AUTHOR=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. 

TITLE=Regional variations in Mediterranean diet adherence: a sociodemographic and lifestyle analysis across Mediterranean and non-Mediterranean regions within the MEDIET4ALL project

JOURNAL=Frontiers in Public Health

VOLUME=Volume 13 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1596681

DOI=10.3389/fpubh.2025.1596681

ISSN=2296-2565

ABSTRACT=IntroductionThe 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.MethodsThe 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.ResultsThe 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.ConclusionOur 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.