The impact of socioeconomic and environmental determinants on Mediterranean diet adherence: a municipal-level spatial analysis in Athens metropolitan area, Greece

Abstract

The aim of this study was to identify the geographical variability, the socio-economic and the environmental determinants of adherence to the Mediterranean diet in a general population sample. Level of adherence to the Mediterranean diet was estimated by the ATTICA epidemiological study for 2,749 participants, while socio-economic, demographic, and environmental characteristics were provided by official national and international databases. Higher adherence to the Mediterranean diet was detected in areas with a greater proportion of females and older people, with lower unemployment rate and immigrant population, as well as, in areas covered at a greater extent by green and with higher frequency of supermarkets and street markets. The present findings provide evidence for policy makers to better understand how layers of influence intersect to shape individuals’ eating habits, while they may also contribute in identifying areas of emerging interventions needed.

Keywords:

• Mediterranean diet
• spatial analysis
• socio-economic
• food environment

Acknowledgements

The authors thank the ATTICA study group of investigators: Christina Chrysohoou, Yannis Skoumas, Natasa Katinioti, Labros Papadimitriou, Constantina Masoura, Spiros Vellas, Yannis Lentzas, Manolis Kambaxis, Konstanitna Paliou, Vassiliki Metaxa, Ekavi Georgousopoulou, Agathi Ntzouvani, Dimitris Mpougatas, Nikolaos Skourlis, Christina Papanikolaou, Aikaterini Kalogeropoulou, Evangelia Pitaraki, Alexandros Laskaris, Mihail Hatzigeorgiou, Athanasios Grekas, and Eleni Kokkou for assistance in the initial physical examination and/or the follow-up evaluation; Efi Tsetsekou for her assistance in psychological evaluation and follow-up evaluation, as well as the laboratory team: Carmen Vassiliadou and George Dedousis (genetic analysis), Marina Toutouza-Giotsa, Constantina Tselika and Sia Poulopoulou (biochemical analysis) and Maria Toutouza for the database management. We would also like to thank all the individuals participated in the ATTICA study.

Ethics approval and consent to participate

ATTICA study was approved by the Bioethics Committee of Athens Medical School. The study was carried out in accordance with the Declaration of Helsinki (1989) of the World Medical Association. All participants were informed about the study aims and procedures and provided written informed consent.

Disclosure of interest

The authors report no conflict of interest.

Author contributions

TT wrote the manuscript (interpretation of the results and discussion) and performed the statistical analysis. AF, MK, TP, CC and CP contributed in the interpretation of the results and discussion. DBP and CP were responsible for the study’s design and implementation and critically reviewed the manuscript.

Data availability statement

The data are available upon request. For expression of interest, please contact Prof. Demosthenes Panagiotakos ([email protected]).

Additional information

Funding

The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].