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Why the Mediterranean diet is actually a lifestyle changeMediterranean diet and food sustainability -
This finding is consistent with the literature on the subject, where LCA is the most commonly used approach 18 — 20 , Despite being the most commonly used approach, LCA methodology is not free from limitations 55 , and other methodologies to assess sustainability, such as the modeling approaches, integrated analytical frameworks, and the proposed adaptive, participatory methods, have been proposed From the environmental perspective, many of the identified studies consistently found that MedDiet is a sustainable option 25 — 31 , 33 , 38 — 40 , 42 — Nevertheless, some studies relying on dietary consumption data or dietary scenarios reported that in some cases, other dietary patterns had a similar or better environmental performance 22 , 25 , 26 , 28 , 32 , 34 — 37 , 41 , while the mixed studies, based on dietary consumption and dietary scenarios, indicated MedDiet as the most environmentally friendly option 42 — Studies examining the impact of foods on environmental sustainability reported animal food sources as the food category with the most deleterious environmental effects 25 , 34 , As previously mentioned, MedDiet is a dietary pattern characterized by moderate consumption of eggs, poultry, and dairy products cheese and yogurt and low consumption of red meat 13 , Furthermore, in its present update, the MedDiet pyramid reflected multiple environmental concerns and strongly emphasizes a lower consumption of red meat and bovine dairy products 13 , Six studies 22 , 26 , 33 , 40 , 41 , 44 measured the cost associated with the adherence to MedDiet as a measure of economic sustainability.
Those studies shed some light on the economic tradeoffs of adhering to MedDiet. In two of the studies 26 , 44 , adherence to the MedDiet, compared to other patterns of dietary consumption, was associated with a higher cost; yet, in one study 33 , it was proposed that isocaloric diets have approximately the same cost.
These results may be explained by the different methodological approaches used in each study but are most likely explained by the dietary patterns compared to the MedDiet.
The MedDiet was more expensive than the Western dietary pattern and the Provegetarian dietary pattern 26 , slightly more expensive than the dietary consumption of the Italian population 44 ; no significant differences were observed between the MedDiet, the SEAD, and the NAOS Monetary cost is one of the key factors in food choice and it is the main factor in shaping the consumer demand; therefore, it will affect consumer preferences and options for a sustainable dietary pattern 18 , Food prices condition the affordability of sustainable diets.
Low prices reduce the income of producers, reduce their ability to invest, and may hinder the development of a sustainable food system. From the sustainability point of view, price is ambivalent; therefore, it is important to guarantee the accessibility and affordability to food choices in order to ensure economic sustainability but at the same time, the affordability may have negative environmental impacts by not discouraging food waste In line with our findings, there is evidence indicating that MedDiet is not necessarily associated with higher overall dietary costs The health-nutrition dimension of nutritional sustainability of MedDiet was assessed in six studies 26 , 30 , 34 , 37 , 42 , The NRF9.
Regardless of the methodological differences, MedDiet was associated with a better performance in the health-nutrition dimension. MedDiet has been consistently shown to be a healthy dietary pattern that may reduce risk related to non-communicable diseases 60 ; and therefore, adherence to the MedDiet or other healthy dietary patterns may be associated with the sustainability of healthcare systems.
The absence of exploration regarding the socio-cultural dimension of sustainability in the identified literature is particularly important, given the critical role of society and culture in the MedDiet. The relevance of this dimension is so clear that MedDiet was acknowledged by UNESCO as an intangible cultural heritage According to UNESCO, MedDiet is a way of life that encompasses a set of skills, knowledge, rituals, symbols, and traditions, ranging from landscape to the table.
Eating together is the foundation of the cultural identity and continuity of communities throughout the Mediterranean Basin. The MedDiet emphasizes values of hospitality, neighborliness, intercultural dialogue and creativity, and a way of life guided by respect for diversity Despite its increasing popularity worldwide, adherence to the MedDiet is decreasing due to multifactorial influences, such as globalization, population growth, and socio-economic changes.
Food chain modernization has increased productivity and resulted in a substantial transformation of lifestyles as a consequence of rising incomes, urbanization, and changes in the agricultural and food sectors.
