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The Influence of Mediterranean Diet on Health and Environment

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 56649

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Prof. Francesca Scazzina

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Human Nutrition Unit, Department of Food and Drug , University of Parma , Parma , Italy
Interests: - Complex carbohydrate, dietary fibre, prebiotics and antioxidants in foods, and their effects on metabolism and intestinal functions. - Food educational health learning programs and children population surveys. - Child malnutrition in developing countries - Diet sustainability, applying the nutritionist's viewpoint to a topic that had been mainly faced with an ecological approach.
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Dr. Alice Rosi

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Human Nutrition Unit, Department of Food and Drugs, University of Parma, Parma, Italy
Interests: dietary assessment; food intake; dietary patterns; nutrients; biomarkers; appetite and satiety regulation; food choices; lifestyle; diet sustainability; nutrition education

Special Issue Information

Dear Colleagues,

Besides being an UNESCO intangible cultural heritage of humanity, the Mediterranean diet is worldwide recognised as a healthy dietary pattern. A large body of evidence has shown that the Mediterranean diet exerts a preventive effect with regard to several non-communicable chronic diseases. It is also associated with a better quality of life and a reduction in overall mortality. At the same time, the Mediterranean diet has been described as a sustainable dietary approach resulting in a low environmental impact.

An in-depth understanding of the key elements of the Mediterranean diet, of the underlying mechanisms impacting human health, and of the intrinsic and extrinsic barriers and drivers towards such dietary regimen is needed to support current evidence, to provide new insights and to identify the most effective strategies to promote a higher adherence to the Mediterranean diet.

This Special Issue of the International Journal of Environmental Research and Public Health, entitled “Influence of the Mediterranean Diet on Health and the Environment”, welcomes manuscripts describing original research or reviewing the scientific literature. Potential manuscripts include, but are not limited to, works regarding the relationship between the Mediterranean diet and various health and environmental outcomes:

human and animal studies, epidemiological, clinical and preclinical studies on the association between adherence to the Mediterranean diet and the risk of cardiovascular disease, cancer and other non-communicable chronic diseases, on nutritional or metabolic outcomes and/or environmental outcomes;
interventional studies aimed at improving adherence to the Mediterranean diet in both Mediterranean and non-Mediterranean countries;
studies investigating the determinants of Mediterranean food choices (psychological, socioeconomic and/or sensorial factors influencing food choices);
systematic reviews and meta-analyses focused on the association between adherence to the Mediterranean diet and human health and/or environmental impact.

Prof. Dr. Francesca Scazzina
Dr. Alice Rosi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Mediterranean Diet
Sustainability of dietary patterns
Health & prevention
Dietary behaviour
Lifestyle
Physical activity
IT for health

Published Papers (10 papers)

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Research

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12 pages, 1159 KiB

Open AccessArticle

Alcohol Consumption, Bone Mineral Density, and Risk of Osteoporotic Fractures: A Dose–Response Meta-Analysis

by Justyna Godos, Francesca Giampieri, Emanuele Chisari, Agnieszka Micek, Nadia Paladino, Tamara Y. Forbes-Hernández, José L. Quiles, Maurizio Battino, Sandro La Vignera, Giuseppe Musumeci and Giuseppe Grosso

Int. J. Environ. Res. Public Health 2022, 19(3), 1515; https://doi.org/10.3390/ijerph19031515 - 28 Jan 2022

Cited by 26 | Viewed by 5634

Abstract

Excess alcohol consumption is known to be detrimental to human health. However, the role of light-to-moderate alcohol intake is under investigation for potential certain health benefits—mostly related to the cardiovascular system. Nevertheless, there is no univocal agreement on this matter, and research is still ongoing to clarify whether there might be other potential outcomes affected by alcohol intake. In this regard, there is evidence that excess alcohol intake may negatively influence the risk of osteoporotic fractures. However, there is no comprehensive evidence of literature assessing the role of alcohol consumption in bone mineral density (BMD) and the risk of osteoporotic fractures. Thus, the aim of this study was to quantitatively assess the dose–response relationship between alcohol intake and BMD and risk of osteoporotic fractures. The Embase and MEDLINE electronic databases were searched from their inception to December 2021 for articles providing a quantifiable measurement of alcohol consumption for at least three categories and (1) a measurement of BMD (and dispersion as continuous variables) in some area of the body or (2) risk of osteoporotic fracture provided as relative risk (RR) or hazard ratio (HR), with a 95% confidence interval (CI) as the measure of the association of each category with alcohol intake. A total of 11 studies including 46,916 individuals with BMD assessment and 8 studies including 240,871 individuals with risk of fracture analysis were included. Compared to non-drinkers, consumption of up to two standard drinks of alcohol per day was correlated with higher lumbar and femur neck BMD values, while up to one standard drink of alcohol was correlated with higher hip BMD compared to no alcohol consumption. Higher risk of hip fractures was found starting from three standard drinks of alcohol per day (RR = 1.33, 95% CI: 1.04; 1.69 for three alcoholic drinks/d, and RR = 1.59, 95% CI: 1.23; 2.05 for four alcoholic drinks/d) compared to no alcohol consumption, with no evidence of heterogeneity. Concerning the risk of any osteoporotic fractures, the risk steadily increased with higher intake of alcohol, although never reaching statistical significance. In conclusion, there is consistent evidence that increased alcohol consumption is associated with higher risk of osteoporotic hip fracture; however, the role of alcohol at lower doses is uncertain, as BMD was even higher in light drinkers compared to abstainers. Full article

