Adherence to the Mediterranean Diet in Association with Self-Perception of Diet Sustainability, Anthropometric and Sociodemographic Factors: A Cross-Sectional Study in Italian Adults.

The adoption of sustainable dietary models, such as the Mediterranean Diet (MD), can be a valuable strategy to preserve ecosystems and human health. This study aims to investigate in an Italian adult representative sample the adherence to the MD and to what extent it is associated with the self-perceived adoption of a sustainable diet, the consideration of the MD as a sustainable dietary model, and anthropometric and sociodemographic factors. By applying an online survey ( = 838, 18-65 years, 52% female), an intermediate level of MD adherence (median: 4.0, IR: 3.0-4.0) in a 0-9 range was observed. Only 50% of the total sample confirmed the MD as a sustainable dietary model, and 84% declared no or low perception of adopting a sustainable diet. Being female, having a higher income and education level, considering the MD as a sustainable dietary model, as well as the perception of having a sustainable diet were the most relevant factors influencing the probability of having a high score (≥6) of adherence to the MD. This study suggests a gradual shift away from the MD in Italy and supports the need to address efforts for developing intervention strategies tailored to adults for improving diet quality. Furthermore, a public campaign should stress the link between a diet and its environmental impact to foster nutritionally adequate and eco-friendly dietary behaviors.