Association between nutrition knowledge and Mediterranean diet adherence in Israeli adults with type 2 diabetes

Objectives: To investigate the association between dietary knowledge and adherence to Mediterranean diet (MedD) among people with type 2 diabetes (T2D) in Israel. Methods: In this cross-sectional single-center study, adults with T2D visiting a diabetes clinic were enrolled for an interviewer-administered survey. Dietary knowledge was assessed using a questionnaire adapted for locally available foods. MedD adherence was measured using the Israeli Mediterranean Diet Adherence Screener (I-MEDAS). Additional clinical and anthropometric characteristics were retrieved from patients’ medical records. The association between dietary knowledge and MedD adherence was analyzed in a multivariable logistic model. ResultsF: A total of 134 people were included. Mean age was 70 ± 10.7 years; 54.5% were women. The mean dietary knowledge score was 12.1 ± 2.4 (range: 0–17), and the MedD adherence score was 11.0 ± 2.1 (range: 0–17). In multivariable analysis, adjusted for age, sex, socio-economic status and diabetes duration, people in the highest tertile of dietary knowledge were more likely to be in the highest tertile of MedD adherence (adjusted odds ratio 4.6, 95% CI 1.5–14.8, p = 0.01), compared to those in the lowest knowledge tertile. The model explained limited variance in adherence (Nagelkerke R² = 0.16). Sensitivity analyses using the exposure and outcome variables as continuous scores were not statistically significant. Conclusion: Dietary knowledge showed a modest association with MedD adherence in Israeli adults with type 2 diabetes, but this association lacked robustness across analytical approaches. Dietary knowledge explains a small proportion of dietary adherence variability, suggesting that unmeasured factors play a more substantial role in determining dietary behavior.