Sustainability Dimensions of the Mediterranean Diet: A Systematic Review of the Indicators Used and Its Results

Mediterranean Dietary Pattern for Healthy and Active Aging: A Narrative Review of an Integrative and Sustainable Approach

The global population is on a trajectory of continuous growth, with estimates projecting an increase from 7.7 billion in 2019 to approximately 9.7 billion by 2050. Longevity is also expected to rise rapidly, with advancements in healthcare contributing to increased life expectancies and an increase in the maximum lifespan. The aging process is accompanied by different changes, often leading to a decline in daily life activities and an increased susceptibility to disease. Age-related changes can cause cellular damage and subsequent cellular death. Oxidative stress and inflammation play significant roles in this process contributing to molecular damage and mitochondrial dysfunction. Active aging has been associated with improved quality of life and a reduced risk of morbidity and premature mortality. In this context, the Mediterranean diet has emerged as a promising approach to promoting healthy aging and sustainability. The phytochemical compounds within the Mediterranean diet have been linked to a lower risk of developing cardiovascular disease, type 2 diabetes, obesity, cancer and neurodegenerative diseases. The findings of peer-reviewed articles regarding the use of the Mediterranean diet as a healthy and sustainable dietary pattern written in Portuguese, Spanish or English were included in this narrative literature review. This dietary pattern's emphasis on the consumption of fresh and local food aligns with both health and environmental sustainability goals. This work provides a comprehensive review of the benefits of the Mediterranean diet and its components in a healthy aging process and highlights the importance of this dietary pattern as a sustainable approach.

Food Choices, Sustainability and Australian Native Foods: Perceptions among University Students

(1) Background: Urgent changes in our food choices are needed for more sustainable, resilient and equitable food systems. Australian native plant-based foods have both environmental and health benefits. Including these foods in our diet may reduce both the risk of chronic diseases and the impact of climate change. This study explored the perceptions and attitudes towards food choices, sustainability and Australian native plant-based food among university students. (2) Methods: A cross-sectional online survey was completed by 212 university students in Australia from October to December 2022. Questions included information about sociodemographic characteristics, food choices, Australian native foods and the impact on sustainability. Logistic regression was used for analyses. (3) Results: Most participants recognised the impact of food choices on sustainability. There was a significant association between recognition of the impact of food choices on sustainability and the environmental and nutritional benefits of Australian native foods (OR = 2.89, 95% CI 1.29, 6.46, p = 0.010). Students who were familiar with or had tried Australian native plant-based foods were significantly more likely to recognise their environmental and nutritional benefits (p < 0.001). (4) Conclusions: Students who recognise the impact of food choices on sustainability and the benefits of Australian native foods are more likely to include native foods in their diet. More studies are needed to investigate the specific native foods consumed and the barriers and facilitators to the intake of these foods.

Influence of culinary skills on ultraprocessed food consumption and Mediterranean diet adherence: An integrative review

The Mediterranean diet is a diet pattern with several healthy characteristics, including a high consumption of fresh fruits, vegetables, whole-grain products, and extra virgin olive oil as the main fat source. It is also characterized by a low consumption of processed foods and high-fat meats. However, there has been a nutritional transition such that, because of globalization and economic growth, the consumption of ultraprocessed foods is increasing, comprising 14% to 57% of total energy intake. North America and Australia have the worst prognosis. Further, the younger population consumes greater amounts of ultraprocessed foods compared with adults, whereas the older population has the lowest rates. Among the various factors responsible for the nutritional transition, culinary skills seem an important function of diet quality, but, unfortunately, culinary skills have been little investigated by the scientific community. Higher culinary skills may be related to increased consumption of homemade meals, higher diet quality, and greater consumption of vegetables and fruits and may be associated with higher Mediterranean diet adherence. Consequently, ultraprocessed foods, ready-to-eat food, and delivered meals, as well as meals outside the home, are reduced. Unfortunately, the process of generational transmission of cooking skills is progressively weakening, aggravated by the reduction of free time for home cooking. Still, even though there are few interventions conducted to improve culinary skills, especially those focused on children, the available results suggest that there have been positive changes in the direction of a healthier dietary pattern. This integrative review analyzes consumption levels of ultraprocessed foods. We then consider the extent to which culinary skills affect ultraprocessed food consumption levels and the relative impact on obesity.

