Sustainable Food Systems and the Mediterranean Diet

Underrated aspects of a true Mediterranean diet: understanding traditional features for worldwide application of a "Planeterranean" diet

Over the last decades, the Mediterranean diet gained enormous scientific, social, and commercial attention due to proven positive effects on health and undeniable taste that facilitated a widespread popularity. Researchers have investigated the role of Mediterranean-type dietary patterns on human health all around the world, reporting consistent findings concerning its benefits. However, what does truly define the Mediterranean diet? The myriad of dietary scores synthesizes the nutritional content of a Mediterranean-type diet, but a variety of aspects are generally unexplored when studying the adherence to this dietary pattern. Among dietary factors, the main characteristics of the Mediterranean diet, such as consumption of fruit and vegetables, olive oil, and cereals should be accompanied by other underrated features, such as the following: (i) specific reference to whole-grain consumption; (ii) considering the consumption of legumes, nuts, seeds, herbs and spices often untested when exploring the adherence to the Mediterranean diet; (iii) consumption of eggs and dairy products as common foods consumed in the Mediterranean region (irrespectively of the modern demonization of dietary fat intake). Another main feature of the Mediterranean diet includes (red) wine consumption, but more general patterns of alcohol intake are generally unmeasured, lacking specificity concerning the drinking occasion and intensity (i.e., alcohol drinking during meals). Among other underrated aspects, cooking methods are rather simple and yet extremely varied. Several underrated aspects are related to the quality of food consumed when the Mediterranean diet was first investigated: foods are locally produced, minimally processed, and preserved with more natural methods (i.e., fermentation), strongly connected with the territory with limited and controlled impact on the environment. Dietary habits are also associated with lifestyle behaviors, such as sleeping patterns, and social and cultural values, favoring commensality and frugality. In conclusion, it is rather reductive to consider the Mediterranean diet as just a pattern of food groups to be consumed decontextualized from the social and geographical background of Mediterranean culture. While the methodologies to study the Mediterranean diet have demonstrated to be useful up to date, a more holistic approach should be considered in future studies by considering the aforementioned underrated features and values to be potentially applied globally through the concept of a "Planeterranean" diet.

Adherence to the Mediterranean Food Pattern and Carbon Footprint of Food Intake by Employees of a University Setting in Portugal

BACKGROUND

The Mediterranean diet is characterized by the predominance of the consumption of fruit, vegetables, cereals, nuts, and pulses; consumption of olive oil as the main source of fat; regular but moderate consumption of win; moderate consumption of fish, dairy products, eggs, and white meats; and low consumption of red meat as well as sugar and sugary products. In addition to the reported health benefits, the Mediterranean diet has also been widely recognized as a sustainable food pattern. The objective of this study was to understand the relationship between the degree of adherence to the Mediterranean diet of employees of the University of Porto and the relationship with the carbon footprint of their food consumption.

METHODS

An observational, analytical study was carried out, through the analysis of food consumption data collected in the form of a survey in the previous 24 h inserted in the eAT24 software, as well as the analysis of sociodemographic, lifestyle, and health data collected in the questionnaire. The carbon footprint was calculated from the previous 24 h surveys using data available on a website, obtained in carbon dioxide equivalent per kilogram of food. Sociodemographic, eating habit, and lifestyle questions were selected to understand the relationship between these and adherence to the Mediterranean diet and the carbon footprint of food consumption.

RESULTS

In total, 13.2% of the participants had a Mediterranean diet score equal to or greater than six, and the sample had an average food intake carbon footprint of 8146 ± 3081 CO2eq/Kg of food. A weak, statistically significant positive correlation (r = 0.142, p = 0.006) was observed between Mediterranean diet adherence and the carbon footprint of food intake.

CONCLUSIONS

Most of the participants had a low adherence to the Mediterranean diet, as well as a high carbon footprint of food intake when compared to other countries. People with higher scores for Mediterranean diet adherence have, on average, a higher carbon footprint from food consumption intake.

Relationship between adherence to the Mediterranean diet, sustainable and healthy eating behaviors, and climate change awareness: A cross-sectional study from Turkey

OBJECTIVES

This study aimed to evaluate the relationship between adherence to the Mediterranean diet, sustainable and healthy eating behaviors, and climate change awareness in adults.

METHODS

This descriptive and cross-sectional study was conducted with 1797 adults ages 19-65 y. Demographic characteristics, anthropometric measurements, adherence to the Mediterranean diet, sustainable and healthy eating behaviors, and climate change awareness were ascertained through a questionnaire.

RESULTS

The mean age of the individuals was 27.5 ± 11.76 y, and 50.5% of the participants were adherent to the Mediterranean diet. A statistically significant difference was found between individuals who did and did not adhere to the Mediterranean diet in terms of age, income status, total score and subscores on the Sustainable and Healthy Eating Behaviors Scale, and subscores for information on climate change causes (P < 0.05). A statistically significant positive correlation was found between the Mediterranean Diet Adherence Scale (MEDAS) total score, the Sustainable and Healthy Eating Behaviors Scale total score and subscores, and the Climate Change Awareness Scale total score and subscores (P < 0.05). It was determined that sex, education level, and income status affected the Climate Change Awareness Scale total score (P < 0.05). It was determined that age, income status, the Sustainable and Healthy Eating Behaviors Scale total score, and the Climate Change Awareness Scale total score affected the MEDAS total score (P < 0.05). Also, it was determined that age, sex, education level, MEDAS total score, and Climate Change Awareness Scale total score affected the Sustainable and Healthy Eating Behaviors Scale total score (P < 0.05).

CONCLUSIONS

This study showed a significant effect of climate change awareness on sustainable and healthy eating behaviors and adherence to the Mediterranean diet.

Evaluation of food insecurity and associated factors in women of childbearing age: A community-based study from Turkey

Food security is an important factor in ensuring a healthy diet. However, it has been reported that women are more vulnerable to food insecurity than men in many countries. In addition, there is little evidence that Mediterranean diet (MD) adherence is associated with a lower risk of food insecurity. Therefore, this study aimed to evaluate food insecurity and associated factors in women of childbearing age. In addition, women's adherence to MD and its relationship with food insecurity were evaluated. This descriptive and cross-sectional study was conducted with 2675 adult women aged 18-49. The demographic characteristics, anthropometric measurements, nutritional habits, compliance with the MD, and the level of food insecurity were evaluated using the structured, self-administered, web-based questionnaire form. The mean age of the individuals was 29.5 ± 10.35 years. 21.6% of individuals had food insecurity, and 5.2% had severe food insecurity. 36.4% of the individuals adhere to the MD. There was a statistically significant difference between the individuals with and without food security regarding age, marital status, and income status (p < .05). However, there was no statistically significant difference in terms of the Mediterranean diet adherence score (MEDAS) and MEDAS classification between individuals with and without food security (p > .05). It was determined that age, marital status, and income status affected food insecurity (R 2 = 0.374; p < .001). Also, it was determined that age, number of main meals and snacks, and income status affected adherence to MD (R 2 = 0.286; p < .001). In conclusion, considering the fragility of women in food insecurity, more comprehensive studies should be conducted in this area to better define the factors associated with food insecurity in women and inform policymakers. In addition, the results of this study can shed light on comprehensive intervention studies in this area.

