Table 3.
Summary of studies reporting MedDiet sustainability using dietary scenarios.
| References | Location | Dietary scenarios | Sustainability indicators | Main findings |
|---|---|---|---|---|
| Belgacem et al. (31) | Not applicable | •MedDiet •European dietary pattern •Western dietary pattern |
•Land use •Water use •GHGs emissions •Eutrophication potential |
•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 g PO4eq/capita/day reductions in eutrophication potential. •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 g PO4eq/capita/day reduction in eutrophication potential. |
| Vanham et al. (32) | Nine Mediterranean countries (Spain, France, Italy, Greece, Turkey, Egypt, Tunisia, Algeria and Morocco) | •MedDiet •EAT-Lancet reference diet |
•WF | •The EAT-Lancet diet requires less water resources than the MedDiet. In terms of water resources use, adherence to the former is thus more beneficial than adherence to the latter. •The EAT-Lancet diet reduces the current WF for all nations consistently, within the range−17–48%, whereas the MedDiet reduces the WF of the European countries, Turkey, Egypt and Morocco within the range of−4-−35%. •For the Maghreb countries Tunisia and Algeria, the Mediterranean diet WF is slightly higher compared to the current WF. |
| Gonzalez-García et al. (33) | Spain | •MedDiet •SEAD •NAOS |
•CF •WF •Cost |
•The dietary energy recommendation of the SEAD is greater than that of MedDiet and NAOS (11 and 15%, respectively), and SEAD also has greater animal source food content than the other two diets. •SEAD has a concomitantly higher CF, WF and cost scores in comparison with MD (+30, +23, and +21%, respectively) and NAOS (+15, +9, and +21%, respectively). •Adjusting recommendations to meet the suggested Spanish adult dietary energy of 2,228 kcal·capita−1·day−1 changed the environmental profiles of the diets, and the NAOS has the highest environmental impact. •Isocaloric diets had approximately the same cost. •Regardless of the dietary scenario, better scores were identified for the Spanish recommendations analyzed than those reported for other healthy diets identified in Europe. |
| Chapa et al. (34) | United States | •MedDiet •Healthy U.S. diet •Lacto-ovo vegetarian diet •Typical American diet |
•NRF9.3 •NQI •FF •Global warming potential |
•Vegetarian diets on average generated the lowest carbon footprint regardless of the NRF9.3, NQI and FF. •Animal products, including meat and dairy especially, and discretionary foods were identified as the specific food categories that contributed the most to the global warming potential. |
| Blackstone et al. (35) | United States | •MedDiet •Healthy US-style diet •Healthy vegetarian dietary pattern |
•Global warming potential •Land use •Water use •Freshwater eutrophication •Marine eutrophication •Particulate matter or respiratory organics. |
•The Healthy US-style dietary pattern and MedDiet pattern had similar impacts, except for freshwater eutrophication. •Freshwater eutrophication was 31% lower in the US pattern than the MedDiet pattern, primarily due to increased seafood in the MedDiet pattern. •All three patterns had similar water depletion impacts, with fruits and vegetables as major contributors. •For five of the six impacts, the Healthy vegetarian dietary pattern had 42–84% lower burdens than both the Healthy US-style dietary pattern and MedDiet pattern. •Reliance on plant-based protein and eggs in the Healthy vegetarian dietary pattern vs. emphasis on animal-based protein in the other patterns was a key driver of differences. |
| Ulaszewska et al. (36) | Italy | •MedDiet •New Nordic Diet |
•GHGs emissions | •Consumption of high protein foods has a similar and comparable environmental impact to fruit and vegetable consumption. •Mediterranean Diet and New Nordic Diet had similar total values of GHG emissions. |
| van Dooren et al. (37) | Netherlands | •MedDiet •New Nordic Diet •Optimized Low Lands Diet |
•GHGs emissions •Land use •Combined GHGE–LU Score •Health score |
•An optimized Low Lands Diet has the same healthy nutritional characteristics (Health Score 123) as the Mediterranean Diet (122) and results in a lower environmental impact than the Mediterranean and New Nordic Diet (higher Combined GHGE-LU Score 121 vs. 90 and 91). •For optimized Low Lands Diet, GHGs emissions are 2.60 kg CO2eq per day and land use are 2.86 m2*year per day, which are the best scores of all diets analyzed. |
| •Vanham et al. (38) | •13 Mediterranean cities (Dubrovnik, Lyon, Athens, Jerusalem, Genova, Pisa, Bologna, Reggio Emilia, Ljubljana, Manresa, Zaragoza, Ankara and Istanbul) | •Healthy MedDiet •Healthy pesco-vegetarian MedDiet •Healthy vegetarian MedDiet |
•WF | •Compared to reference situation, adoption of Healthy MedDiet (including meat), leads to WF reductions of −19–43%. The Healthy pesco-vegetarian MedDiet leads to WF reductions of −28–52%. The Healthy vegetarian MedDiet leads to WF reductions of −30–53%. |
| Blas et al. (39) | Spain and United States | •MedDiet •Typical American diet |
•WF | •American diet has a 29% higher WF in comparison with the MedDiet, regardless of product's origin. •A shift to a Mediterranean diet would decrease the WF by 1,629 L/person/day in the US. A shift toward an American diet in Spain will increase the WF by 1,504 L/person/day. |
| Pairotti et al. (40) | Italy | •MedDiet •Italian average diet •Healthy consumption pattern •Vegetarian consumption pattern |
•Cost •Energy use •CF |
•When compared with the Italian average diet, the MedDiet revealed an improvement in environmental performance of 95.75 MJ (2.44%) and 27.46 kg CO2 equivalent (6.81%) per family. •The best overall environmental performance can be found with the vegetarian diet in which energy consumption is 3.14% lower and the carbon footprint 12.7% lower than the Italian average diet. |
| Rahmani et al. (41) | Iran | •Status-quo diet •MedDiet •WHO recommendations •WCRF recommendation |
•Total changes in output •Environmental load |
•Compared to Sattus-quo diet, total changes in output in WHO, WCRF and Mediterranean dietary scenarios were calculated to be 7010.1, 4802.8 and 3330.8 billion Rials respectively. •The environmental load increased for three dietary scenarios in comparison with the status-quo diet. The greatest and smallest environmental load occurred in WHO and Mediterranean dietary scenarios respectively. |
MedDiet, Mediterranean diet; SEAD, Southern European Atlantic diet; NAOS, Spanish dietary guidelines; WHO, World Health Organization; WCRF, World Cancer Research Fund; GHGs, Greenhouse Gases; WF, Water Footprint; CF, Carbon Footprint; NRF9.3, Nutrient Rich Foods Index 9.3; NQI, Nutritional Quality Index; FF, Fullness Factor™; GHGE-LU, Greenhouse Gases Emissions-Land Use.