Association Between Food Security Status and Adherence to Mediterranean Diet Among Adults in Saudi Arabia: A Cross-Sectional Study.

Food insecurity has been associated with poorer diet quality; however, limited evidence exists on the association between food insecurity and adherence to the Mediterranean diet in Saudi Arabia. This cross-sectional study, conducted among 577 Saudi adults between February and June 2025, examined the association between food security status and adherence to the Mediterranean diet in this region. Data were collected through a self-administered questionnaire that included sociodemographic characteristics, the Food Insecurity Experience Scale, and the Mediterranean diet adherence score. Most participants were food secure (73.0%), and only 12.7% demonstrated high adherence to the Mediterranean diet. The food insecurity score was inversely related to Mediterranean diet adherence (B = -0.107, 95% CI -0.191 to -0.024; p = 0.012); however, the magnitude of the association was small. Age, marital status, and monthly income were also significantly associated with food security status (p < 0.005). Although most of the participants were food secure, overall adherence to the Mediterranean diet was low, with only a small proportion demonstrating high adherence. These findings suggest that socioeconomic factors, particularly income, may be associated with both food access and diet quality. Further research is needed to inform strategies aimed at improving access to affordable healthy foods and promoting healthier dietary patterns, especially among young adults and low-income individuals.