Those changes threaten seriously the transmission and preservation of the MedDiet heritage to present and future generations Measuring the sustainability of the socio-cultural dimension is paramount for the preservation of MedDiet.
The development of indices that combine all the dimensions of nutritional sustainability may facilitate its assessment and the comparability of different dietary patterns or food products.
We did not identify studies that used methodological approaches covering all the conceptual framework of nutritional sustainability of MedDiet; instead, we identified studies that assessed some dimensions of MedDiet nutritional sustainability.
Heterogeneity in the indicators used was found, particularly in the environmental dimension. Studies on the economic and health-nutrition dimensions are less frequent and absent in the socio-cultural dimension. Our findings call for the development of harmonized methodologies for the assessment of MedDiet nutritional sustainability.
Indeed, the methodological approach proposed by Dernini et al. Despite being comprehensive and complete, no indication is given regarding the weight of each dimension or the indicator for a sustainability score; although the authors mention that the methodological approach requires to be tested and further refined in a group of selected Mediterranean countries, indicating that this is an ongoing work.
Traditional and typical agro-food products are at the core of MedDiet A typical agro-food product is characterized by historical and cultural features and by physical attributes that are deep-rooted to the territory of origin encompassing much more than organoleptic qualities.
In the last years, we have observed a deep transformation in consumer perception and in the demand for typical agro-food products.
The retrieval of typical and traditional foods represents an attempt to recover the safety and social aspects of eating habits. To form positive attitudes and expectations toward food, consumers need to be assured and informed about the production and transformation processes as well as about their origin and the symbolic values they encompass Typical agro-food products contribute directly and indirectly to the sustainability of the MedDiet in the Mediterranean basin Considering those aspects, we identified two works related to the sustainability of typical agro-food products 48 , Capone et al.
This methodological proposal englobes all the dimensions of sustainability that are explored in our study. The identified work of Azzini et al. In this work, sustainability was assessed in the environmental, economic, sociocultural, and health-nutrition dimensions.
Considering the included literature, environmental sustainability was assessed and defined as the ability to use fewer resources 23 , 25 — 29 , 31 — 33 , 35 , 37 — 40 , 42 — 45 to produce less byproducts 23 — 29 , 31 , 33 — 37 , 40 , 41 , 43 — Economic sustainability was defined as the ability to promote economic growth 41 or the accessibility to the consumers 22 , 26 , 33 , 40 , The Heath-nutrition dimension was defined as the capability to provide adequate nutrition 30 , 37 , 42 , 43 , promote health, and prevent disease Despite not being assessed, the socio-cultural dimension of sustainability encompasses historical remains and values, local culture, and traditions; therefore, it was defined as the ability to preserve them Nutritional sustainability is an umbrella term that can take several meanings depending on the dimension that is assessed.
Several considerations must be made regarding the findings of this study. Most of the studies identified are from the countries located in the Mediterranean basin and the remaining are from Northern Europe and the United States. While it is not surprising to find studies regarding MedDiet sustainability in the countries of its origin, MedDiet is recommended worldwide as a sustainable dietary option 64 ; therefore, studies on other regions are needed.
Comparisons are difficult due to the heterogeneity of the indicators used in the identified studies and no studies used a comprehensive approach that explores nutritional sustainability in all dimensions. Harmonization is essential for the comparison of results; yet, a significant degree of flexibility is also needed to allow for the wide application of an instrument to assess the nutritional sustainability of diets or food products that are, by nature, dynamic.
Identified studies did not provide examples of approaches to combine all the indicators of sustainability. Identified articles were published between and , highlighting the recent interest in the subject.
Despite a significant body of literature that meets the inclusion criteria for this review, more work is needed to establish a consensual approach to assess the nutritional sustainability of MedDiet and to compare it with other dietary patterns.
Our scoping review has some limitations. A search was performed only in two electronic databases Scopus and PubMed ; therefore, relevant works may have been missed.
Gray literature could be an informative source of evidence to this study; however, the sizable amount of gray literature in the field could have dumped the feasibility of the work. The search strategy was broad enough to capture a significant body of literature in the area, yet it is possible that studies assessing the sustainability indicators but not mentioning the word sustainability or related words have not been captured.
