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

Overview

Journal Int J Environ Res Public Health

Publisher MDPI

Specialties Environmental Health
Public Health

Date 2020 Dec 1

PMID 33255721

Citations 122

Authors

Lluis Serra-Majem

Laura Tomaino

Sandro Dernini

Elliot M Berry

Denis Lairon

Joy Ngo de la Cruz

Anna Bach-Faig

Lorenzo M Donini

Francesc-Xavier Medina

Rekia Belahsen

Suzanne Piscopo

Roberto Capone

Javier Aranceta-Bartrina

Carlo La Vecchia

Antonia Trichopoulou

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Association Between Anthropometric Measurements and Mediterranean Lifestyle in Women Diagnosed with Hashimoto's Thyroiditis: Data from the Mediterranean Region.

Karavelioglu B, Dayi T, Koseoglulari O, Oniz A Nutrients. 2025; 17(5).

PMID: 40077762 PMC: 11901783. DOI: 10.3390/nu17050892.

Health status, lifestyle and quality of life in older adults of rural and urban areas of Tarragona province (Catalonia, Spain): a cross-sectional descriptive study.

Jimenez-Ten Hoevel C, Queral J, Besora-Moreno M, Tarro L, Sospedra-Senar A, Tomas-Piqueras J BMC Public Health. 2025; 25(1):895.

PMID: 40050828 PMC: 11883952. DOI: 10.1186/s12889-025-22045-3.

Influence of Mediterranean Diet and Incidence of Global Warming on Food Habits and Plant Growth in Northern Mediterranean Latitudes: Narrative Review.

Latruffe N, Lizard G Nutrients. 2025; 17(4).

PMID: 40005005 PMC: 11858225. DOI: 10.3390/nu17040677.

The Role of Food Security in Mediterranean Diet Adherence Among Adolescents: Findings from the EHDLA Study.

Aquino-Blanco A, Jimenez-Lopez E, Victoria-Montesinos D, Gutierrez-Espinoza H, Olivares-Arancibia J, Yanez-Sepulveda R Foods. 2025; 14(3).

PMID: 39942005 PMC: 11816826. DOI: 10.3390/foods14030414.

Dietary Restrictions and Cancer Prevention: State of the Art.

Caprara G, Pallavi R, Sanyal S, Pelicci P Nutrients. 2025; 17(3).

PMID: 39940361 PMC: 11820753. DOI: 10.3390/nu17030503.

References

Dernini S, Berry E . Mediterranean Diet: From a Healthy Diet to a Sustainable Dietary Pattern. Front Nutr. 2015; 2:15. PMC: 4518218. DOI: 10.3389/fnut.2015.00015. View

Abete I, Romaguera D, Vieira A, de Munain A, Norat T . Association between total, processed, red and white meat consumption and all-cause, CVD and IHD mortality: a meta-analysis of cohort studies. Br J Nutr. 2014; 112(5):762-75. DOI: 10.1017/S000711451400124X. View

Vanham D, Del Pozo S, Pekcan A, Keinan-Boker L, Trichopoulou A, Gawlik B . Water consumption related to different diets in Mediterranean cities. Sci Total Environ. 2016; 573:96-105. DOI: 10.1016/j.scitotenv.2016.08.111. View

Estruch R, Ros E, Salas-Salvado J, Covas M, Corella D, Aros F . Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018; 378(25):e34. DOI: 10.1056/NEJMoa1800389. View

Heller M, Keoleian G, Willett W . Toward a life cycle-based, diet-level framework for food environmental impact and nutritional quality assessment: a critical review. Environ Sci Technol. 2013; 47(22):12632-47. DOI: 10.1021/es4025113. View

Xavier Medina F . Mediterranean diet, culture and heritage: challenges for a new conception. Public Health Nutr. 2009; 12(9A):1618-20. DOI: 10.1017/S1368980009990450. View

