Associations between Sociodemographic Factors,Lifestyle Behaviors,Pregnancy-Related Determinants,and Mediterranean Diet Adherence among Pregnant Women: The GESTAFIT Project

We examined sociodemographic factors, lifestyle behaviors, and pregnancy-related determinants associated with adherence to the Mediterranean diet (MD) during pregnancy. A total of 152 Caucasian pregnant women were included in this cross-sectional study. Dietary habits and MD adherence were assessed with a food frequency questionnaire. Physical activity (PA) levels and physical fitness (PF) components (cardiorespiratory fitness, relative muscle strength, and flexibility) were objectively measured. A clustered overall PF index was calculated. Participants with a high MD adherence were older, had a lower body mass index (BMI), spent more time in moderate–vigorous PA, had a greater overall PF, cardiorespiratory fitness, and relative muscle strength compared to participants with low MD adherence (all, p < 0.05). When we explored factors associated with improved MD adherence with logistic regression analysis, we found that the following factors: lower pre-pregnancy BMI (OR = 2.337; p = 0.026), meeting PA recommendations (OR = 2.377; p = 0.045), higher relative muscle strength (OR = 2.265; p = 0.016), and higher overall PF (OR = 5.202; p = 0.004) increased the chances to adhere to the MD. Older age, lower BMI, greater PF, and meeting PA recommendations were associated with higher MD adherence. These factors should be considered for a better design of educational programs and guidelines focused on improving materno–fetal health status during pregnancy.     

成都市大学新生膳食状况和体力活动水平与体质状况关系调查

目的探讨膳食和体力活动状况对大学新生体质的影响。方法选取成都市五所高校一年级新生1200人,采用半定量食物频率问卷和国际体力活动问卷结合体质测试进行调查。结果与调查对象体质关系密切的营养素是铁、锌、硒、维生素E等微量营养素,体力活动水平、静坐时间及身体匀称程度对学生体质有较大影响。结论增加体力活动与膳食营养,有利于大学生培养健康的生活习惯。     

Effect of a Six-Month Lifestyle Intervention on the Physical Activity and Fitness Status of Adults with NAFLD and Metabolic Syndrome

(1) Background: Physical inactivity has been linked to NAFLD, and exercise has been reported as useful to reduce intrahepatic fat content in NAFLD. (2) Objectives: To assess the physical activity (PA) and fitness status after a six-month lifestyle intervention (diet and PA) in adults with NAFLD and metabolic syndrome (MetS). (3) Design: Prospective cohort analysis of data obtained between baseline and six-year parallel-group randomized trial (n = 155, aged 40–60 years old, with MetS and NAFLD). Participants were randomized into three nutritional and PA intervention groups: Conventional diet (CD); MedDiet-high meal frequency (MD-HMF); MedDiet-physical activity (MD-PA). (4) Methods: PA and fitness status were assessed using a validated Minnesota questionnaire, ALPHA-FIT test battery, accelerometers, and functional fitness score. Information related to age, gender, education level, marital status, socioeconomic status, smoking habit, and alcohol consumption were also obtained. (5) Results: The CD group had higher improvement in standing handgrip than the MD-HMF group. The MD-PA group did more modified push-up repetitions than the CD group. The MD-PA and CD groups showed higher sitting handgrip than the MD-HMF group. The MD-HMF group showed the highest decrease in aerobic capacity. The MD-PA group showed lower light intensity PA/day than the CD and MD-HMF groups. The MD-PA group showed higher moderate intensity PA than the CD and MD-HMF groups. The CD group reported more METs per day than the MD-HMF group. (6) Conclusions: Lifestyle six-month intervention with diet and regular PA improved functional fitness in middle-aged patients with NAFLD and MetS. Aerobic capacity improved in patients who followed a Mediterranean diet and regular training sessions at six months.     

