediterranean

Background. Body weight dissatisfaction is a hindrance to following a healthy lifestyle and it has been associated with weight concerns. Objectives. The aim of this study was to assess the association between the adherence to the Mediterranean lifestyle (diet and exercise) and the desired body weight loss in an adult Mediterranean population with overweight. Methods. Cross-sectional analysis in 6355 participants (3268 men; 3087 women) with metabolic syndrome and BMI (Body mass index) between 27.0 and 40.0 kg/m2 (55–75 years old) from the PREDIMED-Plus trial. Desired weight loss was the percentage of weight that participants wished to lose. It was categorized into four cut-offs of this percentage (Q1: <10%, n = 1495; Q2: 10–15%, n = 1804; Q3: <15–20%, n = 1470; Q4: ≥20%, n = 1589). Diet was assessed using a validated food frequency questionnaire and a 17-item Mediterranean diet questionnaire. Physical activity was assessed by the validated Minnesota-REGICOR and the validated Spanish version of the Nurses’ Health Study questionnaire. Results. Participants reporting higher percentages of desired weight loss (Q3 and Q4) were younger, had higher real and perceived BMI and were more likely to have abdominal obesity. Desired weight loss correlated inversely to physical activity (Q1: 2106 MET min/week; Q4: 1585 MET min/week. p < 0.001) and adherence to Mediterranean diet (Q1: 8.7; Q4: 8.3. p < 0.001). Conclusions. In older Mediterranean individuals with weight excess, desired weight loss was inversely associated with Mediterranean lifestyle adherence. Deeply rooted aspects of the MedDiet remained similar across groups. Longitudinal research is advised to be able to establish causality.

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Cooking at Home and Adherence to the Mediterranean Diet During the COVID-19 Confinement: The Experience From the Croatian COVIDiet Study

Frontiers in Nutrition ◽

10.3389/fnut.2021.617721 ◽

2021 ◽

Vol 8 ◽

Author(s):

Danijela Pfeifer ◽

Josip Rešetar ◽

Jasenka Gajdoš Kljusurić ◽

Ines Panjkota Krbavčić ◽

Darija Vranešić Bender ◽

...

Keyword(s):

Physical Activity ◽

Mediterranean Diet ◽

Eating Habits ◽

Adult Population ◽

Dietary Behavior ◽

Dietary Quality ◽

Online Questionnaire ◽

Cross Sectional ◽

The Mediterranean ◽

The Impact

Introduction: The primary aims of this study were to evaluate the changes in dietary behavior among the Croatian adult population during the COVID-19 outbreak and to explore the impact of confinement on cooking habits.Methods: The study was based on results from COVIDiet_Int cross-sectional study—a part of COVIDiet project (NCT04449731). A self-administered online questionnaire was used to assess the frequency of food consumption, eating habits, and sociodemographic information. A total number of 4,281 participants (80.5% females and 19.4% males) completed the questionnaire.Results: The Mediterranean Diet Adherence Screener (MEDAS) score before the confinement was 5.02 ± 1.97, while during the confinement, the MEDAS score increased to 5.85 ± 2.04. Participants who had higher adherence to the Mediterranean diet (MedDiet) during the confinement were mostly females (88.8%), aged between 20 and 50 years, with the highest level of education (66.3%) and normal BMI (70.6%). The majority of participants maintained their dietary behavior as it was before COVID-19 confinement, while 36.9% decreased their physical activity. Participants with higher MEDAS score were more eager to increase their physical activity. Additionally, higher median values of MEDAS score were noted for participants with body mass index values below 24.9 kg/m2 (6.0 vs. 5.0 for participants with BMI above 25 kg/m2). Participants in all residence places increased their cooking frequency during the confinement (53.8%), which was associated with an increase in vegetables, legumes, as well as fish and seafood consumption.Conclusions: According to our findings, Croatian adults exhibited medium adherence to the MedDiet during the COVID-19 confinement. The results suggest that cooking frequency could be positively associated with overall dietary quality, which is of utmost importance in these demanding times.

