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Objective: To characterize the multiple dimensions and benefits of the Mediterranean diet as a sustainable diet, in order to revitalize this intangible food heritage at the country level; and to develop a multidimensional framework - the Med Diet 4.0 - in which four sustainability benefits of the Mediterranean diet are presented in parallel: major health and nutrition benefits, low environmental impacts and richness in biodiversity, high sociocultural food values, and positive local economic returns.Design: A narrative review was applied at the country level to highlight the multiple sustainable benefits of the Mediterranean diet into a single multidimensional framework: the Med Diet 4.0. Setting/subjects We included studies published in English in peer-reviewed journals that contained data on the characterization of sustainable diets and of the Mediterranean diet. The methodological framework approach was finalized through a series of meetings, workshops and conferences where the framework was presented, discussed and ultimately refined.Results: The Med Diet 4.0 provides a conceptual multidimensional framework to characterize the Mediterranean diet as a sustainable diet model, by applying principles of sustainability to the Mediterranean diet.Conclusions: By providing a broader understanding of the many sustainable benefits of the Mediterranean diet, the Med Diet 4.0 can contribute to the revitalization of the Mediterranean diet by improving its current perception not only as a healthy diet but also a sustainable lifestyle model, with country-specific and culturally appropriate variations. It also takes into account the identity and diversity of food cultures and systems, expressed within the notion of the Mediterranean diet, across the Mediterranean region and in other parts of the world. Further multidisciplinary studies are needed for the assessment of the sustainability of the Mediterranean diet to include these new dimensions. [ABSTRACT FROM AUTHOR]

Objective: While epidemiological research on the protective role of the Mediterranean diet (MD) is highly publicised, little is known about MD education interventions. This exploratory study aimed to provide insight into methodology and effectiveness of the MD as a nutrition education and health promotion tool., Design and Setting: Two searches were conducted within PubMed using the terms 'Mediterranean diet' and 'Education' or 'Intervention'. Abstracts yielded were screened for distinct studies in which participants were instructed on the application of MD principles in their diet. Four studies met this criterion. These were further analysed for sample/target population, and intervention design, duration, tools, evaluative measures/tests and outcomes., Results: Interventions targeted both healthy and at-risk populations and lasted between 12 weeks to 1 year, including follow-up. They used individual counselling, tailored computer-based counselling, group education, internet-based education, cookery classes and printed materials. Outcomes were measured using food diaries, FFQ, questionnaires on psychosocial factors and on usage of the educational tools, as well as anthropometrics and biomarkers. Interventions showed statistically significant increases in participants' intake of vegetables, legumes, nuts, fruit, whole grains, seeds, olive oil and dietary PUFA and MUFA, and statistically significant decreases in total cholesterol, ox-LDL-cholesterol, total:HDL-cholesterol ratio, insulin resistance, BMI, body weight and waist circumference., Conclusions: MD education interventions may be cost-effective strategies for helping to protect against and treat a variety of health problems in different populations. Details of such interventions need to be publicised internationally. This introductory review could help inform the design of future targeted MD nutrition education.