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Article

Natural Functional Foods as a Part of the Mediterranean Lifestyle and Their Association with Psychological Resilience and Other Health-Related Parameters

by
Efstratios Christodoulou
1,
Georgia-Eirini Deligiannidou
2,
Christos Kontogiorgis
2,
Constantinos Giaginis
1 and
Antonios E. Koutelidakis
1,*
1
Laboratory of Nutrition and Public Health, Department of Food Science and Nutrition, University of the Aegean, 81400 Myrina, Greece
2
Laboratory of Hygiene and Environmental Protection, School of Medicine, Democritus University of Thrace, Dragana Campus, 68100 Alexandroupolis, Greece
*
Author to whom correspondence should be addressed.
Appl. Sci. 2023, 13(7), 4076; https://doi.org/10.3390/app13074076
Submission received: 12 February 2023 / Revised: 11 March 2023 / Accepted: 21 March 2023 / Published: 23 March 2023
(This article belongs to the Special Issue Topical Advisory Panel Members’ Collection Series: Functional Foods)
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Abstract

:
Natural Functional Foods (NFFs) are unprocessed foods with proven health benefits beyond their nutritional value. The Mediterranean Diet (MD) and Mediterranean Lifestyle (MEDILIFE) are well known for their beneficial effects on health. Psychological Resilience (PsyR) is not only an important factor in human well-being; it is also regarded as a key indicator of mental health. The purpose of this study was to explore the relationship between NFFs and the MD and MEDILIFE in Greece, as well as their association with PsyR and other health-related parameters. In a cross-sectional design, 338 healthy adults participated voluntarily in an online research survey. There was a statistically significant association between the consumption of NFFs grown and produced in the Mediterranean region and the MD and MEDILIFE (p < 0.001). When the MD and MEDILIFE associated NFFs scores were summed up to form a 10-item scale (NAFFAME), the NAFFAME had a statistically significant positive correlation with PsyR (p < 0.001) and sleep quality (p < 0.05) and a negative correlation with body mass index (p < 0.001). There was also a statistically significant difference (p < 0.05) between the means of the NAFFAME score on different weight loss diet outcomes. Multinomial regression analysis identified the NAFFAME score as a prognostic factor in maintaining weight loss after a diet (OR: 1.119, 95% CI: 1.035, 1.208, p < 0.01 compared with no weight loss). This study identified NFFs as a part of the MD and MEDILIFE. NFFs linked to the MEDILIFE could help predict the outcome of a weight loss diet and appear to have a positive effect on PsyR, sleep quality, and maintaining a healthy weight. Thus, the consumption of NFFs grown and produced in the Mediterranean region could be a natural, healthy, and sustainable way of enhancing physical–mental health. Randomised controlled trials should be conducted to confirm the findings of this cross-sectional study.

