Food group intake and Mediterranean diet adherence among a representative sample of Spanish middle-aged and older adults. Are we still on track? The HERMEX study

Abstract

Background and aim: To explore food group intake and adherence to the Mediterranean Diet (MD) in a representative sample of 2833 middle-aged and older adults from the HERMEX study. Methods and results: This cross-sectional study utilized a food frequency questionnaire to assess food group intake and measured MD adherence using the MD Score. Sociodemographic, anthropometric, and clinical characteristics were also analyzed. Among participants, 74 % were living with overweight or obesity, 69.9 % were non-smokers, and 88 % showed medium-high adherence to the MD. Compared to the national dietary recommendations issued by the Spanish Agency for Food Safety and Nutrition (AESAN), 76 % had carbohydrate intake below recommended levels (average intake: 35.4 %), whereas 73.5 % consumed protein at 16.6 % of total energy intake. Only 2 % of participants adhered to the fat intake recommendation (<35 % of total energy). Consumption of fruits, vegetables, cereals, potatoes, and eggs was below recommendations, while intake of legumes, nuts, fish, seafood, and dairy met or nearly met the recommendations. Meat consumption exceeded recommendations. Macronutrient intake (carbohydrates, protein, fat, and fiber) was similar across BMI groups. However, participants with obesity consumed fewer nuts, whereas those with normal weight had a higher intake of red wine compared to individuals with overweight (p < 0.05). MD adherence was similar across BMI groups (34 points on a 0–55 scale). Conclusions: Prevalence of overweight and obesity was high despite medium-high adherence to the MD. Overall, caloric intake and food consumption patterns were consistent across BMI groups, with notable differences in nut and red wine intake.