Search Results (764)

Background: Obesity remains a major public health challenge, with central and visceral fat distribution conferring particularly high cardiometabolic risk. Lifestyle factors, including diet, physical activity, and sleep quality, have been implicated in adiposity, yet their combined and interactive effects in working populations remain insufficiently characterized. Methods: We conducted a cross-sectional study in 88,343 Spanish employees (53,122 men, 35,221 women) attending occupational health examinations between 2021 and 2024. Obesity was assessed using four complementary indices: body mass index (BMI), waist-to-height ratio (WHtR), Clínica Universidad de Navarra–Body Adiposity Estimator (CUN-BAE), and Metabolic Score for Visceral Fat (METS-VF). Lifestyle factors included sleep quality (Pittsburgh Sleep Quality Index), Mediterranean diet adherence (MEDAS), and physical activity (IPAQ). Multivariable logistic regression models were adjusted for sociodemographic and lifestyle variables, with interaction, stratified, joint exposure, and dose–response analyses. Results: Obesity prevalence varied widely by index, ranging from 18.9% (BMI) to 55.6% (CUN-BAE). Poor sleep quality was independently associated with higher odds of obesity across all indices, particularly central obesity (WHtR OR 1.58, 95% CI 1.48–1.69), with stronger associations observed in women. Physical inactivity and non-adherence to the Mediterranean diet were robust predictors, with inactivity showing the largest effect sizes (METS-VF OR 9.92, 95% CI 8.70–11.15). Interaction analyses indicated that both Mediterranean diet adherence and regular physical activity attenuated the adverse association between poor sleep and obesity outcomes. Restricted cubic spline models revealed a progressive dose–response relationship between increasing PSQI score and central obesity. Joint exposure analyses showed nearly five-fold higher odds of central obesity among workers with concurrent poor sleep, physical inactivity, and low Mediterranean diet adherence. A graded inverse association was observed between a composite healthy lifestyle score (0–3) and obesity, with a score of 3 associated with 72–75% lower odds of BMI-obesity and WHtR-high. Conclusions: In this large occupational cohort, poor sleep quality, physical inactivity, and low Mediterranean diet adherence emerged as independent and combined determinants of general, central, and visceral obesity. Integrated workplace strategies promoting sleep hygiene, physical activity, and dietary quality—particularly among women and lower socioeconomic groups—may represent an effective approach to reducing obesity risk in working populations. Full article

Background/Objectives: Patients with myeloproliferative neoplasms (MPNs) experience chronic inflammation, elevated cardiovascular risk, and substantial symptom burden. Dietary patterns with anti-inflammatory and cardioprotective effects may represent a modifiable strategy to address these overlapping risks, yet dietary intervention has not been systematically studied in MPN. We evaluated the feasibility, engagement, and preliminary clinical signals of a fully remote dietary counseling intervention in adults with MPN. Methods: In this single-center, randomized, open-label pilot study, 28 adults with polycythemia vera, essential thrombocythemia, or primary myelofibrosis were randomized 1:1 to Mediterranean (MED) or Dietary Approaches to Stop Hypertension (DASH) dietary counseling over 10 weeks. The protocol included a 2-week baseline run-in period, 10-week active intervention with four telehealth dietitian visits, and 4-week postintervention follow-up. Prespecified feasibility endpoints were the completion of dietitian visits, daily MPN Symptom Assessment Form Total Symptom Score (MPN-SAF TSS) surveys, Mediterranean Diet Adherence Screener (MEDAS) questionnaires, and Automated Self-Administered 24-Hour Dietary Recall (ASA24) assessments. Exploratory endpoints included the change in Healthy Eating Index 2015 (HEI-2015) and symptom burden. Results: Twenty-seven participants provided data and were analyzed (14 MED, 13 DASH). Dietitian visit attendance was 96% (MED) and 85% (DASH). Daily symptom survey completion averaged 93% (MED) and 58% (DASH). MEDAS completion was 81% (MED) and 51% (DASH); ASA24 completion was 55% (MED) and 38% (DASH). HEI-2015 increased from 55 to 63 in MED during active intervention. At week 12, 23% of MED and 13% of DASH participants achieved ≥50% TSS reduction. Symptom reductions were observed across multiple domains. Conclusions: A fully remote dietary intervention is feasible in adults with MPN, with strong engagement in the Mediterranean arm. These findings support adequately powered trials incorporating biomarker endpoints to evaluate dietary modification as a strategy for inflammation-driven symptoms and cardiovascular risk in MPN. Full article

