Mediterranean Lifestyle to Promote Physical, Mental, and Environmental Health: The Case of Chile

Guadalupe Echeverría, Ornella Tiboni, Loni Berkowitz, Victoria Pinto, Bárbara Samith, Andrea von Schultzendorff, Nuria Pedrals, Marcela Bitran, Chiara Ruini, Carol D Ryff, Daniele Del Rio, Attilio Rigotti, Guadalupe Echeverría, Ornella Tiboni, Loni Berkowitz, Victoria Pinto, Bárbara Samith, Andrea von Schultzendorff, Nuria Pedrals, Marcela Bitran, Chiara Ruini, Carol D Ryff, Daniele Del Rio, Attilio Rigotti

Abstract

Chile is currently experiencing a progressive epidemiological transition towards chronic diseases. In this country, >50% of annual deaths are attributed to cardiovascular disease and cancer. Moreover, health surveys have shown high prevalence of obesity, diabetes, hypertension, and elevated cardiovascular disease risk. In addition, mental health issues are also frequent among Chilean adults. On the other hand, the agri-food system contributes to 21-37% of greenhouse gases emissions worldwide. Overall, current health and food chain situation calls out for design and implementation of evidence-based feasible and effective nutritional interventions needed to promote physical and mental health along with addressing food sustainability in Chile. Nowadays, the Mediterranean diet is recognized as one of the healthiest dietary patterns based on observational and interventional studies linked to a wide variety of health outcomes. However, a Mediterranean lifestyle goes well beyond food intake: it includes promotion of psychosocial resources, community life as well as cultural traditions. Indeed, Mediterranean lifestyle is a true modus vivendi that integrally promotes physical, mental, and social well-being. In addition, the Mediterranean diet stands out for its environmental sustainability because it is characterized mainly as a plant-based dietary pattern with low carbon and water footprints. Remarkably, Central Chile has a Mediterranean-like setting with plant and animal food production and availability patterns comparable to those present in countries located around the Mediterranean Sea. Therefore, this article reviews how promotion of Mediterranean lifestyle adherence in Chile offers great potential for management of the ongoing epidemiological transition to chronic diseases as well to promote psychological well-being within a unique food system and dietary sustainability vision for this Latin American country.

Keywords: Chile; Mediterranean; chronic diseases; diet; physical health; psychological well-being; sustainability.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the conceptualization of the review; in the writing of the manuscript, or in the decision to publish this manuscript.

Figures

Figure 1
Figure 1
Mediterranean diet sustainability for promotion of physical, mental, and environmental health in Chile.
Figure 2
Figure 2
The double food and environmental pyramid of the Mediterranean diet (adapted from [105]).