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The Association Between the Mediterranean Lifestyle and Depression

Clinical Psychological Science ◽

10.1177/2167702616638651 ◽

2016 ◽

Vol 4 (6) ◽

pp. 1085-1093 ◽

Cited By ~ 21

Author(s):

Almudena Sánchez-Villegas ◽

Miguel Ruíz-Canela ◽

Alfredo Gea ◽

Francisca Lahortiga ◽

Miguel A. Martínez-González

Keyword(s):

Physical Activity ◽

Cohort Study ◽

Mediterranean Diet ◽

Relative Risk Reduction ◽

University Graduates ◽

Depression Risk ◽

Validated Questionnaire ◽

The Mediterranean ◽

Diet Level

This research assessed the association between the adherence to a Mediterranean lifestyle beyond the Mediterranean diet and the risk of depression in a prospective cohort of Spanish university graduates. Through a dynamic cohort study method, diet was assessed with a validated semiquantitative food-frequency questionnaire. The baseline assessment included a validated questionnaire on physical activity and average time spent with friends (socializing). Mediterranean lifestyle was defined as the joint exposure to Mediterranean diet, level of physical activity, and level of socializing. After a median follow-up of 8.5 years, 806 cases of depression among 11,800 participants were observed. Participants with the highest adherence to the Mediterranean lifestyle showed a 50% relative risk reduction in depression risk as compared to those participants with the lowest adherence (multivariable hazard ratio = 0.50; 95% confidence interval = [0.32, 0.81]). The Mediterranean lifestyle might reduce depression risk in the Seguimiento Universidad de Navarra cohort study beyond the known effects of the Mediterranean diet.

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Physical Activity and Adherence to the Mediterranean Diet among Spanish Employees in a Health-Promotion Program before and during the COVID-19 Pandemic: The Sanitas-Healthy Cities Challenge

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052735 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2735

Author(s):

Evelia Franco ◽

Jesús Urosa ◽

Rubén Barakat ◽

Ignacio Refoyo

Keyword(s):

Physical Activity ◽

Health Promotion ◽

Mediterranean Diet ◽

Short Form ◽

Health Promotion Program ◽

Noncommunicable Diseases ◽

Healthy Cities ◽

Sedentary Behaviors ◽

Promotion Program ◽

The Mediterranean

Physical activity and a healthy diet are key factors for avoiding major noncommunicable diseases. The aim of the present study was to analyze how physical activity (PA) and adherence to the Mediterranean diet among employees participating in the Healthy Cities program have been affected during confinement due to the COVID-19 pandemic. The sample was composed of 297 employees from 40 leading companies based in Spain, who participated in the 5th edition of the Sanitas “Healthy Cities” challenge. The participants (148 women and 149 men), aged between 24 and 63 years old (M = 42.76; SD = 7.79) completed the short form of the International Physical Activity Questionnaire (IPAQ) and the PREDIMED (Prevención con Dieta Mediterránea) questionnaire to measure adherence to the Mediterranean diet before and during the pandemic. Pearson χ2 tests revealed that workers were more likely to show sedentary behaviors during the pandemic than before (83.5% vs. 66.7%). Additionally, they were more likely to reach high levels of PA (51.2% vs. 64%), and Wilcoxon tests revealed that energy expenditure measured in Metabolic Equivalent of Task (MET) was higher during the pandemic (4199.03 METs) than before (3735.32 METs), due to an increase in moderate PA. Lastly, a higher adherence to a Mediterranean diet during the pandemic (76.4%) than before (54.5%) was reported. The findings of this investigation suggest a positive effect of working from home for employees involved in a health-promotion program, and highlight the relevance of this kind of action among this population.

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Self-Perceived Physical Activity and Adherence to the Mediterranean Diet in Healthy Adolescents during COVID-19: Findings from the DIMENU Pilot Study

Healthcare ◽

10.3390/healthcare9060622 ◽

2021 ◽

Vol 9 (6) ◽

pp. 622

Author(s):

Angelo Galluccio ◽

Giovanna Caparello ◽

Ennio Avolio ◽

Emanuele Manes ◽

Simona Ferraro ◽

...

Keyword(s):

Physical Activity ◽

Mediterranean Diet ◽

Eating Habits ◽

Wellness Programs ◽

Health Impact ◽

The Self ◽

Global Pandemic ◽

Mediterranean Diet Adherence ◽

The Mediterranean ◽

The Impact

The global pandemic coronavirus disease (COVID-19) resulted in restrictions which forced adolescents to stay at home and influenced their food habits and lifestyles with potential negative health impact. This study aims to investigate the self-reported physical activity (PA) and eating habits related to the consumption of Mediterranean foods in a sample of adolescents during the COVID-19 lockdown enrolled into the DIMENU study. A web survey was launched for 91 adolescents (aged 15–17 years) to assess their adherence to the Mediterranean Diet using the KIDMED test and lifestyle habits using a questionnaire designed following recommendations by Italian National Institute of Health (ISS score). Our results indicate that most of the sample declared no changes in eating habits and PA without sex differences. After dividing the sample into active and sedentary groups based on the self-perceived PA, we found that KIDMED and ISS scores were significantly higher (p = 0.0028 and p = 0.0001, respectively) in active adolescents. Moreover, KIDMED was positively correlated with ISS only in active adolescents (r = 0.311, p = 0.0185). In conclusion, our data underline the impact of the PA on the Mediterranean diet adherence in adolescents during the lockdown, suggesting the usefulness of promoting wellness programs directed towards inactive individuals to increase their awareness on the importance of healthy lifestyles.