Background: The Mediterranean diet (MD) represents a nutritionally balanced eating pattern characterized by high consumption of fruits, vegetables, legumes, nuts, whole grains, olive oil, fish, and extra-virgin olive oil as the principal fat source and limited intake of red meat and refined sugars. Emerging evidence indicates that the MD’s anti-inflammatory and antioxidant properties extend beyond systemic health, potentially reducing the risk and severity of periodontitis. This narrative review aimed to synthesize current evidence on the relationship between adherence to the MD and periodontal health outcomes. Methods: A comprehensive electronic literature search was conducted in PubMed without restrictions on publication date. Fourteen studies, ranging from 2019 to 2025, were included, encompassing human, clinical, experimental, and review designs that examined MD adherence and its effects on periodontal parameters. Eligible studies included cross-sectional, cohort, randomized controlled trials; systematic reviews; and animal models assessing clinical periodontal indices, inflammatory biomarkers, or microbial composition. Extracted data included study design, population characteristics, dietary assessment methods, and primary periodontal findings. Results: Most studies demonstrated that greater adherence to the MD was associated with improved periodontal parameters, including reduced probing pocket depth, clinical attachment loss, and bleeding on probing. Interventional trials showed significant reductions in systemic inflammatory markers such as IL-1β, TNF-α, and CRP, along with decreased counts of periodontopathogenic bacteria. Experimental studies further revealed the protective role of oleic acid and polyphenols in regulating macrophage activity, suppressing osteoclastogenesis, and enhancing IL-10 expression via epigenetic modulation. However, heterogeneity in dietary scoring systems, sample characteristics, and follow-up duration limited direct comparison, and not all associations reached statistical significance. Conclusions: Current evidence supports a beneficial association between MD adherence and periodontal health, mediated through anti-inflammatory, antioxidant, and microbiome-stabilizing mechanisms. Further standardized longitudinal and interventional studies are needed to confirm causality and refine nutritional strategies for periodontal disease prevention and management. Full article

Background: Nutritional status and lifestyle factors are increasingly recognized as relevant modulators of women’s reproductive health. However, data remain limited on the relationship between body composition, dietary habits, and menstrual cycle characteristics in apparently healthy young women. This study aimed to assess nutritional status, body composition, and lifestyle behaviors in young women and to explore their associations with menstrual cycle regularity. Methods: This cross-sectional study included 49 apparently healthy women aged 19–30 years. Anthropometric measurements and body composition were assessed using bioelectrical impedance analysis. Dietary habits were evaluated through a simplified food frequency questionnaire, and adherence to the Mediterranean diet was assessed using the PREDIMED score. Physical activity was estimated using MET values based on the Compendium of Physical Activities. Menstrual cycle characteristics were collected via questionnaire. Group comparisons were performed between women with regular and irregular menstrual cycles. Results: The sample was predominantly normal-weight (mean BMI 22.36 ± 4.26 kg/m²). Anthropometric and bioelectrical impedance parameters did not differ significantly between women with regular and irregular cycles. Women with irregular cycles showed higher resistance and extracellular water and lower phase angle and body cell mass, although differences were not statistically significant. A significant association was found for meat consumption, which was lower in women with irregular cycles (p = 0.007). No associations were observed for other dietary variables, physical activity, or meal frequency. Conclusions: Menstrual regularity in young women was not associated with major anthropometric differences but may be linked to subtle aspects of nutritional status and dietary habits. Lower meat consumption emerged as a potential dietary factor associated with menstrual irregularity. Although associations were modest, these findings support the relevance of nutritional and lifestyle factors in menstrual health. Larger longitudinal studies are needed to clarify these relationships. Full article

Background/Objectives: Adolescents and university students appear to be at increased risk for internet addiction (IA), while disordered eating behavior (DEB) is common in these age groups. At the same time, adherence to the Mediterranean diet (MD) has declined in many countries. This study aimed to explore the potential association between IA, DEB and MD compliance among high school and university students. Methods: A total of 212 students aged 15–24 years participated in this cross-sectional study conducted in Greece. Data were collected via an online questionnaire including the Internet Addiction Test (IAT), KIDMED, and EAT-26 scales. Descriptive statistics, chi-square tests, and univariate and multivariate logistic regression analyses were performed. Results: Most participants demonstrated normal internet use (69.8%), while 23.1% showed mild IA and 7.1% moderate IA. Regarding dietary habits, 9.4% had low MD adherence, 52.8% moderate and 37.7% high adherence. A total of 15.6% scored above the EAT-26 cut-off, indicating risk for disordered eating behavior. IA was only significantly associated with urbanization (p = 0.014). MD adherence was not associated with gender, urbanization, financial or education status. Multivariate logistic regression showed that female gender (OR = 9.28, 95% CI: 2.10–40.91, p = 0.003) and moderate IA (OR = 6.70, 95% CI: 1.71–26.35, p = 0.006) were significant predictors of disordered eating, while educational status and MD adherence were not significant predictors. Conclusions: Moderate IA and female gender were strongly associated with an increased risk for disordered eating. Further qualitative and clinical studies are needed to better understand the interaction between IA, eating behaviors, and dietary patterns in young people. Full article