The SHED Index: A Validation Study to Assess Sustainable HEalthy Diets in Portugal

This study aims to adapt and validate the Sustainable HEalthy Diet (SHED) Index for the Portuguese adult population, which was developed to assess sustainable and healthy eating patterns. Data were collected using a web-based questionnaire administered through interviews with 347 individuals aged between 18 and 65 years old. The SHED Index evaluates 30 items, allowing for the assessment and scoring of sustainable and healthy eating patterns. The higher the SHED Index score, the more sustainable and healthier the diet. A semi-quantitative food frequency questionnaire was used to assess the participants' dietary intake. The criterion validity was examined by testing the relationship between the SHED Index score and adherence to the Mediterranean Diet. Reproducibility was assessed by determining agreement and reliability with test-retest. Construct validity was confirmed based on established criteria. A higher SHED Index score was associated with moderate to high adherence to the Mediterranean diet, while it was inversely related to the proportion of animal-sourced foods in the overall food intake (r = -0.281, p < 0.001). Good reliability and agreement were found for the SHED Index score. Our findings suggest that the SHED Index is a valid and reliable tool for assessing sustainable and healthy diets in the Portuguese adult population.

Diet and Aging: The Role of Polyphenol-Rich Diets in Slow Down the Shortening of Telomeres: A Review

The ends of human chromosomes are defended by DNA-protein complexes named telomeres, which inhibit the chromosomes from fusing with each other and from being known as a double-strand break by DNA reparation proteins. Telomere length is a marker of biological aging, and disfunction of telomeres is related to age-related syndromes. Telomere attrition has been shown to be accelerated by oxidative stress and inflammation. Telomere length has been proven to be positively linked with nutritional status in human and animal scientific research as several nutrients influence it through mechanisms that imitate their function in cellular roles including oxidative stress and inflammation. Data reported in this article support the idea that following a low-in-fat and rich-plant polyphenols food diet seems to be able to slow down the shortening of telomeres.

Mediterranean Diet, Sustainability, and Tourism-A Study of the Market's Demand and Knowledge

Globalization intensified competitiveness among agribusinesses worldwide in recent years. The European Commission focused on enhancing sustainable agriculture and food products' territorial uniqueness for competing in the international market. The Mediterranean diet (MD) is a model of feeding and lifestyle belonging to the ancient Mediterranean culture, which also embodies a sustainable food system. Therefore, in 2010, UNESCO recognized the MD as Intangible Cultural Heritage of Humanity, and Sicily (southern Italy) is its official physical site. Despite its worldwide fame, the notion of the MD runs the risk of being mystified because it is described most often as something that does not correspond to what it is holistically. The aim of this study is to know the market demand of the MD by Italian people and foreign tourists in Sicily and the level of knowledge of the MD by users, both consumers and experts. A survey at top Sicilian traditional restaurants with owners/chefs and their clients was carried out. The study provided an in-depth understanding of the current lack of knowledge about the holistic meaning of the MD. The study highlights the desirability of integrated science-policy actions (also for communication) and proposes a vertical communication system to revive and direct the MD demand toward its holistic model.

Ultra-Processed Foods in the Mediterranean Diet according to the NOVA Classification System; A Food Level Analysis of Branded Foods in Greece

While the Mediterranean diet (MD) is championed as a healthy and sustainable dietary pattern, the NOVA classification is discussed as a tool to identify ultra-processed foods and further specify healthy food choices. We tested whether the NOVA System aligns with the MD recommendations as presented in the MD pyramids. Foods from the Greek branded food composition database, HelTH, (n = 4581) were scored according to NOVA and assigned to the tiers of the traditional and/or sustainable MD pyramids. Nutritional quality was measured as nutrient content and Nutri-Score grades. NOVA identified 70.2% of all foods as UPFs, and 58.7% or 41.0% of foods included in the sustainable and the traditional MD, respectively. Although foods at the top of the pyramids were mostly (>80%) UPFs, NOVA identified > 50% of foods in the MD base as UPFs. Only 22-39% of foods in the MD base were not UPFs and of high nutritional quality (Nutri-Score A-B). NOVA has low discriminatory capacity across the MD tiers, and it restricts food choices to <30% of foods currently available in supermarkets and <60% within the recommended MD tiers. Therefore, the NOVA classification cannot always identify suitable food choices under the MD pyramid in the modern packaged food environment.

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.

Mediterranean Diet: The Role of Phenolic Compounds from Aromatic Plant Foods

Today's global food system aggravates climate change while failing in meeting SDG2 and more. Yet, some sustainable food cultures, such as the Mediterranean Diet (MD), are simultaneously safe, healthy, and rooted in biodiversity. Their wide range of fruits, herbs, and vegetables convey many bioactive compounds, often associated with colour, texture, and aroma. Phenolic compounds are largely responsible for such features of MD's foods. These plant secondary metabolites all share in vitro bioactivities (e.g., antioxidants), and some are evidenced in vivo (e.g., plant sterols lower cholesterol levels in blood). The present work examines the role of polyphenols in the MD, with respect to human and planetary health. Since the commercial interest in polyphenols is increasing, a strategy for the sustainable exploitation of Mediterranean plants is essential in preserving species at risk while valuing local cultivars (e.g., through the geographical indication mechanism). Finally, the linkage of food habits with cultural landscapes, a cornerstone of the MD, should enable awareness-raising about seasonality, endemism, and other natural constraints to ensure the sustainable exploitation of Mediterranean plants.

The Alignment of Recommendations of Dietary Guidelines with Sustainability Aspects: Lessons Learned from Italy's Example and Proposals for Future Development

The main objective of this paper is to describe the process of the inclusion of sustainability in the Italian Dietary Guidelines (IDGs). In the IDGs' sustainability chapter, particular emphasis was put on the selection of foods, recommending a plant-based diet with a large quota of vegetable proteins. Advice was also given on the selection of local seasonal products, with low growth input, such as fertilizers, artificial light and heating. Reduction of animal food was recommended, to be substituted with lower impact foods (poultry, milk, eggs and Mediterranean fish including aquaculture). Food waste was largely addressed. Recommendations were made for food purchase planning, food storage and the reuse of leftovers as strategies to reduce waste and save money. The IDGs sustainability recommendations were related to the 16 guiding principles of a sustainable healthy diet and their contribution to the achievement of the Sustainable Developing Goals was provided. The inclusion of sustainability in dietary guidelines requires a multidisciplinary approach to cover the wide range of aspects of a sustainable diet. In the IDGs, it was possible to show that practical recommendations for improving sustainability behavior can be passed on to consumers. Methodological aspects for developing recommendations are not definitive.

