Association between adherence to the Mediterranean diet and e-healthy diet literacy among pregnant women
DOI:
https://doi.org/10.14306/renhyd.31.1.2896Keywords:
Pregnant women, Mediterranean Diet, Health Literacy, Digital Health, Healthy EatingAbstract
Introduction: The Mediterranean diet (MD) is recognized as a healthy dietary pattern that supports maternal and fetal health during pregnancy. As access to digital nutrition information continues to expand, e-healthy diet literacy (e-HDL) may play an important role in shaping dietary behaviors. This study aimed to investigate the relationship between adherence to the MD and e-HDL among pregnant women (PW).
Methods: This cross-sectional study was conducted among 400 PW residing in Niğde, Türkiye, between January and May 2025. Data were collected through face-to-face interviews using the Mediterranean Diet Adherence Screener (MEDAS) and the e-Healthy Diet Literacy Scale (e-HDL). Anthropometric measurements, including height and body weight, were obtained using a stadiometer and a calibrated scale, respectively. The data were analyzed using correlation and multiple linear regression analyses.
Results: The mean MEDAS and e-HDL scores were 4.8 (1.5) and 35.7 (9.4), respectively, and 88.0% of participants had low Mediterranean diet adherence. MEDAS scores were positively associated with total e-HDL scores (r=0.259, p<0.001), Information Evaluation (IE) (r=0.226, p<0.001), and Application (r=0.244, p<0.001). e-HDL (β=0.280, p<0.001) and educational level (β=0.148, p=0.003) were independently associated with MD adherence.
Conclusions: Higher e-HDL was associated with better adherence to the MD among PW. Enhancing e-HDL through digital nutrition education may support the adoption of healthier dietary behaviors during pregnancy.
Funding: The authors declare that there has been no funding to carry out this study.
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(1) Zaragoza-Martí A, Ruiz-Ródenas N, Herranz-Chofre I, Sánchez-SanSegundo M, Serrano Delgado VC, Hurtado-Sánchez JA. Adherence to the Mediterranean Diet in Pregnancy and Its Benefits on Maternal-Fetal Health: A Systematic Review of the Literature. Front Nutr. 2022;9:813942. doi: 10.3389/fnut.2022.813942 DOI: https://doi.org/10.3389/fnut.2022.813942
(2) Castro-Barquero S, Larroya M, Crispi F, Estruch R, Nakaki A, Paules C, et al. Diet quality and nutrient density in pregnant women according to adherence to Mediterranean diet. Front Public Health. 2023;11:1144942. doi: 10.3389/fpubh.2023.1144942 DOI: https://doi.org/10.3389/fpubh.2023.1144942
(3) Castro-Quezada I, Román-Viñas B, Serra-Majem L. The Mediterranean diet and nutritional adequacy: a review. Nutrients. 2014;6(1):231-248. doi: 10.3390/nu6010231 DOI: https://doi.org/10.3390/nu6010231
(4) Silva P. Food and Nutrition Literacy: Exploring the Divide between Research and Practice. Foods. 2023;12(14):2751. doi: 10.3390/foods12142751 DOI: https://doi.org/10.3390/foods12142751
(5) Aslan Gonul B, Caferoglu Akin Z. Digital healthy eating literacy: its role in sustainable food choices and mediterranean diet adherence. BMC Public Health. 2025;25(1):2109. doi: 10.1186/s12889-025-23353-4. DOI: https://doi.org/10.1186/s12889-025-23353-4