Obesity and Lifestyle Habits among Kidney Transplant Recipients

Background: Obesity may negatively impact clinical outcomes in kidney transplant (KT) recipients. Limited information is available on the prevalence of obesity in this population, and on the lifestyle habits associated with obesity. Methods: we conducted an online, anonymous survey to assess of the proportion of KT recipients with obesity, adherence to the Mediterranean diet (i.e., a dietary regimen with proven renal and cardiovascular outcomes) using the MEDI-Lite questionnaire, and level of physical activity using the International Physical Activity Questionnaire (IPAQ) short form among KT recipients. Results: 255 KT recipients participated. Median (25th–75th quartile) age was 56.0 (48.0; 62.0) years, 43.9% female, median BMI 23.9 (21.6; 26.5) kg/m². The proportion of KT recipients with obesity was 9.8% (95% confidence interval, 6.4 to 14.1%). Adequate adherence to the Mediterranean diet (Medi-Lite score >9) was overall low (44.7%; 40.0 vs. 45.2% in those with or without obesity, respectively; p = 0.618). In participants with obesity the Medi-Lite score inversely correlated with BMI (R = −0.45; p < 0.025). Overall, 30.6% of participants had a low level of physical activity (44.0 vs. 29.1% of those with or without obesity, respectively; p = 0.125). The amount of energy expended walking was significantly lower among participants with obesity (462 (0.0; 1436) vs. 1056 (433; 2005) METs/week, p = 0.017). Conclusions: the burden of obesity among KT recipients is similar to that of the general population. Adherence to the Mediterranean diet was generally low, and nearly one-third of participants had a low level of physical activity. Building specialized multidisciplinary teams to manage obesity in KT recipients is urgently needed.     

Deprivation Index and Lifestyle: Baseline Cross-Sectional Analysis of the PREDIMED-Plus Catalonia Study

This baseline cross-sectional analysis from data acquired in a sub-sample of the PREDIMED-Plus study participants aimed to evaluate the relation between the Composite Socioeconomic Index (CSI) and lifestyle (diet and physical activity). This study involved 1512 participants (759 (52.2%) women) between 55 and 80 years with overweight/obesity and metabolic syndrome assigned to 137 primary healthcare centers in Catalonia, Spain. CSI and lifestyle (diet and physical activity) were assessed. Multiple linear regression or multinomial regression were applied to the data. Cluster analysis was performed to identify dietary patterns. The multiple linear regression model showed that a high deprivation index was related to a higher consumption of refined cereals (11.98 g/d, p-value = 0.001) and potatoes (6.68 g/d, p-value = 0.001), and to a lower consumption of fruits (−17.52 g/d, p-value = 0.036), and coffee and tea (−8.03 g/d, p-value = 0.013). Two a posteriori dietary patterns were identified by cluster analysis and labeled as “healthy” and “unhealthy”. In addition, the multinomial regression model showed that a high deprivation index was related to an unhealthy dietary pattern and low physical activity (OR 1.42 [95% CI 1.06–1.89]; p-value < 0.05). In conclusion, a high deprivation index was related to an unhealthy lifestyle (diet and physical activity) in PREDIMED-Plus study participants.     

The effect of nutritional factors on sex hormone levels in male twins

Dietary intake has been hypothesized as being associated with several hormonally related cancers including prostate, breast, ovarian, and endometrial cancer. Because diet may affect hormones directly, it is logical to examine the effects of dietary factors on hormone production and levels. Therefore, a set of 72 male MZ and 83 male DZ twin pairs was ascertained from the Utah birth certificates. A quantitative food frequency questionnaire was administered and blood samples were drawn for hormonal assays. Heritability estimates for hormonal levels were calculated indicating a range from no heritability for sex hormone binding globulin (SHBG), estrone, and testosterone glucuronide to 70% for androstanediol glucuronide and luteinizing hormone. To examine nutritional factors, the difference in hormone and SHBG levels between each MZ twin and his co-twin were correlated with the difference in nutrient intake. Weight and obesity were significantly correlated with plasma testosterone and follicle stimulating hormone. Fat intake showed a significant association with testosterone. Androstanediol glucuronide, a steroid that reflects tissue formation of dihydrotestosterone, was inversely correlated with caloric intake, theobromine and caffeine. Testosterone glucuronide exhibited significant correlations with calories and vitamin A. This study suggests that dietary intake affects plasma sex-steroid levels in men.     

The Effect of Diet and Lifestyle on the Course of Diabetic Retinopathy—A Review of the Literature

Diabetes is a major social problem. As shown by epidemiological studies, the world incidence of diabetes is increasing and so is the number of people suffering from its complications. Therefore, it is important to determine possible preventive tools. In the prevention of diabetic retinopathy, it is essential to control glycemia, lipid profile and blood pressure. This can be done not only by pharmacological treatment, but first of all by promoting a healthy lifestyle, changing dietary habits and increasing physical activity. In our work, we present a review of the literature to show that physical exercise and an adequate diet can significantly reduce the risk of diabetes and diabetic retinopathy.     