References

    1. WHO . Global Status Report on Noncommunicable Diseases. Attaining the Nine Global Noncommunicable Diseases Targets: A Shared Responsibility. World Health Organization; Geneva, Switzerland: 2014.
    1. Carney R.M., Freedland K.E. Depression and coronary heart disease. Nat. Rev. Cardiol. 2017;14:145–155. doi: 10.1038/nrcardio.2016.181.
    1. Pan A., Keum N., Okereke O.I., Sun Q., Kivimaki M., Rubin R.R., Hu F.B. Bidirectional Association Between Depression and Metabolic Syndrome: A systematic review and meta-analysis of epidemiological studies. Diabetes Care. 2012;35:1171–1180. doi: 10.2337/dc11-2055.
    1. DuBois C.M. Relationships between positive psychological constructs and health outcomes in patients with cardiovascular disease: A systematic review. Int. J. Cardiol. 2015;195:265–280. doi: 10.1016/j.ijcard.2015.05.121.
    1. MINSAL Chile 2018. [(accessed on 6 July 2020)]; Available online: .
    1. MINSAL Chile 2018. [(accessed on 6 July 2020)]; Available online: .
    1. Pedersen S.S., Von Känel R., Tully P.J., Denollet J. Psychosocial perspectives in cardiovascular disease. Eur. J. Prev. Cardiol. 2017;24:108–115. doi: 10.1177/2047487317703827.
    1. García-Fernández E., Rico-Cabanas L., Rosgaard N., Estruch R., Bach-Faig A. Mediterranean Diet and Cardiodiabesity: A Review. Nutrients. 2014;6:3474–3500. doi: 10.3390/nu6093474.
    1. Dussaillant C., Echeverría G., Urquiaga I., Velasco N., Rigotti A. Current evidence on health benefits of the Mediterranean diet. Rev. Med. Chile. 2016;144:1044–1052.
    1. Dinu M., Pagliai G., Casini A., Sofi F. Mediterranean diet and multiple health outcomes: An umbrella review of meta-analyses of observational studies and randomised trials. Eur. J. Clin. Nutr. 2017;72:30–43. doi: 10.1038/ejcn.2017.58.
    1. Soltani S., Jayedi A., Shab-Bidar S., Becerra-Tomas N., Salas-Salvadó J. Adherence to the Mediterranean Diet in Relation to All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Adv. Nutr. 2019;10:1029–1039. doi: 10.1093/advances/nmz041.
    1. Kargın D., Tomaino L., Serra-Majem L. Experimental Outcomes of the Mediterranean Diet: Lessons Learned from the Predimed Randomized Controlled Trial. Nutrients. 2019;11:2991. doi: 10.3390/nu11122991.
    1. Sánchez-Sánchez M.L., García-Vigara A., Hidalgo-Mora J.J., García-Pérez M.Á., Tarín J., Cano A. Mediterranean diet and health: A systematic review of epidemiological studies and intervention trials. Maturitas. 2020;136:25–37. doi: 10.1016/j.maturitas.2020.03.008.
    1. De Lorgeril M., Renaud S., Salen P., Monjaud I., Mamelle N., Martin J., Guidollet J., Touboul P., Delaye J. Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease. Lancet. 1994;343:1454–1459. doi: 10.1016/S0140-6736(94)92580-1.
    1. Estruch R., Ros E., Salas-Salvadó J., Covas M.-I., Corella D., Arós F., Gómez-Gracia E., Ruiz-Gutiérrez V., Fiol M., Lapetra J., et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N. Engl. J. Med. 2013;368:1279–1290. doi: 10.1056/NEJMoa1200303.
    1. Estruch R., Ros E., Salas-Salvadó J., Covas M.I., Corella D., Arós F., Gómez-Gracia E., Ruiz-Gutiérrez V., Fiol M., Lapetra J., et al. Retraction and Republication: Primary Prevention of Cardiovascular Disease with a Med-iterranean Diet. N. Engl. J. Med. 2018;378:2441–2442. doi: 10.1056/NEJMc1806491.
    1. Salas-Salvadó J., Bulló M., Babio N., Martínez-González M.Á., Ibarrola-Jurado N., Basora J., Estruch R., Covas M.I., Corella D., Arós F., et al. Reduction in the Incidence of Type 2 Diabetes With the Mediterranean Diet: Results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2010;34:14–19. doi: 10.2337/dc10-1288.
    1. Diaz-Lopez A. Mediterranean diet, retinopathy, nephropathy, and microvascular diabetes complications: A post hoc analysis of a randomized trial. Diabetes Care. 2015;38:2134–2141. doi: 10.2337/dc15-1117.
    1. Valls-Pedret C., Sala-Vila A., Serra-Mir M., Corella D., de la Torre R., Martínez-González M.Á., Martínez-Lapiscina E.H., Fitó M., Pérez-Heras A., Salas-Salvadó J., et al. Mediterranean Diet and Age-Related Cognitive Decline. JAMA Intern. Med. 2015;175:1094–1103. doi: 10.1001/jamainternmed.2015.1668.
    1. Toledo E., Salas-Salvadó J., Donat-Vargas C., Cosiales P.B., Estruch R., Ros E., Corella D., Fitó M., Hu F.B., Arós F., et al. Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED Trial. JAMA Intern. Med. 2015;175:1752–1760. doi: 10.1001/jamainternmed.2015.4838.
