Adherence to Mediterranean Diet Among Prediabetic Patients in East Jerusalem

Abstract

Background: Prediabetes, a precursor state to type 2 diabetes mellitus (T2DM), is characterized by elevated glucose levels that are not yet in the diabetic range. It is often associated with comorbidities such as obesity, hypertension, and dyslipidemia, driven by unhealthy lifestyle factors. This study aims to assess the relationship between adherence to the Mediterranean diet and anthropometric measures, such as body mass index and waist circumference, in Arab adults with prediabetes, considering other lifestyle patterns, including smoking, socioeconomic status, and physical activity.

Methods: We performed baseline data analysis among a sample of prediabetic participants of a clinical trial aimed at improving physical activity and healthy lifestyle behaviors. Patients were recruited from the Sheikh Jarrah Clalit Health Services clinic in East Jerusalem. Eligible participants were identified via medical record review and invited by their primary physician. After providing informed consent, participants completed interviewer-administered questionnaires covering sociodemographic data, physical activity, and dietary habits. Physical measurements, including height, weight, and waist circumference, were taken using standardized protocols. Adherence to the Mediterranean diet was assessed using the locally adapted Israeli Mediterranean Diet Adherence Screener (I-MEDAS).

Results: A total of 172 prediabetic adults aged 40-69.9 years were recruited. The majority of participants exhibited high adherence to the Mediterranean diet, with 80.2% achieving a high adherence score. However, no significant associations were found between Mediterranean diet adherence and BMI or waist circumference. Active smokers were 70.6% less likely to adhere to the Mediterranean diet compared to nonsmokers, and participants with equal-to-average income had lower odds of adhering to the diet compared to those with below-average income.

Conclusions: These findings underscore the need for tailored public health strategies that address local cultural, economic, and environmental factors influencing dietary habits. Improving adherence to the Mediterranean diet in this population will require a multifaceted approach, with further research needed to understand the complex relationship between diet, lifestyle, and chronic disease prevention.

Keywords: body mass index; mediterranean diet; prediabetes; smoking; socioeconomic status; waist circumference.

Figure A1

Adaptation of original MEDAS. Adapted from Abu-Saad et al. (2019) [17].