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Nutrition behaviour and compliance with the Mediterranean diet pyramid recommendations: an Italian survey-based study

  • Renata Bracale
  • Concetta M. Vaccaro
  • Vittoria Coletta
  • Claudio Cricelli
  • Francesco Carlo Gamaleri
  • Fabio Parazzini
  • Michele CarrubaEmail author
Original Article
  • 41 Downloads

Abstract

Purpose

Adopting a Mediterranean-like dietary pattern may help in preventing several chronic diseases. We assessed the eating behaviour and compliance with the Mediterranean diet pyramid recommendations in Italy.

Methods

This is a cross-sectional study conducted in subjects aged ≥ 20 years. A 14-question survey based on the updated Mediterranean diet pyramid was launched online from April 2015 to November 2016. At test completion, a personalized pyramid displaying the possible deficiencies and/or excesses was generated, that could be the basis to plan diet and lifestyle modifications.

Results

Overall, 27,540 subjects completed the survey: the proportion of females (75.6%), younger subjects (20.7%) and people with a University degree (33.1%) resembled those of the Italian population of Internet users rather than of the general population. 37.8% of participants declared a sedentary lifestyle, including 29.6% of those aged 20–29 years. A lower-than-recommended intake of all food categories included in the Mediterranean diet pyramid, along with excess of sweets, red and processed meats, emerged, that may affect health in the long term. Low adherence to recommendations was observed especially among females and older people. Notably, a discrepancy surfaced between the responders’ perceived and actual behaviour toward the regular consumption of fruits and vegetables (81.8% vs 22.7–32.8%, respectively).

Conclusions

The nutritional habits and lifestyle of Italian participants are poorly adherent to the Mediterranean diet recommendations. The personalized pyramid tool may help in raising the awareness of individuals and their families on where to intervene, possibly with the support of healthcare professionals, to improve their behaviour.

Level of evidence

Level V, cross-sectional descriptive study.

Keywords

Compliance Food pyramid Italy Lifestyle Mediterranean diet Nutrition 

Notes

Acknowledgements

The authors would like to thank all participants who completed the online test. We also thank Scientific Committee members and contributors of Curare la Salute: Luigi Canciani, Alessandro Fornaro. Marcello Giovannini, Elisa Paganini, Annarosa Racca, Paolo Vintani. We thank Pfizer Consumer Healthcare, and especially Antonio Limitone, Ornella Parma and Domenico Giorgio Cassarà for supporting “Curare la salute”. Editorial support was provided by Edra spa, and unconditionally funded by Pfizer Consumer Healthcare.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Participation was voluntary and anonymous and completing the survey was accepted as consent by the participants.

Supplementary material

40519_2019_807_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 20 kb)