1. Introduction

The COVID-19 pandemic outbreak [1], in addition to the high toll on human lives and the environmental, economic, and social impact [2], created an urgency to improve people’s health and well-being in a more natural and sustainable manner [3]. Food and lifestyle have long been regarded as key modifying factors addressing physical and mental health determinants in a non-pharmaceutical setting [4,5,6,7].
The possible therapeutic effect of food on health was emphasised, among other things, by Aristotle, the father of modern science, who stated, “Food moves in two directions. On the one hand, it works to regenerate the body while also limiting disease progression” [8]. Centuries later, in the 1980s in Japan, the term functional foods first appeared to classify foods with therapeutic properties. The Japanese scientific academic community defined functional food as “food that has physiological functions beyond nutrient functions, such as regulation of biorhythms, the nervous system, the immune system, and bodily defense” [9]. Despite the fact that there is not a universally accepted definition [10], one of the most complete terms is that “functional foods are natural or processed foods that contain biologically-active compounds; which, in defined, effective, non-toxic amounts, provide a clinically proven and documented health benefit utilizing specific biomarkers, to promote optimal health and reduce the risk of chronic/viral diseases and manage their symptoms” [11]. In Greece, both Natural Functional Foods (NFFs), such as edible wild greens, herbal infusions, raisins, cruciferous vegetables, berries, seeds, bee products, fermented dairy products, herbs and spices, and whole grains, and fortified functional foods have been studied for their potential effects on physical and mental health by a limited number of studies [12,13,14,15,16]. In a case-control study, Elmaliklis et al. reported that specific natural functional foods rich in fibre are correlated with a decreased risk for gastrointestinal diseases [12], while, in another study, functional food consumption was associated with depression and anxiety indexes [13]. Because of the significant burden placed on public health by the consumption of ultra-processed foods and drinks, policymakers advocate for the consumption of unprocessed or minimally processed foods and drinks [17]. Thus, it is critical to investigate NFFs and their possible effects on human health as part of a balanced dietary pattern, such as the Mediterranean diet, due to the possible synergistic action of the bioactive compounds of NFFs [14]. However, the possible bioactivity of NFFs is still under investigation, and such investigations are focused on a plethora of parameters, such as effective dose, time of consuming, bioavailability, possible toxicity, etc.
One of the dietary patterns that has its foundation in the consumption of unprocessed or minimally processed foods, such as olive oil, whole grains, vegetables, fruits, and nuts [18], and refers to the traditional dietary habits of countries bordering the Mediterranean Sea, primarily Greece and Southern Italy [19], is the Mediterranean Diet (MD). The MD has been characterised as a “functional diet” due to its proven health benefits [20], with its health-promoting properties attributed to its high content of phenolic compounds, fibre, phytosterols, and polyphenols such as resveratrol, as well as MUFAs, PUFAs, vitamins, and minerals [21]. Despite the fact that the MD is one of the most studied dietary patterns in the world [22], the literature largely ignores the role of the Mediterranean Lifestyle (MEDILIFE) and its health-promoting effects [23], even though there have been studies that presented the role of the two main components of the MEDILIFE, that is the MD and physical activity, in reducing inflammation by modifying the composition of the gut microbiota and, as a result, promoting overall health [24,25]. MEDILIFE is regarded as the traditional lifestyle in the Mediterranean region [26], a “true modus vivendi that integrally promotes physical, mental, and social well-being” [27]. MD adherence, physical activity, rest, and social interactions are the most common components of MEDILIFE [26]. Other MEDILIFE characteristics may include proximity to nature and sustainable eating behaviours such as consuming local products and avoiding food waste [28,29,30,31].
PsyR is another important factor regarding one’s physical, mental, and social well-being [32]. A transversal definition of PsyR that was proposed by Sisto et al. in 2019 is, “PsyR is the ability to maintain the persistence of one’s orientation towards existential purposes. It constitutes a transversal attitude that can be understood as the ability to overcome the difficulties experienced in the different areas of one’s life with perseverance, as well as good awareness of oneself and one’s own internal coherence by activating a personal growth project” [33]. PsyR is not only important for a person’s functionality, but it is also linked to good physical and mental health overall [34,35].
There is limited evidence that PsyR is associated to MEDILIFE, although they seem to share common values at their core [36]. Therefore, it is important to study their synergistic effect on physical and mental health promotion, a multi-factorial issue that necessitates more systematic approaches [37]. There is also scarcity of evidence on NFF consumption and its relationship to the MEDILIFE and PsyR.
The aim of the present study was to look into the link between NFFs, the MD, and MEDILIFE in Greece, as well as their relationship with PsyR and other health-related parameters, adding data to the existing body of knowledge. The hypothesis of our study was that NFFs grown and produced in the Mediterranean region are correlated with the MEDILIFE and that NFFs and the MEDILIFE are positively associated with PsyR and health parameters such as sleep quality and a healthful weight in the Greek population both individually and synergistically.

