Adherence to Mediterranean diet and cardiometabolic risk among mountain communities in European Alps

Abstract Background The Mediterranean diet has emerged as a model promoting a better health status, particularly for cardiovascular diseases prevention. Adherence to the Mediterranean diet (AMD) may vary depending on geographical location and sociocultural factors. Mountains and rural communities may experience lower adherence, also depending on food provision-related services availability. Our cross-sectional study aims to investigate the association between AMD and cardiometabolic risk in a cohort of mountain dwellers. As a secondary aim, we will test if services availability may influence health status via AMD. Methods In spring/summer 2023, healthy volunteers from 5 small villages in Italian Alps were enrolled. Dietary habits were investigated by Medi-Lite standardized questionnaire. The waist-to-height ratio (WHtR) was calculated by dividing the waist circumference by height, then used as an anthropometric index for central adiposity and related cardiometabolic risk. Services availability was assessed by network analysis implemented in QGIS. A multilevel logistic regression model, with center as random intercept and adjusted for age, sex, BMI, education and physical activity was used to test the association between AMD and cardiometabolic risk. Ethical approval was provided by University of Turin. Results To date, 142 subjects (59.2% females, 49.9±14.0 y.o.) have been enrolled. Preliminary analyses showed that, as compared to the least adherent group, subjects reporting the highest AMD level (3rd tertile of Medi-Lite scoring) were strongly protected from cardiometabolic risk (OR: 0.07, 95% C.I.: 0.01, 0.67; p = 0.021). A similar trend was observed for the 2nd tertile. Conclusions Our preliminary findings suggest the beneficial role of the Mediterranean diet also in remotely located populations. We plan to investigate how service availability may impact AMD and, indirectly, cardiometabolic health to reinforce the importance of equity in services distribution for Public Health Key messages • Independently of age, sex, BMI, education and physical activity, adherence to the Mediterranean diet can promote cardiometabolic health among rural and mountain communities. • Mediterranean eating pattern can positively influence central adiposity and should be promoted to ensure more effective prevention strategies in mountain dwellers.