(6) Batu Z, Kalaman S, Batu M, Şentürk ZA, İplikçi HG, Vural NE, et al. Understanding health literacy and digital healthy diet literacy in rural women in Türkiye: a cross-sectional study on social media use and Mediterranean diet adherence. Front Public Health. 2025;13:1559159. doi: 10.3389/fpubh.2025.1559159. DOI: https://doi.org/10.3389/fpubh.2025.1559159
(7) Flor-Alemany M, Nestares T, Jiménez NM, Baena-García L, Aparicio VA. Associations between Sociodemographic Factors, Lifestyle Behaviors, Pregnancy-Related Determinants, and Mediterranean Diet Adherence among Pregnant Women: The GESTAFIT Project. Nutrients. 2022;14(7):1348. doi: 10.3390/nu14071348. DOI: https://doi.org/10.3390/nu14071348
(8) Martínez-González MÁ, Corella D, Salas-Salvadó J, Ros E, Covas MI, Fiol M, et al. Cohort profile: design and methods of the PREDIMED study. Int J Epidemiol. 2012;41(2):377-385. doi: 10.1093/ije/dyq250. DOI: https://doi.org/10.1093/ije/dyq250
(9) Özkan Pehlivanoğlu EF, Balcıoğlu H, Ünlüoğlu İ. Turkish Validation and Reliability of Mediterranean Diet Adherence Screener. Osmangazi Journal of Medicine. 2020;42(2):160-164. doi: 10.20515/otd.504188. DOI: https://doi.org/10.20515/otd.504188
(10) Van Duong T, Chiu CH, Lin CY, Chen YC, Wong TC, Chang PWS, et al. E-healthy diet literacy scale and its relationship with behaviors and health outcomes in Taiwan. Health Promot Int. 2021;36(1):20-33. doi: 10.1093/heapro/daaa033. DOI: https://doi.org/10.1093/heapro/daaa033
(11) Onbaşı Ö, Türker PF. Evaluation of Validity and Reliability of the Turkish Form of e-Healthy Diet Literacy Scale. Bes Diy Derg. 2023;51(2):24–33. doi: 10.33076/2023.BDD.1728. DOI: https://doi.org/10.33076/2023.BDD.1728
(12) Gibson RS. Principles of Nutritional Assessment. 2nd ed. New York: Oxford University Press; 2005. DOI: https://doi.org/10.1093/oso/9780195171693.001.0001
(13) World Health Organization. Obesity: preventing and managing the global epidemic: Report of a WHO consultation [Internet]. Geneva: World Health Organization; 2000 [cited 2026 Jun 6]. Available from: https://iris.who.int/handle/10665/42330
(14) Stephenson J, Heslehurst N, Hall J, Schoenaker DAJM, Hutchinson J, Cade JE, et al. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet. 2018;391(10132):1830–1841. doi: 10.1016/S0140-6736(18)30311-8. DOI: https://doi.org/10.1016/S0140-6736(18)30311-8
(15) Zhang Y, Xia M, Weng S, Wang C, Yuan P, Tang S. Effect of Mediterranean diet for pregnant women: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. 2022;35(24):4824–4829. doi: 10.1080/14767058.2020.1868429. DOI: https://doi.org/10.1080/14767058.2020.1868429
(16) Xu J, Wang H, Bian J, Xu M, Jiang N, Luo W, et al. Association between the Maternal Mediterranean Diet and Perinatal Outcomes: A Systematic Review and Meta-Analysis. Adv Nutr. 2024;15(2):100159. doi: 10.1016/j.advnut.2023.100159. DOI: https://doi.org/10.1016/j.advnut.2023.100159
(17) Kundakçı S, Geyik P, Bağlayici R, Aktaç Ş. Mediterranean Diet Adherence and Health Literacy Levels in Pregnant Women with Gestational Diabetes: A case-control study. J H Sci Arel U. 2024;8(3):109-121. Available from: https://izlik.org/JA85HA57XW
(18) Aygün G, Çakır Biçer N, Kahrıman M. Evaluation of Adherence to the Mediterranean Diet and Physical Activity Status in Pregnant Women Diagnosed with Gestational Diabetes Mellitus. Kocaeli Med J. 2025;14(1):42–50. doi:10.5505/ktd.2025.93604. DOI: https://doi.org/10.5505/ktd.2025.93604
