Nutritional indicators to assess the sustainability of the Mediterranean diet

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 relating 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