In the 1960s, Dr. Ancel Keys defined what we call today the traditional Mediterranean diet, a dietary pattern prevailing in the olive tree-growing areas of the Mediterranean basin (Trichopoulou Citation2021). The Mediterranean diet is characterised by high intakes of plant-based foods like fruits, vegetables, legumes, whole grains, nuts and seeds as well as moderate consumption of fish, seafood, dairy products, poultry and eggs. Frequent use of extra virgin olive oil as a dietary source of fat and moderate wine consumption during meals are among its pillars, while consumption of red and processed meat as well as sweets, although not prohibited, is limited (Trichopoulou Citation2021; Sotos-Prieto et al. Citation2022). A few decades later, the United Nations Educational, Scientific and Cultural Organization (UNESCO) inscribed the Mediterranean diet on the Representative List of Intangible Cultural Heritage of Humanity, recognising and emphasising its heritage. A large body of evidence currently attributes numerous health benefits to higher adherence to the Mediterranean diet, including reduced mortality and prevention of non-communicable diseases, including cardiovascular diseases, diabetes, cancer and neurogenerative diseases (Dinu et al. Citation2018). Notwithstanding the robust evidence, over the last decades, an alarming transition from traditional dietary patterns, like the Mediterranean diet, towards higher adherence to suboptimal diets has been observed (Sotos-Prieto et al. Citation2022).
In this issue of the International Journal of Food Sciences and Nutrition, a systematic review from Damigou et al. provided a comprehensive overview of observational studies exploring the adherence to the Mediterranean diet and its variations in different populations across the world (Damigou et al. Citation2023). The summary findings based on 57 studies comprising over 1 million apparently healthy adults point out that although adherence to the Mediterranean diet across the investigated populations is moderate, a significant decline has been observed over the last decade. The study underlines that when considering the geographical region, European countries show a higher adherence than other regions, driven mainly by the countries of the Mediterranean basin. Further analysis of the relation between country-specific socio-economic characteristics, expressed by means of the Human Development Index, and the level of adherence to the Mediterranean diet, suggested that the level of adherence may be influenced by socioeconomic factors and decrease during the economic crisis (Damigou et al. Citation2023).
The decreasing rates of adherence to the Mediterranean diet represent a global threat not only in terms of the population’s health status but also for environmental sustainability. In line with the Sustainable Development Goals of the United Nations, targeting adherence to plant-based diets, like the Mediterranean diet, can be a valid strategy to mitigate climate change. The Mediterranean diet is a plant-based dietary pattern, thus with a better ecological footprint, especially when compared to more Westernised food choices (Sáez-Almendros et al. Citation2013; Seconda et al. Citation2017; Fresán et al. Citation2018; Grosso et al. Citation2020). The sustainable impact on the environment is represented by food production with limited pressure on the food chain, from local production to minimum transportation, including a conscious use of natural resources as opposed to excess eutrophication and massive production, respect for biodiversity, and seasonality (Berry Citation2019). However, current trends are not promising. The abandonment of such dietary patterns has a substantial impact on the physical and bio-geochemical environment, with a variety of negative impacts such as deforestation, fossil fuel consumption, urbanisation, land reclamation, agricultural intensification, freshwater extraction, fisheries overexploitation and waste production (Serra-Majem et al. Citation2020). The environmental advantage characterising the Mediterranean diet of promoting typical local products manufactured by small/medium enterprises is getting counteracted by an economically competitive more globalised food market not always assuring the same quality standards in terms of product (but also social values, traceability and balanced production) (Dernini et al. Citation2017).
Moreover, not just the level of adherence to the Mediterranean diet, but also the quality of the dietary pattern itself has changed over time. Besides the overall abandonment of the Mediterranean diet registered over the last decade, the net level of adherence (measured through scores investigating the adoption of the main components characterising this dietary pattern) has substantially decreased, suggesting that some dietary features of the Mediterranean diet are getting lost (da Silva et al. Citation2009). Contrary to several modelling studies estimating a lower impact of flexitarian dietary patterns (such as the Mediterranean diet), empirical data showed that the abandonment of a Mediterranean-type diet in both Mediterranean and non-Mediterranean EU countries is related to diet-associated greenhouse gas emissions nearly double to what would be expected from a sustainable dietary pattern (Castaldi et al. Citation2022). The primary factor for the divergence in many Mediterranean countries is driven by excessive meat consumption, contributing to 60% of the daily excess of greenhouse gas emissions (Castaldi et al. Citation2022).