(19) Spies HC, Nel M, Walsh CM. Adherence to the Mediterranean Diet of Pregnant Women in Central South Africa: The NuEMI Study. Nutr Metab Insights. 2022;15:11786388221107801. doi:10.1177/11786388221107801. DOI: https://doi.org/10.1177/11786388221107801
(20) Suárez-Martínez C, Yagüe-Guirao G, Santaella-Pascual M, Peso-Echarri P, Vioque J, Morales E, et al. Adherence to the Mediterranean Diet and Determinants Among Pregnant Women: The NELA Cohort. Nutrients. 2021;13(4):1248. doi: 10.3390/nu13041248. DOI: https://doi.org/10.3390/nu13041248
(21) Ibrahim HA, Alshahrani MS, Elgzar WT. Mediterranean Diet Adherence beyond Boundaries: Sociodemographic and Pregnancy-Related Determinants among Saudi Women. Nutrients. 2024;16(15):2561. doi: 10.3390/nu16152561. DOI: https://doi.org/10.3390/nu16152561
(22) Sharma S, Esposito S, Di Castelnuovo A, Gialluisi A, De Domenico P, de Gaetano G, et al. Impact of Mediterranean Diet Adherence During Pregnancy on Preeclampsia, Gestational Diabetes Mellitus, and Excessive Gestational Weight Gain: A Systematic Review of Observational Studies and Randomized Controlled Trials. Nutrients. 2025;17(10):1723. doi: 10.3390/nu17101723. DOI: https://doi.org/10.3390/nu17101723
(23) Ban S, Kim Y, Seomun G. Digital health literacy: A concept analysis. Digit Health. 2024;10:20552076241287894. doi: 10.1177/20552076241287894. DOI: https://doi.org/10.1177/20552076241287894
(24) Korkmaz Aslan G, Kılınç İşleyen E, Kartal A, Koştu N. The relation between eHealth literacy and healthy lifestyle behaviours in pregnant women. Health Promot Int. 2024;39(2): daae022. doi:10.1093/heapro/daae022 DOI: https://doi.org/10.1093/heapro/daae022
(25) Sherer EL, Malik M. Nutrition literacy in pregnant women: a systematic review. Open Health. 2025;6(1): 20250082. doi: 10.1515/ohe-2025-0082. DOI: https://doi.org/10.1515/ohe-2025-0082
(26) Ningrum EW, Lusmilasari L, Huriyati E, Marthias T, Hasanbasri M. Improving maternal health literacy among low-income pregnant women: A systematic review. Narra J. 2024;4(2):e886. doi: 10.52225/narra.v4i2.886. DOI: https://doi.org/10.52225/narra.v4i2.886
(27) Ozkan HD, Gobel P, Guney HD. The relationship between health literacy and digital healthy diet literacy and dietary habits of pregnant women in different trimesters. Ann Med Res. 2025;32(9):408-414. doi: 10.5455/annalsmedres.2025.07.184. DOI: https://doi.org/10.5455/annalsmedres.2025.07.184
(28) Eckl MR, Brouwer-Brolsma EM, Küpers LK. Maternal Adherence to the Mediterranean Diet during Pregnancy: A Review of Commonly Used a priori Indexes. Nutrients. 2021;13(2):582. doi: 10.3390/nu13020582. DOI: https://doi.org/10.3390/nu13020582
(29) Hou K, Hou T. Investigating pregnant women’s health information needs during pregnancy on internet platforms. Front Physiol. 2022;13:1038048. doi: 10.3389/fphys.2022.1038048. DOI: https://doi.org/10.3389/fphys.2022.1038048
(30) Gjestvang C, Haakstad LAH. Navigating Pregnancy: Information Sources and Lifestyle Behavior Choices-A Narrative Review. J Pregnancy. 2024;2024:4040825. doi: 10.1155/2024/4040825. DOI: https://doi.org/10.1155/2024/4040825
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Copyright (c) 2020 Ceren Şarahman Kahraman, Cansu Memiç İnan, Kamile Ercan, Meltem Soylu
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