Background: Age-related cognitive deccline is a significant health issue in Spain, especially among adults over 60 years of age. Addressing this involves establishing intervention guidelines and identifying early diagnostic biomarkers. Objective: To evaluate changes in urine of Brain-Derived Neurotrophic Factor, concentration and cognitive performance after the implementation of the multicomponent CESPORT program (incorporating a Mediterranean Diet, nutritional education, and continuous support). Methods: This controlled trial included 76 older adults, divided into an experimental group (n = 58; mean age 66.9 years; 75.9% female) that participated in the CESPORT program, and a control group (n = 18; mean age 68.8 years; 72.2% female). Cognitive performance was assessed using the Mini-Mental State Examination (MMSE) and the Cognifit^® battery. Urinary BDNF concentrations were quantified via ELISA. Results: After adjusting for baseline scores via ANCOVA, the experimental group demonstrated significantly higher post-intervention outcomes compared to the control group (p < 0.001). Substantial improvements with medium-to-large effect sizes were observed in global cognition, reasoning, attention, coordination and perception. Furthermore, urinary BDNF levels were significantly elevated in the experimental group. Positive correlations were found between Brain-Derived Neurotrophic Factor concentrations and cognitive performance in multiple domains (p < 0.05), particularly regarding global status and reasoning. Conclusions: The multicomponent CESPORT intervention demonstrates a potential protective effect against age-related cognitive decline. Furthermore, urinary BDNF emerges as a promising, non-invasive early biomarker for cognitive health. Further research is warranted to validate these findings. Full article

Background: Diet quality and food processing patterns are increasingly recognized as important determinants of Crohn’s disease (CD) risk and disease outcomes; however, direct comparisons with healthy populations using integrated nutrient- and processing-based frameworks remain limited. Therefore, we aim to quantify ultra-processed food (UPF) consumption using the NOVA classification, compare UPF intake between CD patients and healthy controls, and assess its association with diet quality indices. Methods: Baseline dietary intake data were analyzed from two randomized controlled trial cohorts: adults with mild to moderately active CD enrolled in the Crohn’s Disease Therapeutic Dietary Intervention (CD-TDI) trial (n = 64; NCT04596566), and healthy adults participating in the MAPMed study (n = 33, NCT06765369). Dietary intake was assessed using two non-consecutive 24 h recalls collected with the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24^®). Energy-normalized macronutrient and micronutrient intakes were compared with Dietary Reference Intakes (DRIs). Overall diet quality was evaluated using the Healthy Eating Index-2020 (HEI-2015), Alternate Mediterranean Diet score (aMED), and Dietary Inflammatory Index (DII). Foods were classified according to the NOVA food processing system to estimate total and proportional energy intake from UPFs (NOVA group 4). Results: Both the CD cohort and healthy cohort exhibited suboptimal dietary patterns, with HEI scores indicating a need for improvement, low adherence to the Mediterranean diet (aMED), and neutral-to-pro-inflammatory DII scores, with no significant between-group differences (all p > 0.05). Although total energy intake differed between groups (p = 0.04), the proportion of energy derived from UPFs (NOVA group 4) accounted for half of the total intake in both cohorts (51.3–51.8%; p = 0.55). Higher UPF intake was associated with lower HEI and aMED scores and higher DII scores. Conclusions: In this study, there were no significant differences in the dietary patterns in those with CD compared to healthy controls. The high contribution of UPFs observed in both cohorts underscores widespread suboptimal dietary quality and highlights the utility of NOVA-based food processing measures as complementary to nutrient-based assessments for understanding diet-related inflammatory burden in CD. Full article

