The relationships among food neophobia, mediterranean diet adherence, and eating disorder risk among university students: a cross-sectional study

Abstract

Background

Food neophobia, characterized by the fear of unfamiliar foods, can be influenced by environmental, cultural, and genetic factors, leading to decreased consumption of novel or diverse foods. Understanding the impact of Mediterranean diet adherence and eating disorders on dietary behaviors is crucial, particularly for young adults who are developing lifelong eating patterns.

Methods

The aim of this study was to investigate the relationships among food neophobia, Mediterranean diet adherence, and eating disorders in university students aged 18–24 years. A cross-sectional study was conducted with 1277 students (67.2% female) via an online questionnaire to assess sociodemographic characteristics, food neophobia (Food Neophobia Scale, FNS), Mediterranean diet adherence (KIDMED), and eating disorder risk (Eating Disorder Examination Questionnaire, EDE-Q).

Results

Most participants (67.7%) had a normal body mass index (BMI), 19.3% were classified as overweight, and 3.7% were classified as obese. Compared with male students, female students had significantly higher FNS scores (40.8 ± 9.21) (38.5 ± 10.97, p < 0.05), indicating greater food neophobia among women. Similarly, men’s EDE-Q scores (3.5 ± 3.32) were significantly lower than those of women (4.4 ± 4.05, p < 0.05). Most participants (69.5%) did not experience food neophobia, and underweight individuals (11.0%) were more neophobic than obese individuals (4.4%). No significant differences were observed according to BMI (p > 0.05). A positive correlation was found between age and KIDMED adherence, whereas a negative correlation was observed between BMI and EDE-Q scores regarding food neophobia. The effects of BMI on food neophobia and the risk of eating disorders were found to vary by sex.

Conclusions

These findings suggest that food neophobia may harm Mediterranean diet adherence and increase the risk of eating disorders among university students. Targeted interventions addressing food neophobia could promote healthier eating habits, such as the Mediterranean diet, thereby reducing disordered eating behaviors and associated risks. Further research is needed to confirm these findings, improve population nutritional habits and mental health outcomes, and develop effective public health strategies.

Graphical Abstract

Background

Eating habits are formed early in life through environmental observations and interactions with food, which form the basis for later dietary behavior [1]. The acquisition of healthy eating habits, including the consumption of a wide range of foods, is essential for healthy growth, development and protection from disease. However, fear of new or unfamiliar foods complicates this process and can lead to limited dietary diversity [2, 3]. While curiosity to try new foods is a common and expected behavior, this interest may manifest as fear or discomfort when confronted with new foods [4]. Biological, psychological, and environmental factors play a role in the development of food neophobia. These factors include genetic predispositions, personality traits, familiarity with flavor, the way new foods are introduced, and parental attitudes toward food [4]. Food neophobia, defined as a persistent aversion to unfamiliar foods, is characterized by an aversion to new products, avoidance of new flavors or rejection of unfamiliar textures. The severity of this neophobia can have a significant effect on eating habits, which often persist into adulthood and influence food choices and overall diet quality [1].

High levels of food neophobia have been reported among university students in China [5]. The restrictive nature of food neophobia reduces the consumption of familiar and new foods, and certain healthy food groups, such as fish, fruit and vegetables, are often rejected [4, 6]. This behavior has a negative impact on diet quality, as individuals with neophobia tend to consume more processed, energy-dense foods, which may increase the risk of obesity [6]. Conversely, adherence to healthy dietary patterns, such as the Mediterranean diet, is associated with lower food neophobia [7]. These dietary imbalances and reduced intake of nutrient-rich foods emphasize the importance of addressing food neophobia from both a nutritional and a psychological perspective [1].

