Mediterranean Diet as a model of sustainable, resilient and healthy diet

Main Article Content

Maria Letizia Truzzi
Matteo Ballerini Puviani
Alberto Tripodi
Silvia Toni
Alberto Farinetti
Milena Nasi
Anna Vittoria Mattioli


Mediterranean Diet, sustainability, resilience, pyramids


A sustainable diet is characterized by food security and accessibility; healthy food, respect for environment
and biodiversity, fair trade, locality/Seasonality and protection of culture, heritage, and skills. Being
in line with these points, the Mediterranean Diet (MedD) has been largely recognized as sustainable and
healthy. As a matter of fact, the MedD is built on the consumption of olive oil, cereals, fruit and vegetables,
a moderate amount of fish, dairy and meat, and many condiments and spices, occasionally accompanied by
wine and coffee. In addition, the MedD promotes social interaction, it has given rise to a considerable body of
cultural habits, it is deeply rooted in local territory, it protects biodiversity, and it ensures the conservation and
development of traditional activities. In conclusion Mediterranean diet promotes not only disease prevention
but also a more advantageous and resilient economy.

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1. Dernini S, Berry EM, Serra-Majem L, La Vecchia C, Capone R, Medina FX, et al. Med Diet 4.0: the Mediterranean diet with four sustainable benefits. Public Health Nutr. 2017 May;20(7):1322-1330. doi: 10.1017/S1368980016003177.
2. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC Jr, Virani SS, Williams KA Sr, Yeboah J, Ziaeian B. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;000:e–e. DOI: 10.1161/CIR.0000000000000678
3. United Nations, Department of Economic and Social Affairs, Population Division. World population prospects: The 2017 revision, key findings and advance tables Working paper no. ESA/P/WP248. New York ; 2017
4. Mattioli AV, Palmiero P, Manfrini O, Puddu PE, Nodari S, Dei Cas A et al. Mediterranean diet impact on cardiovascular diseases: a narrative review. J Cardiovasc Med 2017; 18(12):925-935. doi: 10.2459/JCM.0000000000000573.
5. Dernini S, Berry EM, Bach-Faig A et al. (2012) A dietary model constructed by scientists: the Mediterranean diet. In Mediterranea 2012: The Mediterranean Diet for Sustainable Regional Development, pp. 71–88. Paris: CIHEAM–Les Presses de Sciences Po.
6. Bach-Faig A, Berry EM, Lairon D et al. (2011) Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr 14, 2274–2284
7. Zoghbi WA, Duncan T, Antman E Barbosa M, Champagne B, Chen D, et al. Sustainable Development Goals and the Future of Cardiovascular Health: A Statement From the Global Cardiovascular Disease Task force. J Am Heart Assoc. 2014 Sep 22;3(5):e000504. doi: 10.1161/JAHA.114.0005
8. Available from
9. Lairon D. Biodiversity and sustainable nutrition with a food-based approach. In: Sustainable diets and Biodiversity - Directions and solutions for policy, research and action. Roma: FAO; 2012. p. 30–5.
10. Donini LM, Dernini S, Lairon D, Serra-Majem L, Amiot M-J, del Balzo V, Giusti A-M, Burlingame B, Belahsen R, Maiani G, Polito A, Turrini A, Intorre F, Trichopoulou A and Berry EM (2016) A Consensus Proposal for Nutritional Indicators to Assess the Sustainability of a Healthy Diet: The Mediterranean Diet as a Case Study. Front. Nutr. 3:37. doi: 10.3389/fnut.2016.00037
11. Mattioli AV, Coppi F, Migaldi M, Farinetti A. Fruit and vegetables in hypertensive women with asymptomatic peripheral arterial disease. Clinical Nutrition ESPEN 27, October 2018, Pages 110-112
12. Mattioli AV, Migaldi M, Farinetti (2018) A. Coffee in hypertensive women with asymptomatic peripheral arterial disease: A potential nutraceutical effect. J Cardiovasc Med 19: 183-85.
13. Esteve-Llorens X, Darriba C, Moreira MT, Feijoo G, González-García S. Towards an environmentally sustainable and healthy Atlantic dietary pattern: Life cycle carbon footprint and nutritional quality. Sci Total Environ. 2018 Jul 25;646:704-715. doi: 10.1016/j.scitotenv.2018.07.264.
14. Caro PD. Recessions, Recoveries and Regional Resilience: Evidence on Italy.”Cambridge Journal of Regions, Economy and Society 2014, 2: 273–291, doi:10.1093/cjres/rsu029.
15. Alsaffar AA. Sustainable diets: the interaction between food industry, nutrition, health and the environment. Food Sci Technol Int. marzo 2016;22(2):102–11.
16. Friel S, Barosh LJ, Lawrence M. Towards healthy and sustainable food consumption: an Australian case study. Public Health Nutr. 2014;17(5):1156–66.