Background: Childhood nutrition is essential for development and disease prevention. Parental dietary practices and sociodemographic factors shape children’s eating habits. Objective: To assess the association between parental diet quality, children’s diet, and nutritional status, as well as the influence of caregiver sociodemographic factors. Design: Cross-sectional analyses were conducted using data from two waves of the PASOS study (2019–2020 and 2022–2023), which are nationally representative multicentre observational surveys. The analyses were restricted to participants with complete information on parental diet quality, children’s diet quality, and relevant covariates. Methods: Participants aged 8–16 years from the PASOS 2019–2020 (n = 1028) and 2022–2023 (n = 572) studies were included. Caregivers provided sociodemographic information and completed the Short Diet Quality Screener (SDQS), a validated questionnaire to assess parental diet quality. Children’s diet quality was assessed using the validated KIDMED index. Based on parental SDQS scores, participants were classified into low (≤50th percentile) or adequate/high (>50th percentile) diet quality groups. Associations were analysed using logistic regression and Pearson correlation. Results: Higher parental diet quality was consistently associated with greater adherence to the Mediterranean diet and higher consumption of fruit, breakfast cereals, and fish among children in both study waves. Children whose caregivers had better diet quality also showed a lower prevalence of abdominal obesity. Parental diet quality was positively associated with children’s diet quality and inversely related to several adiposity indicators, although associations with anthropometric measures were generally weak. Conclusions: Family-based approaches are essential for improving diet quality and preventing childhood obesity. Full article

Objective: To evaluate the association between adherence to the Mediterranean Diet (MedDiet) and the risk of type 2 diabetes mellitus (T2D) in an urban Ecuadorian population, with emphasis on the protective role of specific dietary components and body composition. Methods: A cross-sectional analytical study was conducted with 1373 adults aged 18–75 years. Adherence to the MedDiet was assessed using the 14-item Mediterranean Diet Adherence Screener (MEDAS-14), while T2D risk was estimated using the Finnish Diabetes Risk Scale (FINDRISC). Anthropometric and body composition parameters were measured using standardized procedures. Adjusted associations between exposure variables and T2D risk were estimated using Poisson regression with robust variance, and prevalence ratios were calculated after controlling for sociodemographic and lifestyle factors. Results: Most participants showed low adherence to the MedDiet (85.2%), which was significantly associated with higher T2D risk. Multivariate analysis of individual dietary components showed relevant associations. Regular consumption of sofrito was associated with lower T2D risk (PR = 0.817; 95% CI: 0.682–0.979; p = 0.028). Similarly, low fruit consumption was associated with a substantially higher T2D risk (PR = 1.350; 95% CI: 1.146–1.589; p = 0.001). In addition, higher body mass index (BMI) and waist circumference (WC) were consistently related to greater T2D risk. Conclusions: Greater adherence to the MedDiet, particularly consumption of key components such as sofrito and fruits, was associated with lower T2D risk. These findings highlight the importance of preventive lifestyle interventions adapted to the Latin American context. Full article

Background: The Mediterranean diet (MedDiet) has been associated with anti-inflammatory effects and potential benefits in several chronic conditions. However, adherence to the MedDiet and its relationship with lifestyle factors and disease severity across different rheumatological diseases remain poorly characterized. Objectives: This study aimed to evaluate differences in MedDiet adherence among patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and fibromyalgia (FM), and to explore its association with cardiovascular comorbidities, bowel habits, and disease-related outcomes. Methods: In this monocentric cross-sectional study, adherence to the MedDiet was assessed using the 14-item PREDIMED questionnaire. Self-reported data on sociodemographic characteristics, cardiovascular comorbidities, bowel habits, and dietary behaviors were collected through questionnaires. Disease activity and severity were assessed using validated disease-specific measures. Differences in MedDiet adherence across diagnostic groups were evaluated using non-parametric tests. Multivariable models were performed to examine associations between MedDiet adherence and cardiovascular comorbidities or disease outcomes, adjusting for potential confounders including age, sex, BMI, smoking status, and educational level. Results: A total of 422 participants were included (RA n = 165, PsA n = 85, FM n = 172). Significant differences in MedDiet adherence were observed across diagnostic groups (p < 0.001), with the highest adherence in RA, intermediate values in PsA, and the lowest in FM. Compared with the other groups, a higher proportion of FM participants reported food intolerances (46.5%) and restrictive diets, including lactose-free (34.9%) and gluten-free (15.1%) diets. In the FM group, high adherence to the MedDiet was significantly associated with lower FIQR scores (β = −16.9; 95% CI −32.1 to −1.7; p = 0.01) and lower PDS scores (β = −4.34; 95% CI −7.81 to −0.86; p = 0.01). Sensitivity analyses using the continuous PREDIMED score confirmed these associations. Conclusions: Adherence to the MedDiet differs across rheumatological diseases, with the lowest adherence observed in FM. Higher adherence was associated with lower disease severity and impact in FM. These findings highlight the potential relevance of nutritional counselling in rheumatological diseases and support the need for longitudinal and interventional studies evaluating the role of the MedDiet within multidisciplinary disease management. Full article