Our study reviewed for the first time the assessment of the nutritional sustainability of MedDiet. From a general perspective, there is sufficient evidence to state that MedDiet is a nutritional sustainable option.
Methodological assessment of nutritional sustainability is challenging and involves multidisciplinary approaches. In its concept, nutritional sustainability is differentiated from other concepts combining nutrition and sustainability; it does not contradict with other similar concepts sustainable diet and sustainable food systems but aggregates concepts from them.
MedDiet nutritional sustainability needs to attract sufficient political attention and become a core priority in the shaping of agriculture, food, and nutrition policies; for that, research needs, in a comprehensive way, to reflect the complexity of the nutritional sustainability concept.
CP-N wrote the first draft of the manuscript. The data acquisition of the article and analysis of its content has been made by a consensus between CP-N and CG.
CS and CG conceived and designed the study. All the authors had revised the manuscript. The CP-N is supported by an AgriFood XXI project post-doctoral fellowship. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Great article Elena! I have just downloaded the Sustainable Diets and Biodiversity report and am very much looking forward to reading it, especially the Mediterranean diet example.
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Skip to content. Facebook Twitter Instagram Linkedin Pinterest. Previous Previous. Next Continue. Leave a Reply Cancel reply Your email address will not be published. The main contributor to land use was meat, and the main contributor to water use was fruit intake at each adherence level.
Figure 2. Environmental footprint of different dietary patterns. Figure 3. Food groups' contribution to environmental footprints for different dietary patterns.
To further explore the relationship between the food groups and the environmental coefficients, we calculated the average consumption of the food-group items for different tertiles of GHG emissions, land use, and water use.
Table 2 shows the mean daily intake of the different food groups by tertiles of environmental footprints. The consumption of animal-based food increased for different land tertiles, demonstrating high use of land resources with increased consumption.
Table 2. Mean daily intake of food groups by tertiles of environmental footprints. The meat intake was 12 times higher in the upper tertile of land use than in the lowest tertile, while poultry intake was 4 times higher, and egg intake was 2.
In the case of water, only poultry and dairy did not differ between tertiles. These results indicate a narrow range of consumption and smaller influence on water use and GHG emissions.
The need to assess both human health and environmental footprint of diets has been widely acknowledged. Nevertheless, most studies have focused on theoretical models of dietary guidelines and their potential contributions to sustainability and human health rather than actual consumption 3.
The analysis presented in this paper joins a limited number of studies that have identified this gap 4 , 5 , By analyzing data from a diverse sample of people in Israel, we evaluated real consumption data in regard to adherence to healthy and sustainable diets. These findings are the integrative product of both the studied population's consumption habits and the environmental factors of each studied commodity.
Our findings indicate that the main contributors to water use were fruits, vegetables, and dairy. The main contributors to land use were meat and poultry, and the main contributor to GHG emissions was dairy products.
We found that the highest tertiles of adherence to the MED and the EAT-Lancet reference diet 6 , 9 were associated with the lowest GHG emissions and land use. On the other hand, the highest tertiles of adherence to the MED and EAT-Lancet were associated with higher water use.
To expand our view on sustainability beyond the environmental footprint, adjoining sociocultural, economic, and health aspects we used the SHED index 7. The need to develop methods to include all 4 dimensions of sustainability of the diet in their case MED were acknowledged in a recent review by Portugal et al.
The results of the SHED index analysis were similar to those obtained for the MED and EAT-Lancet dietary pattern. The health value of the MED is well established. During the last 20 years MED was shown to benefit health and function, reducing mortality rates 9 , 10 , The EAT-Lancet as a theoretical dietary pattern targets both health and the environment using evidence based data, indicating that healthy and sustainable diet is achievable 11 , In a review by Aleksandrowicz et al.
Our findings parallel those of prior studies. In studies from Italy and Spain that used real consumed diet, high adherence to MED pattern was associated with lower GHG emissions and land use 4 , 5. The contribution of animal products meat, poultry, dairy, egg, and fish constituted the greatest contributor to GHG emissions 19 , 21 , 22 , Higher adherence to the MED or the EAT-Lancet recommended diet was associated with lower GHG emissions in other studies In Spain the SUN cohort better adherence to the Spanish MED was associated with decreased environmental pressures in all assessed dimensions including GHG, land and water 5.
