Adherence to the Mediterranean Diet and Its Association with Sustainable Eating Knowledge, Attitudes, Habits, and Cooking Self-Efficacy Among Spanish Adults: A Cross-Sectional Study

This cross-sectional study examines adherence to the Mediterranean Diet (MD) lifestyle and its association with knowledge, attitudes, habits, and cooking self-efficacy related to healthy and sustainable diets among Spanish adults. Additionally, it explores how sociodemographic and behavioral variables influence adherence to the MD. An online survey was conducted with 380 participants, predominantly women, urban dwellers, and highly educated individuals. The results reveal limited knowledge about food sustainability, with only 58.1% recognizing the MD as a sustainable model. Multivariable logistic regression analyses showed that higher adherence to the MD lifestyle was significantly associated with older age. Younger individuals who cooked regularly reported higher cooking self-efficacy, which in turn was associated with living with children and with healthier and more sustainable dietary habits. These dietary habits were also linked to being female, highlighting the interconnected roles of gender, age, and domestic context in shaping attitudes toward healthy and sustainable eating. The findings highlight a strong interrelation among attitudes, habits, and cooking self-efficacy, which together influence MD adherence. These results underscore the importance of designing targeted public health interventions that enhance cooking self-efficacy as a key lever to promote healthier and more sustainable eating habits, particularly among men and individuals who cook infrequently.