The α-Amylase and α-Glucosidase Inhibition Capacity of Grape Pomace: A Review

The concept of functional foods is gaining more importance due to its role in maintaining a healthy status and preventing some metabolic diseases. The control of diabetes, in particular type-2 (T2DM), could be considered a big challenge since it involves other factors such as eating habits. From the pharmacological point of view, inhibiting digestive enzymes, such as α-amylase and α-glucosidase, is one of the mechanisms mainly used by synthetic drugs to control this disease; however, several side effects are described. For that reason, using bioactive compounds may appear as an alternative without presenting the complications synthetic drugs available on the market have. The winemaking industry generates tons of waste annually, and grape pomace (GP) is the most important. GP is recognized for its nutritional value and as a source of bioactive compounds that are helpful for human health. This review highlights the importance of GP as a possible source of α-amylase and α-glucosidase inhibitors. Also, it is emphasized the components involved in this bioactivity and the possible interactions among them. Especially, some phenolic compounds and fiber of GP are the main ones responsible for interfering with the human digestive enzymes. Preliminary studies in vitro confirmed this bioactivity; however, further information is required to allow the specific use of GP as a functional ingredient inside the market of products recommended for people with diabetes.

Graphical abstract

Mediterranean Food Industry By-Products as a Novel Source of Phytochemicals with a Promising Role in Cancer Prevention

The Mediterranean diet is recognized as a sustainable dietary approach with beneficial health effects. This is highly relevant, although the production of typical Mediterranean food, i.e., olive oil or wine, processed tomatoes and pomegranate products, generates significant amounts of waste. Ideally, this waste should be disposed in an appropriate, eco-friendly way. A number of scientific papers were published recently showing that these by-products can be exploited as a valuable source of biologically active components with health benefits, including anticancer effects. In this review, accordingly, we elaborate on such phytochemicals recovered from the food waste generated during the processing of vegetables and fruits, typical of the Mediterranean diet, with a focus on substances with anticancer activity. The molecular mechanisms of these phytochemicals, which might be included in supporting treatment and prevention of various types of cancer, are presented. The use of bioactive components from food waste may improve the economic feasibility and sustainability of the food processing industry in the Mediterranean region and can provide a new strategy to approach prevention of cancer.

New Validated Short Questionnaire for the Evaluation of the Adherence of Mediterranean Diet and Nutritional Sustainability in All Adult Population Groups

High adherence to a Mediterranean diet (MD) is favourable for its sustainability and beneficial effects on health. The available questionnaires, according to the MD dietary pattern, include the assessment of moderate alcohol consumption; but some groups, such as young adults and pre-conceptional and pregnant women, are not allowed to consume it. The aim of this study was to validate a new short questionnaire (MedQ-Sus) excluding alcohol consumption, to measure the adherence to the MD and to evaluate the nutritional adherence to a sustainable diet. The Harvard validated questionnaire was used for the validation study. A total of 316 subjects (20 to 70 YOA) completed both questionnaires. A high Spearman correlation coefficient (rho = 0.69; p < 0.01) was found between the MedQ-Sus and Harvard scores; a statistically significant positive correlation was found for all eight food groups. The MedQ-Sus had a significant discriminative capacity between adherence and non-adherence to the MD (optimal cut-off point = 9.5, sensitivity 0.86, specificity = 0.65). A very high nutritional adherence to a sustainable diet was found in the subjects for olive oil (97%), dairy food (90%), fresh vegetables (89%), fish and fish products (73), fresh fruit (56%), and cereals and cereals products (42%). A very low adherence was found for legumes (22%) and meat and meat products (9%). The results showed MedQ-Sus is a valid and quick assessment instrument for the evaluation of the adherence to the MD in all population groups, and could also be useful to evaluate the nutritional sustainability of the diet.

Alignment of Nutri-Score with Mediterranean Diet Pyramid: A Food Level Analysis

The Mediterranean diet (MD) has been incorporated as a healthy diet pattern in food-based dietary guidelines of countries all over Europe and the world. Testing the alignment of Nutri-Score with the MD Pyramid is a key step in ensuring that future food-level policies will not be conflicting with existing dietary guidelines. All foods available (n = 4002) in the HelTH database, were classified as eligible or not for inclusion in the MD and they were ranked in their respective tier in the food pyramid following two pyramid schemes, the 1995 traditional and 2020 sustainable MD pyramids. For all foods, Nutri-Score was calculated both as the continuous FSAm-NPS score and its categorical outcome-Nutri-Score grades-and their distribution across the MD pyramid tiers was used as a measure of alignment between the MD and the Nutri-Score algorithm. Only 25% of all foods were eligible under the traditional MD, while the sustainable MD covered ~58% of all foods. For both pyramids, Nutri-Score was successful in clearly separating the foods at the top and the bottom of the pyramids (Nutri-Score Mode "D" or "E" for the top tiers and "A" for the bottom tiers), thus suggesting a good alignment between the two. Good discriminatory capacity was also seen within each tier.

Evaluation of an Application for Mobile Telephones (e-12HR) to Increase Adherence to the Mediterranean Diet in University Students: A Controlled, Randomized and Multicentric Study

Mediterranean diet (MD) is potentially one of the best diets regarding health benefits and sustainability. However, it is faced with serious difficulties staying alive, even in traditionally Mediterranean regions. The objective was to evaluate the effectiveness of an application (e-12HR) to improve adherence to the MD (AMD) in university students. This study was a controlled, randomized, and multicentric clinical trial with two parallel groups (control group (CG) and intervention group (IG)), a 28-day follow-up period, and 286 participants (74.1% women). There were two versions of e-12HR: ‘feedback’ e-12HR (IG) and ‘non-feedback’ e-12HR (CG). Only the ‘feedback’ e-12HR had two specific automatic functions: 1. Evaluation of the user’s AMD; 2. Identification of the food groups for which the user has not fulfilled the MD recommendations. Both versions of the application allowed the collection of data on dietary intake in order to calculate the AMD. When comparing CG and IG at 14-, 21-, and 28-days follow-up (no significant statistical differences at baseline), there were significant statistical improvements in favor of IG in AMD index (0.71, 1.56, and 1.43 points, respectively), and in the percentage of participants with medium/high AMD index (14.4%, 20.6%, and 23.7%, respectively). In conclusion, e-12HR could improve AMD among university students.

Food governance for better access to sustainable diets: A review

‘Governance’, understood as organizational governance, is essential to more sustainable food provisioning systems ensuring sustainable health, heritage, and natural environments. Governance enables regional and local perspectives to be aligned with commitments from national and international organizations. Within the wealth of scholarship on food systems governance, agricultural governance and agency is a rarely interrogated dimension, despite the clear impacts of agricultural decisions on health and environmental outcomes. In this paper we discuss the findings of a scoping review that focuses on the question “How can food governance transform food systems to ensure better access to sustainable diets?”, meaning diet that protect health, cultures, and the natural environment. Our results show that it is first needed to determine the governance level and the expected outcomes. From a national perspective, policy coherence is described as a way in which different public institutions can add to the sustainable diets access goal. From a local perspective, community supported activities and the incorporation of local knowledge are also described as ways that can help achieving an improvement on sustainable diets access. Either from a regional or local perspective, commitment from organizations must be ensured for common objectives being aligned. Also, it is necessary to request more from the agricultural sector role in delivering nutritionally and environmentally appropriate food. Thus, the idea of governing agriculture as a health and environmental activity is an approach that should be considered when designing, implementing, and assessing food systems.

