. 2020 Nov 25;17(23):8758.

doi: 10.3390/ijerph17238758.

Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns

Lluís Serra-Majem^{1

2

3}, Laura Tomaino^{1

4}, Sandro Dernini^{2

5}, Elliot M Berry^{2

6}, Denis Lairon⁷, Joy Ngo de la Cruz², Anna Bach-Faig^{8

9}, Lorenzo M Donini¹⁰, Francesc-Xavier Medina⁸, Rekia Belahsen¹¹, Suzanne Piscopo¹², Roberto Capone¹³, Javier Aranceta-Bartrina^{1

3

14}, Carlo La Vecchia⁴, Antonia Trichopoulou¹⁵

Affiliations

¹ Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, and Complejo Hospitalario Universitario Insular-Materno Infantil (CHUIMI), Canarian Health Service, 35016 Las Palmas de Gran Canaria, Spain.
² International Foundation of Mediterranean Diet, Nutrition Research Foundation, Barcelona Science Park, 08028 Barcelona, Spain.
³ CIBEROBN, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, 28029 Madrid, Spain.
⁴ Department of Clinical Medicine and Community Health (DISCCO), Università degli Studi di Milano, 20122 Milan, Italy.
⁵ Forum on Mediterranean Food Cultures, 00148 Rome, Italy.
⁶ Braun School of Public Health, Hebrew University Hadassah Medical School, 91120 Jerusalem, Israel.
⁷ Human Nutrition, Aix Marseille University, INSERM, INRA, C2VN, 13005 Marseille, France.
⁸ FoodLab Research Group (2017SGR 83), Faculty of Health Sciences, Universitat Oberta de Catalunya (Open University of Catalonia, UOC), 08018 Barcelona, Spain.
⁹ Food and Nutrition Area, Barcelona Official College of Pharmacists, 08009 Barcelona, Spain.
¹⁰ Department of Experimental Medicine, Sapienza University, 00136 Rome, Italy.
¹¹ Training and Research Unit on Nutrition & Food Sciences, Biotechnology, Biochemistry & Nutrition Laboratory, Chouaib Doukkali University, El Jadida 24000, Morocco.
¹² Department of Health, Physical Education and Consumer Studies, Faculty of Education, University of Malta, MSD2080 Msida, Malta.
¹³ International Center for Advanced Mediterranean Agronomic Studies (CIHEAM), 70010 Valenzano (Bari), Italy.
¹⁴ Department of Food Sciences and Physiology, University of Navarra, 31008 Pamplona, Spain.
¹⁵ Hellenic Health Foundation, 11527 Athens, Greece.

PMID: 33255721
PMCID: PMC7728084
DOI: 10.3390/ijerph17238758

Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns

Lluís Serra-Majem et al. Int J Environ Res Public Health. 2020.

. 2020 Nov 25;17(23):8758.

doi: 10.3390/ijerph17238758.

Authors

Affiliations

¹ Research Institute of Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, and Complejo Hospitalario Universitario Insular-Materno Infantil (CHUIMI), Canarian Health Service, 35016 Las Palmas de Gran Canaria, Spain.
² International Foundation of Mediterranean Diet, Nutrition Research Foundation, Barcelona Science Park, 08028 Barcelona, Spain.
³ CIBEROBN, Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, 28029 Madrid, Spain.
⁴ Department of Clinical Medicine and Community Health (DISCCO), Università degli Studi di Milano, 20122 Milan, Italy.
⁵ Forum on Mediterranean Food Cultures, 00148 Rome, Italy.
⁶ Braun School of Public Health, Hebrew University Hadassah Medical School, 91120 Jerusalem, Israel.
⁷ Human Nutrition, Aix Marseille University, INSERM, INRA, C2VN, 13005 Marseille, France.
⁸ FoodLab Research Group (2017SGR 83), Faculty of Health Sciences, Universitat Oberta de Catalunya (Open University of Catalonia, UOC), 08018 Barcelona, Spain.
⁹ Food and Nutrition Area, Barcelona Official College of Pharmacists, 08009 Barcelona, Spain.
¹⁰ Department of Experimental Medicine, Sapienza University, 00136 Rome, Italy.
¹¹ Training and Research Unit on Nutrition & Food Sciences, Biotechnology, Biochemistry & Nutrition Laboratory, Chouaib Doukkali University, El Jadida 24000, Morocco.
¹² Department of Health, Physical Education and Consumer Studies, Faculty of Education, University of Malta, MSD2080 Msida, Malta.
¹³ International Center for Advanced Mediterranean Agronomic Studies (CIHEAM), 70010 Valenzano (Bari), Italy.
¹⁴ Department of Food Sciences and Physiology, University of Navarra, 31008 Pamplona, Spain.
¹⁵ Hellenic Health Foundation, 11527 Athens, Greece.

PMID: 33255721
PMCID: PMC7728084
DOI: 10.3390/ijerph17238758

Abstract

Background: Nowadays the food production, supply and consumption chain represent a major cause of ecological pressure on the natural environment, and diet links worldwide human health with environmental sustainability. Food policy, dietary guidelines and food security strategies need to evolve from the limited historical approach, mainly focused on nutrients and health, to a new one considering the environmental, socio-economic and cultural impact-and thus the sustainability-of diets.

Objective: To present an updated version of the Mediterranean Diet Pyramid (MDP) to reflect multiple environmental concerns.

Methods: We performed a revision and restructuring of the MDP to incorporate more recent findings on the sustainability and environmental impact of the Mediterranean Diet pattern, as well as its associations with nutrition and health. For each level of the MDP we provided a third dimension featuring the corresponding environmental aspects related to it.

Conclusions: The new environmental dimension of the MDP enhances food intake recommendations addressing both health and environmental issues. Compared to the previous 2011 version, it emphasizes more strongly a lower consumption of red meat and bovine dairy products, and a higher consumption of legumes and locally grown eco-friendly plant foods as much as possible.

Keywords: Mediterranean diet; Mediterranean diet pyramid; environmental concerns; food-based dietary guidelines; nutrition; sustainability; sustainable diets.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Consensus process for an updated graphical representation of the Mediterranean Diet Pyramid.

**Figure 2**
New Pyramid for a Sustainable Mediterranean Diet.

See this image and copyright information in PMC

Comment in

Mediterranean Dietary Pyramid.
Willett W. Willett W. Int J Environ Res Public Health. 2021 Apr 26;18(9):4568. doi: 10.3390/ijerph18094568. Int J Environ Res Public Health. 2021. PMID: 33925778 Free PMC article.

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Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns

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Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns

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