Background: Parental knowledge and perceptions towards Functional Foods (FFs) play a critical role in shaping children’s dietary behaviors. This study aimed to investigate dietary habits, FFs knowledge and perceptions among Greek primary school children and their parents and to evaluate the feasibility of a one-month pilot asynchronous nutrition education program. Methods: A cross-sectional study included 374 children aged 9–11 years and 159 parents from urban (Thessaloniki) and rural (Lemnos) areas. Children completed questionnaires on dietary habits, FFs knowledge and Mediterranean Diet (MD) adherence (KIDMED score), while parents provided sociodemographic information, BMI, dietary habits, FFs knowledge and perceptions. A pilot asynchronous nutrition education intervention was delivered via pre-recorded videos on FFs, the MD, portion sizes and food label interpretation, with participation tracked and program evaluation conducted among parents. Data was analyzed using IBM SPSS Statistics (version 28). Descriptive statistics were calculated, group differences were assessed with t-tests and ANOVA and associations between variables were examined using chi-square tests and Pearson correlations (p < 0.06). Results: Children showed moderate MD adherence, frequent fast-food and soft drinks consumption and low FF knowledge, with a substantial gap between perceived and actual understanding. Parental FF knowledge was uneven, higher among normal-weight participants and largely limited to fortified products. Positive associations were found between children’s and parents’ diet quality and natural FF consumption, as well as between parental and child physical activity. The asynchronous intervention was positively rated; substantial attrition was observed across sessions and follow-up, which limited the ability to assess the intervention’s effects on behavioral change. Conclusions: This study highlights critical gaps in FFs knowledge among families and demonstrates that asynchronous, family-based nutrition education is feasible but challenged by engagement attrition. Targeted interventions are needed to clarify FF concepts and promote healthier family dietary behaviors. Full article

Background: Cystic fibrosis-related bone disease (CFBD) is a comorbidity whose prevalence is increasing. Conventional areal DXA (aDXA) only assesses part of bone strength, whereas new techniques provide a more comprehensive assessment of bone structure. However, these tools are rarely implemented systematically. Furthermore, the contribution of clinical factors to bone structural parameters remains insufficiently characterized. Therefore, this study aimed to comprehensively assess cortical and trabecular bone alterations in adults with CF, and to explore clinical and lifestyle factors associated with bone health. Methods: A case–control study was conducted including 32 adults with CF and 70 healthy controls matched by age, sex, and BMI. Bone status was assessed using aDXA, trabecular bone score (TBS), and three-dimensional DXA (3D-DXA). Clinical data, body composition, lifestyle variables, and biochemical markers were collected. Multivariate linear regression models were applied to explore factors associated with bone parameters. Results: Twenty-two percent of CF people had prevalent fragility fractures and the percentage with low bone mass was significantly higher (28.1% vs. 5.7%; p < 0.001). TBS categories indicated more degraded microarchitecture in CF (p = 0.002). Cortical and trabecular 3D-DXA values were also significantly lower (p < 0.001). Adherence to the Mediterranean diet (MedDiet) was significantly associated with most of the bone parameters evaluated. Other variables associated with bone parameters included sex, fat-free and fat mass, prolonged corticosteroid use, intake of oral nutritional supplements, FEV₁, disease duration and P1NP-values. Conclusions: Adults with CF revealed significant cortical and trabecular structural deficits. Among the evaluated factors, adherence to MedDiet was associated with several bone parameters, suggesting a potential role of dietary patterns in CF bone health. Further studies are needed to confirm these preliminary results. Full article

