Mediterranean Diet Adherence Is Associated with Lower Prevalence of Depression and Anxiety in University Students: A Cross-Sectional Study in Greece

<b>Background/Objectives</b>: The Mediterranean diet (MD) constitutes one of the most broadly studied dietary patterns, which has been linked to the prevention of non-communicable diseases and mental health disorders. University students, a population exposed to significant psychosocial stressors and lifestyle changes, may particularly benefit from healthy eating patterns such as the MD. This study was designed to examine the potential associations of MD adherence with symptoms of depression and anxiety among Greek university students. <b>Methods</b>: A cross-sectional study was initially conducted among 7160 active university students from ten diverse geographic regions in Greece. After the enrollment procedure and the application of relevant exclusion criteria, 5191 university students (52.0% female; mean age: 21.3 ± 2.4 years) constituted the study population. MD adherence was assessed using the KIDMED index, while depressive and anxiety symptoms were evaluated using the Beck Depression Inventory-II (BDI-II) and State-Trait Anxiety Inventory (STAI-6), respectively. Sociodemographic and anthropometric data were collected for all the enrolled university students. All the questionnaires were completed by face-to-face interviews with expert personnel. <b>Results</b>: Students with low adherence to the MD were significantly more likely to report symptoms of depression (OR = 2.12; <i>p</i> ˂ 0.001) and anxiety (OR = 2.27; <i>p</i> ˂ 0.001) and to be overweight or obese (OR = 2.45; <i>p</i> ˂ 0.001) after adjustment for multiple confounding factors. Low MD adherence was also associated with male gender (OR = 0.73; <i>p</i> ˂ 0.01), living alone (OR = 0.78; <i>p</i> ˂ 0.01), smoking (OR = 0.75; <i>p</i> ˂ 0.01), low physical activity (OR = 1.84; <i>p</i> = 0.001), and poorer academic performance (OR = 0.83; <i>p</i> ˂ 0.01). <b>Conclusions</b>: Low adherence to the MD is significantly associated with increased likelihood of depression, anxiety, and excess body weight among university students in Greece. These findings underscore the importance of promoting healthy dietary habits and related lifestyle behaviors in young adult populations as a potential strategy for mental health prevention and intervention. Due to the presence of several limitations in the present study, future longitudinal and interventional studies should be performed to confirm the present findings.