# Mediterranean Lifestyle Adherence Reflects Coherent Behavioural Patterns Based on the MEDLIFE Index

## TL;DR

The study shows that following a Mediterranean lifestyle involves a unified set of behaviors, not just diet alone, and that these behaviors are interconnected.

## Contribution

The study introduces a novel approach to analyzing the Mediterranean lifestyle using network analysis and score-based enrichment to identify coherent behavioral patterns.

## Key findings

- Dietary restraint behaviors co-occur with recommended Mediterranean food choices, indicating a unified behavioral framework.
- Low adherence to the Mediterranean lifestyle is marked by unhealthy habits and absence of key components.
- High adherence reflects an integrated profile combining healthy food choices, moderation, and lifestyle practices.

## Abstract

Background/Objectives: The Mediterranean diet (MeDiet) is widely recognised as one of the healthiest dietary patterns, associated with reduced risk of chronic diseases and increased longevity. Beyond its nutritional components, the Mediterranean lifestyle encompasses a broader set of culturally rooted behaviours that may contribute to its health benefits. This study aimed to assess adherence to the Mediterranean diet and lifestyle using the MEDLIFE index and to explore how dietary and lifestyle behaviours cluster into coherent behavioural patterns. Methods: We conducted an observational study among undergraduate students in health and sports sciences and a comparison group of older adults, using an anonymous questionnaire based on the MEDLIFE index. Data were analysed using a pattern-based approach combining network analysis and score-based enrichment to characterise behavioural profiles associated with different levels of Mediterranean lifestyle adherence. Results: Network-based analyses revealed a high degree of internal coherence among dietary and lifestyle behaviours traditionally associated with the Mediterranean lifestyle. In particular, dietary restraint behaviours (e.g., limitation of sugar, salt, and snack consumption) systematically co-occurred with recommended Mediterranean food choices, indicating that positive intake and self-regulation are part of a unified behavioural framework. Score-based stratification confirmed these patterns at the individual level, with low adherence characterised by the absence of key Mediterranean components and unhealthy lifestyle habits, and high adherence reflecting an integrated profile combining healthy food choices, moderation, and lifestyle practices. Conclusions: Adherence to the Mediterranean diet reflects a holistic lifestyle strategy rather than a collection of isolated dietary behaviours. These findings support public health approaches that target coherent behavioural patterns, integrating diet, self-regulation, and lifestyle habits, rather than focusing exclusively on individual dietary components.