17. Behrens P, Kiefte-de Jong JC, Bosker T, Rodrigues JF, De Koning A, Tukker A. Evaluating the environmental impacts of dietary recommendations P Natl Acad Sci USA, 114 (51) (2017), pp. 13412-13417
18. Fresán U, Sabaté J. Vegetarian Diets: Planetary Health and Its Alignment with Human Health.Adv Nutr. 2019 Nov 1;10(Suppl_4):S380-S388. doi: 10.1093/advances/nmz019.
19. Reinhardt SL, Boehm R, Tichenor Blackstone N, El-Abbadi NH, McNally Brandow JS, Taylor SF, DeLonge MS. Systematic Review of Dietary Patterns and Sustainability in the United States, Advances in Nutrition, nmaa026,
20. James SW, Friel S. An integrated approach to identifying and characterising resilient urban food systems to promote population health in a changing climate. Public Health Nutr. 2015;18(13):2498–508.
21. Mattioli AV, Coppi F, Migaldi M, Scicchitano P, Ciccone MM, Farinetti A. Relationship between Mediterranean diet and asymptomatic peripheral arterial disease in a population of pre-menopausal women. Nutr Metab Cardiovasc Dis. 2017 Nov;27(11):985-990. doi: 10.1016/j.numecd.2017.09.011. Epub 2017 Oct 3.
22. Serra-Majem L., Roman-Vinas B., Sánchez-Villegas A., Guasch-Ferré M., Corella D., La Vecchia C. Benefits of the Mediterranean diet: Epidemiological and molecular aspects. Mol. Asp. Med. 2019;67:1–55. doi: 10.1016/j.mam.2019.06.001
23. Keys A., Mienotti A., Karvonen M.J., Aravanis C., Blackburn H., Buzina R., Djordjevic B., Dontas A., Fidanza F., Keys M.H. The diet and 15-year death rate in the seven countries study. Am. J. Epidemiol. 1986;124:903–915. doi: 10.1093/oxfordjournals.aje.a114480.
24. Kargin D, Tomaino L, Serra-Majem L. Experimental Outcomes of the Mediterranean Diet: Lessons Learned from the Predimed Randomized Controlled Trial. Nutrients. 2019;11(12):2991. Published 2019 Dec 6. doi:10.3390/nu11122991
25. Kris-Etherton P., Eckel R.H., Howard B.V., St. Jeor S., Bazzarre T.L. AHA Science Adivsory: Lyon diet heart study: Benefits of a Mediterranean-Style, National Cholesterol Education Program/American Heart Association Step I dietary pattern on cardiovascular disease. Circulation. 2001;103:1823–1825. doi: 10.1161/01.CIR.103.13.1823
26. The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases. European Heart Journal (2020) 41, 255-323. doi:10.1093/eurheartj/ehz486
27. Dinu, M., Pagliai, G., Casini, A. et al. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr 72, 30–43 (2018).
28. Sans S. Mediterranean diet, active lifestyle and cardiovascular disease: A recipe for immortality? Eur J Prev Cardiol. 2018 Jul;25(11):1182-1185
29. Sciomer S, Moscucci F, Maffei S, Gallina S, Mattioli AV. Cardiovascular risk factors prevention in women: the life style paradox and stereotypes to defeat. Eur J Prev Cardiol. In press 2018. doi: 10.1177/2047487318810560
30. Mattioli AV, Sciomer S, Moscucci F, et al. Cardiovascular prevention in women: a narrative review from the Italian Society of Cardiology working groups on 'Cardiovascular Prevention, Hypertension and peripheral circulation' and on 'Women Disease'. J Cardiovasc Med (Hagerstown). 2019 Sep;20(9):575-583. doi: 10.2459/JCM.0000000000000831
31. LiveWell for LIFE, WWF. Adopting healthy, sustainable diets: key opportunities and barriers - Report. 2013. Available at:
32. Vieux F, Darmon N, Touazi D, Soler LG. Greenhouse gas emissions of self-selected individual diets in France: changing the diet structure or consuming less? Ecol Econ. marzo 2012;75:91–101.
33. Macdiarmid JI. Is a healthy diet an environmentally sustainable diet? Proc Nutr Soc. Febbraio 2013;72(01):13–20.
34. Macdiarmid, J.I., Kyle, J., Horgan, G.W., Loe, J., Fyfe, C., Johnstone, A.,McNeill, G., Sustainable diets for the future: can we contribute to reducing greenhouse gas emissions by eating a healthy diet? The American journal of clinical nutrition 2012. 96 (3), 632–639.
35. Clonan A, Holdsworth M. The challenges of eating a healthy and sustainable diet. Am J Clin Nutr. 2012;96(3):459–60.
36. Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, de Souza Dias BF, Ezeh A, Frumkin H, Gong P, Head P, et al. Safeguarding human health in the Anthropocene epoch: report of the Rockefeller Foundation-Lancet Commission on Planetary Health. Lancet 2015;386(10007):1973–2028
37. Graça, J., Calheiros, M.M., Oliveira, A., 2014. Moral disengagement in harmful but cherished food practices? An exploration into the case of meat. J Agr Environ Ethic 27 (5), 749–765. http://doi.10.1007/s10806-014-9488-9.
38. Mattioli AV, Nasi M, Coppi F, Gelmini R, Farinetti A. Relationship between socioeconomic status and asymptomatic peripheral arterial disease: a retrospective study. J Cardiovasc Med 2020 in press

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