Cross-country variability in Mediterranean lifestyle adherence and its psychosocial and behavioural correlates: insights from the MEDIET4ALL project across 10 Mediterranean and neighboring countries
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.
Authors
- Slim Zarzissi (ORCID: https://orcid.org/0000-0001-8967-739X)
- Mohamed Ali Boujelbane (ORCID: https://orcid.org/0000-0002-6243-9321)
- Nicola Francesca (ORCID: https://orcid.org/0000-0002-6063-0130)
- Enrico Viola (ORCID: https://orcid.org/0000-0003-3980-528X)
- Atef Salem (ORCID: https://orcid.org/0000-0003-0680-6841)
- Piotr Żmijewski (ORCID: https://orcid.org/0000-0002-5570-9573)
- Nizar Souissi (ORCID: https://orcid.org/0000-0003-1227-8221)
- Christiana Schallhorn (ORCID: https://orcid.org/0000-0003-1564-2658)
- Hamdi Chtourou (ORCID: https://orcid.org/0000-0002-5482-9151)
- Walid Mahdi (ORCID: https://orcid.org/0000-0003-3465-0397)
- Amparo Gamero (ORCID: https://orcid.org/0000-0002-7226-4844)
- Omar Boukhris (ORCID: https://orcid.org/0000-0002-2861-0164)
- Concetta María Messina (ORCID: https://orcid.org/0000-0003-3190-9420)
- Nasreddine Benbettaïeb (ORCID: https://orcid.org/0000-0001-8454-2218)
- Adam Tawfiq Amawi (ORCID: https://orcid.org/0000-0001-7810-748X)
- Bassem Bouaziz (ORCID: https://orcid.org/0000-0002-3692-9482)
- Liwa Masmoudi (ORCID: https://orcid.org/0000-0002-9628-1585)
- H Jahrami
- Hadeel Ghazzawi (ORCID: https://orcid.org/0000-0003-3045-4153)
- Wassim Moalla (ORCID: https://orcid.org/0000-0001-6358-2544)
- Juliane Heydenreich (ORCID: https://orcid.org/0000-0002-7346-4872)
- Kaïs El Abed
- Antonio Cilla (ORCID: https://orcid.org/0000-0001-6532-9032)
- Tarak Driss (ORCID: https://orcid.org/0000-0001-6109-7393)
- Achraf Ammar (ORCID: https://orcid.org/0000-0003-0347-8053)
- Marta Cuenca-Ortolá (ORCID: https://orcid.org/0009-0008-5262-4284)
- Mohamed Kerkeni (ORCID: https://orcid.org/0009-0002-2463-9004)
- Gabriel Müller (ORCID: https://orcid.org/0009-0004-5980-5740)
- Osama Abdelkarim
- Nafaa Souissi
- Clément Poulain (ORCID: https://orcid.org/0009-0004-6370-1581)
- Stefania Filice (ORCID: https://orcid.org/0009-0004-7929-9195)
- Tania Abril-Mera
- Evelyn Frias-Toral
- Ayse Merve Uyar
- Björn Lorenzen
- Laura Reyes
- Sadjia Lahiani
- Khaled Trabelsi
- Taha Khaldi
- Frédéric Debeaufort
- Wolfgang I. Schöllhorn
- Waqar Husain
- Bekir Erhan Orhan
- Giuseppe Grosso
Institutions
- Karlsruhe Institute of Technology (DE)
- University of Jordan (JO)
- University Frères Mentouri Constantine 1 (DZ)
- Texas State University (US)
- University of Sfax (TN)
- COMSATS University Islamabad (PK)
- Multimedia University (MY)
- La Trobe University (AU)
- Johannes Gutenberg University Mainz (DE)
- University of Boumerdes (DZ)
- Universidad Espíritu Santo (EC)
- Universidad Católica de Santiago de Guayaquil (EC)
- University of Catania (IT)
- Université Paris Nanterre (FR)
- Biotechnology Research Center (IR)
- Instituto de Agroquímica y Tecnología de Alimentos (ES)
- Innovation Cluster (Canada) (CA)
- National Observatory (BR)
- Instituts Universitaires de Technologie (FR)
- Institut Agro Dijon (FR)
- Gdansk University of Physical Education and Sport (PL)
- Finnish Society of Sciences and Letters (FI)
- Institut Supérieur du Sport et de l’Éducation Physique de Sfax (TN)
- Arabian Gulf University (BH)
- Istanbul University (TR)
- Norwegian School of Sport Sciences (NO)
- University of Palermo (IT)
- Assiut University (EG)
- ESSCA School of Management (FR)
- Leipzig University (DE)
Publication Details
- Journal
- Frontiers in Nutrition
- Published
- 2026-04-15
- DOI
- https://doi.org/10.3389/fnut.2026.1807414
- Citations
- 1
- Primary Topic
- Physical Activity and Health
- Type
- article
- Field-Weighted Citation Impact
- 18.36
Funders
- Ministerio de Ciencia, Innovación y Universidades
- European Commission
- Agence Nationale de la Recherche
- Bundesministerium für Bildung und Forschung
- Direction Générale de la Recherche Scientifique et du Développement Technologique
- Agencia Estatal de Investigación