(This article belongs to the Special Issue The Influence of Mediterranean Diet on Health and Environment)

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16 pages, 917 KiB

Open AccessArticle

Study Protocol of a Multicenter Randomized Controlled Trial to Tackle Obesity through a Mediterranean Diet vs. a Traditional Low-Fat Diet in Adolescents: The MED4Youth Study

by Noemi Boqué, Lucía Tarro, Alice Rosi, Helena Torrell, Guillermo Saldaña, Elisa Luengo, Zeev Rachman, António Pires, Nuno Tiago Tavares, Ana Salomé Pires, Maria Filomena Botelho, Pedro Mena, Francesca Scazzina, Daniele Del Rio and Antoni Caimari

Int. J. Environ. Res. Public Health 2021, 18(9), 4841; https://doi.org/10.3390/ijerph18094841 - 01 May 2021

Cited by 3 | Viewed by 3422

Abstract

Youth obesity is a strong predictor of adult obesity, which has well-known negative health consequences. Thus, addressing adult obesity requires tackling youth obesity. MED4Youth’s main objective is to strengthen the link between the Mediterranean Diet (MD) and the health benefits against youth obesity and associated cardiovascular disease (CVD) risk factors, identifying positive effects exerted by an MD including sourdough bread and healthy products from the Mediterranean basis (chickpeas/hummus, nuts, and pomegranate juice). For this purpose, a multicenter randomized controlled trial in which an MD-based intervention will be compared to a traditional low-fat diet intervention will be carried out with 240 overweight and obese adolescents (13–17 years) from Spain, Portugal, and Italy. Both interventions will be combined with an educational web-application addressed to engage the adolescents through a learning-through-playing approach, using both educational materials and games. To assess the interventions, adherence to the MD, dietary records, physical activity, food frequency, sociodemographic, and quality of life questionnaires as well as classical anthropometric and biochemical parameters will be evaluated. Furthermore, an omics approach will be performed to elucidate whether the interventions can shape the gut microbiota and gut-derived metabolites to gain knowledge on the mechanisms through which the MD can exert its beneficial effects. Full article

(This article belongs to the Special Issue The Influence of Mediterranean Diet on Health and Environment)

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19 pages, 1292 KiB

Open AccessArticle

Determinants of US University Students’ Willingness to Include Whole Grain Pasta in Their Diet

by Rungsaran Wongprawmas, Giovanni Sogari, Davide Menozzi, Nicoletta Pellegrini, Michele Lefebvre, Miguel I. Gómez and Cristina Mora

Int. J. Environ. Res. Public Health 2021, 18(6), 3173; https://doi.org/10.3390/ijerph18063173 - 19 Mar 2021

Cited by 8 | Viewed by 3541

Abstract

College students’ lifestyle and eating habits strongly affect their health. Among many healthy eating behaviors, including whole grain food in the diet is known as providing health benefits such as maintaining a steady blood sugar, lower cholesterol, and since it is rich in fiber and minerals, it is essential for the well-being. However, consumers’ intakes of whole grain products remain below recommendation, including college students. This study aims to evaluate determinant factors contributing to college students’ willingness to include whole grain pasta in their diets. A sample of 499 students enrolled in a US college participated in this study. Most students perceived whole grain pasta as healthy and filling and somewhat tasty. Availability and price were not barriers for consumption. Logistic regression results suggested that factors affecting students’ willingness to consume whole grain pasta in the future were the desire to eat, cognitive and affective attitudes, perception of whole grain pasta, as well as having already chosen pasta thanks to its availability at the dining. Two student segments were identified according to their healthy eating perception: Uninvolved and Health-conscious. Cognitive attitudes such as beneficial and essential had positive effects on consumption in both segments, suggesting that information provision covering specific health/nutritional benefits of whole grains for students is crucial. Full article

