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The Mediterranean diet pattern has been consistently associated with health benefits but less is known about the association with environmental and economic sustainability in the United States (US). This information is needed to support sustainable policy agendas and provide consumers with evidence-based information needed to make informed food choices. This study fills this research gap by evaluating the environmental sustainability and diet cost associated with adherence to the Mediterranean diet pattern in the US. Dietary data from the National Health and Nutrition Examination Survey (2011-2018, n = 17,079) were merged with data on environmental impacts (greenhouse gas emissions, cumulative energy demand, water scarcity footprint), agricultural resource demand (land, fertilizer nutrients, and pesticides), and food prices from multiple publicly available databases. The Mediterranean Diet Score was used to evaluate adherence to the Mediterranean diet pattern. Multivariable linear regression models were used to evaluate the association between adherence to the Mediterranean diet pattern and environmental impacts, agricultural resource demand, and diet cost. Sensitivity analyses were used to evaluate adjustment of loss and waste and food-away-from-home prices. Greater adherence to the Mediterranean diet pattern was associated with lower greenhouse gas emissions (p < 0.001), land use (p < 0.001), fertilizer nutrient use (p < 0.001), and pesticide use (p < 0.001), higher water scarcity footprint (p < 0.001) and diet cost (p < 0.001), and no change in cumulative energy demand (p = 0.147). These changes were driven primarily by reduced intake of animal-sourced foods such as beef dishes, meat sandwiches, and dairy, as well as decreased intake of refined carbohydrate foods such as refined grain dishes and soft drinks. This nationally representative study demonstrates that greater adherence to the Mediterranean diet pattern is associated with sustainability trade-offs. These findings have implications for the development of sustainable dietary guidelines and clinical practice guidelines that can be used to inform consumer food choices.

The Mediterranean diet pattern has been consistently associated with health benefits but less is known about the association with environmental and economic sustainability in the United States (US). This information is needed to support sustainable policy agendas and provide consumers with evidence-based information needed to make informed food choices. This study fills this research gap by evaluating the environmental sustainability and diet cost associated with adherence to the Mediterranean diet pattern in the US. Dietary data from the National Health and Nutrition Examination Survey (2011-2018, n = 17,079) were merged with data on environmental impacts (greenhouse gas emissions, cumulative energy demand, water scarcity footprint), agricultural resource demand (land, fertilizer nutrients, and pesticides), and food prices from multiple publicly available databases. The Mediterranean Diet Score was used to evaluate adherence to the Mediterranean diet pattern. Multivariable linear regression models were used to evaluate the association between adherence to the Mediterranean diet pattern and environmental impacts, agricultural resource demand, and diet cost. Sensitivity analyses were used to evaluate adjustment of loss and waste and food-away-from-home prices. Greater adherence to the Mediterranean diet pattern was associated with lower greenhouse gas emissions (p < 0.001), land use (p < 0.001), fertilizer nutrient use (p < 0.001), and pesticide use (p < 0.001), higher water scarcity footprint (p < 0.001) and diet cost (p < 0.001), and no change in cumulative energy demand (p = 0.147). These changes were driven primarily by reduced intake of animal-sourced foods such as beef dishes, meat sandwiches, and dairy, as well as decreased intake of refined carbohydrate foods such as refined grain dishes and soft drinks. This nationally representative study demonstrates that greater adherence to the Mediterranean diet pattern is associated with sustainability trade-offs. These findings have implications for the development of sustainable dietary guidelines and clinical practice guidelines that can be used to inform consumer food choices.