Likewise, a cross-sectional study among Italian adults showed that omnivorous dietary choices or low adherence to the MED correlated with higher GHG emissions, land, and water use 4 , Results in the same direction were found in a non-MED country.
Data from the European Prospective Investigation into Cancer and Nutrition—Netherlands EPIC-NL 28 cohort showed that the WHO and Dutch dietary guidelines lower the risk of all-cause mortality and moderately lower the environmental impact, while the DASH diet Dietary Approaches to Stop Hypertension diet , despite leading to similar health outcomes, was associated with higher GHG emissions due to high dairy product consumption in the Netherlands Another study conducted on Italian adults showed that omnivorous dietary choices generated worse carbon, water, and ecological footprints than other plant-based diets, while no differences were found for the environmental impacts of ovo-lacto-vegetarians and vegans Unlike the above studies, in our findings water footprint was higher in the third tertiles of MED, EAT-Lancet and SHED and was connected tofruit intake.
This unique aspect revealed in our analysis needs further discussion. Since fruits and vegetables are more dependent on irrigation than animal-based foods, reducing animal-based foods and increasing plant-based foods do not always correspond with lower water use, as shown by Harris et al.
Plant-based foods were major contributors to dietary blue-water footprints. Grosso et al. Higher fruit consumption was also associated with higher water footprints in the United States, particularly the blue-water footprint However, theoretical dietary models show different results indicating that shifting to a more plant-based diet would reduce the water footprint Other studies also demonstrate that the contribution of fruits and vegetables does not exceed the meat contribution for both blue and green water Indeed, we found that sustainable diets like MED or the EAT-Lancet reference diet are characterized by higher water consumption, but several considerations need to be taken into account.
One is that most fruits and vegetables consumed in Israel are grown locally. It follows that given the climatic conditions, most are irrigated, so they would have relatively high rates of blue-water footprints.
Nevertheless, it is important to note that not all blue water is the same as most of the fruit-related water footprint relies on treated wastewater, which reduces environmental pressure Other solutions such as the use of desalinated water and efficient and cost-effective irrigation techniques already exist in Israel, but our findings emphasize the importance of further development of water management, including advanced technologies, reducing water losses, and improving data quality and monitoring for water—food system linkages 32 , Management of the local food systems can also reduce water consumption.
There are substantial differences of 2—fold in water consumption between different fruit crops Prioritizing certain types of crops that are less burdensome in terms of water requirements while considering their health benefits could be another future direction to increase the health and sustainability of food systems.
As for dairy intake in Israel, the mean intake in our study is ± g per day. This value is higher than the estimated intake in Europe and North America, where the average daily intake is Since most dairy products consumed in Israel are domestically produced, and the production system is based on non-grazing cows, production can occur in a relatively small area 19 , In addition, the productivity of Israeli dairy cows is very high, which reduces the footprint per unit of milk Nevertheless, the high demand for dairy products identified in our analysis led to high rates of dairy-related footprints.
According to the EAT-Lancet commission 6 and in accord with the national dietary recommendations, the requirement for different food groups is calculated based on healthy dietary intake within global boundaries.
For example, the reference intake is 29 g per day for poultry, g per day for vegetables, g per day for fruits, and g per day for dairy. In our data Table 2 , the actual consumption in the lowest tetiles of land GHG and water was nearly similar to the EAT-Lancet recommended diet.
The main difference was fruit consumption. Thus, a shift, toward less animal based and more plant-based diets, is beneficial for both health and the environment. The Isocaloric Substitution of Plant-Based and Animal-Based Protein was related with Aging-Related Health Outcomes A recent paper by Eisen and Brown, 37 show that, following a phaseout of livestock production will independently provide persistent drops in atmospheric methane and nitrous oxide levels, and slower carbon dioxide accumulation.
This reduction through the end of the century, have the same cumulative effect on the warming potential of the atmosphere as a 25 gigaton per year reduction in anthropogenic CO2 emissions.
This level of reduction will provide half of the net emission reductions necessary to limit warming to 2C. Based on our data, which originate from the FFQ results of participants, it seems that there is no conflict between a healthy and sustainable diet, but there is a need to adjust and optimize dietary patterns in light of recommendations for various populations with different dietary needs.