(This article belongs to the Special Issue The Influence of Mediterranean Diet on Health and Environment)

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11 pages, 340 KiB

Open AccessArticle

Total Nut, Tree Nut, and Peanut Consumption and Metabolic Status in Southern Italian Adults

by Agnieszka Micek, Justyna Godos, Achille Cernigliaro, Raffaele Ivan Cincione, Silvio Buscemi, Massimo Libra, Fabio Galvano and Giuseppe Grosso

Int. J. Environ. Res. Public Health 2021, 18(4), 1847; https://doi.org/10.3390/ijerph18041847 - 14 Feb 2021

Cited by 12 | Viewed by 3480

Abstract

Background: Nut consumption has been associated with cardio-metabolic health benefits. However, studies conducted in the Southern Italian population, where adherence to the Mediterranean diet has been reported being relatively high, are rather scarce. The aim of this study was to test the association between consumption of total and specific types of nuts and metabolic status among adults living in Sicily, Southern Italy. Methods: Demographic and dietary characteristics of 2044 adults living in Southern Italy were analyzed. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of the association between nut consumption and metabolic status adjusting for potential confounding factors. Results: The energy-adjusted model revealed that higher nut intake was inversely associated with occurrence of hypertension, type-2 diabetes, and dyslipidemia. However, the association did not remain significant for the latter after adjusting for the main background characteristics, while an inverse association was stably confirmed for hypertension (OR = 0.61, 95% CI: 0.46–0.80 and OR = 0.44, 95% CI: 0.26–0.74, respectively) even after adjusting for adherence to the Mediterranean diet. Among individual nut types, most of the associations were null except for higher almond intake, which was inversely associated with occurrence of hypertension (OR = 0.70, 95% CI: 0.49–0.99). Conclusions: Higher nut consumption is associated with overall better metabolic status in individuals living in the Mediterranean area. Full article

(This article belongs to the Special Issue The Influence of Mediterranean Diet on Health and Environment)

10 pages, 308 KiB

Open AccessArticle

Adherence to the Mediterranean Diet in Maltese Adults

by Sarah Cuschieri and Massimo Libra

Int. J. Environ. Res. Public Health 2021, 18(1), 10; https://doi.org/10.3390/ijerph18010010 - 22 Dec 2020

Cited by 16 | Viewed by 3060

Abstract

Background: Populations living in Mediterranean islands are experiencing a nutrition transition process from traditional to Westernized dietary patterns. No information on this matter regarding individuals living in Malta have been published to date. The aim of this study was to assess the level of adherence of the Maltese people to the Mediterranean diet and which factors were associated with it. Methods: A nationwide cross-sectional study was conducted in the island of Malta between 2014 and 2016. A literature-based Mediterranean diet adherence score was used to assess the level of adherence to the dietary pattern. Results: Out of 3947 adults, the overall Mediterranean diet adherence score mean was 7.19 (SD 1.91): being female, non-smoker, and having older age was associated with higher adherence to the Mediterranean diet. Less clear pattern of association was found for educational and occupational status, for which medium educational level and a high occupational level were associated with lower adherence to Mediterranean diet. Higher adherence was finally associated with consumption of healthier food groups (more rice and dark bread and less pasta and white bread; more all plant-food groups and fish, less animal-food sources, including fast foods; more light cheeses and yogurt were more frequently consumed among higher adherent individuals in spite of regular ones). Conclusions: Adherence to the Mediterranean diet in Malta is lower than in those of populations living in companion Mediterranean islands. Given the lack of data on this topic, further studies should be conducted among the Maltese people and public health nutrition interventions should be planned to improve current eating habits toward more traditional dietary patterns. Full article

(This article belongs to the Special Issue The Influence of Mediterranean Diet on Health and Environment)

14 pages, 696 KiB

Open AccessArticle

Adherence to the Mediterranean Diet and Environmental Impact of the Diet on Primary School Children Living in Parma (Italy)

by Alice Rosi, Beatrice Biasini, Michele Donati, Cristian Ricci and Francesca Scazzina

Int. J. Environ. Res. Public Health 2020, 17(17), 6105; https://doi.org/10.3390/ijerph17176105 - 21 Aug 2020