Eating disorders, which are characterized by disruptive behaviors related to body weight, body image, and food intake, are serious mental illnesses with long-term consequences, particularly for the physical and psychological development of young adults [8, 9]. The prevalence of eating disorders has increased significantly in recent decades, necessitating a detailed and accurate assessment of these disorders. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies several types of eating disorders, including pica, avoidant/restrictive eating disorder (ARFID), and binge eating disorder [10]. Notably, disorders such as food neophobia, pica, and ARFID share common structural and behavioral features, particularly their onset in early childhood [11]. Given the similarities between the patterns of food refusal in neophobic and eating disorders, it is plausible that neophobia related to food may influence the development and maintenance of eating disorders. Research suggests that individuals with low adherence to the Mediterranean diet are at greater risk for disorders such as anorexia nervosa and bulimia nervosa [12]. The aim of this study was to investigate the relationships between food neophobia, adherence to the Mediterranean diet, and eating disorders in a specific subgroup of university students aged 18–24 years from Turkey. This focus provides insights into dietary behavior and eating patterns in this population. Therefore, this study addresses the gap in the literature regarding the potential role of food neophobia in influencing dietary behaviors and mental health in this demographic.

Methods

Study setting and participants

This cross-sectional study investigated the relationships among food neophobia, Mediterranean diet adherence, and eating disorders in university students. On the basis of a power calculation, a minimum sample size of 752 participants was required to achieve a margin of error of 5 at the 90% confidence level. To account for an estimated nonresponse rate of 20, the final sample size is 1277 male and female university students. The data were collected from January to March 2024 via an online questionnaire. In this study, university students aged 18–24 years residing in Turkey were the specific subgroup targeted. The targeted subgroup consisted of students aged 18–24 years from seven different regions of Turkey. The inclusion criteria were as follows: (1) aged 18–24 years, (2) a university student residing in Turkey and (3) volunteering to participate in the study. Illiterate individuals, individuals under 18 or over 24 years of age, and individuals who were not residents of Turkey and pregnant and lactating students and those on any diet were excluded from the study. All procedures followed the principles of the Declaration of Helsinki (2013), and ethical approval was granted by the Social Sciences and Humanities Ethics Committee of Erciyes University (approval number 449). All participants were informed about the study objectives and provided informed consent before participation. The confidentiality of participant data was ensured by anonymizing the responses and securely storing all the data on password-protected servers accessible only to authorized researchers. No personal identifying information was collected, and all the results were reported in aggregate to maintain participant privacy.

Assessment tools

The data were collected via an online questionnaire divided into four sections: (1) sociodemographic characteristics, (2) the Food Neophobia Scale (FNS), (3) the Mediterranean Type Diet Quality Index (KIDMED), and (4) the Eating Disorder Examination Questionnaire (EDE-Q). The participants self-reported their body weight and height. The questionnaire form, which was delivered to the participants online via a link, was presented in a form that the participants could fill out from their phones or computers by spending a maximum of 10 min. Personal information (name-surname, phone number, etc.) of the volunteer participants were not asked, it was stated in the consent form that there were no right or wrong answers to the questions, that there would be no material or moral return to the students after participation in the study, that the data would be used only for scientific purposes, and that they would therefore answer the survey questions sincerely. BMI was calculated by dividing weight (kg) by the square of height (m²). The BMI classification used in this study follows the guidelines established by the World Health Organization (WHO) in the 2020 classification system [13].

Food neophobia scale (FNS)

The Food Neophobia Scale (FNS), developed by Pliner and Hobden, has been widely used to measure a person’s reluctance to try new foods [14]. Its Turkish version was validated by Uçar et al. (2021) [4], who reported good internal consistency, with a Cronbach’s alpha of 0.805 in the Turkish population. The FNS consists of 10 items, with five positively worded statements and five negatively worded statements. The negatively worded items are reverse scored. The answers are rated on a 7-point Likert scale ranging from “strongly disagree” to “strongly agree”. The total score of the FNS ranges from 10 to 70 points, with higher scores indicating a higher level of food neophobia. A score above the mean indicates the presence of food-related fear [2].