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Special Issue “Mediterranean Diet and Metabolic Diseases”

Nutrients ◽

10.3390/nu13082680 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2680

Author(s):

Emmanuella Magriplis ◽

Michail Chourdakis

Keyword(s):

Mediterranean Diet ◽

Dietary Patterns ◽

Metabolic Diseases ◽

Special Issue ◽

Beneficial Effects ◽

The Mediterranean

The Mediterranean diet (MD) has been considered among the healthiest dietary patterns since a little over 50 years ago, Ancel Keys—as the key figure—provided evidence for the beneficial effects of the MD [...]

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Adherence to the Mediterranean Diet and Its Association with the Level of Physical Activity in Fitness Center Users: Croatian-Based Study

Nutrients ◽

10.3390/nu13114038 ◽

2021 ◽

Vol 13 (11) ◽

pp. 4038

Author(s):

Dinko Martinovic ◽

Daria Tokic ◽

Lovre Martinovic ◽

Marko Kumric ◽

Marino Vilovic ◽

...

Keyword(s):

Physical Activity ◽

Mediterranean Diet ◽

Short Form ◽

Well Being ◽

General Information ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Fitness Center ◽

Balanced Diet ◽

The Mediterranean

The Mediterranean diet (MD) is based on the traditional cuisine of south European countries, and it is considered one of the healthiest dietary patterns worldwide. The promotion of combined MD and physical activity has shown major benefits. However, the association between physical activity and the MD in regular fitness center users is still insufficiently investigated. This cross-sectional survey-based study was conducted on 1220 fitness center users in Croatia. The survey consisted of three parts: general information, the Mediterranean Diet Serving Score (MDSS) and the International Physical Activity Questionnaire Short Form (IPAQ-SF). The results showed that 18.6% of fitness center users were adherent to the MD, and there was a significant positive correlation between the level of physical activity and the MDSS score (r = 0.302, p < 0.001). Moreover, after dividing the sample into tertiles based on the IPAQ-SF score, the third tertile (MET > 3150 min/wk) had the most fitness center users (34.4%) adherent to the MD, while the first tertile (MET < 1750 min/wk) had the least (6.1%). These outcomes emphasize the importance of physical activity as they imply that, with higher levels of physical activity, people are also possibly more aware of the importance that a healthy and balanced diet has on their well-being.

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Physical Activity and the Mediterranean Diet

Mediterranean Diet ◽

10.1007/978-3-319-27969-5_16 ◽

2016 ◽

pp. 219-228

Author(s):

Melanie D. Hingle ◽

Deepika R. Laddu ◽

Scott B. Going

Keyword(s):

Physical Activity ◽

Mediterranean Diet ◽

The Mediterranean

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Influence of physical activity, the Mediterranean diet and sociodemographic variables on the values of different cardiovascular risk scales

Mediterranean Journal of Nutrition and Metabolism ◽

10.3233/mnm-211537 ◽

2021 ◽

pp. 1-11

Author(s):

Pere Riutord Sbert ◽

Ángel Arturo López González ◽

Bartomeu Riutord Fe ◽

Neus Riutord Fe ◽

Sebastiana Arroyo Bote ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Risk ◽

Social Class ◽

Mediterranean Diet ◽

Tobacco Consumption ◽

Cross Sectional ◽

Sociodemographic Variables ◽

Mean Values ◽

The Mediterranean ◽

Physical Activity Adherence

INTRODUCTION: Cardiovascular disease (CVD) continues to be one of the main causes of morbidity and mortality in the world. There are several risk factors for CVD, many of which are preventable, including sedentary lifestyles and poor diet. OBJECTIVE: To assess the influence of physical activity, adherence to the Mediterranean diet and sociodemographic variables such as age, sex and social class on the values of different cardiovascular risk scales. METHODS: A descriptive, cross-sectional study in 1584 Spanish workers in which the influence of different sociodemographic variables (age, sex, social class) and healthy habits (tobacco consumption, physical activity assessed with the IPAQ questionnaire, and adherence to the Mediterranean diet) on the values of different cardiovascular risk (CVR) scales (REGICOR, SCORE, DORICA, ERICE, heart age, and vascular age) was assessed. RESULTS: All the CVR scales showed better mean values as the level of physical activity increased, something similar occurring with the prevalence of altered values, in both sexes. High adherence to the Mediterranean diet also improved the mean values and prevalence of altered values in men and women. CONCLUSION: The Mediterranean diet and physical exercise decrease the probability of suffering a cardiovascular event and improve all the CVR scales analyzed in this study.

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