Environmental assessment of diets: overview and guidance on indicator choice

Comprehensive but interpretable assessment of the environmental performance of diets involves choosing a set of appropriate indicators. Current knowledge and data gaps on the origin of dietary foodstuffs restrict use of indicators relying on site-specific information. This Personal View summarises commonly used indicators for assessing the environmental performance of diets, briefly outlines their benefits and drawbacks, and provides recommendations on indicator choices for actors across multiple fields involved in activities that include the environmental assessment of diets. We then provide recommendations on indicator choices for actors across multiple fields involved in activities that use environmental assessments, such as health and nutrition experts, policy makers, decision makers, and private-sector and public-sector sustainability officers. We recommend that environmental assessment of diets should include indicators for at least the five following areas: climate change, biosphere integrity, blue water consumption, novel entities, and impacts on natural resources (especially wild fish stocks), to capture important environmental trade-offs. If more indicators can be handled in the assessment, indicators to capture impacts related to land use quantity and quality and green water consumption should be used. For ambitious assessments, indicators related to biogeochemical flows, stratospheric ozone depletion, and energy use can be added.

Adherence to Mediterranean Diet and its main determinants in a sample of Italian adults: results from the ARIANNA cross-sectional survey

Introduction

Over the last years, many Mediterranean countries, including Italy, have witnessed a shift away from the Mediterranean Diet, thus contributing to the high rates of overweight and obesity. The survey "Adherence to Mediterranean Diet in Italy (ARIANNA)" aimed to evaluate the Adherence to Mediterranean Diet (AMD) and its main determinants in the Italian population.

Materials and methods

This study started on March 2023 and was addressed to adults aged ≥17 years, born and resident in Italy, proficient in Italian. Data are collected electronically through a voluntary, anonymous and self-administered questionnaire on the project website. Univariate and then multivariate logistic regressions were performed to evaluate associations between AMD and demographic characteristics, socio-economic status, health status, and lifestyle.

Results

On a total of 3,732 completed questionnaires, the 87.70% of the respondents was female and the 71.28% was 17-40 years old. The 83.82% of the respondents had medium AMD, 11.33% low and only 4.85% high. The multivariate analysis revealed that being male (p < 0.001), aged >40 years (p < 0.05), workers (p ≤ 0.001), and unemployed (p < 0.05), determined the probability of having a lower AMD. Vegans and vegetarian's diets positively contributed to a higher AMD (p < 0.001).

Discussion

These results highlighted a medium AMD in the Italian adult participants and suggested the necessity to implement tailored public health intervention strategies to improve food habits.

[Limitations and opportunities for the appropriation of the Mediterranean diet in Chilean adults with diagnostic elements of metabolic syndrome]

Introduction

Background: a healthy food intake pattern, specifically the Mediterranean diet (MedDiet), is a factor associated with reduced risk, lower prevalence, and better management of chronic diseases. However, there is limited information regarding how patients integrate proposals for adherence to this food pattern in their daily lives. Objective: to identify factors and conditions that influence adherence to the MedDiet in Chile. Methods: an exploratory qualitative study was applied in 35 to 65-year-old patients of both sexes who presented at least one diagnostic criterion of metabolic syndrome (MetS). Through in-depth interviews and focal groups, knowledge, assessment, attitudes, and practices associated with changes and maintenance of healthy eating habits, with emphasis on the MedDiet, were investigated. Information analysis was carried out under the grounded theory approach using the ATLAS.ti software. Results: participants recognized the value of healthy eating, including the MedDiet, but declared low knowledge (identification of single foods items) together with facilitators (variety of ingredients) and limiting factors (taste, availability/cost of some items, family dynamics) for its routine adoption. In addition, change in eating habits generates a high initial cognitive and emotional load that requires not only individual but also relational effort as it implies modifications of family and collective practices. Conclusions: information obtained on barriers and opportunities to adhere to healthy eating such as the MedDiet is key to design and implement nutritional interventions based on this food pattern and that can be sustainable in time for chronic disease management in Chile.