Cited by 13 | Viewed by 3231

Abstract

The key role of diet in both human health and environmental sustainability is well known. However, there is a lack of studies investigating the environmental impact of children’s dietary behavior. The aim of this observational study was to investigate the dietary environmental impact in a sample of primary school children living in Parma (Italy, n = 172, 8–10 years), in relation to their adherence to the Mediterranean diet (MD). Children completed a 3-day food record in both winter and spring. Dietary records were processed to obtain: (i) adherence to the MD and (ii) mean daily carbon and ecological footprints. Adherence to the MD was similar in winter and spring, with almost half of the participants showing a medium MD score. Carbon and ecological footprints were higher during winter, and the main dietary contributors were red and processed meat for both indexes. A small positive correlation was observed between adherence to the MD and total carbon and ecological footprints. This study provided the first analysis of the relationship between adherence to the MD and environmental impact of primary school children. Further research is needed to better investigate the environmental impact of primary school children’s diet and the possible relationship between the MD and environmental sustainability. Full article

(This article belongs to the Special Issue The Influence of Mediterranean Diet on Health and Environment)

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12 pages, 790 KiB

Open AccessArticle

The Influence of Emotional Intelligence on Resilience, Test Anxiety, Academic Stress and the Mediterranean Diet. A Study with University Students

by Rubén Trigueros, Ana M. Padilla, José M. Aguilar-Parra, Patricia Rocamora, María J. Morales-Gázquez and Remedios López-Liria

Int. J. Environ. Res. Public Health 2020, 17(6), 2071; https://doi.org/10.3390/ijerph17062071 - 20 Mar 2020

Cited by 77 | Viewed by 20595

Abstract

The academic transition to university is a turning point in young people’s lifestyles. However, studies to date have focused on student behaviour within the classroom context, rather than on the consequences it may have on their lifestyle. This study aims to analyze the influence of emotional intelligence of university students on their resilience, academic stress, exam anxiety, and eating habits related to the Mediterranean diet at the university stage. This study was carried out with the participation of 733 male and 614 female students from the University of Almeria, aged between 19 and 27. A structural equation model was made to explain the causal relationships between the variables. The results showed emotional intelligence positively predicted resilience. In turn, test anxiety and academic stress were negatively predicted by resilience. Finally, test anxiety and academic stress were negatively predicted by the Mediterranean diet. In short, the results of the present study have shown that academic transfer to university and grading pressure can generate maladaptive consequences for food consumption. Full article

(This article belongs to the Special Issue The Influence of Mediterranean Diet on Health and Environment)

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13 pages, 724 KiB

Open AccessArticle

Environmental Impact of Dietary Choices: Role of the Mediterranean and Other Dietary Patterns in an Italian Cohort

by Giuseppe Grosso, Ujué Fresán, Maira Bes-Rastrollo, Stefano Marventano and Fabio Galvano

Int. J. Environ. Res. Public Health 2020, 17(5), 1468; https://doi.org/10.3390/ijerph17051468 - 25 Feb 2020

Cited by 51 | Viewed by 5159

Abstract

Background: Current scientific literature suggests healthy dietary patterns may have less environmental impact than current consumption patterns, but most of the studies rely on theoretical modeling. The aim of this study was to assess the impact on resources (land, water, and energy) use and greenhouse gas (GHG) emissions of healthy dietary patterns in a sample of Italian adults. Methods: Participants (n = 1806) were recruited through random sampling in the city of Catania, southern Italy. Dietary consumption was assessed through a validated food frequency questionnaire (FFQ); dietary patterns were calculated through dietary scores. The specific environmental footprints of food item production/processing were obtained from various available life-cycle assessments; a sustainability score was created based on the impact of the four environmental components calculated. Results: The contribution of major food groups to the environmental footprint showed that animal products (dairy, egg, meat, and fish) represented more than half of the impact on GHG emissions and energy requirements; meat products were the stronger contributors to GHG emissions and water use, while dairy products to energy use, and cereals to land use. All patterns investigated, with the exception of the Dietary Approach to Stop Hypertension (DASH), were linearly associated with the sustainability score. Among the components, higher adherence to the Mediterranean diet and Alternate Diet Quality Index (AHEI) was associated with lower GHG emissions, dietary quality index-international (DQI-I) with land use, while Nordic diet with land and water use. Conclusions: In conclusion, the adoption of healthy dietary patterns involves less use of natural resources and GHG emissions, representing eco-friendlier options in Italian adults. Full article

(This article belongs to the Special Issue The Influence of Mediterranean Diet on Health and Environment)

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14 pages, 318 KiB

Open AccessArticle

Determinants of Adherence to the Mediterranean Diet: Findings from a Cross-Sectional Study in Women from Southern Italy

by Andrea Maugeri, Martina Barchitta, Valerio Fiore, Giuliana Rosta, Giuliana Favara, Claudia La Mastra, Maria Clara La Rosa, Roberta Magnano San Lio and Antonella Agodi

