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

Mindful eating is associated with a better diet quality in the NutriNet-Santé study

BACKGROUND

Mindful eating (ME) is a promising approach for promoting healthy eating. Although an association between ME and healthier eating habits has been indicated in the literature, data remain limited. The aim of this cross-sectional study was to investigate the association between ME and several nutritional indicators, including overall diet quality, consumption of ultra-processed foods (UPF), organic foods, food groups, and intake of energy and nutrients in a large population sample.

METHODS

In 2023, 13,759 participants of the NutriNet-Santé cohort study completed the Mind-Eat Scale, assessing total ME (range: 1-5), and its six sub-dimensions, and at least three 24-h dietary records. Multivariable linear regressions were performed to analyze the association between ME (independent variable) and various indices reflecting the nutritional quality of the diet: two scores reflecting the adherence to the French dietary guidelines (sPNNS-GS2) and the Mediterranean diet (MEDI-LITE score), the consumption of UPF (using the NOVA classification), organic foods and food groups, and energy and nutrient intake (dependent variables), adjusted for socio-demographic and lifestyle characteristics.

RESULTS

ME was positively associated with French dietary guideline (β = 0.33; 95%CI: 0.30, 0.45) and Mediterranean diet (β = 0.37; 95%CI: 0.30, 0.45) scores and with organic food consumption (β = 9.72; 95%CI: 8.84, 10.60). Furthermore, ME was negatively associated with energy intake (β = -36.79; 95%CI: 50.92, -22.67) and UPF consumption (β = -1.55; 95%CI: 1.81, -1.29). ME was also associated with the intake of several food groups and nutrients.

CONCLUSION

Overall, ME was associated with a healthier diet. These results suggest that ME could be an interesting lever for promoting healthy eating habits. Further studies are required to better understand the relationships between ME, dietary intake, and health, particularly through the use of longitudinal studies.

Greater adherence to the Mediterranean diet pattern in the United States is associated with sustainability trade-offs

BACKGROUND

The Mediterranean diet pattern has been consistently associated with health benefits but less is known about the association with environmental and economic sustainability in the United States (US). This information is needed to support sustainable policy agendas and provide consumers with evidence-based information needed to make informed food choices. This study fills this research gap by evaluating the environmental sustainability and diet cost associated with adherence to the Mediterranean diet pattern in the US.

METHODS

Dietary data from the National Health and Nutrition Examination Survey (2011-2018, n = 17,079) were merged with data on environmental impacts (greenhouse gas emissions, cumulative energy demand, water scarcity footprint), agricultural resource demand (land, fertilizer nutrients, and pesticides), and food prices from multiple publicly available databases. The Mediterranean Diet Score was used to evaluate adherence to the Mediterranean diet pattern. Multivariable linear regression models were used to evaluate the association between adherence to the Mediterranean diet pattern and environmental impacts, agricultural resource demand, and diet cost. Sensitivity analyses were used to evaluate adjustment of loss and waste and food-away-from-home prices.

RESULTS

Greater adherence to the Mediterranean diet pattern was associated with lower greenhouse gas emissions (p < 0.001), land use (p < 0.001), fertilizer nutrient use (p < 0.001), and pesticide use (p < 0.001), higher water scarcity footprint (p < 0.001) and diet cost (p < 0.001), and no change in cumulative energy demand (p = 0.147). These changes were driven primarily by reduced intake of animal-sourced foods such as beef dishes, meat sandwiches, and dairy, as well as decreased intake of refined carbohydrate foods such as refined grain dishes and soft drinks.

CONCLUSIONS

This nationally representative study demonstrates that greater adherence to the Mediterranean diet pattern is associated with sustainability trade-offs. These findings have implications for the development of sustainable dietary guidelines and clinical practice guidelines that can be used to inform consumer food choices.

Effect of a nutritional intervention based on an energy-reduced Mediterranean diet on environmental impact

OBJECTIVE

To estimate the environmental impact of a dietary intervention based on an energy-reduced Mediterranean diet (MedDiet) after one year of follow-up.

METHODS

Baseline and 1-year follow-up data were used for 5800 participants aged 55-75 years with metabolic syndrome in the PREDIMED-Plus study. Food intake was estimated through a validated semiquantitative food consumption frequency questionnaire, and adherence to the MedDiet was estimated through the Diet Score. Using the EAT-Lancet Commission tables we assessed the influence of dietary intake on environmental impact (through five indicators: greenhouse gas emissions (GHG), land use, energy used, acidification and potential eutrophication). Using multivariable linear regression models, the association between the intervention and changes in each of the environmental factors was assessed. Mediation analyses were carried out to estimate to what extent changes in each of 2 components of the intervention, namely adherence to the MedDiet and caloric reduction, were responsible for the observed reductions in environmental impact.

RESULTS

We observed a significant reduction in the intervention group compared to the control group in acidification levels (-13.3 vs. -9.9 g SO2-eq), eutrophication (-5.4 vs. -4.0 g PO4-eq) and land use (-2.7 vs. -1.8 m2). Adherence to the MedDiet partially mediated the association between intervention and reduction of acidification by 15 %, eutrophication by 10 % and land use by 10 %. Caloric reduction partially mediated the association with the same factors by 55 %, 51 % and 38 % respectively. In addition, adherence to the MedDiet fully mediated the association between intervention and reduction in GHG emissions by 56 % and energy use by 53 %.

CONCLUSIONS

A nutritional intervention based on consumption of an energy-reduced MedDiet for one year was associated with an improvement in different environmental quality parameters.

Adherence to a Mediterranean type of diet in the world: a geographical analysis based on a systematic review of 57 studies with 1,125,560 participants

This systematic review aimed to assess the level and time-trends of adherence to Mediterranean-type diets (MTD) among the general population, globally. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a comprehensive literature search of the MEDLINE and Scopus databases was carried out, until 04/09/2023, based on specific criteria. Fifty-seven studies with 1,125,560 apparently healthy adults from Europe (n = 37), US (n = 8), Asia (n = 8), Australia (n = 4) and Africa (n = 1) were included. Adherence to an MTD was moderate with a significant decline observed in the last decade. European countries, mainly driven by Mediterranean countries, showed higher adherence than other regions. Geographical analysis revealed that adherence to an MTD is related to both geographic location and socioeconomic status throughout the world.