For example, Israel is characterized with mixed Jewish and non-Jewish population, locals and new and established immigrants; and a significant young population alongside a growing share of elderly population.
It is important to note that the EAT-Lancet reference diet stems from a theoretical model for a healthy and sustainable diet, whereas our data represent actual dietary patterns of the Israeli population.
The results may be a proof of concept that the EAT-Lancet reference diet is indeed feasible. One strength of this study is its ability to assign environmental-footprint values to the FFQ lines. The Israeli FFQ was created based on h recall information that was collected in the Israeli National Health and Nutrition Survey MABAT The results of MABAT were available to our group, so we could assign Environmental Footprint values to most of the food items that were on the basic list for the FFQ.
The final lines of the FFQ were extracted from the food items. In many cases, when the FFQ is used, the data behind the questionnaire are not available to the researchers. We believe that the use of this basic method results in a more accurate long-term assessment of EF exposure of our participants 8 , Our footprint analysis was based on local supply coefficients.
It follows that each analyzed food commodity footprint is considered in terms of whether it was supplied from local sources or imported from several other parts of the world.
The footprint was then calculated to reflect the amount of land and water related to the supply from each source 14 , 27 , 32 , 39 , Our study also has several limitations that need to be addressed.
One is the use of a convenience sample that was restricted to people who have access to web-based platforms. However, we made an effort to recruit a representative sample including all sectors in Israel. Our sample consists of a high number of educated participants who practice a healthy lifestyle, which may partially limit the generalizability of the results to the general population.
While the footprint figures included detailed place-based data and calculations, for some commodities, we had to make some assumptions or exclude some footprint categories. For example, in the case of fish-related footprints, we included only global averages of GHG data and not the other footprint coefficients.
Our analysis of consumed diets revealed that animal protein is associated with the highest GHG emissions and land use, while fruits and vegetables were associated with the highest water consumption. Nevertheless, most of them are grown using treated wastewater, which reduces environmental pressure.
The differences in water consumption for different fruit crops support the need to prioritize certain types of crops, which should be less burdensome in terms of water requirements while considering their health benefits. Given these findings, we suggest that adherence to MED and EAT-Lancet dietary patterns should be included in national dietary guidelines and encouraged for consumption by all.
Furthermore, our data could be used as a database to create healthy and sustainable diet recommendations while adjusting for nutritional needs and health status, as well as maintaining diversity within dietary patterns.
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. ST planned and conducted the research and wrote the first draft of the manuscript. MK calculated the environmental footprints and co-authored the manuscript.
DS created the combined database and co-authored the manuscript. KA analyzed the data and co-authored it. All authors contributed to the article and approved the submitted version. This study was supported by Ben-Gurion University's internal fund for nutritional research, MIGAL - Galilee Research Institute grant, and Tel-Hai College research fund.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Thank you for visiting sustainabiltiy. You are using Mediterrahean browser version with sustainabiluty support sustainzbility CSS. Mediterraneann obtain the best experience, Chamomile Tea for Menstrual Cramps recommend you use a more an to date browser or turn off compatibility mode Hydration during breastfeeding Internet Explorer. In the Mediteranean, to ensure continued support, Mediterranean diet and food sustainability are xnd the site without styles and JavaScript. The Mediterranean diet MD is a world-renowned healthy dietary pattern. In the present study we analyse the climate sustainability of the MD and the greenhouse gas emissions E GHG associated with current dietary patterns in Mediterranean and non-Mediterranean EU countries, focusing on the major deviations from the MD health and environmental targets in Mediterranean countries. The E GHG associated with dietary patterns were calculated for seven Mediterranean countries Cyprus, Croatia, Greece, Italy, Portugal, Spain and Malta, referred to as 7MED and the other 21 countries in the EU 28 referred to as 21OTHERusing as the reference year. Chamomile Tea for Menstrual Cramps diet MedDiet is sustaijability used as an example of a sustainable Improves insulin sensitivity that promotes Chamomile Tea for Menstrual Cramps sustainable food system. MedDiet presents low environmental impacts, is characterized by high sociocultural food Mediterrqnean, allows for Mediterranewn 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 andthat dealt with the MedDiet nutritional sustainability.
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