2. Materials and Methods

2.1. Subjects

Based on the Greek population, the total sample size calculated to be required for a confidence level of 95% and a confidence interval of 5% was set at 384 people [38]. A total of 411 people took part in the survey. Every person living in Greece over the age of 18 who agreed to have their responses used anonymously and confidentially for scientific purposes and data analysis met the inclusion criteria for this study. Following the exclusion of 61 people who were not eligible for this study, as well as 17 incomplete or random responses, the final sample consisted of 338 adults. To facilitate accurate responses, participants were given clear instructions on how to complete questionnaires. Social media invitations in Greek domains were used to recruit participants. Transparency, a non-exceptionalist methodology, privacy respect, and adherence to the terms of use of the social media platforms were all part of the recruiting process [39]. The survey was available in both Greek and English.

2.2. Study Design

A cross-sectional study design was chosen because it could be conducted in a relatively short period of time and lead to conclusions about the correlation of two or more factors [40]. For data collection, an online questionnaire was created and implemented using Sogosurvey cloud survey software. Because of the unique circumstances in Greece as a result of the COVID-19 pandemic, an online questionnaire was deemed necessary. Online questionnaires are becoming increasingly popular as a simple, convenient, and low-cost method of data collection. If the design and execution are careful and methodical, their results do not differ from those of printed questionnaires [41]. A pilot study of 50 people was conducted before the survey was officially distributed to check for potential ambiguities. The distribution, data collection, and analysis processes were all tested. A pilot study is essential for improving the quality and efficiency of the main study [42]. The data structure, distribution, collection, and analysis were error free. The results of the pilot study were incorporated into the final sample. The survey was officially distributed in September 2021 and finished in November 2021. The analytic plan and the hypotheses of this study were specified before the data were collected.

2.3. Ethical and Deontological Issues

This study was carried out in strict accordance with the established codes of ethics and deontology. Acceptance of the research terms and conditions was a prerequisite for participation. The research was approved by the University of the Aegean’s ethics and deontology committee (no. 17715/09.09.2021) and complied with the ethical, deontological, and legal framework of research as defined in the university’s Code of Ethics and Deontology of Research.

2.4. Scales

2.4.1. Mediterranean Diet Adherence Screener (14-MEDAS)

Schroeder et al. [43] developed the 14-MEDAS scale (Supplementary Materials S1, questions 3–16) to assess adherence to the Mediterranean diet as part of the PREDIMED study. Each question is graded from 0 to 1. The 14-MEDAS final score ranges from 0 to 14. A score of 0 to 5 indicates low adherence to the Mediterranean diet, 6 to 9 indicates moderate adherence, and 10 to 14 indicates high adherence. 14-MEDAS has been validated in numerous countries and languages, including Greek. Garcia-Conesa et al. [44] found that the Greek version of 14-MEDAS has a very high agreement (81.2, 10.7%) with the Food Frequency Questionnaire (FFQ), making it a very valid and reliable research tool for measuring adherence to the Mediterranean diet in the Greek population.

2.4.2. Connor–Davidson 10-Item Resilience Scale (CD-RISC-10)

CD-RISC-10 (Supplementary Materials S1, questions 32–41) is a brief version of the Connor and Davidson resilience scale [45]. It is one of the most widely used scales for measuring psychological resilience and contains ten of the original scale’s twenty-five items. It is graded on a Likert scale [46], with answers ranging from 0 to 4 points. The total score may range from 0 to 40 points. A higher score indicates greater resilience. CD-RISC-10 was validated in Greek by Tsigaropoulou et al. [47]. The authors concluded from a case-control study of 546 people that the Greek translation of the CD-RISC-10 is a reliable and valid tool for measuring psychological resilience in the Greek population.

2.4.3. Single-Item Sleep Quality Scale (SQS)

The SQS (Supplementary Materials S1, question 54) is a validated, single-item sleep quality scale designed to provide a simple and practical way to assess sleep quality. The participants answer a single question regarding their sleep quality over a 7-day recall period on a 0–10 visual analogue scale. While the SQS’s single-item format allows people to rate their own sleep quality, the addition of a discretising visual analogue scale improves the measurement’s sensitivity [48]. This scale is a valid tool for measuring healthy adults [49].

