Perspectives of Environmental Health Promotion and the Mediterranean Diet: A Thematic Narrative Synthesis

Evaluation of adherence to the Mediterranean diet with sustainable nutrition knowledge and environmentally responsible food choices

Background

Dietary patterns and their possible effects on health and the environment are becoming increasingly important. It is thought that nutritionally balanced diets can also be compatible with environmental targets and, therefore, the Mediterranean diet (MD), which is regarded as a sustainable diet model, comes to the fore. This study was carried out to evaluate adherence to the MD with sustainable nutrition knowledge and environmentally responsible food choices and to determine the factors affecting adherence.

Methods

A questionnaire prepared by the researchers was sent to individuals online and 1732 adults living in Turkey participated in this cross-sectional study. Adherence to the MD was evaluated with the Mediterranean Diet Adherence Screener (MEDAS). In addition, questions were asked about nutritional knowledge and environmentally responsible food choices to evaluate the sustainable nutritional behaviors of individuals.

Results

Half of the participants (51.1% of men / 53% of women) adhere to the MD at a moderate level. Even the individuals with the highest adherence to the MD had low compliance with the recommendations for fruit (43.4%) and fish (37.3%) consumption. A one-unit increase in age, sustainable nutrition knowledge score, and environmentally responsible food choices score increases the MD adherence score by 0.08, 0.125, and 0.148 points, respectively (p < 0.005). Individuals with high adherence to the MD avoid consuming genetically modified organism food more (p < 0.001), prefer to consume environmentally labeled foods (p < 0.001), and buy food more from local businesses (p < 0.001), while they prefer to buy imported food less (p = 0.034).

Conclusion

The results of this study showed that some strategies should be developed to increase the adaptation of individuals to the MD and sustainable nutritional behaviors. Nutritionally adequate, sustainable, and eco-friendly nutritional behaviors should be encouraged to increase the possible health benefits of nutrition and minimize environmental effects. To promote sustainable nutrition, firstly it is important to determine the knowledge level of individuals concerning sustainable nutrition and, for this purpose, it is thought that an international valid sustainable nutrition knowledge assessment tool is needed.

Assessment of the Methodology That Is Used to Determine the Nutritional Sustainability of the Mediterranean Diet-A Scoping Review

Mediterranean diet (MedDiet) is often used as an example of a sustainable diet that promotes a sustainable food system. MedDiet presents low environmental impacts, is characterized by high sociocultural food values, allows for positive local economic returns, and presents major health and nutrition benefits. Previous studies have not systematically examined the methodological assessment of MedDiet nutritional sustainability. In our study, we review the methodological assessment of nutritional sustainability, filling a crucial gap in the literature that can inform the state of the art regarding the cross-disciplinary assessment of MedDiet nutritional sustainability. Through a systematic search on PubMed and Scopus, we identified 28 studies, published between 2013 and 2021, that dealt with the MedDiet nutritional sustainability. Studies that assessed the sustainability of MedDiet based on dietary consumption data, studies that explored the MedDiet sustainability resorting to dietary scenarios, and studies with a mixed approach (dietary consumption and dietary scenarios) and proposals of methodological approaches to assess the MedDiet nutritional sustainability were summarized. We identified 24 studies exploring the dimensions of nutritional sustainability of the MedDiet, and 4 proposing the methodological approaches to assess the MedDiet nutritional sustainability or the sustainability of MedDiet typical agro-foods. From the 24 studies exploring the sustainability of MedDiet, none fully addressed the complexity of the four dimensions of nutritional sustainability (environmental, economic, socio-cultural, and health-nutrition). One of the methodological proposals to assess the MedDiet nutritional sustainability contemplated on the four dimensions of nutritional sustainability, as well as one of the methodological proposals to assess the sustainability of typical agro-foods of MedDiet. Environmental sustainability was the most well-studied dimension, while no study focuses on the socio-cultural dimension of sustainability. Our study reviewed for the first time the assessment of nutritional sustainability of MedDiet. To the best of our knowledge, no research has been made assessing MedDiet in all the dimensions of the complex concept, that is nutritional sustainability. Integrating health and nutrition, environmental, economic, and socio-cultural considerations across scales and contexts can offer a more complete understanding of the opportunities and barriers to achieving nutritional sustainability not only in MedDiet but also in other dietary patterns and food products.

Principles of Sustainable Healthy Diets in Worldwide Dietary Guidelines: Efforts So Far and Future Perspectives

Food choices and eating behaviours have a large impact on both human and planetary health. Recently, the Food and Agricultural Organisation (FAO) of the United Nations and the World Health Organisation have developed a list of 16 guiding principles to achieve sustainable healthy diets (SHDs). They proposed that development of food-based dietary guidelines (FBDGs) should be a core element in the implementation of these SHDs in each country. The objective of this review is to explore the degree of alignment of current FBDGs to these guiding principles. A total of 43 FBDGs, written or translated into English, were collected from the online repository developed by the FAO and were analysed for their adherence to each of the guiding principles. Results were stratified for period of publication and geographical macro-area. Overall, there were high levels of inclusion of the factors related to health outcomes, especially in the most recent FBDGs. Conversely, environmental impact and socio-cultural aspects of diet were considered less frequently, especially in the older FBDGs. These results highlight the importance of revising FBDGs, especially to include emerging topics which represent the areas with the highest scope for improvement in the future versions of FBDGs. Replication of the present study in the coming years will be worthwhile to monitor improvements in the adherence of global FBDGs to the guiding principles of SHDs. The attainment of such a goal could promote a more rapid transition towards SHDs, as well as highlighting pivotal research trajectories to increase adoption and evaluate the impact on the food system.

The Beneficial Health Effects of Vegetables and Wild Edible Greens: The Case of the Mediterranean Diet and Its Sustainability

The Mediterranean diet (MD) concept as currently known describes the dietary patterns that were followed in specific regions of the area in the 1950s and 1960s. The broad recognition of its positive effects on the longevity of Mediterranean populations also led to the adoption of this diet in other regions of the world, and scientific interest focused on revealing its health effects. MD is not only linked with eating specific nutritional food products but also with social, religious, environmental, and cultural aspects, thus representing a healthy lifestyle in general. However, modern lifestyles adhere to less healthy diets, alienating people from their heritage. Therefore, considering the increasing evidence of the beneficial health effects of adherence to the MD and the ongoing transitions in consumers’ behavior, the present review focuses on updating the scientific knowledge regarding this diet and its relevance to agrobiodiversity. In addition, it also considers a sustainable approach for new marketing opportunities and consumer trends of the MD.