Higher nutrition knowledge was positively associated with Mediterranean Diet adherence, but high-tier athletes showed low or suboptimal energy availability, suggesting that targeted nutrition education must integrate MedDiet principles with sport-specific fueling strategies.
MedDiet adherence was moderate across all performance tiers with a mean MEDI-LITE score of 10.6 ± 2.2.
Nutrition knowledge (NK) was significantly and positively associated with MedDiet adherence.
Mean energy availability (EA) across the sample was low, at 31.3 ± 8.6 kcal/kg FFM/day, below the threshold considered optimal.
Eating disorder risk and orthorexic tendencies were low among participants.
Body composition and resting energy expenditure were assessed using skinfolds/BIVA and indirect calorimetry respectively.
High-tier athletes demonstrated low or suboptimal energy availability despite engaging in more intensive training.
This research suggests that among physically active Italian adults and competitive athletes, adherence to the Mediterranean Diet is only moderate, regardless of how competitive or serious the athlete is. The study of 169 participants found that people with greater nutrition knowledge tended to follow the Mediterranean Diet more closely, pointing to education as a potential lever for improving diet quality in this population. Importantly, the findings were consistent across all levels of athletic performance, from recreational exercisers to high-tier competitors. One of the more concerning findings is that many participants, particularly higher-level athletes, were not eating enough relative to their energy expenditure — a condition known as low energy availability (LEA). With an average energy availability of about 31 kcal per kilogram of fat-free mass per day, the group as a whole fell below what is generally considered optimal for health and performance. This is notable because LEA has been linked to hormonal disruption, bone health problems, and impaired recovery, yet it appeared common even among serious athletes who might be expected to be most attentive to their nutrition. This research suggests that simply promoting healthy eating patterns like the Mediterranean Diet may not be sufficient for active populations. Nutrition education for athletes needs to go further, integrating sport-specific fueling strategies — particularly ensuring adequate caloric intake to match training demands — alongside dietary quality guidance. The lack of significant eating disorder risk or poor sleep in this group suggests these are not the primary drivers of poor nutritional status; rather, gaps in applied nutrition knowledge appear central to the problem.
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Upload Your LabsFiorini S, Guglielmetti M, Lopes Neri L, Ferraro O, Rondanelli M, Tagliabue A, et al.. (2026). Mediterranean Diet Adherence, Nutrition Knowledge and Lifestyle Factors in Physically Active Adults and Athletes: The NUTRI_ACTIVE Study.. Nutrients. https://doi.org/10.3390/nu18172810