Mediterranean-type diet quality index (KIDMED)

The importance of the Mediterranean diet lies in its balanced and varied composition, which contains most of the recommended macronutrients in appropriate proportions. This dietary pattern is characterized by a low proportion of saturated fatty acids, a high proportion of monounsaturated fatty acids, and a high proportion of fiber, complex carbohydrates, and antioxidants. The KIDMED test (Mediterranean Diet Quality Index) is an instrument for assessing Mediterranean diet adherence. Developed and validated by Serra-Majem et al. [15], the KIDMED index ranges from 0–12 and is based on a 16-question assessment that can either be self-completed or conducted via interviews. Questions that reflect behaviors that run counter to the Mediterranean diet are scored −1, whereas questions related to positive dietary behavior are scored + 1. The total score is divided into three categories: > 8 for optimal adherence to the Mediterranean diet, scores between 4 and 7 for needing improvement, and ≤ 3 for poor diet quality. The validity and reliability of the KIDMED test in Turkey were confirmed by Kabaran and Gezer (2013) [16].

Eating disorder examination questionnaire

There are several assessment scales for assessing eating disorders in the literature, one of which is the Eating Disorders Examination Questionnaire (EDE-Q). The EDE-Q is a self-reported version of the Eating Disorder Examination (EDE) interview (EDE) developed by Fairburn and Cooper to provide an objective assessment of eating disorders [17]. The Turkish validation and reliability of the EDE-Q were established by Yücel et al. [18] in a sample of adolescents. The questionnaire comprises 28 items distributed over five subscales. All subscales, except the binge eating subscale, are scored on a scale from 0 to 6, with higher scores indicating a greater severity of the disorder. The total score is the sum of the subscale scores, except for the binge-eating subscale.

Statistical analysis

Data analysis was performed with IBM SPSS Statistics (version 23.0) [19]. Categorical variables are presented as frequencies (n) and percentages (%), whereas numerical variables are presented as the means (X) and standard deviations (SD). Based on the mean FNS scores and their standard deviations, the participants were divided into three groups as follows: food neophobic (scores above 49.99), neutral (scores between 30.23 and 49.99), and food neophilic (scores below 30.23). The t test for independent samples was used to compare normally distributed data between two independent groups. In cases where the data were not normally distributed, the Mann‒Whitney U test was used. Pearson and Spearman correlation analyses were performed to assess the relationships between variables. Additionally, regression analysis was performed to determine the relationships between BMI, sex, eating disorders and food neophobia in terms of status and severity. A significance level of p < 0.05 was considered statistically significant in all analyses.

Results

A total of 1277 adolescents aged 18–24 years from seven different regions of Turkey participated in this online study. Among the participants, 67.2% were female, 72.3% had not been diagnosed with any disease, 67.0% did not take dietary supplements, and 67.7% had a normal BMI (see Table 1).

Table 1.

Sociodemographic characteristics of the participants

Characteristics (n = 1277)	n	%
Gender
Female	858	67.2
Male	419	32.8
Diagnosed with disease
No	923	72.3
Yes	354	27.7
Using food supplements
No	856	67.0
Yes	421	33.0
BMI (kg/m2)
Underweight (< 18.5 kg/m2)	119	9.3
Normal (18.5–24.9 kg/m2)	864	67.7
Overweight (25–29.9 kg/m2)	247	19.3
Class I obesity (30–34.9 kg/m2)	34	2.7
Class II obesity (35–39.9 kg/m2)	13	1.0

FNS scores were significantly lower in male participants (38.5 ∓ 10.97) than in female participants (40.8 ∓ 9.21) (p < 0.05). Similarly, males had significantly lower EDE-Q scores (3.5 ∓ 3.32) than females did (4.4 ∓ 4.05) (p < 0.05). In addition, significant differences in EDE-Q scores were observed between the different BMI categories. Underweight and normal-weight participants had significantly lower EDE-Q scores than overweight, class I obese, and class II obese participants did (p < 0.05). In addition, the EDE-Q scores of the underweight participants were significantly lower than those of the normal weight participants (p < 0.05) (see Table 2).

Table 2.