Association between the Sociodemographic Characteristics of Parents with Health-Related and Lifestyle Markers of Children in Three Different Spanish-Speaking Countries: An Inter-Continental Study at OECD Country Level

The purpose of this cross-cultural study was to determine the association between the sociodemographic background of a child’s parents (i.e., their socioeconomic level, marital status, and educational level) with the child’s lifestyle (i.e., Mediterranean diet (MD), physical activity (PA) and screen time (ST)), and health markers. Material: This cross-sectional study included 1273 children, from Chile (n = 496), Colombia (n = 340), and Spain (n = 437). The sociodemographic information together with the lifestyle and health markers of the children were measured. There was an inverse association between a low or medium-low socioeconomic level for the parents of Chilean children and handgrip strength (β −0.61, p < 0.001); meanwhile, for Spanish children, an inverse association between a low or medium-low socioeconomic level and PA after school (β −0.58, p = 0.016), lifestyle (β −0.74, p = 0.015), and with MD adherence (β −0.86, p = 0.004) was found. The risk (i.e., by odd ratios (OR)) of being divorced/separated parents marital status showed an inverse association with abdominal obesity (OR 0.21, p = 0.045) in Spanish children; however, the parent’s marital status and a low educational level were risk factors for the suffering of a low nutritional level in Colombian children (OR 2.02, p = 0.048; OR 2.49, p < 0.001, respectively). On the other hand, a low educational level for parents reported for Chilean children had a positive association with ST of ≥4 h per day (OR 1.82, p = 0.020). In conclusion, in Spanish-speaking children, the lifestyle and health markers of the children are affected by the sociodemographic background of their parents; however, these effects could be moderated by the socio-cultural and economic status of their countries as members of the OCDE; therefore, it is essential to develop policies that decrease these gaps, so that children who are under-resourced can reach their full potential.     

Longitudinal Effects of Active Learning Education on Lifestyle Behavior and Physical Function in Older Adults

ObjectivesSustaining benefits of an exercise program is difficult as adherence is often poor after supervised intervention is over. This study aimed to determine whether the effects of active learning education on physical activity, dietary habits, and physical function were maintained 24 weeks after intervention termination in older adults.DesignNon-randomized controlled trial.Setting and ParticipantsCommunity-dwelling older adults aged ≥65 years who were independent in activities of daily living.MethodsThe intervention group (n = 36) underwent 24 weeks of active learning education. The control group (n = 59) attended a health education class didactically. In both groups, the education program focused on exercise, diet and nutrition, and cognitive activity for health promotion. Active learning included exploratory learning, group work, and self-planning for behavior change that promoted healthy lifestyles. Outcome measures were obtained at baseline (pre), 24 weeks (post), and 48 weeks (follow-up). Physical activity was objectively measured as physical activity level (PAL) using a triaxial accelerometer. Food intake was assessed by obtaining a dietary variety score. Physical function, including gait speed and Timed Up & Go score, was tested as secondary outcome. We used a linear mixed model to estimate the effects of intervention in intention-to-treat analyses.ResultsAll outcomes in the intervention group significantly improved compared with the control group at 24 weeks, and the improvements were sustained over a 48-week follow-up period. For PAL, between-group difference in change from baseline was 0.043 (95% confidence interval = 0.007, 0.080) at 24 weeks and 0.061 (0.023, 0.099) at 48 weeks.Conclusions and ImplicationsActive learning education is effective in enhancing healthy lifestyles and physical function sustainability beyond intervention cessation. A randomized controlled trial with a larger sample size is needed to conclusively clarify the beneficial effects of active health education learning on sustainable behavior change and functional improvement.     

Genetic variance of blood pressure levels in infant twins

A cohort of 166 twin pairs (67 monozygotic and 99 dizygotic) born at the Jackson Memorial Hospital/University of Miami Medical Center between July 1, 1976 and December 31, 1980, was followed from birth to one year of age in order to estimate the genetic variance of blood pressure during the first year of life. The sex-adjusted summary estimate of heritability for systolic blood pressure during all of infancy was 0.22 (p less than 0.001), but statistically significant genetic variance was not found for diastolic blood pressure. When using blood pressures from six to 12 months of age, adjusted for infant sex, heritability was estimated as 0.33 (p less than 0.001) for systolic blood pressure and 0.24 (p = 0.04) for diastolic blood pressure; adjustment for body weight reduced these estimates to 0.27 (p less than 0.001) and 0.17 (p = 0.13), respectively.     