Current evidence reports alarming data on the continuously decreasing rates of adherence to the Mediterranean diet over the years, with socio-economic factors being among the drivers. Taking into account the scientific evidence indicating that a shift towards better adherence to the Mediterranean diet is linked to health benefits and environmental sustainability, future research and actions should advocate for better public awareness of health and environmental benefits associated with higher adherence to the Mediterranean as well as aim at increasing its accessibility for different communities across the world.
Acknowledgements
J.G. was supported by the co-financing of the European Union—FSE-REACT-EU, PON Research and Innovation 2014-2020 DM1062/2021; CUP: E65F21002560001.
Disclosure statement
No potential conflict of interest was reported by the author.
References
- Berry EM. 2019. Sustainable food systems and the Mediterranean diet. Nutrients. 11(9):2229. doi: 10.3390/nu11092229.
- Castaldi S, Dembska K, Antonelli M, Petersson T, Piccolo MG, Valentini R. 2022. The positive climate impact of the Mediterranean diet and current divergence of Mediterranean countries towards less climate sustainable food consumption patterns. Sci Rep. 12(1):8847. doi: 10.1038/s41598-022-12916-9.
- Damigou E, Faka A, Kouvari M, Anastasiou C, Kosti RI, Chalkias C, Panagiotakos D. 2023. Adherence to a Mediterranean type of diet in the world: a geographical analysis based on a systematic review of 57 studies with 1,125,560 participants. Int J Food Sci Nutr. 74(8):799–813. doi: 10.1080/09637486.2023.2262781.
- da Silva R, Bach-Faig A, Raidó Quintana B, Buckland G, Vaz de Almeida MD, Serra-Majem L. 2009. Worldwide variation of adherence to the Mediterranean diet, in 1961–1965 and 2000–2003. Public Health Nutr. 12(9A):1676–1684. doi: 10.1017/S1368980009990541.
- Dernini S, Berry EM, Serra-Majem L, La Vecchia C, Capone R, Medina FX, Aranceta-Bartrina J, Belahsen R, Burlingame B, Calabrese G, et al. 2017. Med Diet 4.0: the Mediterranean diet with four sustainable benefits. Public Health Nutr. 20(7):1322–1330. doi: 10.1017/S1368980016003177.
- Dinu M, Pagliai G, Casini A, Sofi F. 2018. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr. 72(1):30–43. doi: 10.1038/ejcn.2017.58.
- Fresán U, Martínez-Gonzalez M-A, Sabaté J, Bes-Rastrollo M. 2018. The Mediterranean diet, an environmentally friendly option: evidence from the Seguimiento Universidad de Navarra (SUN) cohort. Public Health Nutr. 21(8):1573–1582. doi: 10.1017/S1368980017003986.
- Grosso G, Fresán U, Bes-Rastrollo M, Marventano S, Galvano F. 2020. Environmental impact of dietary choices: role of the Mediterranean and other dietary patterns in an Italian cohort. Int J Environ Res Public Health. 17(5):1468.
- Sáez-Almendros S, Obrador B, Bach-Faig A, Serra-Majem L. 2013. Environmental footprints of Mediterranean versus Western dietary patterns: beyond the health benefits of the Mediterranean diet. Environ Health. 12(1):118. doi: 10.1186/1476-069X-12-118.
- Seconda L, Baudry J, Allès B, Hamza O, Boizot-Szantai C, Soler L-G, Galan P, Hercberg S, Lairon D, Kesse-Guyot E. 2017. Assessment of the sustainability of the Mediterranean diet combined with organic food consumption: an individual behaviour approach. Nutrients. 9(1):61. doi: 10.3390/nu9010061.
- Serra-Majem L, Tomaino L, Dernini S, Berry EM, Lairon D, Ngo de la Cruz J, Bach-Faig A, Donini LM, Medina F-X, Belahsen R, et al. 2020. Updating the Mediterranean diet pyramid towards sustainability: focus on environmental concerns. Int J Environ Res Public Health. 17(23):8758.
- Sotos-Prieto M, Del Rio D, Drescher G, Estruch R, Hanson C, Harlan T, Hu FB, Loi M, McClung JP, Mojica A, et al. 2022. Mediterranean diet – promotion and dissemination of healthy eating: proceedings of an exploratory seminar at the Radcliffe Institute for Advanced Study. Int J Food Sci Nutr. 73(2):158–171. doi: 10.1080/09637486.2021.1941804.
- Trichopoulou A. 2021. Mediterranean diet as intangible heritage of humanity: 10 years on. Nutr Metab Cardiovasc Dis. 31(7):1943–1948. doi: 10.1016/j.numecd.2021.04.011.