2.5. MEDILIFE, Functional Foods, and Demographics and Anthropometrics

2.5.1. MEDILIFE

The 14-MEDAS scale was used to assess the adherence to the MD, a universally accepted component of the MEDILIFE. Other literature-recognised components of the MEDILIFE, such as physical activity, proximity to nature, sleeping habits, social interactions, sustainable eating behaviour, family solidarity, spirituality, and political engagement [23,28,29,30,31], were assessed with 12 self-reported ad hoc questions on a Likert scale, with responses ranging from 0 to 4 points. Five questions about family solidarity, napping, spirituality, and political engagement were excluded from reliably measuring the MEDILIFE because there was no statistically significant (p > 0.05) correlation with the 14-MEDAS scale. The remaining seven questions all had a statistically significant (p < 0.05) correlation with the MD and acceptable internal consistency (Cronbach’s α = 0.675), making them reliable for measuring adherence to the MEDILIFE.

2.5.2. Natural Functional Foods—NFFs

Functional food consumption was assessed with 14 self-reported questions on a 0–4 Likert scale about the participants’ weekly consumption frequency (never, rarely or 1–2 times, sometimes or 2–3 times, usually or 4–6 times, everyday or 7+ times) of some of the most common NFFs worldwide, such as whole grains, edible wild greens, herbal infusions, bee products, raisins, seeds, berries, cruciferous vegetables, fermented dairy products, herbs and spices, cocoa/dark chocolate, milk, and coffee [50], with one of the questions pertaining to fortified functional food consumption. The functional food consumption questions were based on the NHANES study Food Frequency Questionnaire, which was modified to include only functional foods [51].

2.5.3. Demographics and Anthropometrics

The demographic and anthropometric data questions in the questionnaire were placed at the end. This option helped to reduce research abandonment [52]. Among the demographic questions were those relating to education, employment status, marital status, and gender. Participants were asked to fill out forms with their height and weight, which were then used to calculate their Body Mass Index (BMI). Although self-reporting height and weight is not the most reliable source of data for drawing conclusions about respondents’ body composition, it is a valid method of calculating BMI for adults from various socio-demographic groups [53]. To delve deeper into the participants’ eating habits, they were asked if they had previously followed a weight loss diet (Supplementary Materials S1, question 58) and what the long-term effects on their body weight were (Supplementary Materials S1, question 59). Individuals’ BMIs were classified into four categories based on existing guidelines (underweight, normal weight, overweight, and obesity) [54].

2.6. Statistical Analysis

The data were checked for possible omissions. When a participant’s completion of the questionnaire was interrupted (missing completely at random), the data were removed from the observations. In the event of an unintentional omission (missing at random), the average of all respondents’ answers was used to compensate [55]. The data were exported as a file ready for import and processing in SPSS 27 and R-Statistics. The statistical analysis and visualisation of the results were carried out using the statistical analysis programmes SPSS 27 and R-Statistics. Prior to submitting the data to statistical tests, their distribution was checked for regularity. For the best and most reliable control of regularity, a combination of visual evaluation and the Shapiro–Wilk test should be used [56]. Regularity tests were performed on the research’s main variables. The statistical significance level was set at p < 0.05. ANOVA, correlations, t-tests, multiple linear regressions, and multinomial logistic regression were used for the statistical analysis of the data.

3. Results

3.1. Functional Foods and Their Association with the MEDILIFE and PsyR

Functional foods, natural or processed, were tested for their association with MD, the components of the MEDILIFE, and PsyR. There was statistically significant (p < 0.001) Spearman’s correlation coefficients between NFFs, such as whole grains (ρ = 0.393), edible wild greens (ρ = 0.262), herbal infusions (ρ = 0.230), bee products (ρ = 0.177), raisins (ρ = 0.291), seeds (ρ = 0.389), berries (ρ = 0.267), cruciferous vegetables (ρ = 0.325), fermented dairy products (ρ = 0.268), and herbs/spices (ρ = 0.382), and 14-MEDAS. The same group of NFFs was significantly (p < 0.05) associated with most of the other components of the MEDILIFE. On the contrary, other foods, such as milk, cocoa/dark chocolate, coffee, and fortified functional foods, were not significantly associated (p > 0.05) with either 14-MEDAS or the MEDILIFE, except for chocolate, which was associated with sleeping routine, and fortified foods consumption, which was associated with physical activity and meal routine. NFFs associated with MD and MEDILIFE were also correlated significantly to PsyR (p < 0.05), except for berries, for which the association with PsyR was close to statistical significance (p = 0.062). Consumption of cocoa/dark chocolate, milk, and coffee was not linked to PsyR, while the consumption of fortified foods was found to be significantly correlated to PsyR (Table 1).

