Mediterranean Diet Model Research Articles

A transnational movement to support the sustainable transition towards a healthy and Eco-friendly Agri-Food System through the promotion of MEDIET and its lifestyle in modern society: MEDIET4ALL

Abstract The Mediterranean diet is considered the world’s most evidence-based low processed eating pattern for promoting health and longevity while saving water/energy and conserving land. Unfortunately, due to the modern societal trends, adherence to the Mediterranean diet model is decreasing, while the consumption of takeout and ultra-processed foods and drinks (UPFDs) is exponentially growing, with alarming levels in many European-Mediterranean (EUR-MED) regions. The overall objective of “MEDIET4ALL” is to support the transition from UPFs culture to modern and sustainable Mediterranean diet through the creation of transnational movement aiming at implementing best practices and innovative solutions to enhance the convenience, modernity, competitivity, and shelf life of Mediterranean diet. To achieve this overall objective, different multidisciplinary tailored approaches are proposed. Specifically, multicenter databases of ingredients/food and their providers will be created to promote the accessibility. Additionally, a variety of highly nutritional and antioxidant-rich “Quick & Easy” recipes that respond to modern trends while following the Mediterranean diet and considering sustainability aspects will be developed. To preserve the eco-friendly and food safety characteristics and extend the shelf life of the Mediterranean diet products, active bio-packaging will also be designed. A strategic “MEDIET4ALL” platform and m-app integrating the abovementioned MEDIET4ALL products and combined Mediterranean lifestyle interventions tailored to each user profile will be developed. Traditional and technology-based awareness and motivational campaigns with extensive marketing and advertising actions to promote MEDIET4ALL movement are also programmed. Working under the concept of a multidisciplinary approach consortium, multiple impacts, particularly supporting the transition towards a healthy and sustainable MED diet and lifestyle, are expected.

Lifestyle intervention in workers with obesity and sedentary behavior: A pilot study for the “OTTiMo LavorO” project

BACKGROUND: Workplace barriers to physical activity (PA) and sedentary work contribute to obesity. Workplace lifestyle interventions are needed to reduce sedentary behavior. OBJECTIVE: The study evaluates the effects of a self-monitoring PA protocol plus diet on general health of workers with obesity. METHODS: Thirty-nine workers affected by obesity were enrolled in this pilot intervention study. Monthly and daily PA diary, six-minute walking test (6MWT), Short Form-36 health survey (SF-36), and Global Physical Activity Questionnaire (GPAQ) results were evaluated prior (T0) and at the end of the study (T1). A personalized low-calorie diet based on the Mediterranean diet model was also implemented. Participants followed the protocol from one to three months depending on the date of recruitment. RESULTS: Significant improvements in SF36 and GPAQ scores were recorded, along with reductions in sedentary activity, weight, and BMI (p < 0.001). 6MWT significantly increased from 462.5 [412.5–500] m at T0 to 500 [462.5–550] m at T1 (p < 0.001). A multiple linear regression analysis to investigate the impact of selected covariates (PA, body weight reduction, and sedentary time) on the 6MWT was significant in men. CONCLUSIONS: PA self-monitoring protocols and diets are effective and sustainable for workplace interventions. PA should be part of daily medical practice and occupational physicians should encourage behavioral changes in workers.

The Relationship of Adherence to the Mediterranean Diet with Disease Activity and Quality of Life in Crohn's Disease Patients.

Background and Objectives: Emerging evidence is placing the Mediterranean diet (MD) in the spotlight as a potential dietary model that could benefit inflammatory bowel disease (IBD) patients in terms of prevention and progress of the disease. The main aim of the present study is to shed some light on the relationship between the adherence to the MD and the degree of disease activity, as well as the quality of life in patients with Crohn's disease (CD). Materials and Methods: An administered questionnaire was used to assess and record a number of parameters, including recent medical and weight history, anthropometric characteristics, disease activity (in remission or active disease), and quality of life of both male and female CD patients. Moreover, the level of compliance of the participants to the Mediterranean diet model was evaluated and its relationship with disease activity and quality of life was investigated. Results: Adherence to the MD was significantly higher in patients with inactive disease than in those with active disease (p = 0.019). According to the correlation analysis conducted, adherence to the MD was negatively correlated with disease activity (p = 0.039) and positively correlated with quality of life (QoL) (p = 0.046) of the participants. Intake of fruits, vegetables, and dairy products was significantly higher in remission patients (p = 0.046, p = 0.001, p = 0.041, respectively). Conclusions: We conclude, according to the findings of the study, that adherence to the MD is associated with disease activity and QoL in patients with CD. Future research should focus on MD intervention studies on IBD patients in order to assess its effect on modulating disease activity/course and related inflammatory biomarkers.

