He Moves, She Eats Better: How Gender Affects the 'Mediterranean' Lifestyle

That’s what an international team found when they surveyed more than 4,000 people in 10 countries about the “Mediterranean lifestyle” — not just a bowl of salad with olive oil, but also sleep, exercise, stress, and social activity. The study was published in the journal Frontiers in Nutrition.

What was studied

The researchers analyzed 4,010 fully completed online questionnaires of the MEDIET4ALL project (Germany, France, Italy, Spain, Luxembourg, Tunisia, Algeria, Morocco, Turkey and Jordan). To assess not just the diet, but the complex Mediterranean lifestyle, they used the MedLife index: it includes three blocks - what and how we eat (frequency of vegetables, fruits, whole grains, oils, etc.), eating habits (home cooking, meal schedule, etc.) and behavioral factors (physical activity, sleep, participation in social life). Additionally, they measured sleep, physical activity, anxiety/depression/stress levels, life satisfaction and other validated questionnaires.

Main results

Overall, men and women scored similar overall MedLife scores. But under the hood, the picture is different:

• women hold on to the “plate” part better – they more often choose the “right” products and eating habits;
• Men are more likely to perform more physical activity and are more likely to engage in social activities.

Sleep is a weak link in women: lower efficiency, longer time to fall asleep, shorter duration; insomnia is more pronounced, as is psychological distress. Women more often reported a need for psychosocial and nutritional support.

The higher the overall MedLife score, the more movement and social contacts, and the better the satisfaction with sleep. But with insomnia, depression, stress, and anxiety, there is an inverse relationship: the stronger the “Mediterranean” lifestyle, the lower the levels of these problems (even if moderate in strength).

Why is this important?

The Mediterranean diet has long been associated with lower risks of cardiovascular disease, type 2 diabetes, and some types of cancer. But in practice, it is not only money and food availability that prevent people from following it “by the book,” but a combination of behavioral and social factors — sleep, exercise, stress, communication. This study neatly shows that gender differences in these “building blocks” are significant, which means that support measures should also differ.

How to read this in practical terms

• If you focus on food, but "sag" in sleep and movement, the overall effect will be incomplete. And vice versa: sports without adjusting your diet is only part of the puzzle.
• For women, the priority may be sleep hygiene and stress management (and access to psychological/social support), while for men, it may be improving the quality of nutrition and household habits (cooking more often at home, planning meals).

Restrictions

This is an online survey (a cross-section, not an experiment), so we are talking about associations, not causality. Participation is voluntary, which means there is a risk of sample bias (people who are already interested in a healthy lifestyle usually answer). But the volume and geography are impressive, and the tools are validated.

Authors' comments

• Achraf Ammar (co-author, University of Sfax/University of Jordan): “We looked beyond the plate to the entire Mediterranean lifestyle. Based on data from 4,010 respondents from 10 countries, women were on average more likely to adhere to the dietary components of the diet, while men were more likely to increase physical activity and social participation – something that could be important to consider in prevention programmes.”
• Mohamed Ali Boujelbane (first author, University of Sfax): “The overall MedLife score did not differ between men and women, but the profile of differences was noticeable: women had better nutrition, worse sleep; men had more exercise. This suggests that support tools should be targeted: for women, an emphasis on sleep hygiene and stress management, and for men, on diet quality.”
• Juliane Heydenreich (Leipzig University): "Sleep turned out to be the 'weak link' in women: lower efficiency, longer latency, shorter duration, higher severity of insomnia. But sleep contributes to dietary compliance no less than physical activity - this should be integrated into the recommendations."
• Giuseppe Grosso (University of Catania): "We see that a high MedLife score is consistently associated with greater physical activity and social participation, as well as better sleep and lower levels of depression, stress and anxiety. This 'multi-domain' relationship confirms that it is a lifestyle issue, not just a set of foods."
• Khaled Trabelsi (University of Sfax): “The practical implication is the customization of interventions: for men, focusing on foods, portions, and eating habits; for women, supporting sleep, mental health, and removing barriers to adherence.”
• Hamdi Chtourou (University of Sfax): “Despite the cross-sectional design, the scale and consistency of the associations provide a good basis for targeted health programs – from corporate to national – taking into account gender differences.”

What does it lead to?

The next step is personalized, gender-sensitive programs to popularize MedLife: combining nutrition + movement + sleep + support for mental well-being, rather than “treating with a plate” in isolation from habits and context.