3.2. Assessment of NFFs’ Group Associated with the MEDILIFE

In order to create an instrument that assessed the consumption pattern of the group of NFFs related to the MEDILIFE, 8 of the 14 questions about functional foods that were significantly (p < 0.001) associated with both 14-MEDAS and four or more of the seven MEDILIFE components formed a tool assessing the consumption of Natural Functional Foods Associated with the Mediterranean Lifestyle (NAFFAME). This newly formed 10-item tool had good internal consistency (Cronbach’s α = 0.776) and item intercorrelations, making NAFFAME a reliable instrument for the assessment of NFFs that are part of the MEDILIFE.

3.3. NAFFAME, 14-MEDAS, PsyR, Sleep Quality, and Body Weight

Following the development of the NAFFAME tool, we were able to investigate the association between MEDILIFE-related NFF consumption and 14-MEDAS, PsyR, sleep quality, and BMI. The Spearman’s correlation test revealed a statistically significant (p < 0.05) positive correlation of NAFFAME with 14-MEDAS (ρ = 0.518), CD-RISC-10 (ρ = 0.244), and SQS (ρ = 0.112) and a negative correlation of NAFFAME with BMI (ρ = −0.187). The adherence to the MD, as measured by the 14-MEDAS score, was not significantly associated with either CD-RISC-10 or BMI (Table 2).
To further explore the association of NAFFAME with the main variables of our study, we categorised PsyR, sleep quality, and BMI. PsyR was grouped into low resilience (CD-RISC-10 score < 20), moderate resilience (CD-RISC-10 score = 20–29), and high resilience (CD-RISC-10 score = 30–40); sleep quality was grouped into low (SQS = 0–3), adequate (SQS = 4–6), and high (SQS = 7–10); and BMI was categorised as underweight (BMI < 18.5), normal (BMI = 18.5–24.9), overweight (BMI = 25–29.9), and obesity (BMI = 30+), according to guidelines. One-way ANOVA and an independent-samples Kruskal–Wallis test were performed in order to observe the difference in the means of NAFFAME in different CD-RISC-10, SQS, and BMI categories. There was a statistically significant (p < 0.05) difference between the means of the NAFFAME score in different CD-RISC-10 categories (Figure 1).
BMI in our study was not normally distributed; therefore, we performed an independent-samples Kruskal–Wallis test. There was a significant (p = 0.008) difference between the means of the NAFFAME in different BMI categories (Figure 2).
NAFFAME consumption seemed to be important for the long-term results of a weight-reducing diet. After conducting a one-way ANVOA test, it was found that there was a statistically significant difference (p < 0.012) in the mean scores of NAFFAME for different diet outcomes. The means of NAFFAME were higher in the no need for diet and maintaining weight loss categories than the no weight loss and regaining weight categories (Figure 3).
Although the difference between the means of NAFFAME and different sleep quality categories was not significant (p = 0.128), a post hoc LSD test revealed a significant (p < 0.05) difference in the high and adequate sleep quality categories. People with higher NAFFAME scores had better sleep quality overall.
To further explore the relation of NAFFAME to PsyR, sleep quality, and BMI, multinomial logistic regression analysis was performed. This analysis identified NAFFAME as a prognostic factor in having high vs. low PsyR, normal vs. obesity BMI category, and maintaining weight loss vs. no weight loss category (Table 3).

