The relationship between adherence to the Mediterranean diet, food literacy, orthorexia and food insecurity in pregnancy

The Mediterranean diet is one of the healthy eating models accepted worldwide and has been associated with beneficial health outcomes in pregnant women. This study was conducted to evaluate the adherence of pregnant women to the Mediterranean diet and to examine the relationship between the Mediterranean diet and food literacy, food insecurity, orthorexia and prenatal stress. In this cross-sectional study, a questionnaire including demographic information, Mediterranean diet adherence scale, orthorexia nervosa scale, Short Food Literacy questionnaire, Household Food Insecurity Access Scale and Prenatal Distress scale were applied to 300 pregnant women. 41.3% of the participants were undergraduate and/or postgraduate; 72.7% were unemployed; 54.0% had equal income and expenditures; 35.7% were experiencing their first pregnancy; and 41.7% were in their second trimester. It was found that 78.0% of the participants had high adherence to the Mediterranean diet (MD), 88.0% had adequate food literacy, 76.3% had orthorexia tendency and 21.1% had food insecurity (FI). Adherence to the Mediterranean diet was found to be negatively associated with FI and positively associated with orthorexia tendency and food literacy (p < 0.05). Food insecurity was positively correlated with ORTO-15 scores (r = 0.119, p = 0.039), indicating that higher food insecurity is associated with a lower tendency toward orthorexia. Furthermore, food insecurity was negatively associated with food literacy (r=-0.144, p = 0.012) and positively associated with prenatal stress (r = 0.383, p < 0.001). In addition, orthorexic tendencies and adequate food literacy significantly increased the likelihood of adherence to the Mediterranean diet (p < 0.05). Food insecurity, not dieting before pregnancy, and not exercising before pregnancy decreased the likelihood of high adherence to the Mediterranean diet (p < 0.05). It was observed that the majority of pregnant women have high adherence to the Mediterranean diet, adequate nutritional literacy, and a tendency toward orthorexia. Food insecurity is negatively associated with adherence to the Mediterranean diet and nutritional literacy; it is positively associated with orthorexia and prenatal stress. The Mediterranean diet (MD) is a globally accepted model of healthy eating. Adherence to the MD during pregnancy contributes to improved maternal and infant health. Food literacy (FL) can increase adherence to the MD. Orthorexia, defined as obsession with healthy eating, is a condition that can be seen in pregnant women and can negatively affect the health of mother and baby. Another factor that poses a risk for maternal and infant health during pregnancy is food insecurity (FI). In this study, the relationship between adherence to MD, FL, orthorexia and FI in pregnant women was examined. There is a positive correlation between food literacy and adherence to the Mediterranean diet, whereas there is a negative correlation with food insecurity. A positive correlation was also found between adherence to the Mediterranean diet and orthorexia in pregnant women. Adherence to MD is high in most pregnant women, FL is adequate. Pregnant women are prone to orthorexia and at risk of FI. Food insecurity has been found to be associated with adherence to the Mediterranean diet, food literacy, orthorexia tendencies, and prenatal stress.