Association between food environment and adherence to the Mediterranean diet in apparently healthy Lebanese adults

Abstract

Background: The Mediterranean diet (MD), the golden standard for healthy nutrition, has positive health impacts on metabolic disorders. Over the last few decades, Lebanon has been witnessing a gradual change in food intake nowadays referred to as “nutritional transitioning” defined as a shift from traditional to Western dietary pattern. Exploring the main determinants of adherence to the MD may be useful in understanding and counterbalancing this shift toward a Western diet. Objectives: The aims of our study were to assess the level of MD adherence and examine the associations between perceived food environment at home and in food stores and MD adherence among Lebanese adults prior to the COVID-19 pandemic and economic crises that have hit Lebanon since February 2020. Methods: During the month of July 2021, a cross-sectional study was carried out among a convenient sample of 326 Lebanese adults who completed an online self-administered questionnaire composed of a) questions about socio-demographics, anthropometrics and lifestyle behaviors; b) the 14-item Mediterranean Diet Adherence Screener (14-MEDAS); and c) the Perceived Nutrition Environment Measures Survey in the Mediterranean Context (NEMS-PMED-AR). Results: The overall sample had a mean 14-MEDAS score of 7.59±2.22 reflecting moderate-tofair adherence to the MD. Significant positive associations were reported between availability of whole wheat pasta, rice or flour; whole grain or brown bread; and fish at home and MD score. After controlling for the effects of individual characteristics, only availability of whole wheat pasta, rice or flour and fish at home remained to be significantly associated with MD score. In addition, borderline significant association between perceived importance of availability of easy to cook foods at food stores and MD adherence score was reported before and after controlling for the effects of the individual characteristics. Conclusion: The findings of our study emphasize the need for addressing availability of healthy foods at home and individual cooking/meal preparation skills so that to improve the MD adherence in Lebanon.