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Adherence to the Mediterranean Diet is not significantly associated with overall disease severity in Familial Mediterranean Fever, reinforcing that FMF severity is driven by a complex interplay of multifactorial components. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

November 21, 2025Socio-Environmental Systems Modeling1 citationsOpen Access

Association of Mediterranean diet adherence with familial Mediterranean fever severity in a Lebanese cohort

RHRazane HammoudLebanese American University RHRemie El HelouLebanese American University DSDalal SabbaghLebanese American University

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Abstract

BACKGROUND: Familial Mediterranean Fever (FMF) is an autoinflammatory disease characterized by a wide clinical variability among individuals, indicating that both genetic and environmental factors influence disease progression. Although the Mediterranean Diet (MD) is recognized for its anti-inflammatory properties, its relationship with FMF severity remains uninvestigated. This study aims to explore the association between MD adherence and FMF severity, while considering individuals' genetic background, lifestyle, and comorbid health conditions. METHODS: A cross-sectional survey was conducted among 101 confirmed individuals with FMF in Lebanon. Data were collected using a questionnaire that included participants' demographics, socio-economic status, disease manifestations, comorbidities, treatment, and lifestyle habits. FMF severity was determined using the International Severity Score for FMF (ISSF), dietary adherence was assessed using the Modified Mediterranean Prime Screen (MMPS), and physical activity was evaluated using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). RESULTS: Adherence to the MD Score (MDS) was categorized as low (34%), moderate (48%), and high (19%). Most MD component intakes did not meet the recommended ranges. While no relationship was found between MD adherence and FMF severity, specific clinical manifestations, such as diarrhea, differed significantly, with a higher frequency noted in the low MD group. Obesity, high levels of physical activity, and the presence of comorbidities-particularly rheumatoid manifestations, inflammatory bowel disease, and cardiovascular diseases-were associated with a significant increase in FMF severity among participants; however, none of these factors emerged as independent predictors in multivariate models. CONCLUSIONS: Our findings reinforce the multifactorial aspect of FMF and underscore the need for a comprehensive approach that addresses all contributing factors collectively.

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