Adherence to the Mediterranean diet and psychological wellbeing before and during the COVID-19 pandemic: a prospective analysis of the English Longitudinal Study of Ageing

Objectives Following a Mediterranean-like diet has been associated with lower depression levels but there has been limited study of links with positive states of psychological well-being. We tested whether adherence to a Mediterranean diet was cross-sectionally associated with positive well-being among older adults in England in 2018/2019 and prospectively through the COVID-19 pandemic. Design Prospective observational cohort analysis. Setting Population study of older people ≥50 years in England. Participants 3296 participants (46% men) in the English Longitudinal Study of Ageing (ELSA) aged 68.18±7.43 years, who completed a dietary module in 2018/2019 for the assessment of the Mediterranean diet (relative Mediterranean Diet Index (rMED)). Primary and secondary outcome measures Psychological well-being measured using the CASP12 at baseline (2018/2019) and again in the early months of the COVID-19 pandemic (2020). Results Cross-sectionally, higher rMED scores were associated with greater psychological well-being (β=0.054, p<0.001), independent of depressive symptoms, income, education, physical activity, smoking, self-rated health and limiting long-standing illness. Longitudinal analyses revealed that higher adherence to the Mediterranean diet predicted smaller declines in well-being during the early months of the COVID-19 pandemic (β=0.026, p=0.042), even after accounting for baseline well-being and COVID-19 infection experience. Conclusions Greater adherence to a Mediterranean diet was positively associated with psychological well-being among older adults in England. This relationship persisted even during a period of widespread societal stress. Promoting Mediterranean-style dietary patterns may support not only physical but also mental well-being in later life, underscoring the importance of nutritional public health strategies for mental health resilience in ageing populations.