Nutrition behaviour and compliance with the Mediterranean diet pyramid recommendations: an Italian survey-based study

  • Renata Bracale
  • Concetta M. Vaccaro
  • Vittoria Coletta
  • Claudio Cricelli
  • Francesco Carlo Gamaleri
  • Fabio Parazzini
  • Michele CarrubaEmail author
Original Article



Adopting a Mediterranean-like dietary pattern may help in preventing several chronic diseases. We assessed the eating behaviour and compliance with the Mediterranean diet pyramid recommendations in Italy.


This is a cross-sectional study conducted in subjects aged ≥ 20 years. A 14-question survey based on the updated Mediterranean diet pyramid was launched online from April 2015 to November 2016. At test completion, a personalized pyramid displaying the possible deficiencies and/or excesses was generated, that could be the basis to plan diet and lifestyle modifications.


Overall, 27,540 subjects completed the survey: the proportion of females (75.6%), younger subjects (20.7%) and people with a University degree (33.1%) resembled those of the Italian population of Internet users rather than of the general population. 37.8% of participants declared a sedentary lifestyle, including 29.6% of those aged 20–29 years. A lower-than-recommended intake of all food categories included in the Mediterranean diet pyramid, along with excess of sweets, red and processed meats, emerged, that may affect health in the long term. Low adherence to recommendations was observed especially among females and older people. Notably, a discrepancy surfaced between the responders’ perceived and actual behaviour toward the regular consumption of fruits and vegetables (81.8% vs 22.7–32.8%, respectively).


The nutritional habits and lifestyle of Italian participants are poorly adherent to the Mediterranean diet recommendations. The personalized pyramid tool may help in raising the awareness of individuals and their families on where to intervene, possibly with the support of healthcare professionals, to improve their behaviour.

Level of evidence

Level V, cross-sectional descriptive study.


Compliance Food pyramid Italy Lifestyle Mediterranean diet Nutrition 



The authors would like to thank all participants who completed the online test. We also thank Scientific Committee members and contributors of Curare la Salute: Luigi Canciani, Alessandro Fornaro. Marcello Giovannini, Elisa Paganini, Annarosa Racca, Paolo Vintani. We thank Pfizer Consumer Healthcare, and especially Antonio Limitone, Ornella Parma and Domenico Giorgio Cassarà for supporting “Curare la salute”. Editorial support was provided by Edra spa, and unconditionally funded by Pfizer Consumer Healthcare.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Participation was voluntary and anonymous and completing the survey was accepted as consent by the participants.

Supplementary material

40519_2019_807_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 20 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Renata Bracale
    • 1
  • Concetta M. Vaccaro
    • 2
  • Vittoria Coletta
    • 2
  • Claudio Cricelli
    • 3
  • Francesco Carlo Gamaleri
    • 4
  • Fabio Parazzini
    • 5
  • Michele Carruba
    • 6
    Email author
  1. 1.Department of Medicine and Sciences for HealthMolise UniversityCampobassoItaly
  2. 2.Fondazione CensisRomeItaly
  3. 3.Società Italiana di Medicina Generale e delle Cure Primarie FirenzeFlorenceItaly
  4. 4.Ordine dei Farmacisti delle Province di Milano, Lodi e Monza BrianzaMilanItaly
  5. 5.Dipartimento di scienze Cliniche e di ComunitàUniversità di MilanoMilanItaly
  6. 6.Department of Medical Biotechnology and Translational Medicine, Center for the Study and Research on ObesityUniversity of MilanMilanItaly

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