Negative Physical Self-Concept Is Associated to Low Cardiorespiratory Fitness,Negative Lifestyle and Poor Mental Health in Chilean Schoolchildren

Background: Evidence suggests that physical self-concept (PSC) is linked to well-being in children and adolescents. Objective: The objective was to investigate the association of PSC with mental health (i.e., depression and body image), physical status (i.e., fitness and weight status) and lifestyle (physical activity (PA) patterns and nutritional level) in Chilean schoolchildren. Methods: A total of 617 schoolchildren (n = 271 girls and n = 346 boys) aged 10–14 years participated in this study. Self-concept, depression and body image dissatisfaction were determined by questionnaires. Physical fitness, PA, screen time (ST), Mediterranean diet (MD) adherence and anthropometric parameters were also included. Results: Poor PSC was linked to bad cardiorespiratory fitness (CRF) (<42 VO_2max) (OR 1.64; 95%CI 1.12–2.34; p = 0.01), severe body image dissatisfaction (OR 2.51, 95%CI 0.99–6.35; p = 0.05), ST of more than two hours a day (OR 2.1; 95%CI 1.41–3.12; p < 0.001), PA after school of no more than two hours per week (OR 1.52; 95%CI 1.08–2.13; p = 0.015) and depression (OR 1.80; 95%CI 1.1–2.92; p = 0.017). High nutritional level showed an association with general PSC and general self-concept (p < 0.05). Absence of body image dissatisfaction was related to general self-concept (p < 0.01) and physical condition dimensions (p < 0.05). Conclusions: PSC is associated with CRF, PA after school, ST and nutritional level. According to mental health variables, poor PSC is related to depression in Chilean schoolchildren. Therefore, promoting a healthy lifestyle among children should be a target of community- and school-based interventions to promote PSC.     

Screening for Sarcopenia among Elderly Arab Females: Influence of Body Composition,Lifestyle, Irisin,and Vitamin D

Sarcopenia is the loss of skeletal muscle mass, and is most common in older people. The present multi-center cross-sectional study aimed to determine the prevalence of sarcopenia and possible risk factors among Arab elderly females. A total of 131 ambulatory Saudi elderly females aged 60–85 years (mean age 65.9 ± 5.5 years) were recruited to participate. A general questionnaire with questions related to sociodemographic factors, medical history, diet, physical activity, and lifestyle was administered. Anthropometrics and muscle assessments were done. Fasting blood glucose and lipids were measured routinely. Circulating 25(OH)D and irisin levels were measured using commercially available assays. Sarcopenia was assessed using the criteria of the Asian Working Group for Sarcopenia (AWGS). Over-all prevalence of sarcopenia was 19.8% (26 out of 131 participants). Novel measures such as abdominal volume index (AVI), dietary fiber, and irisin were found to be significantly lower in the sarcopenia group than those without sarcopenia, independent of age. No associations were found with physical activity or dietary and lifestyle habits. In conclusion, sarcopenia is relatively common among Arab elderly females. Longitudinal studies are needed to determine whether lifestyle modifications can decrease the incidence of sarcopenia in this population. Irisin maybe a promising biomarker for sarcopenia but needs to be confirmed using larger sample sizes.     

Effect of COVID-19 Pandemic-Induced Dietary and Lifestyle Changes and Their Associations with Perceived Health Status and Self-Reported Body Weight Changes in India: A Cross-Sectional Survey

Home confinement during the COVID-19 pandemic is accompanied by dramatic changes in lifestyle and dietary behaviors that can significantly influence health. We conducted an online cross-sectional survey to assess COVID-19 pandemic-induced dietary and lifestyle changes and their association with perceived health status and self-reported body weight changes among 1000 Indian adults in early 2021. Positive improvements in dietary habits, e.g., eating more nutritious (85% of participants) and home-cooked food (89%) and an increase in overall nutrition intake (79%), were observed. Sixty-five percent of participants self-reported increased oat consumption to support immunity. There were some negative changes, e.g., more binge eating (69%), eating more in between meals (67%), and increasing meal portion size (72%). Two-thirds of participants reported no change in lifestyles, whereas 21 and 23% reported an increase, and 13 and 10% reported a decrease in physical activity and sleep, respectively. Overall, 64 and 65% of participants reported an improvement in perceived health and an increase in body weight during the COVID-19 period compared to pre-COVID-19, respectively. The top motivations for improving dietary habits included improving physical and mental health and building immunity. In conclusion, the overall perceived health was improved and there was an increase in self-reported body weight in most participants during COVID-19. Diet emerged as the most crucial determinant for these changes.     