Evaluation of the Relationships Among Mindful Eating, Environmental Beliefs, Adherence to the Mediterranean Diet, and Obesity in Children

OBJECTIVE

This study aimed to evaluate the relationship between adherence to the Mediterranean diet (MD), mindful eating, environmental beliefs, and obesity in children.

MATERIALS AND METHODS

The study included 318 children (50.6% male, 49.4% female, 10.0 ± 0.73 years old). Data were obtained using survey and a face-to-face interview method. The questionnaire includes general information, anthropometric measurements, the New Ecological Paradigm Scale for Children (NEP), the Mediterranean Diet Quality Index for children and adolescents (KIDMED), and the Mindful Eating Questionnaire for Children.

RESULTS

According to the KIDMED classification, 52.5% of the children were in the group that needs improvement, 35.2% were in the low diet quality group, and 12.3% were in the optimal MD group. The Mindless score was higher in overweight/obese children compared to the normal body mass index (BMI) group (P < .05). Awareness, NEP, and KIDMED scores were the lowest in overweight/obese children (P < .05). In regression analysis, the father's age, KIDMED, and Awareness scores related to NEP scores positively (R2 : 0.545, P < .001). Also, children's body mass index-related KIDMED scores negatively, and awareness and NEP scores related KIDMED scores positively (R2 : 0.276, P < .001).

CONCLUSION

Our results show that higher adherence to the MD is associated with higher environmental beliefs. Children with higher mindful eating have higher environmental beliefs and adherence to the MD, and these scores are lower in obese children. Therefore, raising generations that adopt sustainable diet models and have high environmental awareness is necessary. This research provides significant findings for future clinical studies on children's body weight maintenance and sustainability. Cite this article as: Bozkurt O, Kocaadam-Bozkurt B, Koçyiğit E. Evaluation of the relationships among mindful eating, environmental beliefs, adherence to the mediterranean diet, and obesity in children. Turk Arch Pediatr. 2024;59(1):98-105.

Sustainability analysis of the Mediterranean diet: results from the French NutriNet-Santé study

The Mediterranean diet is often proposed as a sustainable diet model. This study aimed to evaluate the associations between adherence to the Mediterranean diet and sustainability domains in a cohort of French adults, using multiple criteria including nutritional quality, environmental pressures, monetary cost and dietary pesticide exposure. Food intakes of 29 210 NutriNet-Santé volunteers were assessed in 2014 using a semi-quantitative FFQ. Adherence to the Mediterranean diet was evaluated using the validated literature-based adherence score (MEDI-LITE). The associations between the MEDI-LITE and various sustainability indicators were examined using ANCOVA models, adjusted for sex, age and energy intake. Higher adherence to the MEDI-LITE was associated with higher nutritional quality scores, better overall nutrient profile as well as reduced environmental impact (land occupation: Q5 v. Q1: -35 %, greenhouse gas emissions: -40 % and cumulative energy demand: -17 %). In turn, monetary cost increased with increasing adherence to the Mediterranean diet (Q5 v. Q1: +15 %), while higher adherents to the Mediterranean diet had overall higher pesticide exposure due to their high plant-based food consumption. In this large cohort of French adults, greater adherence to the Mediterranean diet was associated with nutritional and environmental benefits, but also with higher monetary cost and greater exposure to pesticides, illustrating the necessity to develop large-scale strategies for healthy, safe (pesticide- and contaminant-free) and environmentally sustainable diets for all.

Scientific evidence supporting the newly developed one-health labeling tool "Med-Index": an umbrella systematic review on health benefits of mediterranean diet principles and adherence in a planeterranean perspective

BACKGROUND

Med-Index is a one-health front-of-pack (FOP) label, based on Mediterranean diet (MedDiet) principles, developed to summarize information about the nutritional properties and related-health benefits of any food as well as its sustainable production processes, and the associated food company's social responsibility parameters in a new "Planeterranean" perspective. Thus, Med-Index can be adopted in and by any European region and authority as well as worldwide; this is achieved by consumption and cooking of locally available and sourced foods that respect MedDiet principles, both in terms of healthy nutrition and sustainable production. The huge body of scientific evidence about the health benefits of the MedDiet model and principles requires a comprehensive framework to encompass the scientific reliability and robustness of this tool. A systematic review was carried out to examine the association between human health and adherence to MedDiet patterns upon which the "Med-Index" tool was subsequently developed.