    1. Martínez-González M., Buil-Cosiales P., Corella D., Bulló M., Fitó M., Vioque J., Romaguera D., Martínez J.A., Wärnberg J., López-Miranda J., et al. Cohort Profile: Design and methods of the PREDIMED-Plus randomized trial. Int. J. Epidemiol. 2018;48:387–388. doi: 10.1093/ije/dyy225.
    1. Sotos-Prieto M. Rationale and design of feeding America’s bravest: Mediterranean diet-based intervention to change firefighters’ eating habits and improve cardiovascular risk profiles. Contemp. Clin. Trials. 2017;61:101–107. doi: 10.1016/j.cct.2017.07.010.
    1. Itsiopoulos C., Kucianski T., Mayr H.L., Van Gaal W.J., Martínez-González M.Á., Vally H., Kingsley M., Kouris-Blazos A., Radcliffe J., Segal L., et al. The AUStralian MEDiterranean Diet Heart Trial (AUSMED Heart Trial): A randomized clinical trial in secondary prevention of coronary heart disease in a multiethnic Australian population: Study protocol. Am. Heart J. 2018;203:4–11. doi: 10.1016/j.ahj.2018.05.010.
    1. Köppen V. In: Das Geographische System der Climate. Köppen V., Geiger‎ R., editors. Gebrüder Borntraeger; Berlin, Germany: 1936.
    1. Armesto J.J. The Mediterranean environment of Central Chile. Oxford University Press; Oxford, UK: 2007.
    1. Chilealimentos Evolución Exportaciones de Alimentos. [(accessed on 8 July 2020)]; Available online:
    1. Rozowski J. Is the Chilean diet a Mediterranean-type diet? Biol. Res. 2004;37:313–319. doi: 10.4067/S0716-97602004000200018.
    1. Urquiaga I., Echeverría G., Dussaillant C., Rigotti A. Origin, components and mechanisms of action of the Mediterranean diet. Rev. Med. Chile. 2017;145:85–95. doi: 10.4067/S0034-98872017000100012.
    1. Echeverría G., Dussaillant C., McGee E., Inés U., Velasco N., Rigotti A. Mediterranean Identities—Environment, Society, Culture. IntechOpen; London, UK: 2017. Mediterranean diet beyond the mediterranean basin: Chronic disease prevention and treatment; p. 401.
    1. Echeverría G., Dussaillant C., McGee E.E., Mena C., Nitsche M.P., Inés U., Bitran M., Pedrals N., Rigotti A. Promoting and Implementing the Mediterranean Diet in the Southern Hemisphere: The Chilean Experience. Eur. J. Clin. Nutr. 2018;72:38–46. doi: 10.1038/s41430-018-0307-7.
    1. Panico S., Mattiello A., Panico C., Chiodini P. Mediterranean Dietary Pattern and Chronic Diseases. Cancer Treat. Res. 2013;159:69–81. doi: 10.1007/978-3-642-38007-5_5.
    1. Harmon B., Boushey C.J., Shvetsov Y.B., Ettienne R., Reedy J., Wilkens L.R., Le Marchand L., Henderson B., Kolonel L.N. Associations of key diet-quality indexes with mortality in the Multiethnic Cohort: The Dietary Patterns Methods Project. Am. J. Clin. Nutr. 2015;101:587–597. doi: 10.3945/ajcn.114.090688.
    1. Mantzioris E., Villani A. Translation of a Mediterranean-Style Diet into the Australian Dietary Guidelines: A Nutritional, Ecological and Environmental Perspective. Nutrients. 2019;11:2507. doi: 10.3390/nu11102507.
    1. Echeverria G., Urquiaga I., Concha M.J., Dussaillant C., Villarroel L., Velasco N., Leighton F., Rigotti A. Validation of self-applicable questionnaire for a Mediterranean dietary index in Chile. Rev. Med. Chile. 2016;144:1531–1543.
    1. Echeverría G., McGee E.E., Urquiaga I., Jiménez P., D’Acuña S., Villarroel L., Velasco N., Leighton F., Rigotti A. Inverse Associations between a Locally Validated Mediterranean Diet Index, Overweight/Obesity, and Metabolic Syndrome in Chilean Adults. Nutrients. 2017;9:862. doi: 10.3390/nu9080862.
    1. Garcia-Hermoso A., Vegas-Heredia E.D., Fernández-Vergara O., Ceballos-Ceballos R., Andrade-Schnettler R., Arellano-Ruiz P., Ramírez-Vélez R. Independent and combined effects of handgrip strength and adherence to a Mediterranean diet on blood pressure in Chilean children. Nutrients. 2019;60:170–174. doi: 10.1016/j.nut.2018.08.019.
    1. Delgado-Floody P., Alvarez C., Caamaño-Navarrete F., Jerez-Mayorga D., Latorre-Román P. Influence of Mediterranean diet adherence, physical activity patterns, and weight status on cardiovascular response to cardiorespiratory fitness test in Chilean school children. Nutrients. 2020;71:110621. doi: 10.1016/j.nut.2019.110621.
    1. Lavados P.M., Mazzon E., Rojo A., Brunser A.M., Olavarría V.V. Pre-stroke adherence to a Mediterranean diet pattern is associated with lower acute ischemic stroke severity: A cross-sectional analysis of a prospective hospital-register study. BMC Neurol. 2020;20:1–8. doi: 10.1186/s12883-020-01824-y.
