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  • Item type: Item , ZeitschriftenaufsatzAccess status: Open Access ,
    Multifactorial determinants of health status : insights from the MEDIET4ALL large-scale survey on eco-sociodemographic, psychological, and lifestyle (diet, physical activity, and sleep) factors
    (2026) Ammar, Achraf; Salem, Atef; Boujelbane, Mohamed Ali; Trabelsi, Khaled; Bouaziz, Bassem; Kerkeni, Mohamed; Masmoudi, Liwa; Heydenreich, Juliane; Schallhorn, Christiana; Müller, Gabriel; Uyar, Ayse Merve; Ghazzawi, Hadeel Ali; Amawi, Adam Tawfiq; Orhan, Bekir Erhan; Grosso, Giuseppe; Abdelkarim, Osama; Driss, Tarak; El Abed, Kais; Zmijewski, Piotr; Debeaufort, Frédéric; Benbettaieb, Nasreddine; Poulain, Clément; Reyes, Laura; Gamero, Amparo; Cuenca-Ortolá, Marta; Cilla, Antonio; Francesca, Nicola; Messina, Concetta Maria; Viola, Enrico; Lorenzen, Björn; Filice, Stefania; Lahiani, Sadjia; Khaldi, Taha; Souissi, Nafaa; Boukhris, Omar; Frias-Toral, Evelyn; Jahrami, Haitham; Husain, Waqar; Mahdi, Walid; Chtourou, Hamdi; Schöllhorn, Wolfgang I.
    Background: Non-communicable diseases are a growing public health challenge, shaped not only by biological predispositions but also by geo-demographic, socioeconomic, psychological, and lifestyle factors. A comprehensive understanding of these determinants is essential for developing targeted public health strategies. This study aimed to examine the multifactorial determinants of individual health status by analyzing geo-demographic, socio-economic, behavioral, psychological, and lifestyle variables.Methods: Data were collected from 4,010 participants (age: 37.2 ± 15.4 years; 59.5% female) across 10 Mediterranean and neighboring countries using the multinational MEDIET4ALL e-survey. Health status was categorized as healthy, at-risk, or with diseases. Multinomial logistic regression, Quade’s Rank ANCOVA and series of multiple regression models were conducted.Results: Collectively, around 25% of respondents declared to be at-risk of or with known disease. BMI emerged as the strongest negative predictor of health status (β = −0.145), with both obesity and underweight significantly increasing the odds of being at risk (OR = 1.8 and 5.2, respectively) and having diseases (OR = 2.2 and 11.9, respectively). Other significant negative predictors included psychological distress (notably anxiety, β = −0.091), insomnia (β = −0.084), alcohol consumption (β = −0.053), and prolonged sitting time (β = −0.037). Conversely, life satisfaction was the strongest significant protective factor (β = 0.066), followed by higher education, better sleep quality, and adherence to the Mediterranean Diet and lifestyle (β = 0.034 to 0.050). Socio-economic disparities, including employment status (β = −0.045) and living environment (β = −0.031), also significantly influenced health outcomes with rural environment and employed individual showing lower odd ratios of being at-risk and/or having diseases (p < 0.001). Furthermore, individuals residing in Mediterranean regions, females, married or cohabiting individuals, and non-smokers exhibited significantly lower odds of being at-risk or having diseases (p < 0.05). While gender remained a significant predictor in the final refined comprehensive regression model (β = −0.049), marital status lost significance, suggesting that its protective effect may be mediated by psychological well-being and health-related behaviors.Conclusion: These findings highlight the complex interplay of lifestyle, mental health, and socio-environmental factors in determining health outcomes, while emphasizing the urgent need for multi-level public health interventions, including policies promoting physical activity, healthy eating, mental well-being, and equitable healthcare access. Future research should employ longitudinal designs to establish causal relationships and guides preventive strategies.