Trichopoulou A . Diversity v. globalization: traditional foods at the epicentre. Public Health Nutr. 2013; 15(6):951-4. DOI: 10.1017/s1368980012000304. View

Steffen W, Richardson K, Rockstrom J, Cornell S, Fetzer I, Bennett E . Sustainability. Planetary boundaries: guiding human development on a changing planet. Science. 2015; 347(6223):1259855. DOI: 10.1126/science.1259855. View

Fresan U, Martinez-Gonzalez M, Sabate J, Bes-Rastrollo M . Global sustainability (health, environment and monetary costs) of three dietary patterns: results from a Spanish cohort (the SUN project). BMJ Open. 2019; 9(2):e021541. PMC: 6398639. DOI: 10.1136/bmjopen-2018-021541. View

10.

La Vecchia C . Association between Mediterranean dietary patterns and cancer risk. Nutr Rev. 2009; 67 Suppl 1:S126-9. DOI: 10.1111/j.1753-4887.2009.00174.x. View

11.

Scarborough P, Appleby P, Mizdrak A, Briggs A, Travis R, Bradbury K . Dietary greenhouse gas emissions of meat-eaters, fish-eaters, vegetarians and vegans in the UK. Clim Change. 2015; 125(2):179-192. PMC: 4372775. DOI: 10.1007/s10584-014-1169-1. View

12.

Bosetti C, Pelucchi C, La Vecchia C . Diet and cancer in Mediterranean countries: carbohydrates and fats. Public Health Nutr. 2009; 12(9A):1595-600. DOI: 10.1017/S1368980009990425. View

13.

Kesse-Guyot E, Baudry J, Assmann K, Galan P, Hercberg S, Lairon D . Prospective association between consumption frequency of organic food and body weight change, risk of overweight or obesity: results from the NutriNet-Santé Study. Br J Nutr. 2017; 117(2):325-334. DOI: 10.1017/S0007114517000058. View

14.

Perez-Jimenez F, Delgado Lista J, Perez-Martinez P, Lopez-Segura F, Fuentes F, Cortes B . Olive oil and haemostasis: a review on its healthy effects. Public Health Nutr. 2007; 9(8A):1083-8. DOI: 10.1017/S1368980007668566. View

15.

Dernini S, Berry E, Serra-Majem L, La Vecchia C, Capone R, Medina F . Med Diet 4.0: the Mediterranean diet with four sustainable benefits. Public Health Nutr. 2016; 20(7):1322-1330. PMC: 10261651. DOI: 10.1017/S1368980016003177. View

16.

Seconda L, Baudry J, Alles B, Hamza O, Boizot-Szantai C, Soler L . Assessment of the Sustainability of the Mediterranean Diet Combined with Organic Food Consumption: An Individual Behaviour Approach. Nutrients. 2017; 9(1). PMC: 5295105. DOI: 10.3390/nu9010061. View

17.

Galli A, Iha K, Halle M, El Bilali H, Grunewald N, Eaton D . Mediterranean countries' food consumption and sourcing patterns:An Ecological Footprint viewpoint. Sci Total Environ. 2016; 578:383-391. DOI: 10.1016/j.scitotenv.2016.10.191. View

18.

Sofi F, Cesari F, Abbate R, Gensini G, Casini A . Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008; 337:a1344. PMC: 2533524. DOI: 10.1136/bmj.a1344. View

19.

Xavier Medina F . Food consumption and civil society: Mediterranean diet as a sustainable resource for the Mediterranean area. Public Health Nutr. 2011; 14(12A):2346-9. DOI: 10.1017/S1368980011002618. View

20.

Grosso G, Fresan U, Bes-Rastrollo M, Marventano S, Galvano F . Environmental Impact of Dietary Choices: Role of the Mediterranean and Other Dietary Patterns in an Italian Cohort. Int J Environ Res Public Health. 2020; 17(5). PMC: 7084186. DOI: 10.3390/ijerph17051468. View