Cross-country variability in Mediterranean lifestyle adherence and its psychosocial and behavioural correlates: insights from the MEDIET4ALL project across 10 Mediterranean and neighboring countries

Abstract

Background: The Mediterranean lifestyle is increasingly recognized as a multidimensional determinant of health. However, cross-country comparisons using harmonized instruments remain limited. This study aimed to provide a comprehensive country-by-country comparison of Mediterranean lifestyle adherence and associated psychosocial and lifestyle correlates across 10 Mediterranean and neighboring countries participating in the MEDIET4ALL project. Methods: Cross-sectional data were collected from 4,010 participants (age: 37.2 ± 15.4 years; 59.5% female) using the multinational MEDIET4ALL e-survey. Mediterranean lifestyle adherence was assessed using the MedLife Index and its three domains. Psychosocial status, sleep characteristics, physical activity, sedentary behaviour, social participation, and technology use were evaluated using validated instruments. Results: < 0.001), with Jordan reporting the lowest physical activity levels and Tunisia lower sedentary time. Conclusion: Mediterranean lifestyle adherence and its psychosocial and behavioural correlates vary substantially across countries, reflecting distinct constellations of sociocultural, socioeconomic, and lifestyle factors rather than dietary patterns alone. These findings highlight the importance of multidimensional, context-sensitive approaches to Mediterranean lifestyle promotion and provide a descriptive framework to inform tailored public-health strategies and future longitudinal and intervention research.