Mediterranean Diet: Potential Health Benefits, Barriers to Adherence and Intervention Strategies

Abstract

The Mediterranean diet (MD) is widely recognized as a healthy eating pattern linked to a lower risk of chronic diseases and better overall health. Despite strong scientific evidence supporting its benefits, many populations, especially outside Mediterranean regions, show low adherence to the MD. This narrative review aims to analyse existing research on nutritional knowledge, adherence levels, benefits, and barriers to following the Mediterranean diet among adults. Relevant peer-reviewed articles, systematic reviews, and observational studies published in the past twenty-five years were examined using electronic databases such as PubMed, ScienceDirect, and other renowned databases. Studies were selected based on predefined inclusion and exclusion criteria. Included studies were peer-reviewed articles published within the last twenty-five years, focusing on adults and examining the Mediterranean diet in relation to adherence, nutritional knowledge, health outcomes, or barriers. Studies older than twenty-five years, or those not directly relevant to the research topic were excluded. The results show that greater nutritional knowledge is associated with better adherence to the MD, while limited awareness, misconceptions, and lack of practical skills hinder compliance. Common barriers include high perceived costs, limited availability of key foods, cultural food preferences, time constraints, and inadequate cooking skills. Additionally, socioeconomic and environmental factors play significant roles in shaping dietary behaviour. Overall, the review identifies significant gaps between knowledge and practice, particularly in low- and middle-income countries (LMICs) and among underrepresented populations in Africa and Asia, where research on Mediterranean diet awareness and adherence remains limited. Important methodological and conceptual gaps also persist, including inconsistent definitions of the diet and limited generalizability of findings across diverse populations. These gaps underscore the need for culturally tailored nutrition education and supportive food environments. These findings provide a solid foundation for future research, and a dire need to evaluate nutritional knowledge and barriers of Mediterranean diet adherence among adults in different community settings with a potential to reduce the increase in non-communicable diseases.