4. Discussion

The MD is one of the most extensively researched dietary patterns, with a plethora of reliable scales measuring adherence. However, the consumption of NFFs grown and produced in the Mediterranean region is currently missing from its measurement scales. The current study attempted to fill this void. To our knowledge, this is the first study to investigate the relationship between NFFs, the MEDILIFE, and their association with PsyR and health-related parameters such as sleep and long-term dieting results.
The findings of this study confirmed our hypothesis that NFFs grown and produced in the Mediterranean region, such as whole grains, edible wild greens, herbal infusions, bee products, raisins, seeds, berries, cruciferous vegetables, fermented dairy products, and herbs/spices, are associated significantly with the MD and other components of the MEDILIFE. This hypothesis was also supported by the fact that functional foods more closely associated to a Western diet pattern, such as milk, cocoa/chocolate, coffee, and fortified foods, were not associated with adherence to the MD or to the MEDILIFE. The only exceptions were cocoa/chocolate consumption, which was linked to sleep routine, and fortified food consumption, which was linked to physical activity and meal routine. These results confirmed previous findings that cocoa/chocolate may have a beneficial effect on circadian desynchrony [57] and that fortified food consumers may exhibit behaviours corresponding to our study’s behaviours [58].
The consumption of NFFs associated with the MEDILIFE had a positive effect on health, both individually and synergistically. Grouping these NFFs into the NAFFAME tool to assess the synergistic effect of their consumption revealed a statistically significant correlation of NAFFAME with the MD, PsyR, sleep quality, and body weight. ANOVA and independent-samples tests further confirmed this association, while multinomial logistic regression analysis revealed that NAFFAME score could predict the PsyR and BMI of the study’s participants.
The relationship between nutrition and mental health has been underappreciated in recent decades. This trend has shifted in recent years, with interest growing in neuropsychiatry research [5]. PsyR is an essential component of mental health, and its promotion may be critical to people’s mental health and well-being. Sleep quality is another factor that, as demonstrated by a recent meta-analysis of randomised controlled trials, leads to improved mental health [59]. The research on functional foods and their relationship to mental health and sleep quality is still in its infancy, with a limited number of articles studying this link [5,13,60]. The association of NAFFAME with both PsyR and sleep quality, as demonstrated by this study, adds to the ongoing psych-dietetics research. A plethora of parameters, such as the brain–intestinal axis and gut microbiota, possibly affect sleep quality, body weight, and neuropsychology [61,62,63,64].
Contrary to the limited evidence on the link of nutrition to mental health, nutrition’s relation to physical health and body weight has been vigorously researched. Apart from the nutritional value of food, and its contribution to the calorie equilibrium, only a few studies have demonstrated the association between functional foods and healthy body weight [14,15,61]. Kandyliari et al. reported in a recent epidemiological study that specific Mediterranean functional foods are associated with decreased BMI [14]. The present study not only confirmed the negative association of NFFs and BMI, but also highlighted the predicting nature of their consumption on long-term dieting results. These findings are significant because, for the first time in the literature, NFF consumption has been linked to long-term weight loss maintenance, or the yo-yo dieting phenomenon, which has not been adequately addressed and contributes to the high prevalence of obesity [62]. This study could contribute to the design of randomised controlled trials to investigate the effect of NFFs on the yo-yo dieting phenomenon and obesity.
Although NAFFAME was strongly related to 14-MEDAS (ρ = 0.514, p < 0.001), it outperformed 14-MEDAS in terms of PsyR and BMI, highlighting the functional nature of NAFFAME’s components. These findings support our decision to develop the NAFFAME tool and may pave the way for the emergence of randomised controlled trials focusing on the synergistic effects on health of the Mediterranean region’s traditionally grown and produced NFFs.
The study has some limitations. The cross-sectional design of this study makes it impossible to determine the direction of the causal correlation. It is not impossible that the consumption of NFFs associated with the MEDILIFE is influenced by PsyR, sleep quality, and/or body weight. Nonetheless, previous studies have shown that adherence to the MD, which contains a plethora of NFFs, may contribute to better PsyR, sleep quality, and/or body weight [36,63,64,65]. These findings support the causal direction of the current study’s hypothesis. Another limitation is the use of an online questionnaire to collect study data—non-probability sampling. In addition, the weight and the height of the participants were self-reported. In order to address the limitations of an online survey, including low data quality due to bots, random responses, and satisficing, this survey included open-ended questions (e.g., enter height and weight), timing checks (surveys completed under 4 min were excluded), and consistency checks (follow-up questions were included). Finally, the use of an unvalidated tool (NAFFAME) for measuring NFFs associated with the MEDILIFE comes with its limitations. On the other hand, both the good internal consistency and the intercorrelations between the tool’s items are good indications of a tool’s validity [66].

