Nutrients · 3 authors, 1 centre
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This study of 610 members of the University of Almeria community found that only 12.1% had high adherence to the Mediterranean Diet (MedD), while 40.9% had low adherence. Students showed the lowest adherence (42.3% low), and the strongest predictor of MedD adherence was being a Spanish woman living with family. The findings suggest that university authorities should promote MedD benefits and offer MedD-based menus in campus canteens to improve health outcomes.
**Background:** The Mediterranean Diet (MedD) is recognized by UNESCO as Intangible Cultural Heritage and is associated with reduced risk of non-communicable diseases including diabetes, heart disease, stroke, and cancer. However, adherence to MedD has declined in Mediterranean countries over the past 70 years, with Spain dropping to 18th position globally. Young people are particularly affected by this trend. The transition to university life often involves leaving the family home, time pressure, and economic constraints that may promote unhealthy eating. This study aimed to assess MedD adherence in the university community of Almeria, Spain, and identify sociodemographic and behavioral predictors of adherence.
**Methods:** The study was conducted at the University of Almeria (UAL) during the 2021/2022 academic year (September–November). From a university community of 15,268 people, a sample of 610 completed surveys was obtained (error margin ±3.9%). Participants included 64.7% women, 34.1% men, and 1.3% who preferred not to disclose; 59.7% were students, 23% teaching/research staff (PDI), and 17.3% administration/services staff (PAS). Mean age was 32 years, and 92.5% were Spanish. The questionnaire "Nutritional Habits, Health and Environmental Engagement in the University Community" included four sections: informed consent, consumption behavior, food/sustainability knowledge, and lifestyle/sociodemographic data. MedD adherence was measured using the Mediterranean Diet Score 2 Tool (T-MDS), which assigns 0 or 1 to nine components of daily intake (MUFA/SFA ratio, vegetables, legumes, fruit/nuts, cereals, fish, alcohol, dairy, meat), yielding a total score from 0 (no adherence) to 9 (maximum adherence). Scores of 7-9 were classified as "good" adherence. Data were analyzed using SPSS 25.0.0 with linear regression models.
**Key Results:** Overall, 78.2% of respondents considered their lifestyle healthy or very healthy, and 71.8% reported always or almost always maintaining a healthy diet. However, actual dietary assessment revealed that respondents met recommendations for vegetable consumption but were deficient in cereals, nuts/seeds, water, and fruit intake, while consuming excessive processed foods, salt, and sweets. No participant scored 0 or 9 on the T-MDS scale. The highest percentage (25.1%) scored 1, indicating nearly no MedD-recommended food consumption. After grouping, 40.9% had low adherence, 47% intermediate adherence, and 12.1% high adherence. Women showed higher adherence (17% high) compared to men (7.1% high). Spaniards had higher adherence than non-Spaniards, with more than half of non-Spaniards scoring low. No age group showed high adherence; the highest was 22.6% among those aged 41-45, while the 56-60 age group had only 5.1% high adherence. Students showed the lowest adherence (42.3% low) compared to teaching/research staff (27.9% low) and administrative staff (32.4% low). By faculty, Humanities had the highest high adherence (20%), followed by Health Sciences (17.8%), while Economics and Business Sciences had only 5% high adherence and 66.7% low adherence. Linear regression (Model 4, full model) identified being female and regular exercise as the strongest positive predictors of MedD adherence. Other significant predictors included Spanish citizenship, living with family (not alone), reading food labels, knowledge of what constitutes a Healthy Dish, and recycling waste. Throwing food away was a negative predictor. Student status and young age were negative predictors.
**Clinical Implications:** The study reveals a substantial gap between perceived and actual healthy eating in the university community, with only 12.1% achieving high MedD adherence despite 71.8% believing they maintain a healthy diet. Students are particularly vulnerable, with 42.3% showing low adherence. The authors recommend that university authorities (1) disseminate knowledge about healthy eating beyond health science curricula to all university members, and (2) intervene in campus catering services to promote MedD-recommended foods using local Almerian produce. An intervention protocol was registered for the 2022/2023 academic year. These findings highlight the need for structural and educational interventions in university settings to combat the decline in MedD adherence, particularly among young adults transitioning to independent living.