The relationship between adherence to the Mediterranean Diet and constipation severity, microbiota awareness, and gut health in adults

This study was conducted to evaluate the relationship between adherence to the Mediterranean Diet and the severity of constipation, microbiota awareness, and gut health in adults. The study is a single-center, descriptive, cross-sectional study conducted on a total of 122 participants with good (n=61) and poor (n=61) adherence to the Mediterranean Diet who applied to the Dietitian Dilara Kaya Nutrition and Counseling Center between March 1, 2025, and September 1, 2025. Subjects were adults aged 18-65 voluntarily participating in the study. Exclusion criteria included individuals with auditory or cognitive impairments that could affect their ability to answer study questions, individuals with bowel disease, those using medication/supplements that accelerate or slow bowel movements, those who had undergone bariatric surgery (DS and RYGB), pregnant women, and cancer patients. Data collection tools included a General Information Form prepared by the researcher, a 24-Hour Food Consumption Record Form, the Mediterranean Diet Adherence Scale, the Microbiota Awareness Scale, the Constipation Severity Scale, and the Bristol Stool Scale. There was a higher proportion of female participants in both groups, but no statistically significant differences were found between the groups in terms of age, gender, marital status, education level, employment, or income (p>0.05). Similar distributions were observed in both groups regarding health and lifestyle habits, in terms of chronic diseases, regular medication and supplement use, probiotic consumption, smoking, alcohol consumption, and exercise habits. When anthropometric measurements were evaluated, the group with good adherence to the Mediterranean Diet was found to have an average body weight of 74.00 ± 17.65 kg, height of 1.66 ± 0.09 m, waist circumference of 87.36 ± 18.35 cm, and BMI of 26.66 ± 5.67 kg/m². The group with poor adherence had an average body weight of 78.85 ± 17.70 kg, height of 1.67 ± 0.10 m, waist circumference of 89.69 ±1 5.52 cm, and BMI of 28.24 ± 6.08 kg/m². The average waist-to-height ratio was 0.53 ± 0.11 in the good adherence group and 0.54 ± 0.10 in the poor adherence group. Overall, the demographic and anthropometric findings suggest that the groups showed similar distributions in terms of baseline characteristics, and any potential differences may be related to dietary habits. When participants' daily energy and nutrient intake was evaluated according to their adherence to the Mediterranean Diet, the group with good adherence had significantly higher daily water intake (686.23±209.31 mL) compared to the group with poor adherence (598.77±209.81 mL) (p=0.023). Conversely, sodium intake (1782.26±813.87 mg) was significantly higher in the group with poor adherence compared to the group with good adherence (1402.66±720.54 mg) (p=0.007). Similarly, saturated fat intake was also significantly higher in the group with poor adherence (26.33±11.19 g) compared to the group with good adherence (20.36±10.23 g) (p=0.003). No statistically significant differences were observed between the groups in terms of energy, protein, carbohydrate, or fiber intake (p>0.05). The similar fiber intake levels in both groups (22.85 g and 22.79 g) suggest that the difference in adherence to the Mediterranean Diet may be related more to fatty acid composition and food choices than to fiber consumption. No significant differences were found between the groups in terms of micronutrients. Comparison with the 2022 Turkish Nutrition Guidelines reference values revealed that both groups had insufficient water intake, while sodium and saturated fat intake reached risky levels. Although the good adherence group had significantly higher water intake than the other group, it only met 27.4% of the recommended daily intake; this rate was 24.0% in the poor adherence group. Regarding sodium intake, the poor adherence group reached 77.5% of the recommended upper limit, while this rate was 61.0% in the good adherence group. In terms of saturated fat intake, the poor adherence group exceeded the reference limit, achieving 119.7%, while this rate remained at 92.5% in the good adherence group. When assessed in terms of overall nutritional adequacy, both groups were found to more than meet their protein (118–120%) and total fat (125–138%) requirements. However, micronutrient deficiencies were common in both groups, with intakes of vitamin D (16–21%), folate (39–40%), vitamin A (39–43%), and potassium (46–54%) significantly below reference values. These findings suggest that although participants' energy intake was adequate, the quality of their diet in terms of micronutrient density needs improvement.