5. Conclusions

To our knowledge, the current study is the first to investigate the association between NFFs, the MEDILIFE, PsyR, sleep quality, and body weight, adding data to the existing literature. The results of this study suggest that NFFs grown and produced in the Mediterranean region, such as whole grains, edible wild greens, herbal infusions, bee products, raisins, seeds, berries, cruciferous vegetables, fermented dairy, and herbs/spices, are associated with the MD and the MEDILIFE. Total consumption of these NFFs may be a predictor of PsyR, BMI, and long-term dieting outcomes. Their content of bioactive compounds may act synergistically to possibly promote human health. In conclusion, the consumption of NFFs grown and produced in the Mediterranean region is associated to PsyR, sleep quality, and a healthy body weight. To confirm the findings of this cross-sectional study, further randomised control trials should be conducted.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/app13074076/s1, Supplementary Materials S1: the questionnaire okof the study.

Author Contributions

Conceptualization, E.C. and A.E.K.; Methodology, E.C. and A.E.K.; Software, E.C.; Validation, E.C., C.K. and C.G.; Formal analysis, E.C. and A.E.K.; Investigation, E.C. and G.-E.D.; Resources, G.-E.D. and C.K.; Data curation, E.C., G.-E.D., C.K. and C.G.; Writing—original draft, E.C.; Writing—review & editing, A.E.K.; Supervision, A.E.K.; Project administration, A.E.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The research was approved by the University of the Aegean’s ethics and deontology committee (no. 17715/09.09.2021).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available within this article.

Acknowledgments

We thank all the volunteers who participated in this study.

Conflicts of Interest

The authors declare no conflict of interest.

