Adherence to Mediterranean Diet in Croatia: Lessons Learned Today for a Brighter Tomorrow

Abstract

Non-communicable diseases (NCD) and lifestyle, particularly diet, have a close relationship. Based on the recent statistics, Croatian men and women lead in European overweight lists, which implies pessimistic prognosis in terms of incidence and prevalence of NCDs in the future. One of the possible solutions to overcome weight problems is turn to traditional balanced and sustainable diets, such as the Mediterranean diet. In this study, we assessed adherence towards Mediterranean diet using a validated questionnaire in an online survey and associated adherence scores with several demographic and anthropometric data. Based on the results of a validated Mediterranean Diet Adherence Screener (N = 3326), we assessed the adherence score to be 7.6 ± 2.5. The score tended to depend on sex, residence, age, education, income, and body mass index (BMI); indeed, women, residents of a coastal part of the country, older volunteers, those possessing a higher education degree, those with higher income, and those with lower BMI were associated with higher scores. As income was one of the significant findings related to higher adherence scores, we developed a dietary plan complying with Mediterranean diet principles that, on average, costed less than the average traditional balanced diet menu. Taken together, this study brought new findings regarding target groups who need to be encouraged to make lifestyle changes, and highlighted the first steps on how to make them.

Keywords: Mediterranean diet; dietary plan; health; lifestyle; nutrition.

Figure 1

Photographs of representative food items based on EFSA’s national food consumption data and mass/volume for questions in the Mediterranean diet adherence questionnaire: (A) olive oil, (B) vegetables: chard, cucumber, pepper, carrot, broccoli, and lettuce, (C) fruit: blueberry and grapes, (D) meat: grilled minced meat “ćevapčići”, Kranj sausage, and Frankfurt sausage, (E) butter, (F) sweetened beverage, (G) red wine, (H) legumes: beans, broad beans, lentils, and chickpeas, (I) seeds and nuts: sunflower seeds, pumpkin seeds, flax seeds, walnuts, hazelnuts, and almonds, (J) fish and seafood: gilt-head bream, hake, European pilchard, salmon fillet, and mixed seafood.

Figure 2

Distribution of volunteers based on a Mediterranean diet score according to: (A) area of residence—either continental or coastal part of Croatia; (B) sex—male or female; (C) age—those younger or older than median of 36 y; (D) income—where 1–4 represent income quartiles based on the National Bureau of Statistics data.

Figure 3

The distribution of volunteers when grouped into low (0–4), intermediate (5–9), and high (10–14) Mediterranean diet score groups according to: (A) area of residence—either continental or coastal part of Croatia; (B) sex—male or female; (C) income—where low or high-income was based on the National Bureau of statistics median data (D) body mass index (BMI) (kg/m²) and age. *: p < 0.05, **: p ≤ 0.01, ***: p ≤ 0.001, ****: p ≤ 0.0001.

Figure 4

Spearman’s correlation plot for different parameters and Mediterranean diet score for the entire study group, as well as for separately presented volunteers from the continental and coastal parts of Croatia. Checked boxes indicate that correlation was not statistically significant (p < 0.05).

Figure 5

Ordinal logistic regression odds ratio and 95% confidence intervals for each parameter contributing to the Mediterranean diet score. ***: p ≤ 0.001, ****: p ≤ 0.0001.

Figure 6

The results of the repeatability study with box plots and the distribution of Mediterranean diet score before and after the initial survey. No statistical differences were observed (Wilcoxon signed-rank test, p = 0.73).

Figure 7

Tailored 2000 kcal, 7-day dietary plan based on Mediterranean diet principles and its cost per day.