FNS, KIDMED and EDE-Q scores according to sex and BMI classification of individuals

Variables and Categories	FNS		KIDMED		EDE-Q
	$\overline{x}\mp SD$(Min–Max)		$\overline{x}\mp SD$(Min–Max)		$\overline{x}\mp SD$(Min–Max)
Gender
Female	40.8 ± 9.21 (10.00–61.00)	Z = − 3.561 p = 0.000*	4.4 ± 2.72 (− 3.00–11.00)	Z = − 0.396 p = 0.712	4.4 ± 4.05 (0.00–18.03)	Z = − 3.602 p = 0.000*
Male	38.5 ± 10.97 (10.00–65.00)		4.3 ± 2.87 (− 2.00–12.00)		3.5 ± 3.32 (0.00–15.35)
Total	40.1 ± 9.88 (10.00–65.00)		4.4 ± 2.77 (− 3.00–12.00)		4.2 ± 3.85 (0.00–18.03)
BMI Classification
Underweight	40.8 ± 9.66 (10.00–58.00)	χ2 = 5.859 p = 0.210	4.3 ± 2.72 (− 2.00–10.00)	χ2 = 1.406 p = 0.843	2.2 ± 2.53 (0.00–11.35)	χ2 = 175.690 p = 0.000*
Normal	40.0 ± 9.94 (10.00–65.00)		4.3 ± 2.73 (− 3.00–11.00)		3.5 ± 3.54 (0.00–18.03)
Overweight	39.5 ± 9.95 (10.00–61.00)		4.3 ± 2.97 (− 3.00–12.00)		6.4 ± 3.93 (0.00–16.95)
Class I obesity	43.1 ± 7.88 (15.00–57.00)		4.9 ± 2.43 (0.00–10.00)		7.2 ± 4.28 (0.93–16.64)
Class II obesity	40.0 ± 11.13 (17.00–56.00)		4.5 ± 2.90 (0.00–10.00)		9.4 ± 4.08 (3.08–15.35)

Z “Mann‒Whitney U test” statistic value, χ² Kruskal‒Wallis H statistic value

*p < 0.05

A positive and significant correlation was found between age and BMI with KIDMED adherence (r = 0.135; p = 0.000, r = 0.086; p = 0.000, respectively). A significant positive correlation was also found between the EDE-Q scores and BMI, and a negative correlation was observed between KIDMED adherence and the EDE-Q scores (except for the “restrictive eating” subscale) (p < 0.05). In addition, a negative correlation was found between BMI and the EDE-Q score, with a specific negative correlation observed for the “eating anxiety,” subscale (p < 0.05) (see Table 3).

Table 3.

Relationships between individuals’ age, BMI, FNS, KIDMED and EDE− Q scores

Variables	BMI	FNS	KIDMED	EDE-Q
BMI	r = 1	r = − 0.024	r = 0.003	r = 0.412
		p = 0.387	p = 0.927	p = 0.000**
FNS	r = − 0.024	r = 1	r = 0.023	r = − 0.021
	p = 0.387		p = 0.417	p = 0.453
KIDMED	r = 0.003	r = 0.023	r = 1	r = − 0.060
	p = 0.927	p = 0.417		p = 0.032*
EDE-Q	r = 0.412	r = − 0.021	r = − 0.060	r = 1
	p = 0.000**	p = 0.453	p = 0.032*
EDE-Q Subscales
Restrictive eating	r = 0.357	r = − 0.002	r = − 0.052	r = 0.886
	p = 0.000**	p = 0.946	p = 0.063	p = 0.000**
Form anxiety	r = 0.460	r = − 0.023	r = − 0.77	r = 0.904
	p = 0.000**	p = 0.408	p = 0.006*	p = 0.000**
Eating anxiety	r = 0.337	r = − 0.065	r = − 0.73	r = 0.841
	p = 0.000**	p = 0.020*	p = 0.009*	p = 0.000**
Weight anxiety	r = 0.375	r = − 0.012	r = − 0.078	r = 0.935
	p = 0.000**	p = 0.679	p = 0.005*	p = 0.000**

*p < 0.05, **p < 0.001

Food neophobia was not observed in 69.5% of the participants, with underweight individuals (11.0%) showing higher levels of neophobia than obese individuals (4.4%). However, no significant differences in food neophobia were found between BMI categories (p > 0.05). With respect to adherence to the Mediterranean diet, 69.5% of participants with a normal BMI had moderate adherence, while the highest levels were observed in underweight individuals (10.0%). Overall, 37.8% of the participants adhered to the Mediterranean diet to a high degree, although the differences between BMI groups were not statistically significant (p > 0.05) (data not shown in the table).

