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 [22,23,24] 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 [26,27,28,29,30]. 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 [45,46,47].

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.