The current study explores selected diet quality indices FCS, the 14-MEDAS, and the DPI in a representative sample of the Lebanese adult population, and their association with sociodemographic characteristics and FI.
FI levels revealed in our study are alarming, as they are exceptionally high compared to regional data (39.4%)35 and to other countries facing similar harsh situations, such as Palestine, where FI prevalence was 34% in 202236.
Dietary diversity measured using the FCS was generally low, with more than half of the households classified as having low HDD (56.3%). This current finding shows an increase by over 3% in comparison with a nationally representative study done in Lebanon in 2021 which revealed that 53% of households have low dietary diversity37,38. This is similar to the South African phenomena among adults, where 38.3% of South African adults had poor dietary diversity39. In contrast, findings from Arab countries show that 10.7% of households have a low HDD40.
Despite the low dietary diversity, adherence to the MD measured using the 14-MEDAS was relatively moderate, with 45.9% of our sample showing weak adherence. Higher estimates were found in Slovenia (50.6%) and Ireland (58.5%)41,42, while lower estimates were found in Tunisia (23.7%)43. In addition, low adherence to recommended consumption according to the 14-MEDAS was observed for many food groups, with olive oil consumption (0.5%) being the least contributor, followed by ‘nuts and seeds’ (1.1%), and legumes (1.6%). This low consumption of olive oil, despite Lebanon being a Mediterranean country, could be due to the increased prices of olive oil in the country, its reduced production44, or the changing dietary habits of the population14,15. In comparison with the United Arab Emirates (UAE), legumes (18%) were one of the least contributors to MD adherence, aligning with our findings; however, fish (9.3%) expressed the least contribution to MD adherence, contrasting our findings45. Moreover, fruits had a low contribution to the score based on our findings, similarly to what is reported from the UAE45. Compared with a study assessing adherence to the MD in the Arabian Gulf (Kuwait, Oman, Kingdom of Saudi Arabia)46, our findings agree when it comes to low compliance with the MD recommendations for olive oil, fruits, sweets, fish, legumes, and nuts. The low adherence observed may be explained by the dietary shift towards a more Western diet among Gulf country residents, which is high in animal-derived foods, added sugar, salt, and fat, and low in plant-based foods like fruits and vegetables14,15,46. In the majority of the region’s nations, these changes in eating patterns have been linked to rising urbanization, economic and technological advancement, and modernization14,15,46.
Concerning the DPI, the phytochemical intake represented 22.25% of TEI. Almost similar estimates were found in Iran (23.13%)47. A slightly higher intake was reported in Switzerland (25.5%)48. This finding is not surprising, given the dietary transition in Lebanon, characterized by a decrease in the consumption of plant-based food such as whole grains, fruits, and vegetables, and an increase in the consumption of animal-based foods, salt, fat, and added sugars14,15.
Based on our findings, participants with food security had higher odds of a high HDD and significantly greater consumption of vegetables, olives/nuts/seeds, dairy products, sweets, eggs, and red and processed meats compared with participants experiencing FI. A systematic review in the United States showed that adults with FI consumed fewer vegetables and dairy products than those with food security, aligning with our findings11. This likely reflects the fact that food-secure individuals have better access to adequate, safe, and diverse foods, contributing to improved diet quality49. Surprisingly, having FI was associated with better MD adherence in our sample. This could be due to economic constraints—such as low income and unemployment—leading individuals with FI to rely more heavily on less preferred but cheaper foods (e.g., legumes, grains) and reduce consumption of sweets and processed foods50. Additionally, participants with FI had slightly better adherence scores for red meat, sweet beverages, and sweets, while adherence levels were similar across groups for olive oil, fish, legumes, and nuts. However, no significant differences were observed in fruit and fish consumption between food-secure and food-insecure participants. This may indicate that both groups face similar barriers to accessing these items, possibly due to high cost, limited availability, or cultural dietary patterns. Similar trends have been reported in neighboring countries such as Jordan and Egypt, where consumption of fruits and fish remains low regardless of food security status51. Moreover, participants with FI exceeded the recommended intake of potatoes, likely reflecting a reliance on low-cost, energy-dense but nutrient-poor foods due to economic hardship. These dietary compromises can increase the risk of micronutrient deficiencies, which is especially concerning in Lebanon, where prior studies have already documented inadequate intake of essential vitamins and minerals among adults13,14. Food insecurity remains a major barrier to dietary adequacy and quality. While some findings were unexpected, they highlight the complex and sometimes paradoxical relationships between food insecurity, affordability, and diet patterns in crisis-affected populations.