Table 4 shows the results of a moderation analysis examining the interaction effect of BMI and gender on food neophobia. The analysis tested whether sex moderated the relationship between BMI and food neophobia. BMI was found to be a significant predictor of food neophobia, with a positive relationship (β = 2.4829, p = 0.018), suggesting that individuals with a higher BMI tend to report greater food neophobia. Gender also had a significant main effect (β = 2.6592, p < 0.001), with females having higher food neophobia scores than males. The interaction term between BMI and sex was significant (β = − 1.4567, p = 0.016).

Table 4.

Results of Moderation Analysis for the Effects of BMI and Gender on Food Neophobia

Predictor	Coefficient (β)	Standard error	t value	p value
Constant	35.4881	1.084	32.745	< 0.001
BMI	2.4829	1.046	2.374	0.018
Gender	2.6592	0.617	4.308	< 0.001
BMIxGender interaction	− 1.4567	0.604	− 2.412	0.016

These findings suggest that the effect of BMI on food neophobia is moderated by sex and that the positive association between BMI and food neophobia is weaker in women than in men. The interaction effect indicates that although BMI is associated with greater food neophobia in both genders, the increase is more pronounced in men. For women, the relationship between BMI and food neophobia is less steep, as shown in Fig. 1.

Fig. 1.

Moderating effect of sex on BMI and food neophobia

A moderation analysis was conducted to investigate whether the relationship between BMI and eating disorder risk was moderated by sex. The interaction term BMI × sex was included in the regression model alongside the main effects of BMI and sex. The results revealed a significant interaction effect between BMI and sex on the risk of developing an eating disorder (β = 0.5579, p = 0.007). This finding indicates that the influence of BMI on the risk of an eating disorder is stronger in women than in men. Specifically, BMI was a significant predictor of eating disorder risk (β = 0.9230, p = 0.011), suggesting that higher BMI is associated with higher eating disorder risk. Gender also had a significant main effect (β = 1.8598, p < 0.001), with women showing a greater risk of eating disorders. The moderation effect illustrates that the risk of eating disorders increases more for women than for men as BMI increases. This finding supports the hypothesis that sex moderates the relationship between BMI and eating disorder risk (see Table 5).

Table 5.

Results of the Moderation Analysis for the Effects of BMI and Gender on Eating Disorders

Predictor	Coefficient (β)	Standard error	t value	p value
Constant	1.1226	0.374	3.004	0.003
BMI	0.9230	0.361	2.560	0.011
Gender	1.8598	0.213	8.740	< 0.001
BMIxGender interaction	0.5579	0.208	2.679	0.007

Discussion

Food neophobia, the reluctance to try unfamiliar foods, is closely related to food choice and often results in less variety and consumption of fruit, vegetables and novel foods [20]. High levels of food neophobia are associated with poor diet quality and a general aversion to new or unfamiliar foods, affecting both food preferences and health outcomes [21]. To our knowledge, this is the first study to provide valuable insights into the associations between food neophobia, Mediterranean diet adherence and eating disorders in university students. Increased food neophobia was found to be positively associated with Mediterranean diet adherence and disordered eating behavior. The effects of BMI on food neophobia and the risk of eating disorders were found to vary by sex. Individuals with increased food neophobia may engage in restrictive eating behaviors, resulting in an unbalanced diet that could contribute to weight gain and the development of eating disorders.