References

  1. 1.
    Bach-Faig A, Berry EM, Lairon D et al (2011) Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr 14:2274–2284.  https://doi.org/10.1017/S1368980011002515 CrossRefPubMedGoogle Scholar
  2. 2.
    Martinez-Lacoba R, Pardo-Garcia I, Amo-Saus E, Escribano-Sotos F (2018) Mediterranean diet and health outcomes: a systematic meta-review. Eur J Public Health 28:955–961.  https://doi.org/10.1093/eurpub/cky113 CrossRefPubMedGoogle Scholar
  3. 3.
    Sofi F, Macchi C, Abbate R et al (2014) Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr 17:2769–2782.  https://doi.org/10.1017/S1368980013003169 CrossRefPubMedGoogle Scholar
  4. 4.
    Rees K, Hartley L, Flowers N et al (2013) “Mediterranean” dietary pattern for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD009825.pub2 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Panagiotakos DB, Georgousopoulou EN, Pitsavos C et al (2015) Exploring the path of Mediterranean diet on 10-year incidence of cardiovascular disease: the ATTICA study (2002–2012). Nutr Metab Cardiovasc Dis NMCD 25:327–335.  https://doi.org/10.1016/j.numecd.2014.09.006 CrossRefPubMedGoogle Scholar
  6. 6.
    Estruch R, Ros E, Salas-Salvadó J et al (2018) Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med 378:e34.  https://doi.org/10.1056/NEJMoa1800389 CrossRefGoogle Scholar
  7. 7.
    Zappalà G, Buscemi S, Mulè S et al (2018) High adherence to Mediterranean diet, but not individual foods or nutrients, is associated with lower likelihood of being obese in a Mediterranean cohort. Eat Weight Disord EWD 23:605–614.  https://doi.org/10.1007/s40519-017-0454-1 CrossRefPubMedGoogle Scholar
  8. 8.
    Kesse-Guyot E, Ahluwalia N, Lassale C et al (2013) Adherence to Mediterranean diet reduces the risk of metabolic syndrome: a 6-year prospective study. Nutr Metab Cardiovasc Dis NMCD 23:677–683.  https://doi.org/10.1016/j.numecd.2012.02.005 CrossRefPubMedGoogle Scholar
  9. 9.
    Babio N, Bulló M, Basora J et al (2009) Adherence to the Mediterranean diet and risk of metabolic syndrome and its components. Nutr Metab Cardiovasc Dis NMCD 19:563–570.  https://doi.org/10.1016/j.numecd.2008.10.007 CrossRefPubMedGoogle Scholar
  10. 10.
    Khalili-Moghadam S, Mirmiran P, Bahadoran Z, Azizi F (2018) The Mediterranean diet and risk of type 2 diabetes in Iranian population. Eur J Clin Nutr.  https://doi.org/10.1038/s41430-018-0336-2 CrossRefPubMedGoogle Scholar
  11. 11.
    Vitale M, Masulli M, Calabrese I et al (2018) Impact of a Mediterranean dietary pattern and its components on cardiovascular risk factors, glucose control, and body weight in people with type 2 diabetes: a real-life study. Nutrients.  https://doi.org/10.3390/nu10081067 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Esposito K, Giugliano D (2014) Mediterranean diet and type 2 diabetes. Diabetes Metab Res Rev 30(Suppl 1):34–40.  https://doi.org/10.1002/dmrr.2516 CrossRefPubMedGoogle Scholar
  13. 13.
    Bonaccio M, Di Castelnuovo A, Costanzo S et al (2016) Adherence to the traditional Mediterranean diet and mortality in subjects with diabetes. Prospective results from the MOLI-SANI study. Eur J Prev Cardiol 23:400–407.  https://doi.org/10.1177/2047487315569409 CrossRefPubMedGoogle Scholar
  14. 14.
    Maraki MI, Yannakoulia M, Stamelou M et al (2018) Mediterranean diet adherence is related to reduced probability of prodromal Parkinson’s disease. Mov Disord.  https://doi.org/10.1002/mds.27489 CrossRefPubMedGoogle Scholar
  15. 15.
    Solfrizzi V, Custodero C, Lozupone M et al (2017) Relationships of dietary patterns, foods, and micro- and macronutrients with Alzheimer’s disease and late-life cognitive disorders: a systematic review. J Alzheimers Dis JAD 59:815–849.  https://doi.org/10.3233/JAD-170248 CrossRefPubMedGoogle Scholar
  16. 16.
    Solfrizzi V, Panza F (2014) Mediterranean diet and cognitive decline. A lesson from the whole-diet approach: what challenges lie ahead? J Alzheimers Dis JAD 39:283–286.  https://doi.org/10.3233/JAD-130831 CrossRefPubMedGoogle Scholar
  17. 17.
    Aridi YS, Walker JL, Wright ORL (2017) The association between the Mediterranean dietary pattern and cognitive health: a systematic review. Nutrients.  https://doi.org/10.3390/nu9070674 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Bravi F, Spei M-E, Polesel J et al (2018) Mediterranean diet and bladder cancer risk in Italy. Nutrients.  https://doi.org/10.3390/nu10081061 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Filomeno M, Bosetti C, Bidoli E et al (2015) Mediterranean diet and risk of endometrial cancer: a pooled analysis of three Italian case-control studies. Br J Cancer 112:1816–1821.  https://doi.org/10.1038/bjc.2015.153 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Turati F, Bravi F, Polesel J et al (2017) Adherence to the Mediterranean diet and nasopharyngeal cancer risk in Italy. Cancer Causes Control CCC 28:89–95.  https://doi.org/10.1007/s10552-017-0850-x CrossRefPubMedGoogle Scholar
