BACKGROUND: Dietary guidelines can be derived from dietary patterns known to be healthy such as the traditional Mediterranean diet. They can also be deduced by translating a set of nutrient recommendations into food combinations. However, the latter may vary depending on the decisions made by different expert committees. Objective: The objective was to compare the effect of removing or adding selected nutrient recommendations on the dietary changes needed to fulfill a whole set of nutrient recommendations. Design: For each adult participating in the French INCA dietary survey (Enquête Individuelle et Nationale sur les Consommations Alimentaires) (n = 1171), a nutritionally adequate diet was modeled that simultaneously met a whole set of nutrient goals (proteins, fiber, essential fatty acids, 10 vitamins, 9 minerals, sodium, saturated fatty acids, free sugars) while deviating the least from the observed diet in terms of food content. Eight sets of models were developed according to the inclusion or not of constraints on total fats, total carbohydrates, total MUFAs, and cholesterol. Results: Compared with the observed intakes, fulfilling the whole set of nutrient constraints systematically decreased total fats and increased total carbohydrates, even in the absence of specific constraints on those macronutrients. For whichever model used, a strong consistency was observed in the dietary changes needed to fulfill the constraints, and the greatest increases were seen for unsalted nuts, unrefined grains, legumes, fruit, fish and shellfish, and vegetables. Conclusion: Whether recommendations on total fats, MUFAs, or total carbohydrates are included or not in the definition of overall nutrient adequacy, foods typical of the Mediterranean diet are needed to reach overall nutrient adequacy