Assessment of Mediterranean Diet Adherence and Lifestyle Change during COVID-19 National Lockdown in Tunisian Adult Population

Abstract

The Mediterranean diet (MD) is a plant-based diet associated with a reduction in the risk of developing COVID-19 comorbidities. Lockdown instigation during the COVID-19 pandemic has affected eating habits and lifestyles, highlighting the need to analyze the healthiness of new consumption patterns. We conducted a survey to assess lifestyle change in Tunisian adults and their MD adherence. A total of 1082 respondents completed a self-administered online survey designed to assess their food and lifestyle habits. Poor overall adherence to MD was observed (mean MEDAS score 6.6, SD 1.07) in a preponderance of the mid-MD adherent subgroup (71.2% of the participants). Location, age, profession, and household welfare proxy were the main determinants of high MD adherence. When adjusting for sociodemographic variables, location and income remained statistically significant. Positive health outcomes were noticed in respondents with high MEDAS scores. Most importantly, binary logistic regression showed that risk of COVID-19 infection decreased as MEDAS score increased for unvaccinated obese participants (OR = 0.63; confidence interval (CI) 0.4-0.98; p = 0.045). Regarding lifestyle changes, confinement had contributed to an overall reduction in cigarette consumption, sleeping hours, and physical activity. Long-term consequences of these changes on health outcomes must be further explored.

Keywords: COVID-19; MD adherence; Tunisian adults; lifestyle change; lockdown.

Figure 1

Distribution of MEDAS score over age categories. Elderly subjects had significantly higher MEDAS scores than younger groups (post hoc analysis p < 0.001, p < 0.001 for adults and young adults, respectively).

Figure 2

Distribution of MEDAS score over household welfare proxy. Significant difference for the mean MEDAS score between the three economic classes (p < 0.001). A post hoc analysis showed that a significantly higher mean score is noticed for high economic level (upper tertile) compared to medium (p = 0.025) and low economic classes (p < 0.001).

Figure 3

Impact of MD adherence on health status for the three MD-adherence profiles. Distribution of MEDAS score over MD adherence by age category and chronic diseases declared by participants. Kruskal–Wallis tests showed a significant difference in MEDAS score related to health status considered (p = 0.047). For all age categories, healthy participants recorded the highest MEDAS scores. Adults with morbid health status with multiple chronic diseases recorded the lowest MEDAS scores.

Figure 4

Compliance with items from PREDIMED questionnaire according to adherence profile: high (green), medium (yellow) and low adherence (red) to the Mediterranean diet (MD). The radar chart plots the values of each item of the questionnaire along a separate axis. Each axis refers to one of the 14 recommendations of PREDIMED questionnaire. Axis starts in the center of the chart (0% compliance) and ends at the outer ring (100% compliance). The values are the percentage of respondents compliant with each recommendation. The figure shows that consumption of fish and seafood, legumes, nuts and wine are commonly inappropriate for the three MD-adherence profiles.