Diet quality measured using the Mediterranean diet score and anxiety during armed conflict

Background – Processed diets, particularly those high in fat, added sugars, and refined carbohydrates, are associated with increased anxiety, whereas dietary patterns rich in vegetables, fruits, dairy, nuts, and seeds appear protective. Mediterranean-style diets, characterized by high consumption of plant foods and olive oil with moderate intake of fish and poultry, are associated with reduced cardiometabolic, oncologic, and neurocognitive risks. Prior studies have linked adherence to Mediterranean-style diets with reduced anxiety; however, it remains unclear whether this association persists during periods of severe external stress, such as armed conflict. Objectives – To evaluate whether diet quality, assessed via adherence to a Mediterranean-style diet, was associated with anxiety levels among Israeli adults during the Iron Swords War (2023–2025). Methods – This cross-sectional online survey was conducted in a representative stratified (age, sex, ethnicity) random sample of Israeli adults from November 6–14, 2023. Participants completed validated measures assessing anxiety [General Anxiety Disorder (GAD-7)], diet quality [Israel Mediterranean diet screener (I-MEDAS)], food insecurity (Hunger Vital Sign), and demographic and lifestyle characteristics. Statistical analyses included t-tests, Mann–Whitney U tests, chi-square tests, and logistic regression. Results – Among 534 respondents, 39.7% exhibited moderate to severe anxiety (GAD-7 ≥ 10). Total I-MEDAS scores did not differ by anxiety level; however, poorer diet quality indicators—including reduced fruit and vegetable intake, increased snacking, self-reported dietary deterioration and weight gain—were significantly more common among highly anxious participants. Food insecurity, weight gain, younger age, and female sex independently predicted moderate to severe anxiety. Conclusion – While overall Mediterranean diet adherence was not associated with anxiety level, multiple indicators of diet deterioration were strongly linked to higher anxiety during armed conflict. These findings support the importance of public health strategies targeting both nutrition and mental health during periods of societal stress.