METHODS

MEDLINE and PubMed databases were searched for eligible publications from 1990 to April 2023. Systematic literature reviews, with or without meta-analysis, of clinical trials and observational studies were screened by two independent investigators for eligibility, data extraction, and quality assessment. English language and the time interval 1990-2023 were applied. A registry code CRD42023464807 was generated on PROSPERO and approved for this search protocol. The corrected covered area (CCA), calculated to quantify the degree of overlap between reviews, gave a slight overlap (CCA = 4%).

RESULTS

A total of 84 systematic reviews out of 6681 screened records were selected. Eligible reviews included studies with predominantly observational designs (61/84, 72.6%%), of which 26/61 referenced studies of mixed observational and RCT designs, while 23/84 (27.4%) were RCT-only systematic reviews. Seventy-nine different entries were identified for health outcomes, clustered into 10 macro-categories, each reporting a statistically significant association with exposure to the MedDiet. Adherence to MedDiet was found to strongly benefit age-related chronic diseases (21.5%), neurological disorders (19%), and obesity-related metabolic features (12.65), followed by CVDs (11.4%), cancer (10.1%), diabetes (7.5%), liver health (6.3%), inflammation (5%), mortality (5%), and renal health (1.2%). The quality of the studies was moderate to high.

CONCLUSION

In the context of a "Planeterranean" framework and perspective that can be adopted in any European region and worldwide, MedDiet represents a healthy and sustainable lifestyle model, able to prevent several diseases and reduce premature mortality. In addition, the availability of a FOP, such as Med-Index, might foster more conscious food choices among consumers, paying attention both to human and planetary health.

Insight into the Sustainability of the Mediterranean Diet: The Water Footprint of the Recommended Italian Diet

At present, as we face climate change and natural resource scarcity, one of the major challenges linking humans and the environment is to ensure sufficient, nutritious, safe, and affordable food for a rapidly growing world population. In a nutshell, "feed the world without destroying it". The water footprint (WF), i.e., the withdrawals of fresh water necessary to produce one kilogram of food product, is one of the key indicators of the environmental impact of diets. In this work, the WF of the food patterns suggested by the Italian Food Based Dietary Guidelines, considered a model of the Mediterranean Diet, was evaluated for the first time. The data reported here clearly demonstrate that the suggested Italian dietary patterns have a low WF, the reduction of which by replacing animal foods with plant foods is limited because the suggested consumption of meat is already low. Consumer choice in the consumption of specific products within a food group could further reduce the WF of the diet, underlining the need to provide correct information not only to consumers but also to farmers and producers to encourage them to make water-saving choices.

Assessing the interlinkage between biodiversity and diet through the Mediterranean diet case

The adoption of healthy and sustainable diets, and the transition to sustainable food systems is of principal importance in order to counteract the double burden of climate change and non-communicable diseases. The Mediterranean diet (MD) has been widely recognized as a biodiversity and healthy nutrition resource to support sustainable development and food security. This study explored biodiversity in terms of food plants species, subspecies, varieties and races, and also addressed food-plant diversity differences between the MD and western-type consumption patterns. It was funded by the EU BioValue Project, aiming to promote the integration of underutilized crops into the food value chains. Using a two-stage scheme, data were selected from MEDUSA and Euro+Med databases (including 449 species, 2,366 subspecies, varieties, and races). Furthermore, 12 countries from North Africa and Europe were classified in two groups according to their sub-regional attributes and their traditionally most prevalent dietary pattern (MD or western-type diets). Statistical analysis showed that the mean of the majorly cultivated food plants in the MD was significantly higher than its counterpart in the Western-diet. Furthermore, no statistical difference was detected in the averages of native food plants between the MD group and the Western diet group, implying that the higher diversity in food plants observed in the MD seems to be attributed to crop utilization rather than crop availability. Our findings indicated the interlinkage between biodiversity and prevailing dietary patterns, and further underlined that biodiversity could constitute a prerequisite for dietary diversity, and hence nutrition security. In addition, this study demonstrated that diets and nutrition should be approached in a broader way within the context of both agro-food and ecological systems.