Background/Objectives: An intensive lipid-lowering therapy is needed in familial hypercholesterolemia (FH) subjects; however, the adherence to the Mediterranean diet (MD) and its effects have not been fully evaluated in FH subjects. This study aimed to evaluate the impact of the MD on metabolic and vascular profiles in FH subjects. Methods: In this cross-sectional study 253 genetically confirmed FH subjects were included. Adherence to MD was assessed by the validated Pyramid-based MD Score (PyrMDS) and FH subjects were stratified according to the tertiles of PyrMDSs (low, intermediate, and high), with a higher score indicating higher adherence to MD. The lipid profile as well as the subendocardial viability ratio (SEVR), an indirect measure of myocardial perfusion, were assessed in all FH subjects. Results: Compared to the low-PyrMDS group, FH subjects with a high MD adherence showed lower levels of low-density lipoprotein cholesterol (LDL-C) (149.7 ± 71.4 vs. 176.7 ± 77.4 mg/dL, p = 0.006). After accounting for lipid-lowering therapies, smoking habit, and arterial hypertension, individuals in the high-PyrMDS group showed higher SEVR than those in the intermediate- and low-PyrMDS groups (167 ± 3.51 [standard error—SE] vs. 150 ± 5.03 [SE] vs. 148 ± 3.75 [SE], all p < 0.01). After adjusting for age, sex, and lipid-lowering therapies, PyrMDS was independently associated with LDL-C (β = −0.11, p = 0.03). Conclusions: Greater adherence to the MD was associated with more favorable metabolic and vascular profiles in FH subjects independent of lipid-lowering therapies. This suggests that MD adherence should be actively promoted in clinical practice alongside pharmacological interventions. Full article

Background: Healthy eating habits during childhood and adolescence are essential to support optimal nutritional status and may influence health in adulthood. This study assessed nutritional status and adherence to the Mediterranean diet (MD) among Albanian students. Methods: A cross-sectional study was conducted on a convenience sample of 388 students aged 9–17 years living in Vlora and Tirana. Data collected included sociodemographic information, anthropometric measurements, and KIDMED index. Factors associated with poor MD adherence were investigated using univariate analysis and multivariable logistic regression (AORs: 95% CIs). Results: Data from 388 students were included in the analysis (mean age: 13.0 ± 1.9 years; 54.1% females). Pre-adolescents (≤13 years) accounted for 53.4% of the sample, while adolescents (>13 years) accounted for 46.6%. Overall, 35% of students were overweight or obese. The mean KIDMED score indicated suboptimal MD adherence (5.5 ± 2.6), with significant differences by sex (females 5.2 ± 2.7 vs. males 5.8 ± 2.5; p = 0.03), place of residence (Vlora 5.8 ± 2.5 vs. Tirana 5.2 ± 2.6; p = 0.05), and age (≤13 years 6.1 ± 2.3 vs. >13 years 4.8 ± 2.7; p < 0.001). Adolescence was the strongest predictor of poor MD adherence (AOR 3.25; 1.96–5.38; p < 0.001). Conclusions: The MD is a key dietary pattern for supporting health across the life course. Girls and adolescents showed poorer MD profiles. Further research is needed to clarify the determinants that drive suboptimal dietary behaviors in Albanian youth, in line with growing concerns about the “hidden crisis” of adolescent nutrition. Full article

Background/Objectives: Internalized weight bias has been linked to adverse mental health outcomes and maladaptive eating-related behaviors. However, its relationship with habitual dietary intake and overall diet quality remains insufficiently explored. The objective of this study was to examine associations between internalized weight bias and habitual energy intake, macronutrient composition, and adherence to the Mediterranean diet among adults with a history of overweight or obesity. Methods: In this web-based cross-sectional study, 484 adults with a history of excess body mass index completed validated assessments of internalized weight bias (Weight Bias Internalization Scale–Modified; WBIS-M) and usual dietary intake (69-item Food Frequency Questionnaire). Adherence to the Mediterranean diet (MeDi) was assessed via the MedDietScore. Multivariable analyses adjusted for several covariates were performed. Results: Higher levels of internalized weight bias were associated with lower adherence to the MeDi (B_adj = −0.670, p = 0.025). Higher adherence to the MeDi was associated with reduced odds of being classified in the medium or the highest WBIS-M tertile, corresponding to an approximately 5% reduction per 1-unit increment in the MedDietScore. No associations were observed between internalized weight bias and total energy intake. At the macronutrient level, higher internalized weight bias was associated with higher saturated fat intake, independent of total energy intake. Conclusions: Internalized weight bias was associated with poorer habitual diet quality and unfavorable macronutrient profiles, independent of total energy intake. These findings suggest that internalized weight bias relates to qualitative differences in habitual food choices, highlighting the potential importance of addressing weight bias in efforts to improve diet quality among adults with overweight or obesity. Full article