  • Item type: Item , ZeitschriftenaufsatzAccess status: Open Access ,
    Cross-country variability in Mediterranean lifestyle adherence and its psychosocial and behavioural correlates : insights from the MEDIET4ALL project across 10 Mediterranean and neighboring countries
    (2026) Ammar, Achraf; Salem, Atef; Zarzissi, Slim; Abril-Mera, Tania; Trabelsi, Khaled; Bouaziz, Bassem; Boujelbane, Mohamed Ali; Kerkeni, Mohamed; Masmoudi, Liwa; Heydenreich, Juliane; Schallhorn, Christiana; Müller, Gabriel; Uyar, Ayse Merve; Ghazzawi, Hadeel Ali; Amawi, Adam Tawfiq; Orhan, Bekir Erhan; Grosso, Giuseppe; Abdelkarim, Osama; Driss, Tarak; El Abed, Kais; Moalla, Wassim; Zmijewski, Piotr; Debeaufort, Frédéric; Benbettaieb, Nasreddine; Poulain, Clément; Reyes, Laura; Gamero, Amparo; Cuenca-Ortolá, Marta; Cilla, Antonio; Francesca, Nicola; Messina, Concetta Maria; Viola, Enrico; Lorenzen, Björn; Filice, Stefania; Lahiani, Sadjia; Khaldi, Taha; Souissi, Nafaa; Boukhris, Omar; Frias-Toral, Evelyn; Jahrami, Haitham; Husain, Waqar; Mahdi, Walid; Souissi, Nizar; Chtourou, Hamdi; Schöllhorn, Wolfgang I.
    Background: The Mediterranean lifestyle is increasingly recognized as a multidimensional determinant of health. However, cross-country comparisons using harmonized instruments remain limited. This study aimed to provide a comprehensive country-by-country comparison of Mediterranean lifestyle adherence and associated psychosocial and lifestyle correlates across 10 Mediterranean and neighboring countries participating in the MEDIET4ALL project.Methods: Cross-sectional data were collected from 4,010 participants (age: 37.2 ± 15.4 years; 59.5% female) using the multinational MEDIET4ALL e-survey. Mediterranean lifestyle adherence was assessed using the MedLife Index and its three domains. Psychosocial status, sleep characteristics, physical activity, sedentary behaviour, social participation, and technology use were evaluated using validated instruments.Results: Significant cross-country differences were observed in global MedLife adherence and across all domains (p < 0.001, η2 = 0.07–0.11), as well as in the distribution of adherence categories across countries (χ2 = 113.936, p < 0.001). Spain consistently showed higher MedLife scores than several countries (z = 3.42–8.12, adjusted p < 0.001–0.02) and tended to display higher proportions of participants in the high-adherence category, whereas lower adherence was observed in multiple non-Mediterranean and North African contexts. Psychological distress differed significantly between countries (p < 0.001), with several contexts showing elevated depression, anxiety, or stress levels (z ≈ 3.57–14.29, adjusted p < 0.001–0.05). Life satisfaction and social participation also varied substantially (194.86, p < 0.001), with some European countries reporting lower social participation compared with Mediterranean and neighboring contexts (z = 3.79–9.31, adjusted p < 0.001–0.05). Sleep parameters and insomnia severity differed markedly across countries (H = 66.64–198.63, p < 0.001), with less favourable sleep profiles observed in several contexts (z ≈ 3.28–12.82, adjusted p < 0.001–0.05). Physical activity and sedentary behaviour showed pronounced variability (p < 0.001), with Jordan reporting the lowest physical activity levels and Tunisia lower sedentary time.Conclusion: Mediterranean lifestyle adherence and its psychosocial and behavioural correlates vary substantially across countries, reflecting distinct constellations of sociocultural, socioeconomic, and lifestyle factors rather than dietary patterns alone. These findings highlight the importance of multidimensional, context-sensitive approaches to Mediterranean lifestyle promotion and provide a descriptive framework to inform tailored public-health strategies and future longitudinal and intervention research.
  • Item type: Item , DissertationAccess status: Open Access ,