The Mediterranean diet pattern has been consistently associated with health benefits but less is known about the association with environmental and economic sustainability in the United States (US). This information is needed to support sustainable policy agendas and provide consumers with evidence-based information needed to make informed food choices. This study fills this research gap by evaluating the environmental sustainability and diet cost associated with adherence to the Mediterranean diet pattern in the US. Dietary data from the National Health and Nutrition Examination Survey (2011-2018, n = 17,079) were merged with data on environmental impacts (greenhouse gas emissions, cumulative energy demand, water scarcity footprint), agricultural resource demand (land, fertilizer nutrients, and pesticides), and food prices from multiple publicly available databases. The Mediterranean Diet Score was used to evaluate adherence to the Mediterranean diet pattern. Multivariable linear regression models were used to evaluate the association between adherence to the Mediterranean diet pattern and environmental impacts, agricultural resource demand, and diet cost. Sensitivity analyses were used to evaluate adjustment of loss and waste and food-away-from-home prices. Greater adherence to the Mediterranean diet pattern was associated with lower greenhouse gas emissions (p < 0.001), land use (p < 0.001), fertilizer nutrient use (p < 0.001), and pesticide use (p < 0.001), higher water scarcity footprint (p < 0.001) and diet cost (p < 0.001), and no change in cumulative energy demand (p = 0.147). These changes were driven primarily by reduced intake of animal-sourced foods such as beef dishes, meat sandwiches, and dairy, as well as decreased intake of refined carbohydrate foods such as refined grain dishes and soft drinks. This nationally representative study demonstrates that greater adherence to the Mediterranean diet pattern is associated with sustainability trade-offs. These findings have implications for the development of sustainable dietary guidelines and clinical practice guidelines that can be used to inform consumer food choices.

A healthy diet is the cornerstone of disease prevention, and dietary guidelines have been issued in most countries. We aimed to assess trends in compliance with dietary guidelines in the population of Geneva, Switzerland. Multiple cross-sectional, population-based surveys conducted between 1993 and 2016 in the canton of Geneva, Switzerland [20,310 participants (52.3% women, mean age 51.9 [plus or minus] 10.7 years)]. Trends in compliance with the Swiss dietary guidelines regarding food intake were assessed using logistic regression (a) for each guideline and (b) for at least three guidelines. Compliance before and after the first and second issuing of the guidelines was assessed. After multivariable adjustment, compliance with fruits increased overall [odds ratio and (95% confidence interval) for 1-year increase: 1.007 (1.003-1.012), p < 0.001], in men, participants aged over 45 and with low educational level. Compliance with vegetables increased overall [1.015 (1.008-1.022), p < 0.001], in both genders, age groups [45-54 and 55-64] and participants with low educational level. Compliance with meat increased in women [1.007 (1.001-1.013), p = 0.021] and participants with a university degree. Compliance with fresh fish increased in age group [55-64] [1.009 (1.000-1.018), p = 0.041]. Compliance with dairy products decreased overall [0.979 (0.972-0.986), p < 0.001] and in all groups studied, except for age group [65-74]. Compliance with at least three guidelines increased in age group [55-64] only [1.013 (1.002-1.024), p = 0.019]. No effect of the issuing of the guidelines was found. In the Geneva adult population, compliance with the Swiss dietary guidelines improved little. Issuing of dietary guidelines did not impact trends.

A healthy diet is the cornerstone of disease prevention, and dietary guidelines have been issued in most countries. We aimed to assess trends in compliance with dietary guidelines in the population of Geneva, Switzerland. Multiple cross-sectional, population-based surveys conducted between 1993 and 2016 in the canton of Geneva, Switzerland [20,310 participants (52.3% women, mean age 51.9 [plus or minus] 10.7 years)]. Trends in compliance with the Swiss dietary guidelines regarding food intake were assessed using logistic regression (a) for each guideline and (b) for at least three guidelines. Compliance before and after the first and second issuing of the guidelines was assessed. After multivariable adjustment, compliance with fruits increased overall [odds ratio and (95% confidence interval) for 1-year increase: 1.007 (1.003-1.012), p < 0.001], in men, participants aged over 45 and with low educational level. Compliance with vegetables increased overall [1.015 (1.008-1.022), p < 0.001], in both genders, age groups [45-54 and 55-64] and participants with low educational level. Compliance with meat increased in women [1.007 (1.001-1.013), p = 0.021] and participants with a university degree. Compliance with fresh fish increased in age group [55-64] [1.009 (1.000-1.018), p = 0.041]. Compliance with dairy products decreased overall [0.979 (0.972-0.986), p < 0.001] and in all groups studied, except for age group [65-74]. Compliance with at least three guidelines increased in age group [55-64] only [1.013 (1.002-1.024), p = 0.019]. No effect of the issuing of the guidelines was found. In the Geneva adult population, compliance with the Swiss dietary guidelines improved little. Issuing of dietary guidelines did not impact trends.