Consumers' Attitude towards Sustainability in Italy: Process of Validation of a Duly Designed Questionnaire

This study aimed to describe the process of validation of a questionnaire assessing Italian consumers’ perception of food sustainability. The study has a multiphase design. Phase 1 consisted in translating and structuring the questionnaire. Phase 2 aimed at assessing the validity of the content by experts. Phase 3 consisted of a pilot study (n = 150) carried out to revise the questionnaire based on the reactions of consumers representing the target group of the assessment. The questionnaire showed adequate content validity for 11 out of 14 questions (>0.79) and S-CVI/Ave > 0.80. Cronbach’s alpha values ranged from 0.08 to 0.90. The construct with insufficient results (0.08) was changed because it failed to correlate with the rest of the questionnaire. The factor analysis permitted the identification of questions that needed improvement in terms of comprehensibility, elimination of redundancies, and repetitions. The validated questionnaire included 12 questions (71 response options); 3 sections were identified: food sustainability knowledge (4 questions-30 items); sources of proteins alternative to meat (3 questions-20 items); eating behaviors (5 questions-21 items). This study showed the importance of validation before the administration on a large scale of a questionnaire on a topic such as sustainability still lacking large support from consensus documents.

Individual Nutrition Is Associated with Altered Gut Microbiome Composition for Adults with Food Insecurity

Diet is widely recognized as a key contributor to human gut microbiome composition and function. However, overall nutrition can be difficult to compare across a population with varying diets. Moreover, the role of food security in the relationship with overall nutrition and the gut microbiome is unclear. This study aims to investigate the association between personalized nutrition scores, variation in the adult gut microbiome, and modification by food insecurity. The data originate from the Survey of the Health of Wisconsin and the Wisconsin Microbiome Study. Individual nutrition scores were assessed using My Nutrition Index (MNI), calculated using data from food frequency questionnaires, and additional health history and demographic surveys. Food security and covariate data were measured through self-reported questionnaires. The gut microbiome was assessed using 16S amplicon sequencing of DNA extracted from stool samples. Associations, adjusted for confounding and interaction by food security, were estimated using Weighted Quantile Sum (WQS) regression models with Random Subset and Repeated Holdout extensions (WQSRSRH), with bacterial taxa used as components in the weighted index. Of 643 participants, the average MNI was 66.5 (SD = 31.9), and 22.8% of participants were food insecure. Increased MNI was significantly associated with altered gut microbial composition (β = 2.56, 95% CI = 0.52−4.61), with Ruminococcus, Oscillospira, and Blautia among the most heavily weighted of the 21 genera associated with the MNI score. In the stratified interaction WQSRSRH models, the bacterial taxa most heavily weighted in the association with MNI differed by food security, but the level of association between MNI and the gut microbiome was not significantly different. More bacterial genera are important in the association with higher nutrition scores for people with food insecurity versus food security, including Streptococcus, Parabacteroides Faecalibacterium, and Desulfovibrio. Individual nutrition scores are associated with differences in adult gut microbiome composition. The bacterial taxa most associated with nutrition vary by level of food security. While further investigation is needed, results showed a higher nutrition score was associated with a wider range of bacterial taxa for food insecure vs. secure, suggesting nutritional quality in food insecure individuals is important in maintaining health and reducing disparities.

The influence on fish and seafood consumption, and the attitudes and reasons for its consumption in the Croatian population

Fish makes an important part of the Mediterranean diet, which has been scientifically proven to help preserve human health by protecting against major chronic and inflammatory diseases. Eating fish and seafood is very important, not only for its proven health benefits but also for its positive impact on the environment. Due to many fish and seafood significant positive effects on human health, this study aimed to investigate the socio-demographic factors associated with the consumption of fish and seafood in the population of Primorsko-goranska County in Croatia. Another aim was to determine people's attitudes, choices, and reasons for the consumption of fish and seafood. Self-reported data from 2,910 participants were used. According to the European dietary recommendations for fish consumption, the participants were divided into two groups; the very low to low fish consumption group and the moderate to high fish consumption group, in order to examine the differences in socio-demographic and lifestyle variables, and their attitudes, opinions, and reasons for fish and seafood consumption. More fish and seafood were consumed by women, the elderly, the more educated, non-smokers, and more physically active participants. Age, the highest level of education, and a diet even moderately adherent to the Mediterranean diet was found to significantly increase the likelihood of recommended fish consumption. Participants considered the best reasons to consume more fish lower prices, buy much more locally produced fishery products, and prefer to eat wild-caught fish rather than farmed fish. The study has found a slight increase in fish consumption, although still lower than the European average. It also showed significant socio-demographic associations, also the reasons and attitudes toward higher fish and seafood consumption of the Croatian population. The obtained research data are valuable for planning future public health programs in Croatia aimed at greater consumption of fish and seafood, as well as their promotion as an important part of a sustainable diet.

Food Security and Nutrition as the Neglected Missing Links in Cultural Evolution: The Role of the Sociotype

Food security and nutrition were major drivers of cultural evolution by enabling sociotypic development and communal living after the Neolithic agricultural revolution some 12,000 years ago. The sociotype unites concepts from the sciences and the humanities; in concert with the genotype it determines an individual's phenotype (observable traits and behavior), and together they advance societal culture. As such, the sociotype relates to an individual's dynamic interactions with the surrounding social environment throughout life and comprises three domains: the Individual, Relationships, and Context. Nutrition affects each domain, respectively, by ensuring the following dimensions of food security: utilization (metabolic fuel and health); accessibility (physical and economic); and availability (the right to nutritious food for all citizens). The sociotype is influenced by multiple factors, including diet-gene interactions, allostasis, microbiota, oxytocin, and culturally through mate selection, family bonds, social communication, political ideologies, and values. Food security, sociotypes, and culture form a complex adaptive system to enable coping with the circumstances of life in health and disease, to achieve sustainable development, and to eradicate hunger. The current geopolitical unrest highlights the absolutely critical role of this system for global security, yet many challenges remain in implementing this paradigm for society. Therefore, sustainable food security must be considered a fundamental human right and responsibility for safeguarding the survival and progress of the sociotypes of humankind (Homo culturus) worldwide.

