Men's and Women's "Mediterranean Style": What the MEDIET4ALL survey of 4,010 people shows

An international team analyzed how men and women adhere to the Mediterranean diet and the lifestyle associated with it - physical activity, sleep, social habits. The study is based on 4,010 online responses from 10 countries and the validated MedLife Index, which evaluates not only food, but also eating habits and behavioral factors. The main result: the overall "Mediterranean" score is similar for the sexes, but the ways to achieve it differ. Women are better at adhering to dietary recommendations, men - to activity and social engagement.

Background of the study

The Mediterranean approach has long gone beyond “what to eat”: it is about lifestyle (food + eating habits + exercise, sleep, sociality) that is associated with better health outcomes. But actual adherence to it varies significantly between countries and population groups and can depend on gender, age, activity level, and barriers to everyday life. That is why the authors of the MEDIET4ALL project set out to look at the picture broadly and comparatively – across several countries at once and with special attention to gender differences.

For this assessment, the validated MedLife Index was selected — a tool that intentionally measures not only diet, but also dietary habits and behavioral components. It is divided into three blocks: (1) frequency of consumption of “core” Mediterranean products, (2) daily eating habits (whole grains, sugar in drinks, snacks, etc.), (3) lifestyle elements (physical activity, rest, social practices). In addition, participants filled out validated scales on activity, sleep, mental health, social involvement and subjective barriers — to see the context in which the eating style is formed.

The focus on gender differences is not accidental: men and women often achieve “Mediterraneanness” in different ways—some are stronger in food, others in movement and social activity; and women are more likely to experience sleep disturbances and psychological distress, which can make it difficult to maintain healthy practices without additional support. Understanding these differences is important for developing targeted, gender-sensitive interventions.

Methodologically, MEDIET4ALL is an international cross-sectional online study of 4,010 participants from 10 countries with an average age of ~36 years. While this design does not prove causality and is vulnerable to self-reporting, the large sample size and use of validated instruments provide a rare, comparable “slice” of how people actually put together their Mediterranean lifestyle—and where exactly they need help.

How was it carried out?

The MEDIET4ALL study is an international cross-sectional survey using a set of validated questionnaires. Participants (mean age 36.0 ± 15.1 years, 59.5% women) completed the MedLife Index (28 items) and scales on activity, sleep, mental health and social inclusion.

• MedLife Index includes 3 blocks:
  • food frequencies (15 points),
  • dietary habits (7),
  • lifestyle (6).
    Participants were divided into tertiles: low (<12), medium (12-16), high (>16) commitment (range 0-28).
• Additionally: IPAQ-SF (physical activity), ISI (insomnia), DASS-21 (stress/anxiety/depression), SLSQ (life satisfaction), questionnaires of barriers and needs for support.

Key Findings

The final MedLife score did not differ between genders, but the structure of the score did. Women more often followed the recommendations for food items, men - for activity and the social sphere. In parallel, gender differences were revealed in sleep, smoking and the need for support.

• Block 1. Food frequencies: women have a higher sum (Z=−4.83; p <0.001).
  • Women were more likely to meet the recommended intake for: red meat, processed meat, eggs, vegetables, olive oil, herbs/spices, and potatoes ( p < 0.001).
  • Men - by: fish/seafood, sweets, legumes ( p = 0.001).
  • No distinction: white meat, low-fat dairy, nuts/olives, fruits, grains.
• Block 2. Dietary habits: in total, no differences, but by points:
  • Women - better with whole grains, less frequent snacks, less sugar in drinks;
  • Men - more often water/infusions, moderate wine, better salt control.
• Block 3. Lifestyle (activity/leisure/sociality): men are higher (Z=−9.3; p <0.001) - more physical activity, team sports and meetings with friends; women are more likely to watch TV.
• Sleep and mental health: women showed worse sleep metrics (efficiency, latency, duration) and higher insomnia severity, as well as more psychological distress; they more often reported the need for psychosocial, physical and nutritional support ( p < 0.001).
• Smoking: men smoke cigarettes more often ( p <0.001), women smoked hookah more often ( p <0.05); however, there were more non-smokers among women ( p <0.001).
• Adherence categories (low/medium/high): distribution across tertiles did not differ between genders.

Links to activity, sleep and mental health

The higher the MedLife score, the better the picture of movement, sleep and psyche. In large samples, not only the "significances" are important, but also the magnitudes of the effects - here they are moderate but stable.

• Positive correlations:
  • with physical activity ( r = 0.298),
  • with social involvement ( r = 0.227),
  • with satisfaction with sleep ( r = 0.181).
• Negative correlations:
  • with insomnia ( r = -0.137),
  • depression ( r = -0.115),
  • stress ( r = -0.089),
  • anxiety ( r = -0.076).

What does this mean in practice?

The authors suggest talking not about a “diet,” but about the Mediterranean lifestyle (MedLife) – a package of habits where food, movement, sleep, and sociality work together. At the same time, it is useful to “gender-tailor” interventions.

• For women (stronger in food, weaker in activity, more barriers and distress):
  • short and everyday activity formats (group walks, short workouts),
  • sleep support and psychological support,
  • Maintaining strengths - vegetables, whole grains, sugar in moderation.
• For men (stronger in activity/sociality, weaker in terms of food items):
  • emphasis on vegetables/olive oil/whole grains,
  • reducing sweets and being more mindful of alcohol/salt,
  • prevention of tobacco smoking.

Important Disclaimers

This is a cross-sectional survey study: it does not prove causality and is vulnerable to bias (self-reporting, social desirability, under-controlling for socioculture). Large data sets increase power - and very small differences can become statistically significant. Findings should be interpreted practically, not just by p -values.

Conclusion

Men and women come to the "Mediterranean style" by different roads. Women are better at observing the dietary components, men - the physical and social ones. The higher the overall MedLife score, the more movement, better sleep and calmer the psyche. This means that public healthy lifestyle programs are more effective in being gender-sensitive and multi-component - so MedLife becomes not a diet, but an environment.

Source: Boujelbane Ma et al. Gender-specific insights into adherence to Mediterranean diet and lifestyle: analysis of 4,000 responses from the MEDIET4ALL project. Frontiers in Nutrition (2025), 12: 1570904. DOI 10.3389/fnut.2025.1570904