In recent years, food neophobia has increased among young adults, such as university students. Understanding food neophobia in this population is particularly important because their overall dietary habits are considered unhealthy. Because they consume too much fat, sugar, and salt; too few fruits and vegetables; and too little fiber. Although there are numerous studies on food neophobia in children, few data are available for university students [5]. There are no studies in the literature that have examined the possible effects of food neophobia on Mediterranean diet adherence and eating disorders. Therefore, this study is the first to examine the relationships among food neophobia, Mediterranean diet adherence, and eating disorders. It is expected to fill this gap in the literature.

To date, studies on sex-specific differences are still rather inconclusive [5]. Although some authors [22–24] have reported that women are more neophobic than men, as in our study. There is a study reporting the opposite [25], as well as studies reporting that there is no difference between genders in the literature [26–30]. The fact that food neophobia can be acquired through both genetic and environmental conditioning could explain these differences in outcomes [22, 31]. In addition, in the present study, in which the source of this difference between genders was investigated, it was found that the effect of BMI on food neophobia varied according to gender and the positive relationship between BMI and food neophobia was weaker in women compared to men.

The participants were divided into three groups according to their FNS score means and standard deviations. The numbers of participants in the food neophobic, neutral, and food neophilic groups were 182 (14.3%), 888 (69.5%), and 208 (16.3%), respectively. Jezewska-Zychowicz et al. [28] reported that the neophobic, neutral, and neophilic groups included 146 (14.4%), 747 (73.4%), and 124 (12.2%), respectively [28]. These results indicate that most participants belonged to the neutral group.

The average score of food neophobia varies from society to society. For example, Lebanon has 36.4 ± 9.8 [32]; South India has 37.7 ± 8.8 (vegetarians), 38.9 ± 8.3 (ovo-vegetarians), 37.3 ± 8.6 (nonvegetarians) [33]; China has 36.27 ± 7.61 [5] above that reported in developed countries such as the United Kingdom 29.51 (26.67–30.30) [29]; the United States has 29.80 ± 11.70 [32]; Spain has 31.74 ± 10.98 [34]; Finnish adolescents have 32.3 ± 10.5 [25]; South Korea has 33.50 ± 9.0 [35]; and the highest value reported in Turkey is 41.3 ± 10.93 [36], with a mean value of 40.1 ± 9.9. Although the reason for this situation is not clearly stated in the studies, it is believed to be related to the level of development of the country. This is because food neophobia is lower in developed countries than in underdeveloped countries.

The Mediterranean diet is a dietary pattern that describes the eating habits of people living in the Mediterranean region [37]. The Mediterranean diet is characterized by several features, including consumption of whole grains, a wide variety of regional and seasonal fruits and vegetables, moderate consumption of dairy products, vegetable sources of protein, and reduced consumption of saturated fats, with olive oil and olives as the main sources of fat. In addition reduced consumption of red meat, moderate consumption of red wine, and the use of herbs and spices as salt alternatives are recommended [38]. One of the tools used to assess adherence to the Mediterranean diet is the KIDMED. Adherence to the Mediterranean diet was investigated among university students and it was found that 32.7% of Lebanese university students [37] and 21.8% of Cypriot university students adhered to the Mediterranean diet [39]. A total of 37.5% of Turkish university students adhered to a Mediterranean diet [40], which is similar to the results of Lebanese university students (37.4%) [32]. In this study, 62.6% of the students showed moderate to good adherence to the Mediterranean diet (data not shown in tables). Moreover, in present study, adherence to the Mediterranean diet did not differ significantly by gender similar to another study conducted in Turkey [41].

When compared with students’ BMI and KIDMED scores, it was observed that as BMI increased, adherence to the Mediterranean diet increased. The results of the study by Hajj and Julien are not consistent with this study. It was found that students with a lower mean BMI had a higher adherence to the Mediterranean diet [37]. BMI is an important indicator of the importance of nutritional awareness, especially in emphasizing the importance of the Mediterranean diet and its various health benefits among students.

Eating disorders are common among university students, and if left untreated, the physical, psychological, social, and academic consequences can be severe. Early diagnosis and treatment of eating disorders is very important, but it is difficult to determine the prevalence of these disorders among university students [42, 43]. The EDE-Q is a well-established instrument for assessing eating disorder psychopathology and is used for both research and clinical purposes [44]. Numerous studies in the literature have shown that eating disorders affect women more often than men do. In fact, women are reportedly 20 times more likely to suffer from an eating disorder than men are [45–47].