Weekend-Weekday Differences in Adherence to the Mediterranean Diet among Spanish University Students

Daily routines may influence eating patterns; however, differences in intake on weekdays and at weekends have rarely been explored. Furthermore, these differences have not been analyzed among university students (a particularly interesting group among the younger generations). The aim of the study was to evaluate weekend−weekday variation in the Mediterranean diet among Spanish university students, while investigating the potential influence of age, gender, studies, body mass index, smoking status and physical activity status. A repeated-measurement 28-day cross-sectional observational study with self-reported dietary intake collected using the e12HR app was conducted. There were 361 participants: average age 20.6 years; 72.9% women; 58.2% students of Pharmacy; average BMI 21.9 kg/m2; 91.4% nonsmokers; 77.6% performed ≥150 min/week of physical activity. Outcome measurements were adherence to the Mediterranean diet (AMD) index and percentage of participants meeting recommendations for each food group on weekdays and at weekends. In all subgroups, Spanish university students’ global diet was associated with low AMD, with poorer diet quality (>12% reductions in mean scores of AMD index and >26% reductions in adequate adherence scores (≥9)) at weekends. In conclusion, weekend health behaviors of Spanish university students displayed less favorable eating behavior, making the weekend an important target for public health interventions aiming to improve dietary intake.

Is high adaptation to the Mediterranean diet effective in increasing ecological footprint awareness? A cross-sectional study from Turkey

BACKGROUND

The effect of diet type on sustainable environment is known. It is important to understand the adaptation of individuals with high ecological footprint awareness to the Mediterranean type diet, especially under the assumption that the Mediterranean diet will reduce the ecological footprint. In the study, it is aimed to examine the relationship between the level of adherence to the Mediterranean diet and Ecological Footprint awareness of adults.

RESULTS

The sample of the study consisted of 395 individuals with a mean age of 26.2 ± 8.7 years: 293 females (74.2%) and 102 males (25.8%). As the Mediterranean Diet Adherence Scale (MDAS) score of individuals increased, the Ecological Footprint Awareness Scale score also increased. Similarly, a positive correlation was found between the participants' MDAS score and the awareness of food (r = 0.157; P = 0.002), energy (r = 0.133; P = 0.008), waste (r = 0.149; P = 0.003) and water consumption (r = 0.101; P = 0.045), which are sub-factors of the Ecological Footprint Awareness Scale.

CONCLUSION

As far as is known, this cross-sectional study is one of the first studies on compliance with the Mediterranean diet and awareness of the ecological footprint. The findings of the study show that as individuals' compliance with the Mediterranean diet increases, their awareness of their ecological footprint will also increase. To reach a conclusion on this issue, future studies should evaluate the relationship between adherence to the Mediterranean diet and awareness of food-environmental impact on different samples. © 2021 Society of Chemical Industry.

MedDiet adherence score for the association between inflammatory markers and cognitive performance in the elderly: a study of the NHANES 2011-2014

Background

To explore the optimal Mediterranean diet (MedDiet) adherence score threshold for the association between inflammatory markers and cognitive performance among older adults.

Methods

In this cross-sectional study, we selected data of the elderly (≥ 60 years old) from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 (n = 2830). Participants completed at least one cognitive measurement and two 24-h food recalls. By analyzing the relation between inflammatory markers and cognitive performance using the subdivided MedDiet adherence score, we got the optimal MedDiet adherence score threshold. Then the optimal threshold was used to divide participants into high and low MedDiet adherence groups and multivariate logistic regression models were developed to examine the association between inflammatory markers and cognitive performance in each group. Subgroup analysis was conducted based on gender, race, BMI, physical activity level, and chronic diseases.

Results

We chose 4 as the optimal MedDiet adherence score threshold and included these participants whose MedDiet adherence score was 4 or above into the high MedDiet adherence group, while the MedDiet adherence score of the low adherence group was less than 4. We found that the increased white blood cell (WBC) count (OR = 1.44, 95% CI: 1.09–1.90, P = 0.008), neutrophil count (OR = 1.30, 95% CI: 1.03–1.65, P = 0.023), and neutrophil-albumin ratio (NAR) (OR = 1.34, 95% CI: 1.06–1.70, P = 0.012) were all related to a higher risk of low cognitive performance in the low MedDiet adherence group. A higher PLR was linked to a reduced risk of low cognitive performance (OR = 0.86, 95% CI: 0.74–1.00, P = 0.036) in the high MedDiet adherence group. Significant differences were found in the associations of WBC count, neutrophil count and NAR with low cognitive performance between the low and high MedDiet adherence groups (all P < 0.001). The weakened negative association between inflammatory markers and cognitive performance in the high MedDiet adherence group also existed among male, non-Hispanic white, normal-weight, overweight, moderate work activity, moderate recreational activity, non-depression, hypertension, non-hypertension, non-diabetes, non-stroke, non-heart failure, non-coronary heart disease, or non-heart attack subpopulations of older adults.

Conclusions

The optimal threshold for the MedDiet adherence score was 4, and the negative association between inflammation and cognitive performance could be weakened in older adults whose MedDiet adherence score was ≥ 4.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03140-1.

Health and Sustainability Co-Benefits of Eating Behaviors: Towards a Science of Dietary Eco-Wellness

Two of the greatest challenges of our times - climate change and the linked epidemics of obesity, diabetes, and cardiovascular disease - are fueled in part by the over-consumption of carbon-intensive high calorie foodstuffs. Converging evidence from hundreds of studies has confirmed that transitioning from diets high in meat and dairy to largely plant-based diets not only is necessary for climate change mitigation but will also lead to substantive reductions in morbidity and mortality. Nevertheless, there are only the faintest beginnings of a robust science of behavioral eco-wellness, defined here as the study of how individual choices, behaviors, and habits impact both personal health and environmental sustainability. This paper focusses on the sub-field of dietary eco-wellness, which looks at health and sustainability impacts of food production, procurement, preparation, and consumption. To advance this crucial agenda, investigators will need to invent, develop, and assess approaches aimed at helping people transition towards healthier and more sustainable diets. In order to accurately and reliably assess appropriate outcomes, existing assessment methods will need to be refined, new techniques will need to be advanced, and all measurement methods will need to be validated. Local conditions will influence the effectiveness of various approaches, and so it is important that scientists and communities share their stories of success and challenge for others to learn from. This paper reviews emerging evidence from relevant studies in dozens of countries, suggesting next steps, potential pathways, and a framework for interpretation.

The 2018 Revision of Italian Dietary Guidelines: Development Process, Novelties, Main Recommendations, and Policy Implications

The fourth edition of the Italian Dietary Guidelines (IDGs) for Healthy Eating was published in 2019. The objective of this paper is to describe the developmental process of IDGs, the main recommendations, the differences with previous revisions, and the concordance and differences with international guidance on a healthy diet. A National Commission oversaw IDG development. A Scientific Dossier (SD), including analysis on nutrition, health, and risk factors status in Italy, was the reference for IDGs preparation. The IDGs are based on the principles of the Mediterranean Diet and are mainly aimed to prevent obesity and nutrition-related non-communicable diseases. The IDGs included 13 directives that were divided into four conceptual blocks: i) how to balance weight; ii) foods to be promoted; iii) foods to be limited; and iv) how to ensure a varied and sustainable diet. Each directive has a box summarizing the key recommendation, myths lists, and false beliefs to be dispelled. The topics of sustainability and the correct approach to food supplementation and weight-loss diet were introduced in the present edition of IDGs. This paper contributes to the debate on the complexity of derivation of Dietary Guidelines and their adaptation to the national context.