A genetic and environmental time series analysis of blood pressure in male twins

Systolic and diastolic blood pressures were measured on 254 monozygotic (MZ) and 260 dizygotic (DZ) male twin pairs, during middle age (average age 48 years) and at two later age points. Genetic and environmental components of covariation were modeled by time series. For both measures, shared environmental influences were absent and specific environmental influences were largely time-specific. Although heritability was about 0.5 at each time point, genetic variation present at middle age contributed only about 60% to that present 9 years later, the remaining 40% being new. Fifteen years later, at the third time point, no new genetic variation was evident, variation in individual differences being entirely attributable to genetic differences laid down at the two earlier ages. © 1993 Wiley-Liss, Inc.     

Poor Mental Health Is Related to Excess Weight via Lifestyle: A Cross-Sectional Gender- and Age-Dependent Mediation Analysis

Within mental health as risk factor for excess weight, prevention-relevant questions remain: does the relation persist after considering lifestyle, which lifestyle parameters might be most important to target, which gender or age subgroups are most at risk? The cross-sectional Belgian health survey 2013 (n = 4687; ≥15 years) measured mental health via anxiety and depression symptoms (Symptom Check List 90-R) and distress (General Health Questionnaire-12). Logistic regression, multiple mediation and moderated mediation were applied. Poor mental health was significantly related to a higher excess weight prevalence (odds ratio (OR) = 1.18 with 95% confidence interval (0.17–1.19)) and an unhealthier lifestyle i.e., more smoking, sleep problems, disordered eating, soft-drink, and alcohol consumption; while less fruit/vegetables and physical activity and even lower snack intake. Associations were often gender- and age-specific e.g., poor mental health was only related to less snacking in men and middle-adulthood, while an association with more snacking appeared in youth (<25 years). Disordered eating, physical activity and smoking were significant mediators explaining 88% of mental-weight associations, after which the association became negative (OR = 0.92 (0.91–0.93)). Mediation by snacking and disordered eating was stronger in the youngest and mediation by smoking was stronger in women. Thus, especially youth has high mental health associated behavioral and weight risks and gender or age differences can explain conflicting literature results on lifestyle.     

Association between Non-Alcoholic Fatty Liver Disease and Mediterranean Lifestyle: A Systematic Review

Background and Aims: Non-alcoholic fatty liver disease (NAFLD) is an excessive accumulation of fat in the liver without alcohol abuse. It is linked to metabolic syndrome (MetS) and no pharmacological treatment exists. This systematic review aims to assess evidence about the effect of Mediterranean lifestyle on the prevention and reversion of NAFLD. Methods: A systematic literature search was performed in MEDLINE via Pubmed. MeSH terms used were: non-alcoholic fatty liver disease [MeSH Major Topic] AND metabolic syndrome [MeSH Term] AND (Diet, Mediterranean [MeSH Term]) OR (Exercise [MeSH Term]). (PROSPERO ID: 2021 CRD42021289495). Results: Thirteen articles were selected and divided into two categories (four focused on Mediterranean diet and NAFLD and nine focused on Mediterranean diet, physical activity, and NAFLD). Information of clinical endpoints was based on NAFLD, as well as MetS, body mass index, fasting glycemia, obesity, cholesterol, triglycerides, transaminases, albuminuria, and hepatic steatosis, among others. All studies found beneficial associations between the clinical parameters of NAFLD/MetS and following a Mediterranean diet and regular physical activity. Conclusions: An effective treatment that prevents, and even reverses, NAFLD is to adapt lifestyle to the Mediterranean one, based on a Mediterranean diet and regular physical activity.     