Digital native students using nutritional apps: are they more adherent to a mediterranean diet model? Results from the good APPetite survey

Reading and understanding food labels are crucial steps in healthy dietary choices. Nutrition-related applications (n-apps) have increased in the recent years and the aim of this study was to assess the use and the perception of n-apps among a population of university students, also investigating the attitude and relationship with reading food labels and adherence to the Mediterranean diet (Medi-Lite score).In 2023, 316 students, mainly attending the courses of Medicine, Pharmacy and Dietetics at the University of Brescia, Italy, completed an anonymous and specifically designed survey. 33.9% of the students stated that they use or have used n-apps. The most used apps were Yuka, MyFitnessPal, Fat Secret and Yazio, especially for the ease of use, speed, nutritional values estimation and barcode reading. 53.2% and 53.5% of the students declared to be food information and nutrition label readers respectively and the Medi-Lite mean value was 9.98 ± 2.46. N-app-users were significantly more attentive to food information and nutrition label than app not-users (both p < 0.0001) and recorded a Medi-Lite score significantly higher (p = 0.0131).The present study found for the first time an extensive correlation between the use of n-apps, the food labels awareness and healthy eating habits in a digitally native population.

A cross-section from the consumer perspective on sustainable nutrition: consumer awareness and motivation status.

Sustainable diets and food production systems are important for healthy life and future generations. This goal should be reachable by consumer motivations. The study aim is the evaluation of awareness and knowledge of sustainability and logo/claims related with sustainability.Participants' knowledge about sustainability definition and logos/claims related to sustainability were assessed by an online-questionnaire. The questionnaire involved the calculation of annual dietary carbon emissions (kg), nitrogen waste (g), and water consumption (L).Four hundred-two volunteers participated in the study (male: 24.9%; female: 75.1). Only 44 participants (10.9%) explained what sustainable nutrition definition, correctly. The rates of knowledge about logos were quite low; 29.4% for organic product logo; 26.6% for Good farming practice logo; 86.1% for Recycle logo; and 8.0% for Eco-label logo, respectively. The education status of participants affected to knowledge of logo/claim ratio (p < 0.05). Ethic production and environmental impact statement information were care of participants' ratio of 33.6% and 34.1%, respectively. The mean dietary carbon emission of participants was 551.0 ± 343.6kg/year, which was 81% of the upper limit (680kg/year). The mean nitrogen waste was 3238.8 ± 4620.9g/year and mean water consumption was 91,538.7 ± 157,537.9 L/year. Mediterranean diet model carbon emission and nitrogen waste were higher than other diet models, omnivore diet models had more water consumption than other diet models. But these differences were not found statistically significant (p > 0.05).Sustainable nutrition can be achieved via consumers' awareness. Food industry and government should encourage the people about promotion of sustainable food preferences.

Moderate Wine Consumption and Health: A Narrative Review.

Although it is clearly established that the abuse of alcohol is seriously harmful to health, much epidemiological and clinical evidence seem to underline the protective role of moderate quantities of alcohol and in particular of wine on health. This narrative review aims to re-evaluate the relationship between the type and dose of alcoholic drink and reduced or increased risk of various diseases, in the light of the most current scientific evidence. In particular, in vitro studies on the modulation of biochemical pathways and gene expression of wine bioactive components were evaluated. Twenty-four studies were selected after PubMed, Scopus and Google Scholar searches for the evaluation of moderate alcohol/wine consumption and health effects: eight studies concerned cardiovascular diseases, three concerned type 2 diabetes, four concerned neurodegenerative diseases, five concerned cancer and four were related to longevity. A brief discussion on viticultural and enological practices potentially affecting the content of bioactive components in wine is included. The analysis clearly indicates that wine differs from other alcoholic beverages and its moderate consumption not only does not increase the risk of chronic degenerative diseases but is also associated with health benefits particularly when included in a Mediterranean diet model. Obviously, every effort must be made to promote behavioral education to prevent abuse, especially among young people.