The impact of nutrition and lifestyle modification on health

The main recommendations from public health entities include healthy diets and physical activity as the main lifestyle factors impacting the development of chronic diseases such as cardiovascular and metabolic diseases, cancer, and even neurological diseases. Randomized clinical trials have been designed to demonstrate those lifestyle modifications can change the pattern of chronic diseases development and progression. Among these, nutrition is one of the most impacting factors. Therefore, nutrition and diets were also included in different randomized clinical trials, and most of them showed a favorable impact of nutrition modification on the participant's health. Nevertheless, study designs were considerably different, and future studies are needed to support nutrition modifications further. The choice of a healthy considered diet, like the Mediterranean diet, was shown to impact chronic diseases, cardiovascular risk, and adult life expectancy mainly due to its anti-inflammatory and antioxidant properties. Furthermore, a high intake of fibers, fruits, and vegetables together with a low intake of fat and energy-dense, processed foods contribute to an inflammation reduction and a more robust immune system leading. Besides these well-known properties, all lifestyle modifications must be personalized according to the availability of foods, geographic localizations, and the healthy status of the patient.

Maintaining, Managing, and Tele-Monitoring a Nutritionally Adequate Mediterranean Gluten-Free Diet and Proper Lifestyle in Adult Patients

The gluten-free diet (GFD) is a restrictive diet. In many cases, it must be permanent and strict, and it may be associated with both nutritional deficiencies and excesses, which can be prevented by following a healthy, natural Mediterranean GFD (Med-GFD). In this paper, we describe the importance of the Mediterranean diet, the correct intake of vitamins and minerals, and how they may play an important protective role against chronic or degenerative conditions. Herewith, we analyze different aspects that influence the ability to maintain a correct and balanced Med-GFD, which may contribute to the health status of patients, including a conscious use of gluten-free products to maintain a healthy lifestyle. Monitoring the Med-GFD remains a pivotal issue: to evaluate the presence of gluten peptides in urine, it could be important to introduce point-of-care testing, an efficient method for GFD self-monitoring (immunochromatographic technique), together with online nutritional questionnaires. Indeed, medical care via telemedicine can provide practical indications aimed at supporting patients and doctors. A natural Med-GFD can ensure the correct intake of nutrients and could be important for patients affected by gluten-related disorders, helping them to maintain a correct and healthy lifestyle.

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.

A Review on Life Cycle Assessment of the Olive Oil Production

Olive oil is one of the most globally recognized high-value products, with 4 million hectares cultivated in the Mediterranean area. The production process involves many stages: farming, extraction, packing, and waste treatment. Each one of these stages should present critical points for the environmental impacts, and for this reason, the entire sector is adopting mitigation strategies to begin to be more sustainable. The mitigation actions’ efficiency should be evaluated through environmental indicators or environmental impact assessment by Life Cycle Assessment (LCA). This review aimed to carry out an overview of recent papers (2011–2021) involving an LCA study in the olive oil supply chain by giving a framework of what is included in LCA studies and highlighting the main contributors to environmental impacts. The main scholarly literature databases have been exploited, highlighting a great increase in publications, especially from the producer countries. The review results reflect the heterogeneity of the production process. However, the use of pesticides, fertilizers, water, and fuel for machinery heavily weigh on the farming stage’s environmental impact. Finally, special focus was given to key elements of LCA studies in the olive oil supply chain, such as functional unit, system boundaries, impact categories, calculation method, and software widely used.

Modification of Mediterranean Diet Pyramid from an Island’s perspective

ABSTRACT Objective The present study aimed to determine traditional and local food consumption and adherence to the Mediterranean diet in Cyprus. And also, aimed to improve their adherence to the Mediterranean diet and traditional and local food consumption. From this point, this current study aimed to revise the Cyprus Mediterranean Diet Pyramid, based on the Current Mediterranean Diet Pyramid. Methods The sample size was calculated as a minimum of 386 according to a 95.0% confidence interval, and a 5.0% error. This study was conducted online between November 2020-April 2021 in Cyprus. All volunteers were invited to this study on the national public internet platforms. Participant´s adherence to the Mediterranean diet was determined by the Mediterranean Diet Adherence Screener. Traditional and local food consumption frequencies were determined by a Food Frequency Questionnaire. A novel Cyprus Mediterranean Diet Pyramid was developed with traditional and local food items for Cyprus. The modification was also aimed to safeguard planet health, to increase traditional food consumption and adherence to the Mediterranean diet. Results 1,007 adults (78.0% native islanders/Cypriots) participated voluntarily in the current study. The mean Mediterranean Diet Adherence Screener score was 7.55±2.30 points and only 34.4% had high adherence to the Mediterranean diet. According to their responses, there was a need to increase use of olive oil, vegetables, fruits, fish, and red wine consumption and to decrease red meat and dessert consumption. According to responses to the Mediterranean Diet Adherence Screener and their traditional/local food consumption frequencies an up-to-date Cyprus Mediterranean Diet Pyramid was done hence a national food pyramid for Cyprus. Commonly consumed traditional and local foods were added to the pyramid to facilitate increased adaptation of the Mediterranean diet in the general population. Adequately consumed foods were added to make it more region-specific and rarely consumed foods were added to help to increase consumption. Conclusion This modification is believed to be instrumental to increase Mediterranean diet adaptation, traditional/local food consumption and decrease the impact of nutrition on the planet´s health. And also, this modification can shed light on the development of the other traditional food pyramids.

The Role of Socioeconomic Status in Adherence to the Mediterranean Diet and Body Mass Index Change: A Follow-Up Study in the General Population of Southern Croatia

The Mediterranean diet (MD) is one of the most healthful dietary patterns, beneficial for humans and the environment. However, the MD has recently exhibited a declining trend, especially in younger and less affluent people. This study investigated the association between socioeconomic indicators and adherence to the MD in 4671 adult subjects from Dalmatia, Croatia (age range 18–98 years; 61.9% were women). Additionally, in the follow-up we examined the change in adherence to the MD and in BMI (subsample, N = 1342; 62.5% were women; mean follow-up time of 5.8 years). The adherence to the MD was based on the Mediterranean Diet Serving Score (range 0–24 points, cut-off value ≥ 14 points), with a prevalence in the overall sample of 28.5%. Higher odds of adherence to the MD were recorded in women, older subjects, and those with higher level of objective material status, while it was less likely in the period after economic crisis of 2007–2008. Additionally, we detected no change in adherence to the MD in the follow-up subsample (−8.5%, p = 0.056), but there was an increase in BMI (+6.5%, p < 0.001). We recorded an increase in adherence for nuts (+127.5%), sweets (+112.6%), red meat (+56.4%), and wine (+50.0%), unlike the reduction in adherence for vegetables (−35.1%), fish (−23.4%), white meat (−11.6%), cereals (−10.9%), and dairy products (−9.6%). Similar results were obtained across all quartiles of objective material status. Over time, the absolute change in the MD score was positively associated with female gender, age, higher education, and moderate physical activity, but it was negatively associated with adherence to the MD at baseline. BMI change was positively associated with female gender, and negatively with initial BMI, initial adherence to the MD, and MD change. Our findings point towards a less than ideal adherence to the MD in the general population of southern Croatia, and identify important characteristics associated with adherence change over time, informing necessary interventions aimed at increasing MD uptake.

