Greater adherence to the Mediterranean diet pattern in the United States is associated with sustainability trade-offs

The Mediterranean diet pattern has been consistently associated with health benefits but less is known about the association with environmental and economic sustainability in the United States (US). This information is needed to support sustainable policy agendas and provide consumers with evidence-based information needed to make informed food choices. This study fills this research gap by evaluating the environmental sustainability and diet cost associated with adherence to the Mediterranean diet pattern in the US. Dietary data from the National Health and Nutrition Examination Survey (2011-2018, n = 17,079) were merged with data on environmental impacts (greenhouse gas emissions, cumulative energy demand, water scarcity footprint), agricultural resource demand (land, fertilizer nutrients, and pesticides), and food prices from multiple publicly available databases. The Mediterranean Diet Score was used to evaluate adherence to the Mediterranean diet pattern. Multivariable linear regression models were used to evaluate the association between adherence to the Mediterranean diet pattern and environmental impacts, agricultural resource demand, and diet cost. Sensitivity analyses were used to evaluate adjustment of loss and waste and food-away-from-home prices. Greater adherence to the Mediterranean diet pattern was associated with lower greenhouse gas emissions (p