Associates of adherence to the Mediterranean diet among Lebanese adults: A cross sectional study

Background and aim: The Mediterranean Diet (MD) is valued for its health benefits, yet adherence is declining, especially in its regions of origin. In Middle Eastern Mediterranean countries like Lebanon, this decline is exacerbated by ongoing economic challenges, which have disrupted dietary habits and access to MD components. Revitalizing adherence to the MD requires a clear understanding of its determinants, which remain poorly understood in these contexts. This study aims to address this gap by examining the socio-cognitive and environmental factors influencing MD adherence among Lebanese adults, using the Socio-Ecological Model (SEM). Methods: A cross-sectional study was conducted in Lebanon between November 2023 and January 2024 using an online questionnaire, available in Arabic and English. Adults aged 18 and above were recruited via convenience and snowball sampling. The questionnaire assessed socio-demographics, socio-cognitive and environmental factors, and adherence to the MD using the validated MEDAS questionnaire. Data were analyzed using univariate tests and multiple regression to examine associations between MD adherence and socio-demographic, socio-cognitive, and environmental factors. Results:A total of 304 participants completed the survey. The majority were women (74.7%). The research population had a mean age of 33.3 years and a relatively high education (92.7% bachelor's degree and above). Adherence to the MD was generally low to moderate (mean score: 5.97 ± 2.0 on a scale from 0 to 14), with only 4.3% showing high adherence. While several socio-cognitive and environmental factors were correlated with MD adherence in bivariate analysis, only perceived ease of following the MD, a component of perceived behavioral control, was significantly associated with MD adherence in the multiple regression analysis (β = 0.23; p = 0.002). Conclusions: These findings highlight the importance of addressing perceived behavioral control by implementing practical, context-specific interventions that make adherence to the MD easier, especially in times of crisis.