Lifestyle Factors Influencing Dietary Patterns of University Professors

The objectives of this study are to identify eating patterns of university professors and to assess the relationships among sociodemographic factors in relation to lifestyle and physical activity. It is a cross-sectional, descriptive-correlational, and observational study with a representative sample of 127 educators, which covers almost the total population of university professors belonging to one of the campuses of the University of Granada (Spain). Two eating patterns were identified a posteriori through explanatory factor analysis: a Western pattern characterised by the consumption of dairy products, eggs, meat, sausages, refined oils, and butter, sugar, processed baked goods, and sugar-containing beverages and alcoholic drinks, and a Mediterranean pattern based on olive oil, fish, fruits, nuts, vegetables, pulses, cereals, and honey, which explain the 20.102 and 17.411 of variance, respectively. Significant differences are observed between the two genders with respect to anthropometric characteristics (weight and size, p < 0.001 in both cases) and to nutritional status (p = 0.011). Origin (p = 0.022) and level of physical activity (p = 0.010) were significantly related to adherence to a Western diet pattern. In the case of the Mediterranean diet pattern, significant differences are observed according to the professors' type of bachelor's degree (p = 0.37). This study provides evidence on factors having an impact on adherence to eating patterns of professors of the University of Granada, and it suggests that programmes addressed to such groups should be developed to promote health.

Changing Dietary Behavior for Better Biodiversity Preservation: A Preliminary Study

Broadly consumed dietary patterns, such as the European and Western ones, are exerting pressures on biodiversity both in Europe and globally, and shifting toward a sustainable dietary pattern has thus become a must. This paper constitutes a preliminary communication of the results of a research project on the issue. In this study, the pressures of three dietary patterns (European, Western, and Mediterranean) on biodiversity are addressed in terms of land use, water use, greenhouse gas emissions, and eutrophication impact indicators. The environmental impacts are calculated based on a compositional analysis of each dietary pattern and the environmental footprints of the corresponding food groups. Food balance sheets published by the FAO are used as a basis for the compositional analysis, while the environmental footprints of each of the representative food products are retrieved from related life cycle assessment (LCA) studies. The results show that a shift from the European to the Mediterranean dietary pattern would lead to 10 m²/capita/day land savings, 240 L/capita/day water savings, 3 kg CO₂/capita/day reduction in greenhouse gas emissions, and 20 gPO₄eq/capita/day reductions in eutrophication potential. Likewise, a shift from the Western to the Mediterranean dietary pattern would lead to 18 m²/capita/day land savings, 100 L/capita/day water savings, 4 kg CO₂/capita/day reduction in greenhouse gas emissions, and 16 gPO₄eq/capita/day reduction in eutrophication potential. Based on these findings, it is clear that this shift is urgently needed as a step toward environmentally sustainable dietary patterns, such as the Mediterranean one, to preserve biodiversity for future generations.

Consumer Preferences for Origin and Organic Attributes of Extra Virgin Olive Oil: A Choice Experiment in the Italian Market

The paper investigates Italian consumers’ behavior towards characteristics of extra virgin olive oil, in particular organic production methods and geographical origin. On the basis of the existing literature, the concepts of sustainability of food systems, diets, and the olive oil supply chain are analyzed. A choice experiment (CE), using a face-to-face questionnaire with over 1000 participants, was conducted to quantify the willingness to pay (WTP) for these two attributes. Findings show positive preference for origin attributes, while the organic attribute is not highly valued. The article also offers some perspectives on future research to improve the competitiveness and sustainability of the Italian olive oil supply chain.

Mediterranean diet: a nutrient-packed diet and a healthy lifestyle for a sustainable world

The Mediterranean diet (MD), as a sustainable diet and a healthy way of living, is in a good agreement with the UN's Sustainable Development Goals (2015). © 2020 Society of Chemical Industry.

Persistent Moderate-to-Weak Mediterranean Diet Adherence and Low Scoring for Plant-Based Foods across Several Southern European Countries: Are We Overlooking the Mediterranean Diet Recommendations?

The Mediterranean diet (MD) has been sponsored worldwide as a healthy and sustainable diet. Our aim was to update and compare MD adherence and food choices across several Southern European countries: Spain (SP), Portugal (PT), Italy (IT), Greece (GR), and Cyprus (CY) (MED, Mediterranean), and Bulgaria (BG) and the Republic of North Macedonia (NMK) (non-MED, non-Mediterranean). Participants (N = 3145, ≥18 y) completed a survey (MeDiWeB) with sociodemographic, anthropometric, and food questions (14-item Mediterranean Diet Adherence Screener, 14-MEDAS). The MED and non-MED populations showed moderate (7.08 ± 1.96) and weak (5.58 ± 1.82) MD adherence, respectively, with significant yet small differences across countries (SP > PT > GR > IT > CY > BG > NMK, p-value < 0.001). The MED participants scored higher than the non-MED ones for most of the Mediterranean-typical foods, with the greatest differences found for olive oil (OO) and white meat preference. In most countries, ≥70% of the participants reported quantities of red meat, butter, sweet drinks, and desserts below the recommended cutoff points, whereas <50% achieved the targets for plant-based foods, OO, fish, and wine. Being a woman and increasing age were associated with superior adherence (p-value < 0.001), but differences were rather small. Our results suggest that the campaigns carried out to support and reinforce the MD and to promote plant-based foods have limited success across Southern Europe, and that more hard-hitting strategies are needed.

The Mediterranean diet from past to future: Key concepts from the second "Ancel Keys" International Seminar

The year 2020 celebrated the tenth anniversary of the recognition of the Mediterranean Diet as Intangible Cultural Heritage of Humanity by the UNESCO Intergovernmental Committee. This event represented a milestone in the history of nutrition, as the Mediterranean diet was the first traditional food practice to receive such award. Since then, a lot has been discussed not only on the beneficial aspects of the Mediterranean diet, but also on its complex role as a lifestyle model that includes a set of skills, knowledge and intercultural dialogue. This process ended up with the recognition in 2019 of Mediterranean diet as a possibly universal model of healthy diet from the EAT-Lancet Commission. These concepts were widely debated at the 2019 "Ancel Keys" International Seminar, held in Ascea (Italy) (for more information see: www.mediterraneandietseminar.org) with the aim to stimulate interest and awareness of a young group of participants on the current problems inherent to the effective implementation of the Mediterranean diet. The present article collects the contributions of several lecturers at the Seminar on key issues such as methodological and experimental approach, sustainability, molecular aspects in disease prevention, future exploitation, without neglecting a historical view of the Seven Countries Study. From the Seminar conclusions emerged a still vibrant and modern role of Mediterranean diet. The years to come will see national and international efforts to reduce the barriers that limit adherence to Mediterranean diet in order to plan for multi-factorial and targeted interventions that would guide our populations to a sustainable healthy living.

