Influence of socio-demographic determinants on adherence to Mediterranean diet and health status in Italian adolescents and adults

Despite its well-documented benefits for overall health, adherence to the Mediterranean Diet (MD) is progressively declining across Mediterranean countries, underscoring the importance of understanding the factors that influence dietary habits. This PhD project aimed to investigate the influence of socio-demographic determinants on MD adherence and health outcomes in both Italian adolescents and adults. The project was divided into two studies to account for age-specific differences and methodological considerations. The first study involved over 1,600 adolescents from across Italy and assessed MD adherence, eating behaviors, perceived stress, and health- related quality of life. Adolescents generally showed moderate-to-low MD adherence, with girls exhibiting significantly lower compliance than boys, a higher prevalence of dysfunctional eating behaviors, higher perceived stress, and poorer perceived quality of life. Furthermore, perceived stress emerged as a key factor, negatively affecting diet quality, eating behaviors, and overall well- being. Geographic region and urbanization further influenced stress levels and lifestyle behaviors, highlighting the contextual determinants of adolescent health. The second study focused on Italian adults evaluating dietary intake, MD adherence, and cardiometabolic health. Overall, MD adherence was moderate, with higher adherence observed among individuals over 60 years, and was associated with higher fiber intake, greater intake of micronutrients, including vitamin C, calcium, and iron, and a more favorable cardiometabolic profile. Nonetheless, the overall dietary pattern of the sample was characterized by high fat and low carbohydrate intake, with insufficient fiber and essential micronutrients, compared to the Dietary Reference Values for the Italian population (LARN). Adults living in urban areas and older adults generally reported higher fiber intake and greater intake of micronutrients, including vitamin C, and magnesium. Gender differences were also observed, with men more likely to meet LARN recommendations for vitamin B12, iron, and calcium, and women for vitamin C. Across both studies, socio-demographic factors played a significant role in shaping dietary patterns and broader lifestyle and health outcomes. These findings highlight the importance of accounting for socio-demographic determinants when evaluating diet and health, identifying vulnerable groups and critical periods for intervention. Such insights can inform the development of tailored public health strategies, educational programs, and interventions to improve MD adherence and promote healthy lifestyles across the lifespan.