  21. 21.
    Turati F, Carioli G, Bravi F et al (2018) Mediterranean diet and breast cancer risk. Nutrients.  https://doi.org/10.3390/nu10030326 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Schwingshackl L, Schwedhelm C, Galbete C, Hoffmann G (2017) Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis. Nutrients.  https://doi.org/10.3390/nu9101063 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bonaccio M, Di Castelnuovo A, Costanzo S et al (2018) Mediterranean diet and mortality in the elderly: a prospective cohort study and a meta-analysis. Br J Nutr 120:841–854.  https://doi.org/10.1017/S0007114518002179 CrossRefPubMedGoogle Scholar
  24. 24.
    Jennings A, Cashman KD, Gillings R et al (2018) A Mediterranean-like dietary pattern with vitamin D3 (10 µg/day) supplements reduced the rate of bone loss in older Europeans with osteoporosis at baseline: results of a 1-y randomized controlled trial. Am J Clin Nutr.  https://doi.org/10.1093/ajcn/nqy122 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Sahni S, Mangano KM, Kiel DP et al (2017) Dairy intake is protective against bone loss in older vitamin D supplement users: the framingham study. J Nutr 147:645–652.  https://doi.org/10.3945/jn.116.240390 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Bracale R, Milani L, Ferrara E et al (2013) Childhood obesity, overweight and underweight: a study in primary schools in Milan. Eat Weight Disord EWD 18:183–191.  https://doi.org/10.1007/s40519-013-0036-9 CrossRefPubMedGoogle Scholar
  27. 27.
    Spinelli A, Nardone P, Buoncristiano M et al (2015) Italy 2014: childhood obesity is decreasing. Epidemiol Prev 39:63PubMedGoogle Scholar
  28. 28.
    Renzella J, Townsend N, Jewel J et al (2018) What national and subnational interventions and policies based on Mediterranean and Nordic diets are recommended or implemented in the WHO European Region, and is there evidence of effectiveness in reducing noncommunicable diseases? http://www.euro.who.int/__data/assets/pdf_file/0011/365285/hen-58-eng.pdf?ua=1. Accessed 14 Oct 2019
  29. 29.
    Balzaretti CM, Ventura V, Ratti S et al (2018) Improving the overall sustainability of the school meal chain: the role of portion sizes. Eat Weight Disord EWD.  https://doi.org/10.1007/s40519-018-0524-z CrossRefPubMedGoogle Scholar
  30. 30.
    SINU—Società Italiana di Nutrizione Umana. https://sinu.it/. Accessed 14 Oct 2019
  31. 31.
    Aspetti della vita quotidiana (2016). https://www.istat.it/it/archivio/186843. Accessed 26 Sep 2019
  32. 32.
    Istat.it| Multiscopo sulle famiglie (2018) Aspetti della vita quotidiana—parte generale. https://www.istat.it/it/archivio/217037. Accessed 14 Oct 2019
  33. 33.
    Mayer-Davis EJ, Costacou T (2001) Obesity and sedentary lifestyle: modifiable risk factors for prevention of type 2 diabetes. Curr Diabetes Rep 1:170–176CrossRefGoogle Scholar
  34. 34.
    EUPATI (2017) Fattori di rischio per la salute: fumo, obesità, alcol e sedentarietà. https://www.istat.it/it/archivio/202040. Accessed 26 Sep 2019
  35. 35.
    Fernandes I, Pérez-Gregorio R, Soares S et al (2017) Wine flavonoids in health and disease prevention. Mol Basel Switz.  https://doi.org/10.3390/molecules22020292 CrossRefGoogle Scholar
  36. 36.
    Haseeb S, Alexander B, Baranchuk A (2017) Wine and cardiovascular health: a comprehensive review. Circulation 136:1434–1448.  https://doi.org/10.1161/CIRCULATIONAHA.117.030387 CrossRefPubMedGoogle Scholar
  37. 37.
    Bonnefont-Rousselot D (2016) Resveratrol and cardiovascular diseases. Nutrients.  https://doi.org/10.3390/nu8050250 CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Farinetti A, Zurlo V, Manenti A et al (2017) Mediterranean diet and colorectal cancer: a systematic review. Nutrition (Burbank Los Angel City California) 43–44:83–88.  https://doi.org/10.1016/j.nut.2017.06.008 CrossRefGoogle Scholar
  39. 39.
    International Agency for Research on Cancer, International Agency for Research on Cancer (1988) Alcohol drinking: views and experts opinions of an IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, which met in Lyon 13–20 Oct. 1987. Lyon. https://monographs.iarc.fr/wpcontent/uploads/2018/06/mono98.pdf. Accessed 14 Oct 2019
  40. 40.
    Warren JL, Bacon WE, Harris T et al (1994) The burden and outcomes associated with dehydration among US elderly, 1991. Am J Public Health 84:1265–1269CrossRefGoogle Scholar
  41. 41.
    Popkin BM, D’Anci KE, Rosenberg IH (2010) Water, hydration, and health. Nutr Rev 68:439–458.  https://doi.org/10.1111/j.1753-4887.2010.00304.x CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Frangeskou M, Lopez-Valcarcel B, Serra-Majem L (2015) Dehydration in the elderly: a review focused on economic burden. J Nutr Health Aging 19:619–627.  https://doi.org/10.1007/s12603-015-0491-2 CrossRefPubMedGoogle Scholar