In addition to food security, we identified several sociodemographic predictors of diet quality. Employment status and higher educational attainment were positively associated with dietary diversity, suggesting that economic stability and education play crucial roles in shaping dietary choices. Aligning with our findings, having a master’s level or above increased the odds of higher dietary diversity in China52. Potentially, employed individuals can adopt a more diversified dietary pattern by being able to afford high-priced food items, therefore having more choices. Plus, employed individuals usually have a higher income compared with unemployed individuals, which can facilitate access to diverse food sources, including markets with a wider selection of foods, or even the ability to afford transportation to access better food options53,54. As for education, research showed that graduate and postgraduate groups have high nutrition literacy and healthy dietary patterns55,56, which could explain the higher HDD for the more educated participants in our study. In fact, education can lead to a better understanding of nutritional needs and the importance of a balanced diet, influencing food choices57. Higher education may also increase awareness of the link between diet and health, including the risks associated with poor dietary choices57. Additionally, female participants and those who were unmarried were more likely to adhere to the MD, and had a significantly higher DPI, potentially reflecting gender-related dietary behaviors and social factors influencing food choices. Sex disparities when it comes to consumption are quite normal: males and females often have distinct tastes and eat various kinds of food58,59. Females often consume more fruits and vegetables, more dietary fiber, and less fat58,59, which explains the higher DPI and the better MD adherence compared with males. In contrast to our findings, being married predicted higher adherence to the MD in the United Arab Emirates (UAE)45 and England60. Moreover, older age (51–64 years) was associated with significantly higher DPI, suggesting a possible preference for traditional, plant-based diets among older adults. Older people are more likely to stick to traditional eating patterns, characterized by fruits and vegetables, dietary fiber, and less likely to try new and trendy foods, which are mainly ultra-processed, in contrast to younger generations14,15. Conversely, living in a crowded household was associated with lower DPI, potentially due to economic constraints limiting access to phytochemical-rich foods.
The discrepancies observed between our findings and those of other studies may stem from several factors, including variations in the tools used to assess food security and diet quality, differences in sampling techniques, and distinct methodological approaches. For example, while our study targeted the entire adult population (18–64 years), many studies focused on different or specific age groups, such as young adults (university students) or older adults aged 52 years and above12,18,30,31,42,48. Furthermore, many prior studies relied on convenience sampling12,42, or included specific gender (i.e., only women)10, which limits the generalizability of their findings, highlighting the need for future research employing representative sample sizes to generate evidence-based conclusions applicable to the broader population. Additionally, cultural differences in dietary habits and other countries’ socioeconomic contexts could contribute to these variations.
Finally, in our sample, the prevalence of overweight and obesity was high (61.9%), suggesting a potential paradox where FI coexists with overweight and obesity, a phenomenon commonly observed in low-income populations61,62. Additionally, one-fourth of the participants (25%) reported having at least one chronic disease, with anemia (32.4%) and hypertension (30.6%) being the most prevalent. These findings highlight the potential link between poor dietary intake, economic constraints, and the risk of NCDs61,62.
We strongly recommend continuous monitoring of diet quality and FI rates in Lebanon using validated assessment tools. Monitoring diet quality is crucial to explore the link between diet and health outcomes, and to have better knowledge about dietary priorities that will be the most beneficial for the population. As for FI, monitoring is essential for directing food and financial assistance, supporting global monitoring and early famine warning systems, evaluating development, health, and nutrition initiatives, and shaping government policies across multiple sectors63. Additionally, implementing effective policies and interventions to enhance access to healthy and nutritious foods for all individuals is crucial. As outlined by the World Health Organization (WHO), strategies such as incentivizing the production and retail of fresh fruits and vegetables while discouraging the production and marketing of foods high in trans- and saturated fats can be impactful1. Furthermore, given that higher education levels were associated with greater dietary diversity, promoting nutrition education could serve as an effective strategy to improve the overall well-being of this population by fostering healthier dietary choices. This can be achieved through educational campaigns in schools and workplaces, as well as by regulating the advertising of unhealthy foods1: nutrition education enhances dietary knowledge, increases dietary diversity, and improves overall diet quality64. Investing in such initiatives can contribute to long-term improvements in public health and nutritional outcomes.