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Applsci 13 04076 g001 550
Figure 1. One-way ANOVA test showing the difference between NAFFAME scores in different PsyR categories.
Figure 1. One-way ANOVA test showing the difference between NAFFAME scores in different PsyR categories.
Applsci 13 04076 g001
Applsci 13 04076 g002 550
Figure 2. Independent-samples Kruskal–Wallis test showing the means of NAFFAME in different BMI categories.
Figure 2. Independent-samples Kruskal–Wallis test showing the means of NAFFAME in different BMI categories.
Applsci 13 04076 g002
Applsci 13 04076 g003 550
Figure 3. ANOVA test displaying the difference in 10-MDLNFF scores of various outcomes of weight-reducing diet.
Figure 3. ANOVA test displaying the difference in 10-MDLNFF scores of various outcomes of weight-reducing diet.
Applsci 13 04076 g003
Table
Table 1. p-values of the Spearman’s correlation coefficients of Natural Functional Foods (NFFs) with MD, MEDILIFE, and PsyR.
Table 1. p-values of the Spearman’s correlation coefficients of Natural Functional Foods (NFFs) with MD, MEDILIFE, and PsyR.
Natural Functional
Foods (NFFs)		14-MEDASPhysical
Activity		Proximity to NatureAvoiding
Food Waste		Choosing
Local Food		Meal
Routine		Sleeping
Routine		Meeting FriendsCD-RISC-10
Whole
grains		<0.001 *<0.001 *0.002 *<0.001 *0.005 *<0.001 *<0.001 *0.0520.011 *
Edible wild
greens		<0.001 *0.014 *0.008 *<0.001 *<0.001 *<0.001 *0.007 *0.273<0.001 *
Herbal
infusions		<0.001 *0.007 *0.002 *<0.001 *<0.001 *0.3960.0820.096<0.001 *
Bee products<0.001 *<0.001 *<0.001 *0.005 *<0.001 *<0.001 *<0.001 *0.007 *<0.001 *
Raisins<0.001 *<0.001 *<0.001 *0.019 *0.001 *0.001 *0.3890.261<0.001 *
Seeds<0.001 *0.002 *<0.001 *<0.001 *<0.001 *<0.001 *<0.001 *0.025 *0.037 *
Berries<0.001 *0.016 *0.003 *0.034 *0.007 *0.0040.0850.1030.062
Cruciferous
Vegetables		<0.001 *0.013 *<0.001 *<0.001 *<0.001 *<0.001 *0.020 *0.4350.010 *
Fermented dairy<0.001 *<0.001 *0.003 *0.034 *0.0700.002 *0.1110.150<0.001 *
Herbs and spices<0.001 *0.1500.166<0.001 *<0.001 *<0.001 *<0.001 *0.1880.042 *
Cocoa/dark
chocolate		0.2260.2180.1310.5030.0740.0990.005 *0.3540.320
Milk0.4630.3200.7810.4310.1190.5510.2070.0980.419
Coffee0.5880.5650.4300.9940.6860.4970.7190.0980.813
Fortified
foods		0.5050.012 *0.1070.8720.6370.029 *0.2200.0670.019 *
* Statistical significance (p < 0.005).
Table
Table 2. p-values of the correlations between NAFFAME, 14-MEDAS, PsyR, sleep quality, and BMI.
Table 2. p-values of the correlations between NAFFAME, 14-MEDAS, PsyR, sleep quality, and BMI.
NAFFAME14-MEDASCD-RISC-10SQSBMI
NAFFAME1<0.001 *<0.001 *0.038 *<0.001 *
14-MEDAS<0.001 *10.0660.002 *0.066
CD-RISC-10<0.001 *0.0661<0.001 *0.947
SQS0.038 *0.002 *<0.001 *10.081
BMI<0.001 *0.0660.9470.0811
* Statistical significance (p < 0.005).
Table
Table 3. Multinomial logistic regression analysis between NAFFAME and PsyR, BMI, long-term diet results, and sleep quality.
Table 3. Multinomial logistic regression analysis between NAFFAME and PsyR, BMI, long-term diet results, and sleep quality.
OR95% CIp-Value
Psychological Resilience
(High vs. Low)		1.1741.099–1.254<0.001 *
Body Mass Index
(Normal vs. Obesity)		1.0851.033–1.1390.001 *
Long-Term Dieting Results
(Maintaining Weight Loss vs. No Weight Loss)		1.1261.039–1.2200.004 *
Sleep Quality
(High vs. Low)		1.0340.965–1.1070.126
* Statistical significant differences (p < 0.05).
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Christodoulou, E.; Deligiannidou, G.-E.; Kontogiorgis, C.; Giaginis, C.; Koutelidakis, A.E. Natural Functional Foods as a Part of the Mediterranean Lifestyle and Their Association with Psychological Resilience and Other Health-Related Parameters. Appl. Sci. 2023, 13, 4076. https://doi.org/10.3390/app13074076

AMA Style

Christodoulou E, Deligiannidou G-E, Kontogiorgis C, Giaginis C, Koutelidakis AE. Natural Functional Foods as a Part of the Mediterranean Lifestyle and Their Association with Psychological Resilience and Other Health-Related Parameters. Applied Sciences. 2023; 13(7):4076. https://doi.org/10.3390/app13074076

Chicago/Turabian Style

Christodoulou, Efstratios, Georgia-Eirini Deligiannidou, Christos Kontogiorgis, Constantinos Giaginis, and Antonios E. Koutelidakis. 2023. "Natural Functional Foods as a Part of the Mediterranean Lifestyle and Their Association with Psychological Resilience and Other Health-Related Parameters" Applied Sciences 13, no. 7: 4076. https://doi.org/10.3390/app13074076

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