Assessing the Association between Mediterranean Diet Adherence and Quality of Life among Syrian Refugee Women in Mardin, Türkiye

Abstract

Background Türkiye hosts over 3.5 million Syrian refugees, with women facing heightened socioeconomic and health-related vulnerabilities. Structural constraints, including food insecurity, may influence dietary behaviors and overall well-being. Objective This study aimed to assess quality of life (QoL), Mediterranean diet adherence, and food security levels among Syrian refugee women living in Mardin, Türkiye; to examine the association between Mediterranean Diet Score (MDS) and QoL domains; to identify independent predictors of total QoL; and to explore the mediating role of food insecurity in this relationship. Methods A cross-sectional study was conducted with 310 Syrian refugee women aged 18-49 years. Data were collected using structured questionnaires, including the 14-item Mediterranean Diet Adherence Screener and the WHOQOL-BREF instrument. Descriptive statistics, ANOVA, Pearson correlation analysis (continuous variables only), multiple linear regression, and exploratory mediation analysis were performed. Results The mean total QoL score was 59.3 (SD = 14.5). The mean Mediterranean Diet Score (MDS) was 7.1 (SD = 2.6), with 22.6% of participants demonstrating high adherence. Food insecurity was prevalent, affecting 79.4% of households. Higher MDS was positively associated with all QoL domains (physical: r = 0.28, p < 0.001; psychological: r = 0.24, p = 0.002; social: r = 0.21, p = 0.004; environmental: r = 0.19, p = 0.007). Although statistically significant, these correlations were weak in magnitude (r < 0.30). In multiple regression analysis, MDS, education, and income were positive predictors of QoL, whereas food insecurity and larger household size were negatively associated. Exploratory mediation analysis identified a statistically significant indirect effect consistent with a potential partial mediation pattern; however, given the cross-sectional design, these findings should not be interpreted as evidence of a causal pathway. Conclusion Mediterranean diet adherence was positively associated with quality of life among Syrian refugee women. Socioeconomic disadvantage and food insecurity were linked to lower well-being. Given the cross-sectional design, causal inferences cannot be made, and longitudinal studies are needed to clarify these relationships.