Olive oil consumption confers protective effects on maternal-fetal outcomes: A systematic review of the evidence

Because of the maternal diet's importance, numerous studies have examined the effects of olive oil on pregnancy outcomes. This study provides a systematic review that evaluates the evidence between olive oil consumption and maternal-fetal outcomes. We hypothesized that olive oil reduced the risk of adverse pregnancy complications. We searched Web of Science, Scopus, PubMed, and Biblioteca Virtual em Saúde electronic databases (October and November 2021). The keywords used were pregnancy, olive oil, and pregnancy outcomes. This review included all the available studies in English and Portuguese. The exclusion criteria were (1) unrelated to olive oil consumption, (2) other outcomes, and (3) animal studies. The review included 9 articles (6 experimental and 3 observational). In the maternal outcome studies (n = 6), a higher olive oil consumption was associated with a lower prevalence of gestational diabetes mellitus, preeclampsia, and cardiovascular risk. In the fetal outcome studies (n = 8), olive oil consumption was associated with a lower risk for small- or large-for-gestational-age infants. Olive oil consumption confers protective effects on pregnancy outcomes; however, further studies are needed that are specifically designed for the impact of olive oil consumption on maternal-fetal outcomes.

Environmental impacts and diet quality of popular diet models compared to Turkey's national nutrition guidelines

AIMS

This study aimed to compare the environmental impacts and diet qualities of popular diet models with the recommendations of the Turkish national dietary guidelines.

METHODS

Seven-day isocaloric (8368 kJ) diet models were created taking into account the Mediterranean, Atkins (20/40/100), Ornish, Zone diets, and Turkey Dietary Guidelines-2015 recommendations with different food and nutrient contents. Water footprints were evaluated using the global water footprint standards. Greenhouse gas emissions were evaluated using carbon footprint factors compiled as a result of meta-analyses of life cycle analysis studies in the literature. In addition, the quality of diets was evaluated with the Diet Quality Index-International.

RESULTS

Atkins20 diet model had the most harmful environmental impact (greenhouse gas emissions 8.74 kg CO₂ -eq/per/day and total water footprint 7731 L/per/day), whereas Ornish and Mediterranean diet models (greenhouse gas emissions 2.2/3.07 kg CO₂ -eq/per/day and total water footprints 3184/3675 L/per/day, respectively) had less harmful environmental impact. The highest Diet Quality Index-International score was in the Ornish diet model while the lowest Diet Quality Index-International was in the Atkins20 diet model.

CONCLUSION

Ornish and Mediterranean diet models had less harmful environmental impacts, which contributed to sustainable nutrition. The importance of diet quality and environmental impacts should be kept in mind when evaluating diet models to ensure sustainable nutrition.

Health Determinants Associated with the Mediterranean Diet: A Cross-Sectional Study

INTRODUCTION

The Mediterranean diet (MD) has been shown to be a good tool for the prevention of obesity and other chronic noncommunicable diseases (NCDs) and to have a low environmental impact. The aim of the present study was to evaluate the relationship between declared morbidity, lifestyles and other sociodemographic factors with high adherence to the MD (AMD) in an adult population in southeastern Spain.

MATERIAL AND METHODS

We conducted a cross-sectional study of a sample (n = 2728) representative of a non-institutionalized population ≥16 years. The data corresponded to the 2010-11 Nutrition Survey of the Valencian Community. The AMD was assessed using the Mediterranean Diet Adherence Screener questionnaire. The association of variables and high AMD was assessed by univariate and multivariate logistic regression determining crude and adjusted odds ratios.

RESULTS

Multivariate analysis showed that age 45 years or older, living with a partner, eating between meals, and not smoking were associated with high AMD. The age groups 45-64 years and 65 years or older showed the strongest association with high AMD in both sexes.

CONCLUSION

The investigation showed a generational loss of AMD. People older than 45 years and living in company are more likely to adhere to DM, the risk group being young people living alone and smokers.