A healthy diet is the cornerstone of disease prevention, and dietary guidelines have been issued in most countries. We aimed to assess trends in compliance with dietary guidelines in the population of Geneva, Switzerland. Multiple cross-sectional, population-based surveys conducted between 1993 and 2016 in the canton of Geneva, Switzerland [20,310 participants (52.3% women, mean age 51.9 [plus or minus] 10.7 years)]. Trends in compliance with the Swiss dietary guidelines regarding food intake were assessed using logistic regression (a) for each guideline and (b) for at least three guidelines. Compliance before and after the first and second issuing of the guidelines was assessed. After multivariable adjustment, compliance with fruits increased overall [odds ratio and (95% confidence interval) for 1-year increase: 1.007 (1.003-1.012), p < 0.001], in men, participants aged over 45 and with low educational level. Compliance with vegetables increased overall [1.015 (1.008-1.022), p < 0.001], in both genders, age groups [45-54 and 55-64] and participants with low educational level. Compliance with meat increased in women [1.007 (1.001-1.013), p = 0.021] and participants with a university degree. Compliance with fresh fish increased in age group [55-64] [1.009 (1.000-1.018), p = 0.041]. Compliance with dairy products decreased overall [0.979 (0.972-0.986), p < 0.001] and in all groups studied, except for age group [65-74]. Compliance with at least three guidelines increased in age group [55-64] only [1.013 (1.002-1.024), p = 0.019]. No effect of the issuing of the guidelines was found. In the Geneva adult population, compliance with the Swiss dietary guidelines improved little. Issuing of dietary guidelines did not impact trends.

Tools for measuring adherence to sustainable healthy diets among children and adolescents are lacking. To advance methods for measuring adherence to sustainable healthy diets among children and adolescents by adapting an existing index, compare scores obtained using the original and adapted versions of the index in a sample of Chilean children, and describe the adapted index association with diet characteristics. The Planetary Health Diet Index (PHDI) was adapted to better reflect children's and adolescents' nutritional requirements. The adapted index (PHDI-C) comprises 16 components with a maximum score of 150 points. PHDI-C was piloted among a sample of 958 Chilean children (3-6 years) using dietary data collected in 2016 through single 24-h recalls. A decision tree and food disaggregation methodology were developed to guide the calculation of scores. Scores obtained using the original and adapted versions of the index were compared. Linear regression models adjusted by child's gender and age were fitted to explore associations between total PHDI-C score, dietary recall characteristics and nutritional composition of children's diets. PHDI accounted for 75.7% of children's total caloric intake, whereas PHDI-C accounted for 99.6%. PHDI & PHCI-C scores were low among this sample of children; however, mean total score was lower when using PHDI compared to PHDI-C [40.7(12.1) vs 50.1(14.6)]. Children's scores were very low for nuts & peanuts, legumes, dark green vegetables, whole cereals, tubers & potatoes, and added sugars components across both indices, but were higher for dairy products and eggs & white meats components when using the PHDI-C due to adjustments made to ensure nutritional adequacy. Mean total PHDI-C score was significantly lower on weekends and special occasions, and significantly higher when children reported having a special diet (e.g., vegetarian). Total PHDI-C score was negatively associated with total sugars, saturated fats, trans fats, and animal-based protein intake, and positively associated with total protein, plant-based protein, total carbohydrates, and total fibre intake. This study provides a replicable method for measuring adherence to sustainable healthy diets among children and adolescents that can be used to monitor trends and measure the effectiveness of actions targeting improving children's diets.