title: Decline of the Mediterranean diet at a time of economic crisis. Results from the Moli-sani study.
abstract: OBJECTIVE
  Adherence 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.
  
  
  RESULTS
  Cross-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.
  
  
  CONCLUSIONS
  Adherence 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.
authors.affiliation: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Via dell'Elettronica, 86077 Pozzilli (Isernia), Italy. Electronic address: marialaura.bonaccio@neuromed.it.
authors.forename: M
authors.initials: M
authors.lastname: Bonaccio
authors.affiliation: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Via dell'Elettronica, 86077 Pozzilli (Isernia), Italy.
authors.forename: A
authors.initials: A
authors.lastname: Di Castelnuovo
authors.affiliation: Epicomed Research Srl, 86100 Campobasso, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bonanni
authors.affiliation: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Via dell'Elettronica, 86077 Pozzilli (Isernia), Italy.
authors.forename: S
authors.initials: S
authors.lastname: Costanzo
authors.affiliation: Associazione Cuore Sano ONLUS, Campobasso, Italy.
authors.forename: F
authors.initials: F
authors.lastname: De Lucia
authors.affiliation: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Via dell'Elettronica, 86077 Pozzilli (Isernia), Italy.
authors.forename: M
authors.initials: M
authors.lastname: Persichillo
authors.affiliation: Transfusion Unit, Ospedale di Isernia, Isernia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Zito
authors.affiliation: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Via dell'Elettronica, 86077 Pozzilli (Isernia), Italy.
authors.forename: M B
authors.initials: MB
authors.lastname: Donati
authors.affiliation: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Via dell'Elettronica, 86077 Pozzilli (Isernia), Italy.
authors.forename: G
authors.initials: G
authors.lastname: de Gaetano
authors.affiliation: Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Via dell'Elettronica, 86077 Pozzilli (Isernia), Italy. Electronic address: licia.iacoviello@moli-sani.org.
authors.forename: L
authors.initials: L
authors.lastname: Iacoviello
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D038441:Diet, Mediterranean / Q000191:economics*; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D015999:Multivariate Analysis; D009752:Nutritional Status; D010349:Patient Compliance; D012044:Regression Analysis; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Cerebrovascular risk; Economic crisis; Mediterranean Diet; Obesity; socioeconomic status