Research project
36 | monthsPROMETEO

Promoting adherence to an unprocessed mediterranean diet over the lifecourse

Related toSpoke 05

Principal investigators
Licia Iacoviello,Marialaura Bonaccio
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Task involved

Task 5.1.1.

Identification of areas in Italy, based on existing databank, in order to: a) assess the populations at higher risk of over- and under-nutrition b) select the strategic partners to meet and educate the at-risk population (schools, recreative centres, churches, other associations) in connection with Spoke 7.

Task 5.1.2.

Analysis of existing data on food consumption, lifestyle and biochemical/genetic parameters in Italian population groups along the lifecycle: elaboration of available datasets providing information on eating and lifestyle habits, accessibility, drivers and barriers towards a healthy diet of defined groups (children, adolescents, adults, pregnant women, older subjects) in connection with Spoke 1.

Task 5.3.1.

Identify the factors influencing adherence to the Mediterranean diet with attention to children and adolescents in Italy (including consumer needs and preferences, local determinants/drivers of food choices in connection with Spoke 1).

Task 5.3.2.

Identify key sociodemographic and psychosocial factors associated with adherence to the Mediterranean diet in adults and free-living older adults throughout Italy, and also detecting individual-level and environmental barriers that may affect this age group engaging in consistent healthful dietary habits in connection with Spoke 1 (e.g., social isolation, low-income, neighbourhoods with high rates of poverty, poor nutrition literacy).

Project deliverables


Provide a comparison between urban and non-urban areas (M30)


Report on national food consumption accessibility, drivers, and barriers towards a healthy diet of defined groups (M32)


Identification of variables related to Mediterranean diet adherence, including socio-economic and cultural factors, lifestyle, nutrition knowledge, consumer preferences, etc. (M12)


Analyses on existing population-based cohorts including adults and people aged ≥65 years (M24)


Establishment of cohorts of older adults (aged ≥65 years) to expandknowledge on major determinants/drivers (either favoring factors or barriers) of healthy eating and to collect biospecimens for future investigations on the contribution of diet to successful aging (M30)

Interaction with other spokes

State of the art

A traditional Mediterranean Diet (MD) has long been considered as a major protective factor against diet-related non-communicable diseases but recent data indicated a progressive decline in the adherence to this diet across all population groups, although an exhaustive analysis in the Italian population is missing. However, the MD–health relationship has been traditionally explained almost exclusively by food composition, with no or little attention paid to degree of food processing. Such a nutrient-driven approach has some important limitations, since other aspects in the diet-health relationship are increasingly acknowledged as important as nutrients in shaping health risk at population level, as consistently demonstrated in several cohorts worldwide.  A clear map of the nutritional status including an analysis of food processing is therefore warranted to plan effective intervention strategies targeted to end all types of malnutrition across populations at different health risk. 

Operation plan

Analyses will take advantage of existing population-based cohorts (e.g. Moli-sani Study, INHES survey, RoCaV cohort, and the MEAL cohort) where the following analyses are planned:
1) dietary intakes (e.g. macro- and micronutrient; food groups; dietary patterns) and consumption of foods at different level of processing by sex, and across age groups, socioeconomic and demographic strata (e.g. urban/rural areas);
2) meal timing and diet quality, including processing levels;
3) nutritional status and assessment of MD adherence amongst participants aged ≥65 y from both cohorts, and analysis of major determinants (e.g. socioeconomic, demographic, psychosocial, cultural and lifestyle);
4) assessment of adherence to MD in a sized sample of older people (≥65 years) to be recruited at the IRCCS Neuromed and identification of key correlates to identify barriers/favouring factors to MD adherence. Biospecimens will be collected.

A pilot cohort of mother-child pairs will be established to complete the long-life dietary assessment. 

Expected results

1. Provide an exhaustive map of nutritional status in Italy across population groups at different health risk, also including an analysis of food processing.

2. Identify key correlates of adherence to an MD, and therefore highlight barriers/favouring factors to healthful eating patterns, specifically in adults/elderly.

3. Increase knowledge on key determinants/correlates of healthful diets at any age to possibly set effective public health prevention strategies at population level, to promote health and decrease the risk of developing diseases during later life.