  43. 43.
    El-Sharkawy AM, Sahota O, Lobo DN (2015) Acute and chronic effects of hydration status on health. Nutr Rev 73(Suppl 2):97–109.  https://doi.org/10.1093/nutrit/nuv038 CrossRefPubMedGoogle Scholar
  44. 44.
    Castro-Quezada I, Román-Viñas B, Serra-Majem L (2014) The Mediterranean diet and nutritional adequacy: a review. Nutrients 6:231–248.  https://doi.org/10.3390/nu6010231 CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Manson JE, Bassuk SS (2018) Vitamin and mineral supplements: what clinicians need to know. JAMA 319:859–860.  https://doi.org/10.1001/jama.2017.21012 CrossRefPubMedGoogle Scholar
  46. 46.
    DiNicolantonio JJ, Lucan SC, O’Keefe JH (2016) The evidence for saturated fat and for sugar related to coronary heart disease. Prog Cardiovasc Dis 58:464–472.  https://doi.org/10.1016/j.pcad.2015.11.006 CrossRefPubMedGoogle Scholar
  47. 47.
    Widmer RJ, Flammer AJ, Lerman LO, Lerman A (2015) The Mediterranean diet, its components, and cardiovascular disease. Am J Med 128:229–238.  https://doi.org/10.1016/j.amjmed.2014.10.014 CrossRefGoogle Scholar
  48. 48.
    van den Heuvel EGHM, Steijns JMJM (2018) Dairy products and bone health: how strong is the scientific evidence? Nutr Res Rev 31:164–178.  https://doi.org/10.1017/S095442241800001X CrossRefPubMedGoogle Scholar
  49. 49.
    Feldman D, Krishnan AV, Swami S et al (2014) The role of vitamin D in reducing cancer risk and progression. Nat Rev Cancer 14:342–357.  https://doi.org/10.1038/nrc3691 CrossRefPubMedGoogle Scholar
  50. 50.
    Wintermeyer E, Ihle C, Ehnert S et al (2016) Crucial role of vitamin D in the musculoskeletal system. Nutrients.  https://doi.org/10.3390/nu8060319 CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Pilz S, Trummer C, Pandis M et al (2018) Vitamin D: Current Guidelines and Future Outlook. Anticancer Res 38:1145–1151.  https://doi.org/10.21873/anticanres.12333 CrossRefPubMedGoogle Scholar
  52. 52.
    Norman PE, Powell JT (2014) Vitamin D and cardiovascular disease. Circ Res 114:379–393.  https://doi.org/10.1161/CIRCRESAHA.113.301241 CrossRefPubMedGoogle Scholar
  53. 53.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281.  https://doi.org/10.1056/NEJMra070553 CrossRefPubMedGoogle Scholar
  54. 54.
    Wacker M, Holick MF (2013) Vitamin D—effects on skeletal and extraskeletal health and the need for supplementation. Nutrients 5:111–148.  https://doi.org/10.3390/nu5010111 CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Wimalawansa SJ (2018) Non-musculoskeletal benefits of vitamin D. J Steroid Biochem Mol Biol 175:60–81.  https://doi.org/10.1016/j.jsbmb.2016.09.016 CrossRefPubMedGoogle Scholar
  56. 56.
    Chowdhury R, Kunutsor S, Vitezova A et al (2014) Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ 348:g1903CrossRefGoogle Scholar
  57. 57.
    Weaver CM, Alexander DD, Boushey CJ et al (2016) Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int J (Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA) 27:367–376.  https://doi.org/10.1007/s00198-015-3386-5 CrossRefGoogle Scholar
  58. 58.
    Avenell A, Mak JCS, O’Connell D (2014) Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD000227.pub4 CrossRefPubMedGoogle Scholar
  59. 59.
    Kahwati LC, Weber RP, Pan H et al (2018) Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-dwelling adults: evidence report and systematic review for the us preventive services task force. JAMA 319:1600–1612.  https://doi.org/10.1001/jama.2017.21640 CrossRefPubMedGoogle Scholar
  60. 60.
    Zhao J-G, Zeng X-T, Wang J, Liu L (2017) Association between calcium or vitamin d supplementation and fracture incidence in community-dwelling older adults: a systematic review and meta-analysis. JAMA 318:2466–2482.  https://doi.org/10.1001/jama.2017.19344 CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Bracale R, Milani Marin LE, Russo V et al (2015) Family lifestyle and childhood obesity in an urban city of Northern Italy. Eat Weight Disord EWD 20:363–370.  https://doi.org/10.1007/s40519-015-0179-y CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Renata Bracale
    • 1
  • Concetta M. Vaccaro
    • 2
  • Vittoria Coletta
    • 2
  • Claudio Cricelli
    • 3
  • Francesco Carlo Gamaleri
    • 4
  • Fabio Parazzini
    • 5
  • Michele Carruba
    • 6
    Email author
  1. 1.Department of Medicine and Sciences for HealthMolise UniversityCampobassoItaly
  2. 2.Fondazione CensisRomeItaly
  3. 3.Società Italiana di Medicina Generale e delle Cure Primarie FirenzeFlorenceItaly
  4. 4.Ordine dei Farmacisti delle Province di Milano, Lodi e Monza BrianzaMilanItaly
  5. 5.Dipartimento di scienze Cliniche e di ComunitàUniversità di MilanoMilanItaly
  6. 6.Department of Medical Biotechnology and Translational Medicine, Center for the Study and Research on ObesityUniversity of MilanMilanItaly

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