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Sustainability Dimensions of the Mediterranean Diet: A Systematic Review of the Indicators used and Its Results.

The concern about sustainability is growing and the Mediterranean Diet has been extensively identified as a promising model, with benefits for human and environmental health. This systematic review aims to identify and describe the indicators which have been used to evaluate the sustainability of the Mediterranean Diet and the results from their application. A methodology using PRISMA guidelines was followed, and searches performed in Web of Science, PubMed, Scopus, and GreenFile. A total of 32 studies assessing the sustainability of the Mediterranean Diet were identified. Twenty-five of these studies quantified the environmental impact, seven studies evaluated the nutritional quality, and twelve studies assessed the daily cost of this dietary pattern. A total of 33 distinct indicators were identified, of which ten were used to assess the environmental dimension (mainly Carbon, Water, and Ecological Footprint), eight were used to assess the nutritional dimension (mainly Health score and Nutritional Rich Food Index), one was used to assess the economic dimension (dietary cost) and, eight used combined indicators. The remaining six indicators for the assessment of sociocultural dimension were only identified in one study but were not measured. The Mediterranean Diet had a lower environmental impact than Western diets and showed a Carbon Footprint between 0.9 and 6.88 kg CO2/d per capita, a Water Footprint between 600 and 5280 m3/ d per capita, and an Ecological Footprint between 2.8 and 53.42 m2/ d per capita. Regarding the nutritional dimension, the Mediterranean Diet had a high nutritional quality and obtained 122 points on the Health Score and ranged between 12.95 and 90.6 points on the Nutrient Rich Food Index. The cost of Mediterranean Diet is similar to other diets and varied between 3.33 and 14.42€/ d per capita. These findings show that no uniformity in assessing the MDiet's sustainability exists.