Nutritional indicators to assess the sustainability of the Mediterranean diet

Abstract : There is increasing evidence of the multiple effects of diets on public health nutrition, society and environment. Sustainability and food security are closely inter-related. The traditional Mediterranean diet (MD) is recognized as a healthier dietary pattern with a lower environmental impact. As a case study, the MD may guide innovative inter-sectorial efforts to counteract the degradation of ecosystems and loss of biodiversity and homogeneity of diets due to globalization, through the improvement of sustainable healthy dietary patterns. This chapter defines a suite of the most appropriate nutrition and health indicators for assessing the sustainability of diets based on the MD. Thirteen nutrition indicators of sustainability were identified in five areas: biochemical characteristics of food (A1. Vegetable/animal protein consumption ratios; A2. Average dietary energy adequacy; A3. Dietary energy density score; A4. Nutrient density of diet and foods); food quality (A5. Fruit and vegetable consumption/intakes; A6. Dietary diversity score); environment (A7. Food biodiversity composition and consumption; A8. Local/regional foods and seasonality; A9. Organic/eco-friendly production and consumption); lifestyle (A10. Physical activity/physical inactivity prevalence; A11. Adherence to the Mediterranean dietary pattern); and clinical aspects (A12. Diet-related morbidity/mortality statistics; A13. Nutritional anthropometry). These proposed nutrition indicators will be a useful methodological framework for designing health, education and agricultural policies in order to conserve the traditional diets of the Mediterranean area as a common cultural heritage and lifestyle and also to enhance the sustainability of diets in general.