Consumer preferences for the Mediterranean Diet: Results of an empirical analysis

The Mediterranean Diet is a very healthy diet for the human organism. The study focuses on consumer behavior toward products that are part of the Mediterranean Diet. The purpose of this research is to give an insight into food awareness, to improve consumer health, by highlighting the food pyramid and lifestyles related to the Mediterranean Diet, and to understand cultural customs and habits regarding food. The empirical analysis was carried out through a survey of a sample of consumers. The questionnaire, administered online, included general cultural questions on the Mediterranean Diet, food groups, individual lifestyles, and eating habits of the consumers interviewed. Adherence to the Mediterranean diet model, concentrated in the territories proper of the Mediterranean, leads to an agri-food model that favors the development of local agri-food products, with the consequent increase in demand for products proper to Mediterranean agriculture. This situation potentially makes it possible to expand the supply of agri-food businesses that produce products of the Mediterranean diet and thus determine a positive effect of increased income and employment in the area. The results show that this dietary regime is widely followed and can be an opportunity for Mediterranean agro-food enterprises to expand the offer and produce healthier products aimed at that segment of consumers that follow this diet to reduce the risk of cardiovascular diseases or to prevent and cure metabolic diseases (such as hypertension, type 2 diabetes) and to prevent obesity. • The Mediterranean Diet is important for human health. • The Mediterranean Diet is a World Heritage Site. • The Mediterranean Diet promotes the development and growth of Mediterranean crops.

The effect of intermittent fasting diets on body weight and composition.

This study was carried out to determine and compare the effects on anthropometric measurements of the Mediterranean Diet (MD) with daily energy restriction and four different intermittent fasting diets (IFD), which were created as an alternative to MD and gained popularity. 360 people aged 18-65 years, with body mass index (BMI) between 27 and 35kg/m2 participated to the study. Demographic information, anthropometric measurements, physical activity and food consumption records were obtained by the researcher through weekly face-to-face interviews. The study lasted for 13 weeks, the first of which was a trial. Statistical significance level was accepted as 0.05. Participants were randomly assigned to 5 equal groups: Mediterranean Diet (MD), Week on Week off (WOWO), 6-Hour Time-Restricted Eating (TRE-6), 8-Hour Time-Restricted Eating (TRE-8), Alternative Day Diet (ADD). Of the 360 people who participated in the study, 32 (2 TRE-6, 7 WOWO, 1 MD, 16 ADD, 6 TRE-8) dropped out after the trial week. It was determined that throughout the study, body weights, BMI, arm circumferences and waist circumferences in all groups decreased significantly. However, trends in changes in body weights and BMIs did not differ between groups. While the energy, carbohydrate, protein and fat intakes of the participants did not change significantly during the study, fiber consumption increased considerably in the MD and WOWO groups. It was observed that IFD were not superior to MD in terms of anthropometric measurements. The health effects and long-term consequences are not clear for IFD, unlike MD. For these reasons, it is thought that the most effective nutritional therapy that can be preferred for healthy weight loss is the energy-restricted MD model.

Short-Term Pilot Study to Evaluate the Impact of Salbi Educa Nutrition App in Macronutrients Intake and Adherence to the Mediterranean Diet: Randomized Controlled Trial.

Promoting a healthy diet is a relevant strategy for preventing non-communicable diseases. This study aims to evaluate the impact of an innovative tool, the SAlBi educa nutrition app, in primary healthcare dietary counseling to improve dietary profiles as well as adherence to the Mediterranean diet. A multi-center randomized control trial comprising 104 participants was performed. Both control (n = 49) and intervention (n = 55) groups attended four once-weekly sessions focusing on healthy eating habits and physical activity, over one month. As well as attending the meetings, the intervention group used the app, which provides self-monitoring and tailored dietary advice based on the Mediterranean diet model. In a second intervention (one arm trial), the potential of SAlBi educa was evaluated for three months during the COVID-19 pandemic. At 4 weeks, the intervention group had significantly increased their carbohydrate intake (7.7% (95% CI: 0.16 to 15.2)) and decreased their total fat intake (−5.7% (95% CI: −10.4 to −1.15)) compared to the control group. Significant differences were also found for carbohydrates (3.5% (95% CI: −1.0 to 5.8)), total fats (−5.9% (95% CI: −8.9 to −3.0)), fruits and vegetables (266.3 g/day (95% CI: 130.0 to 402.6)), legumes (7.7g/day (95% CI: 0.2 to 15.1)), starchy foods (36.4 g/day (95% CI: 1.1 to 71.7)), red meat (−17.5 g/day (95% CI: −34.0 to −1.1)), and processed meat (−6.6 g/day (95% CI: −13.1 to −0.1)) intakes during the COVID-19 pandemic. SAlBi educa is a useful tool to support nutrition counseling in primary healthcare, including in special situations such as the COVID-19 pandemic. Trial registration: ISRCTN57186362.