A pilot intervention to reduce postpartum weight retention and central adiposity in first‐time mothers: results from the mums OnLiNE (Online,Lifestyle, Nutrition & Exercise) study

Background

Postpartum weight retention (PPWR ) increases the risk for obesity and complications during subsequent pregnancies. Few interventions have been successful in limiting PPWR in mothers. The present study assessed the effectiveness of the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) intervention with respect to reducing PPWR and improving diet, physical activity and sedentary behaviour.

Methods

A subsample of first‐time mothers enrolled in the Extended Melbourne Infant Feeding Activity and Nutrition Trial (InFANT Extend) completed the nonrandomised mums OnLiNE intervention. Women in the intervention (I) group (n  =  28) received access to an online calorie tracking program, smartphone app, three telephone counselling calls with a dietitian and written material. Women in two comparison groups (CI and C2) (n  =  48; n  =  43) were from the control (C1) and intervention (C2) arms of InFANT Extend and received no additional support. Weight and waist circumference were measured objectively. Written surveys assessed diet and physical activity. Sedentary behaviour was self‐reported. Linear and logistic regression assessed changes in outcomes between groups from 9 to 18 months postpartum.

Results

Mean PPWR decreased in the (I) group (?1.2 kg) and the C2 group (?1.2 kg), although the changes were not significant. Mean waist circumference for all groups exceeded recommendations at baseline but decreased to below recommendations for women in the (I) group (78.3 cm) and significantly for the (I) group (?6.4 cm) compared to C1 (?1.1 cm; P  =  0.002) and C2 (?3.3 cm; P  =  0.001). Changes in diet, physical activity or sedentary behaviour were not significant.

Conclusions

The online intervention reported in the present study shows promise with respect to reducing waist circumference in postpartum women. Further evidence of strategies that may improve weight and related behaviours in this target group is needed.

     

Association between Creativity and Memory with Cardiorespiratory Fitness and Lifestyle among Chilean Schoolchildren

The objective was to investigate the association between creativity and memory with cardiorespiratory fitness (CRF; i.e., CFR classification and V˙O_2max); lifestyle parameters (i.e., physical activity (PA), sleep duration, screen time (ST), and food habits); and anthropometric measures (i.e., body mass index (BMI), waist circumference (WC)) among Chilean schoolchildren. A total of 248 schoolchildren (137 boys, 111 girls, 11.80 ± 1.17 and 11.58 ± 1.09 years, respectively) participated in the cross-sectional study. Creativity, memory, concentration, and selective attention and lifestyle (PA, ST, sleep duration, and Mediterranean diet (MD) adherence) were measured using a standard questionnaire. CRF (measured by the 20 m shuttle run test and expressed as maximum oxygen consumption (V˙O_2max) and anthropometric measures (BMI and WC) were also included. Creativity showed a positive association with V˙O_2max (mL/kg/min) (β; 0.209, 95% CI; 0.02–0.40, p = p < 0.05) and MD Adherence (score) (β; 0.206, 95% CI; 0.01; 0.74, p = p < 0.05). Long-term memory reported a positive association with CRF (β; 1.076, 95% CI; 0.02–2.13, p = p < 0.05). An increase in CRF levels, together with healthy food habits and normal nutritional status, should be a target for community- and school-based interventions to promote cognitive development in creativity and memory among schoolchildren.     

Adherence to the Mediterranean Diet and Its Association with the Level of Physical Activity in Fitness Center Users: Croatian-Based Study

The Mediterranean diet (MD) is based on the traditional cuisine of south European countries, and it is considered one of the healthiest dietary patterns worldwide. The promotion of combined MD and physical activity has shown major benefits. However, the association between physical activity and the MD in regular fitness center users is still insufficiently investigated. This cross-sectional survey-based study was conducted on 1220 fitness center users in Croatia. The survey consisted of three parts: general information, the Mediterranean Diet Serving Score (MDSS) and the International Physical Activity Questionnaire Short Form (IPAQ-SF). The results showed that 18.6% of fitness center users were adherent to the MD, and there was a significant positive correlation between the level of physical activity and the MDSS score (r = 0.302, p < 0.001). Moreover, after dividing the sample into tertiles based on the IPAQ-SF score, the third tertile (MET > 3150 min/wk) had the most fitness center users (34.4%) adherent to the MD, while the first tertile (MET < 1750 min/wk) had the least (6.1%). These outcomes emphasize the importance of physical activity as they imply that, with higher levels of physical activity, people are also possibly more aware of the importance that a healthy and balanced diet has on their well-being.