Background:
We compared dietary and lifestyle habits in a sample population living in the small cities of the Madonie Mountains (MM), Palermo’s Province, an Italian area characterized by one of the highest prevalence of centenarians and in a sample of residents living in the Metropolitan Area of Palermo (PA) to highlight any difference of public health interest.

Methods:
A cross sectional study was conducted administering an anonymous questionnaire in digital format since August 2022 and still ongoing. The questionnaire includes items which explore socio-demographic features, lifestyle, eating habits and supplement use. A MD adherence score was calculated based on fruit, vegetable, red meat intake, and walking habit.

Results:
Overall, 749 subjects were enrolled (RR 74%), with an average age of 38.6 years: 526 living in MM and 223 in PA. Only 21% of sample showed good adherence to MD, with young individuals having a statistically significant lower adherence to MD. Wholegrain flours consumption was found to be significantly associated with greater adherence to MD (Adj-OR: 2.04; CI95%:1.41-2.96) Residents in MM showed a significantly higher consumption of fruits (61.2% vs 52% - Adj-OR:1.45; CI95%:1.06-2.00) and vegetables (80.7%vs.50.9% - AdjOR:4.02; CI95%:2.86-5.65), mainly coming from local or homegrown production. Lastly, MM subjects were found to eat red meat mainly from local or household production as comparison with urban residents (Adj-OR:4.77; CI95%:3.32-6.85).

Conclusion:
Our findings confirmed the central role played in dietary habits by local and household production. Because of important role played by seasonality of fruits and vegetables and local production on MD food pyramid, data collected should encourage public health Authorities to promote proper lifestyle and nutrition also in Metropolitan Areas.