Adherence to Mediterranean Diet among athletes participating at the XXX summer universiade.

Background: A well-balanced diet is essential in sport. Due to its typical content in high-quality proteins, low glycemic index foods, and unsaturated fats, Mediterranean Diet (MD) may represent a good choice to cover nutritional needs of athletes. The aim of this study was to explore how the dietary habits of elite athletes, such as those competing at the XXX Summer Universiade, comply with the MD model. A comparison between athletes coming from the Mediterranean and non-Mediterranean countries was also assessed. Methods: The Mediterranean Diet Serving Score (MDSS) questionnaire was administered to a sample of 433 university student athletes from all over of the world to evaluate the level of adherence to the MD pattern and possible differences between geographical areas. Results: The total sample showed a medium adherence to the MD, with a mean MDSS of 15.73 ± 3.71 out of a total of 23 points. A satisfactory consumption of fruits and vegetables was reported. Athletes from Northern European countries had a lower MD pattern adherence than the other ones. Conclusions: These findings suggest that the MD model is common among elite athletes, and it may be promoted as a healthy dietary pattern in the sport setting.

Adherence to the Mediterranean Diet and COVID-19: A Segmentation Analysis of Italian and US Consumers

The COVID-19 pandemic has led many countries to implement restrictions on individual freedom to stop the contagion. The imposition of lockdowns has affected many socio-economic aspects and, in particular, eating habits, highlighting the need to analyse the healthiness of new consumption patterns. The aim of our study was to investigate the changes in adherence to the Mediterranean diet, a dietary model universally recognized as healthy, that have occurred both during and since the lockdown. The subsequent profiling of consumers allowed us to understand which sociodemographic and psychographic factors favoured the development of more or less adherence to Mediterranean diet consumption patterns. The study was conducted by administering a questionnaire to a representative sample of Italians and New Yorkers. Both groups, defined by deep socio-economic differences and by their own eating habits compared to the Mediterranean diet model, were affected by similar lockdown measures. The data collected were processed by cluster analysis that allowed to identify four homogeneous groups with respect to the adherence to the Mediterranean diet model. The results highlight a worrying situation with respect to the impacts of the pandemic on maintaining a proper dietary style according to the principles of the Mediterranean diet. In fact, there has been a general worsening trend due to an increase in consumption, in part linked to emotional eating, which is a cause for concern about the potential future impacts on the health of consumers. The study highlights the need, therefore, to implement actions by public decision-makers aimed at raising the awareness of citizens on the issue of correct eating habits and at developing adequate food policies to stem the trend towards unhealthy diets.

Physical activity level and mediterranean diet adherence evaluation in older people - observational, uncontrolled, pilot study

WHO recommend to associate a proper dose of movement with healthy and balanced diet, also in elderly. Promoting healthy lifestyles and adopting healthy habits can lead to a successful aging. The Mediterranean diet model is considered the gold standard nutritional treatment in some Non Communicable Diseases and the evaluation of adherence to this diet becomes essential to study the lifestyle of the population in order to prevent the risk of onset of age-related chronic diseases. In order to implement appropriate interventions for successful aging and to prevent functional alterations affecting the people autonomy in Activities of Daily Living, the LIFestyle of the Elderly in Umbria Population Project (LIFEUP) was promoted in 2018, in Italy. 36 subjects were invited to fill out self-report questionnaires used to assess health status and quality of life (EuroQol), physical activity levels (IPAQ) and Mediterranean diet adherence (MED Diet Score). Anthropometric variables (height, BMI), body composition and functional capacities (through Senior Fitness Test battery) were studied. We observed a situation of overweight (average BMI=27.4) with fat mass=30.45% and low total body water 47.64%), with a medium adherence to the Mediterranean diet (Score=7.19). Furthermore, we noted a good health status perceived (71,14/100), and acceptable physical activity levels (36.55 MET/h/week), and good functional capacities (2 minutes steps average=86.73; chair stands average=14.09; 8-foot up and go test average=6.47 sec.), according to international guidelines and standard ranges for this age. This pilot study gave an overview of a small group of the elderly Umbrian population to implement prevention and health promotion plans among the elderly.