Int. J. Environ. Res. Public Health 2019, 16(16), 2963; https://doi.org/10.3390/ijerph16162963 - 17 Aug 2019

Cited by 37 | Viewed by 3240

Abstract

The Mediterranean diet (MD)—the dietary pattern usually consumed by Mediterranean populations—can help promote a favorable health status and better quality of life. Uncovering the main factors associated with the adherence to MD may be useful in understanding and counteracting the global shift toward a Western diet, which has been documented also in the Mediterranean region. Here, we evaluated the adherence to MD and its major social and behavioral determinants in women from Catania, Southern Italy. This cross-sectional study included 841 women, aged 25–64 years, with no history of severe diseases. Adherence to MD was assessed by the Food Frequency Questionnaire and Mediterranean Diet Score (MDS). Associations between variables were tested by multivariable logistic regression analysis and expressed as an odds ratio (OR) with a 95% confidence interval (CI). Among social factors, medium and high educational levels were associated with an ideal intake of alcohol (OR = 4.059; 95%CI = 1.311–12.570; p = 0.015; OR = 4.258 95%CI = 1.068–16.976; p = 0.040; respectively), living in a couple with ideal intake of cereals (OR = 2.801 95%CI = 1.188–6.602; p = 0.018), and having children with an ideal intake of fruits (OR = 3.149; 95%CI = 1.245–7.762; p = 0.015). With respect to behaviors, current smoking was negatively associated with an ideal intake of meat (OR = 0.449; 95%CI = 0.0220–0.917; p = 0.028), while more engagement in physical activity was associated with an ideal intake of vegetables (OR = 6.148; 95%CI = 1.506–25.104; p = 0.011) and legumes (OR = 5.832; 95%CI = 1.414–24.063; p = 0.015). In line with these findings, moderately or highly physically active women were more likely to show medium or high adherence to MD than those who performed less physical activity (OR = 6.024; 95%CI = 1.192–30.440; p = 0.040; OR = 9.965 95%CI = 1.683–58.993; p = 0.011; respectively). Our results confirm an urgent need for public health strategies, which should take into account determinants of diet quality. Particularly, our study indicates that more engagement in physical activity is a major positive determinant of the adherence to MD. Full article

(This article belongs to the Special Issue The Influence of Mediterranean Diet on Health and Environment)

Review

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17 pages, 3631 KiB

Open AccessReview

Mediterranean Lifestyle to Promote Physical, Mental, and Environmental Health: The Case of Chile

by Guadalupe Echeverría, Ornella Tiboni, Loni Berkowitz, Victoria Pinto, Bárbara Samith, Andrea von Schultzendorff, Nuria Pedrals, Marcela Bitran, Chiara Ruini, Carol D. Ryff, Daniele Del Rio and Attilio Rigotti

Int. J. Environ. Res. Public Health 2020, 17(22), 8482; https://doi.org/10.3390/ijerph17228482 - 16 Nov 2020

Cited by 22 | Viewed by 4151

Abstract

Chile is currently experiencing a progressive epidemiological transition towards chronic diseases. In this country, >50% of annual deaths are attributed to cardiovascular disease and cancer. Moreover, health surveys have shown high prevalence of obesity, diabetes, hypertension, and elevated cardiovascular disease risk. In addition, mental health issues are also frequent among Chilean adults. On the other hand, the agri-food system contributes to 21–37% of greenhouse gases emissions worldwide. Overall, current health and food chain situation calls out for design and implementation of evidence-based feasible and effective nutritional interventions needed to promote physical and mental health along with addressing food sustainability in Chile. Nowadays, the Mediterranean diet is recognized as one of the healthiest dietary patterns based on observational and interventional studies linked to a wide variety of health outcomes. However, a Mediterranean lifestyle goes well beyond food intake: it includes promotion of psychosocial resources, community life as well as cultural traditions. Indeed, Mediterranean lifestyle is a true modus vivendi that integrally promotes physical, mental, and social well-being. In addition, the Mediterranean diet stands out for its environmental sustainability because it is characterized mainly as a plant-based dietary pattern with low carbon and water footprints. Remarkably, Central Chile has a Mediterranean-like setting with plant and animal food production and availability patterns comparable to those present in countries located around the Mediterranean Sea. Therefore, this article reviews how promotion of Mediterranean lifestyle adherence in Chile offers great potential for management of the ongoing epidemiological transition to chronic diseases as well to promote psychological well-being within a unique food system and dietary sustainability vision for this Latin American country. Full article

(This article belongs to the Special Issue The Influence of Mediterranean Diet on Health and Environment)

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