Goals in Nutrition Science 2020-2025

Five years ago, with the editorial board of Frontiers in Nutrition, we took a leap of faith to outline the Goals for Nutrition Science - the way we see it (1). Now, in 2020, we can put ourselves to the test and take a look back. Without a doubt we got it right with several of the key directions. To name a few, Sustainable Development Goals (SDGs) for Food and Nutrition are part of the global public agenda, and the SDGs contribute to the structuring of international science and research. Nutritional Science has become a critical element in strengthening work on the SDGs, and the development of appropriate methodologies is built on the groundwork of acquiring and analyzing big datasets. Investigation of the Human Microbiome is providing novel insight on the interrelationship between nutrition, the immune system and disease. Finally, with an advanced definition of the gut-brain-axis we are getting a glimpse into the potential for Nutrition and Brain Health. Various milestones have been achieved, and any look into the future will have to consider the lessons learned from Covid-19 and the sobering awareness about the frailty of our food systems in ensuring global food security. With a view into the coming 5 years from 2020 to 2025, the editorial board has taken a slightly different approach as compared to the previous Goals article. A mind map has been created to outline the key topics in nutrition science. Not surprisingly, when looking ahead, the majority of scientific investigation required will be in the areas of health and sustainability. Johannes le Coutre, Field Chief Editor, Frontiers in Nutrition.

Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns

BACKGROUND

Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy, dietary guidelines and food security strategies need to evolve from the limited historical approach, mainly focused on nutrients and health, to a new one considering the environmental, socio-economic and cultural impact-and thus the sustainability-of diets.

OBJECTIVE

To present an updated version of the Mediterranean Diet Pyramid (MDP) to reflect multiple environmental concerns.

METHODS

We performed a revision and restructuring of the MDP to incorporate more recent findings on the sustainability and environmental impact of the Mediterranean Diet pattern, as well as its associations with nutrition and health. For each level of the MDP we provided a third dimension featuring the corresponding environmental aspects related to it.

CONCLUSIONS

The new environmental dimension of the MDP enhances food intake recommendations addressing both health and environmental issues. Compared to the previous 2011 version, it emphasizes more strongly a lower consumption of red meat and bovine dairy products, and a higher consumption of legumes and locally grown eco-friendly plant foods as much as possible.

Mediterranean Lifestyle to Promote Physical, Mental, and Environmental Health: The Case of Chile

Chile is currently experiencing a progressive epidemiological transition towards chronic diseases. In this country, >50% of annual deaths are attributed to cardiovascular disease and cancer. Moreover, health surveys have shown high prevalence of obesity, diabetes, hypertension, and elevated cardiovascular disease risk. In addition, mental health issues are also frequent among Chilean adults. On the other hand, the agri-food system contributes to 21-37% of greenhouse gases emissions worldwide. Overall, current health and food chain situation calls out for design and implementation of evidence-based feasible and effective nutritional interventions needed to promote physical and mental health along with addressing food sustainability in Chile. Nowadays, the Mediterranean diet is recognized as one of the healthiest dietary patterns based on observational and interventional studies linked to a wide variety of health outcomes. However, a Mediterranean lifestyle goes well beyond food intake: it includes promotion of psychosocial resources, community life as well as cultural traditions. Indeed, Mediterranean lifestyle is a true modus vivendi that integrally promotes physical, mental, and social well-being. In addition, the Mediterranean diet stands out for its environmental sustainability because it is characterized mainly as a plant-based dietary pattern with low carbon and water footprints. Remarkably, Central Chile has a Mediterranean-like setting with plant and animal food production and availability patterns comparable to those present in countries located around the Mediterranean Sea. Therefore, this article reviews how promotion of Mediterranean lifestyle adherence in Chile offers great potential for management of the ongoing epidemiological transition to chronic diseases as well to promote psychological well-being within a unique food system and dietary sustainability vision for this Latin American country.

Food Sustainability Knowledge and Attitudes in the Spanish Adult Population: A Cross-Sectional Study

Moving towards sustainable food systems and food consumption are proposed as strategies to reduce environmental impact. However, these strategies require joint action between different stakeholders, including the general population's knowledge and perception, as final consumers. To assess the knowledge and awareness on food sustainability and environmental impact concepts in a representative sample of Spanish adult population, we conducted a cross-sectional, nationally representative telephone survey. After random selection, 2052 respondents aged ≥18 years (57% woman and 43% men) participated. A questionnaire was specifically designed for the research. Participants showed a good attitude towards sustainable diets, which were described as healthy by 40% of the population. Most of the responders (>70%), did not well understand ecological and carbon footprints, and green and blue water concepts. Men declared a higher understanding of sustainability concepts, as compared to women. More than 50% of the population misunderstood the impact of meat and derivatives production on sustainability, and 70% perceived the same for fish and dairy products. Women were more prone to pay more money to afford a sustainable diet than men were. In conclusion, although consumers show a positive attitude towards sustainability, important misconceptions remain, and thus require intervention through education, information, and motivation.

Erosion of the Mediterranean diet among adolescents: evidence from an Eastern Mediterranean Country

At a time when the health benefits of the Mediterranean diet (MD) are pervasively recognised, a paradoxical observation is the decreasing adherence to this dietary pattern in its native countries. This study aims to investigate temporal trends in adherence to the MD among adolescents (10–19 years old) in Lebanon. Data were drawn from three national cross-sectional surveys conducted at three points in time: 1997 (n2004), 2009 (n3656) and 2015 (n1204). Dietary intake was assessed using 24-h dietary recalls, and adherence to the MD was assessed using two country-specific indexes: the composite Mediterranean diet (c-MED) index and Lebanese Mediterranean diet (LMD) index. Significant decreases in c-MED and LMD scores and in the proportion of adolescents adhering to the MD were observed between 1997 and 2015, with more consistent results among females (P< 0·05). Projections for the year 2030 showed further decreases, with less than a quarter of adolescents remaining adherent to the MD. Based on linear regression analyses, belonging to the year 2009 was associated with significantly lower MD scores compared with 1997, even after adjustment for potential covariates (c-MEDβ= –0·16, 95 % CI –0·30, –0·01; LMDβ= –0·42, 95 % CI –0·67, –0·17). Similar results were obtained when comparing survey year 2015 with 1997 (c-MED scoreβ= –0·20, 95 % CI –0·33, –0·06; LMD scoreβ= –0·60, 95 % CI –0·82, –0·37). Findings highlight the erosion of the MD among Lebanese adolescents and underline the need for a comprehensive food system approach that fosters the promotion of the MD as a nutritionally balanced and sustainable dietary pattern.