Consuming Selected Groups of Products Among Polish and Spanish Physical Education Students Within the Context of the Assumptions Proposed by the Mediterranean Diet

Introduction: Nutritional behaviour is determined by individual and environmental factors. Aim: The aim of the study was to analyse the frequency of consuming selected groups of food products within the context of the recommendations proposed by the Mediterranean diet model, depending on the country of residence: Polish vs. Spanish physical education students. Material and methods: Research was carried out among 219 Polish and 280 Spanish students, using the standardised Kom-PAN questionnaire. In the statistical analysis, the chi-square test was used, at the α=0.05 level of statistical significance. Results: Nutritional mistakes of the general population were related to the low frequency of consuming: fruit, vegetables, wholemeal bread and other whole grains, fermented dairy products and vegetable oils, and the relatively frequent consumption of red meat, processed meat products and confectionery. Among the Polish students, significantly more frequent consumption of some products recommended in the Mediterranean diet (fruit, vegetables and wholegrain cereal products) as well as poultry meat was noted, but also more frequent consumption of sweets and confectionery products (p&lt;0.001). The Spanish students significantly more often consumed the recommended dishes with legume seeds and sea fish (p&lt;0.001), but also non-recommended products - red meat and fast food (p&lt;0.01). Conclusions: Among Polish and Spanish physical education students, the assumptions of the Mediterranean diet were implemented to a limit extent, while depending on the country of residence, their differentiation was demonstrated.

Adherence to the Mediterranean diet model and psoriatic disease (skin, joint and metabolic expression of psoriasis)

Psoriasis is a chronic disease, characterized by systemic inflammation with skin, joint and metabolic involvement. The most common tools to evaluate the severity of each disease is respectively the Psoriasis Area Severity Index (PASI) and the Disease Activity Index for Psoriatic Arthritis (DAPSA). The association between psoriasis and obesity and the role of visceral fat in producing an inflammatory state have been demonstrated. The Mediterranean Diet (MD) has been recommended as a model of healthy diet on the basis of scientific evidence and considered as an adjuvant therapy for all patients affected by chronic inflammatory diseases. Our study evaluated the association between adherence to MD (assessed with the Predimed questionnaire) and psoriatic disease severity. 80 patients (40 with psoriasis and 40 with psoriatic arthritis) were evaluated for disease severity (PASI, DAPSA) and were assessed for Metabolic Syndrome according to the International Diabetes Federation (IDF) definition. To evaluate adherence to the MD, each patient was administered the Predimed questionnaire which includes 14 questions. Our study shows a correlation between low adherence to MD and a high expression of psoriasis, considering cutaneous, joint symptoms and the metabolic profile.

Mediterranean Diet conceptual model and future trends of its use in Portugal.

The aim of this study was to present a new model for the Mediterranean Diet definition and to identify the major trends for the use of the Mediterranean Diet concept by 2028, in Portugal. A Delphi panel was implemented with 28 experts with solid knowledge and understanding of the Mediterranean Diet concept. The first round evaluated the degree of expert self-knowledge, which also contributed to the final questionnaire building. It was answered in 2 successive rounds with 21 statements, divided into 2 dimensions: Mediterranean Diet concept and use. A Mediterranean Diet model definition was produced with 73.8% of agreement. Culture, education, environment, health, food industry/distribution and tourism were identified as the future trends of Mediterranean Diet use areas. The model presented can be used as a pedagogical tool. For the first time, it was possible to explore the future trends of Mediterranean Diet use, which can help with the initiatives to safeguard the Mediterranean Diet concept.

Diyabetli Bireylere Hangi Beslenme Modeli Önerilmeli?