This is thought to be due to the physical and physiological changes women undergo during adolescence [45]. Some studies have reported that BMI is a risk factor for the development of eating disorders [47, 48]. According to previous research, people with a BMI of 25 or more are twice as likely to have eating disorders [48]. Sanlier et al. [47] reported a positive relationship between BMI and the risk of eating disorders in a study of 610 university students. In this study, as in the literature, it has been found that higher BMI is associated with higher levels of disordered eating and this association is approximately two times higher in women. In addition, while there was an inverse relationship between eating anxiety and FNS scores among the sub-factors of the EDE-Q, a positive relationship was found between eating anxiety, fitness anxiety, weight anxiety and KIDMED. Our study also revealed that sex plays an important role in moderating the relationship between BMI and the risk of eating disorders. Specifically, the risk of eating disorders increases more in women than in men as BMI increases. Body image concerns and societal pressures related to weight disproportionately affect women, further exacerbating the link between higher BMI and eating disorders.

This study has strengths and limitations. Firstly, to our knowledge, this is the first study to investigate the relationship between food neophobia, adherence to the Mediterranean diet, and eating disorders in university students. It highlights the need not only to identify food neophobia among university students but also to promote healthy eating behaviors by raising awareness of adolescent adaptation to the Mediterranean diet and eating behavior disorders. The strengths of this study include the large and representative sample of 1277 university students, the use of validated and reliable assessment tools such as the FNS, KIDMED, and EDE-Q, and the novel investigation of the interactions between food neophobia, adherence to the Mediterranean diet and the risk of eating disorders. The inclusion of moderation analyses examining the role of BMI and gender further increases the robustness of the results. This study provides a valuable foundation for future research by addressing an area that has not yet been adequately explored in the literature. It contributes to the development of effective public health interventions targeting young adults. Despite these strengths, several limitations should be acknowledged. Firstly, this study is cross-sectional, it may not help establish a cause-and-effect relationship. Second, since the current study’s findings were based on the participants’ self-report data, there may be a risk of resource bias, as participants may underreport or overreport their food neophobia, dietary habits or body weight due to social desirability or recall errors. Third, the generalizability of the findings may be limited by the specific demographics of the university student sample. The results may not apply to broader populations or different age groups. Fourth, the impact of social and cultural factors on food choices and attitudes toward new foods can be significant. These factors might not be adequately captured in research, leading to an incomplete understanding of the relationship. Finally, one limitation of this study is the lack of information on the participants’ fields of study. This additional information could have shed light on whether academic background has an influence on neophobia towards food, adherence to the Mediterranean diet and the risk of an eating disorder. Future studies should consider collecting such data to further investigate these potential associations.

Conclusions

The results show that there is a significant positive relationship between BMI and the eating disorder risk scale EDE-Q and a significant negative relationship between BMI and KIDMED. In addition, the effects of BMI on food neophobia and eating disorder risk were found to vary by gender. It was observed that food neophobia decreased as the risk of eating disorder increased, but this relationship was not confirmed with all subscales of the EDE-Q. Although food neophobia is prevalent worldwide, the associations between food neophobia, adherence to the Mediterranean diet and eating disorders have not been studied worldwide. Therefore, further studies on larger samples from more diverse populations are needed to obtain generalizable results and increase power.

Abbreviations

ARFID

Avoidance/restriction of food intake disorder

BMI

Body mass index

EDE-Q

Eating disorder examination questionnaire

FNS

Food neophobia scale

KIDMED

Mediterranean type diet quality index

WHO

World health organization

Author contributions

N.O.: conceptualization, methodology, investigation, writing-review and editing; F.H.G.: investigation, writing-original draft preparation; N.O. and F.H.G.: writing-review and editing. All the authors approved the final submitted and published version.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Availability of data and materials

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Social Sciences and Humanities of Erciyes University (No. 449).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.