Decline of the Mediterranean diet at a time of economic crisis. Results from the Moli-sani study

Background and aimsAdherence to Mediterranean diet (MD) is reportedly declining in the last decades. We aimed to investigate the adherence to MD over the period 2005–2010 and exploring the possible role of the global economic crisis in accounting for the changing in the dietary habits in Italy.Methods and resultsCross-sectional analysis in a population-based cohort study which randomly recruited 21,001 southern Italian citizens enrolled within the Moli-sani study. Food intake was determined by the Italian EPIC food frequency questionnaire. Adherence to MD was appraised by the Italian Mediterranean Index (IMI). A wealth score was derived to evaluate the economic position and used together with other socioeconomic indicators. Highest prevalence of adherence to MD was observed during the years 2005–2006 (31.3%) while the prevalence dramatically fell down in the years 2007–2010 (18.3%; P < 0.0001). The decrease was stronger in the elderly, less affluent groups, and among those living in urban areas. Accordingly, we observed that in 2007–2010 socioeconomic indicators were strongly associated with higher adherence to MD, whereas no association was detected in the years before the economic crisis began; both wealth score and education were major determinants of high adherence to MD with 31% (95%CI: 18–46%) higher adherence to this pattern within the wealthier group compared to the less affluent category.ConclusionAdherence to MD has considerably decreased over the last few years. In 2007–2010 socioeconomic indicators have become major determinants of adherence to MD, a fact likely linked to the economic downturn.