Bin dokuz yüzlü yılların özellikle ikinci çeyreğinden itibaren başlayan ve günümüze dek artarak devam eden çalışmalarla “diyabet yönetiminde en etkili beslenme modeli” arayışı sürmektedir. Bu konudaki araştırmalar daha çok “çok düşük kalorili diyetler”, “düşük karbonhidratlı ve düşük yağlı diyetler”, “vejetaryen ya da vegan beslenme”, “DASH beslenme modeli” ve “Akdeniz tipi beslenme modeli” üzerine yoğunlaşmıştır. Bu derlemede, bahsi geçen diyet ve beslenme modellerinin diyabet tedavisindeki yerlerinin bilimsel literatür doğrultusunda incelenmesi hedeflenmiştir. Çeşitli kılavuzlarda, Akdeniz, DASH ve bitkisel bazlı diyetlerin, diyabetik bireyler ile ilişkili olumlu sonuçları nedeniyle sağlıklı beslenme modellerine örnek teşkil ettiği vurgulanmaktadır. Düşük karbonhidratlı diyetlerin rolü ise henüz net değildir. Sonuç olarak bireyselleştirilmiş beslenme planı, belirli beslenme modellerinin önerilmesinden ziyade kişisel tercihler, ihtiyaç ve hedefler üzerine odaklanmalıdır.

New and traditional foods in a modernized Mediterranean diet model.

Mediterranean diet is definitely one of the healthiest dietary models. Next questions are: is the traditional Mediterranean diet adapted to the modern environmental and existential conditions? Could and/or should it be "modernized" to adapt to the various geographical, environmental, ethnic, and religious characteristics? If "modernization" is required, which traditional Mediterranean foods should be imperatively conserved as they are? Alternatively, which "new" foods-not traditional or not Mediterranean-could be introduced to help people to still respect the basic healthy Mediterranean diet principles? The present article intends to help solving these new questions.

A Mediterranean Diet Model in Australia: Strategies for Translating the Traditional Mediterranean Diet into a Multicultural Setting.

Substantial evidence supports the effect of the Mediterranean Diet (MD) for managing chronic diseases, although trials have been primarily conducted in Mediterranean populations. The efficacy and feasibility of the Mediterranean dietary pattern for the management of chronic diseases has not been extensively evaluated in non-Mediterranean settings. This paper aims to describe the development of a MD model that complies with principles of the traditional MD applied in a multiethnic context. Optimal macronutrient and food-based composition was defined, and a two-week menu was devised incorporating traditional ingredients with evidence based on improvements in chronic disease management. Strategies were developed for the implementation of the diet model in a multiethnic population. Consistent with the principles of a traditional MD, the MD model was plant-based and high in dietary fat, predominantly monounsaturated fatty acids from extra virgin olive oil. Fruits, vegetables and wholegrains were a mainstay, and moderate amounts of nuts and seeds, fish, dairy and red wine were recommended. The diet encompassed key features of the MD including cuisine, biodiversity and sustainability. The MD model preserved traditional dietary components likely to elicit health benefits for individuals with chronic diseases, even with the adaptation to an Australian multiethnic population.

Assessment to Mediterranean diet and quality of life in oncology patients

Background & aims: One question that has not been answered so far in our bibliography is the impact of the Mediterranean diet on the quality of life of oncology patients, which we will try to investigate. Cancer and its treatment carry severe biochemical and physiological changes in the patient's body, which has a profound impact on the quality the patients' lives. According to the Schwingshack and Hoffmann 2014 study, individuals who follow the Mediterranean diet model seemed to have a reduced risk of cancer mortality and a 10% risk reduction in getting sick with cancer. The purpose of this study is to investigate compliance with the Mediterranean diet of oncology patients and the impact on their quality of life.

Exploring the Adherence to the Mediterranean Diet and Its Relationship with Individual Lifestyle: The Role of Healthy Behaviors, Pro-Environmental Behaviors, Income, and Education.

The reduction of diet-related diseases and the improvement of environmental sustainability represent two of the major 21st century food policy challenges. Sustainable diets could significantly contribute to achieving both of these goals, improving consumer health and reducing the environmental impact of food production and consumption. The Mediterranean diet (MD) represents an excellent example of sustainable diet, however recent evidence indicates that such a dietary pattern is now progressively disappearing in Mediterranean countries. In such a context, this paper explores how individual lifestyle and habits are related to a high/low adherence to the MD model. The goal is to examine whether there is a relationship between individuals’ healthy and pro-environmental behaviors and their level of adherence to the MD. The analysis also explores the role of consumer income and education. The study is based on the Italian population (n = 42,000) and uses a structural equation model approach. The results outline that the MD is part of a sustainability-oriented lifestyle and stress the key role of both income and education in affecting adherence to MD. Future policy aimed at contrasting the gradual disappearance of the MD should emphasize the sustainable dimension of the MD, meanwhile reducing socio-economic disparities among different population segments.