    1. Urquiaga I., Strobel P., Perez D., Martinez C., Cuevas A., Castillo O., Marshall G., Rozowski J., Leighton F. Mediterranean diet and red wine protect against oxidative damage in young volunteers. Atherosclerosis. 2010;211:694–699. doi: 10.1016/j.atherosclerosis.2010.04.020.
    1. Urquiaga I., Guasch V., Marshall G., San Martín A., Castillo O., Rozowski J., Leighton F. Effect of Mediterranean and Occidental diets, and red wine, on plasma fatty acids in humans. An intervention study. Biol. Res. 2004;37:253–261. doi: 10.4067/S0716-97602004000200012.
    1. Mezzano D., Leighton F., Strobel P., Martínez C., Marshall G., Cuevas A., Castillo O., Panes O., Muñoz B., Rozowski J., et al. Complementary effects of Mediterranean diet and moderate red wine intake on haemostatic cardiovascular risk factors. Eur. J. Clin. Nutr. 2001;55:444–451. doi: 10.1038/sj.ejcn.1601202.
    1. Leighton F., Cuevas A., Guasch V., Pérez D.D., Strobel P., Martín A.S., Urzua U., Díez M.S., Foncea R., Castillo O., et al. Plasma polyphenols and antioxidants, oxidative DNA damage and endothelial function in a diet and wine intervention study in humans. Drugs Under Exp. Clin. Res. 1999;25:133–141.
    1. Rodriguez J.M. Reduction of serum advanced glycation end-products with a low calorie Mediterra-nean diet. Nutr. Hosp. 2015;31:2511–2517.
    1. Leighton F., Polic G., Strobel P., Perez D., Martinez C., Vásquez L., Castillo O., Villarroel L., Echeverría G., Inés U., et al. Health impact of Mediterranean diets in food at work. Public Health Nutr. 2009;12:1635–1643. doi: 10.1017/S1368980009990486.
    1. Willett W.C., Sacks F., Trichopoulou A., Drescher G., Ferro-Luzzi A., Helsing E., Trichopoulos D. Mediterranean diet pyramid: A cultural model for healthy eating. Am. J. Clin. Nutr. 1995;61(Suppl. 6):1402S–1406S. doi: 10.1093/ajcn/61.6.1402S.
    1. Trichopoulou A., Lagiou P. Healthy Traditional Mediterranean Diet: An Expression of Culture, History, and Lifestyle. Nutr. Rev. 2009;55:383–389. doi: 10.1111/j.1753-4887.1997.tb01578.x.
    1. Bach-Faig A., Berry E.M., Lairon D., Reguant J., Trichopoulou A., Dernini S., Medina F.X., Battino M., Belahsen R., Miranda G., et al. Mediterranean Diet Foundation Expert Group. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14:2274–2284. doi: 10.1017/S1368980011002515.
    1. Lăcătușu C.-M., Grigorescu E.-D., Floria M., Onofriescu A., Mihai B.-M. The Mediterranean Diet: From an Environment-Driven Food Culture to an Emerging Medical Prescription. Int. J. Environ. Res. Public Health. 2019;16:942. doi: 10.3390/ijerph16060942.
    1. UNESCO Mediterranean Diet: UNESCO Intangible Cultural Heritage. [(accessed on 8 July 2020)]; Available online: .
    1. Psaltopoulou T., Sergentanis T.N., Panagiotakos D.B., Sergentanis I.N., Kosti R., Scarmeas N. Mediterranean diet, stroke, cognitive impairment, and depression: A meta-analysis. Ann. Neurol. 2013;74:580–591. doi: 10.1002/ana.23944.
    1. Martínez-González M.A., Sánchez-Villegas A. Food patterns and the prevention of depression. Proc. Nutr. Soc. 2016;75:139–146. doi: 10.1017/S0029665116000045.
    1. Molendijk M., Molero P., Sánchez-Pedreño F.O., van der Does W., Martínez-González M.A. Diet quality and depression risk: A systematic review and dose-response meta-analysis of prospective studies. J. Affect. Disord. 2018;226:346–354. doi: 10.1016/j.jad.2017.09.022.
    1. Lassale C., Batty G.D., Akbaraly T. Reply to Veronese and Smith: Healthy dietary indices and risk of depressive outcomes: A systematic review and meta-analysis of observational studies. Mol. Psychiatry. 2019;24:1–2. doi: 10.1038/s41380-019-0510-5.
    1. Shafiei F., Salari-Moghaddam A., Larijani B., Esmaillzadeh A. Adherence to the Mediterranean diet and risk of depression: A systematic review and updated meta-analysis of observational studies. Nutr. Rev. 2019;77:230–239. doi: 10.1093/nutrit/nuy070.
    1. Sanchez-Villegas D.A., Martinez-Gonzalez M.A., Estruch R., Salas-Salvadó J., Corella D., Covas M.-I., Arós F., Romaguera D., Gómez-Gracia E., Lapetra J., et al. Mediterranean dietary pattern and depression: The predimed randomized trial. BMC Med. 2013;11:208. doi: 10.1186/1741-7015-11-208.
    1. Opie R.S., O’Neil A., Jacka F.N., Pizzinga J., Itsiopoulos C. A modified Mediterranean dietary intervention for adults with major depression: Dietary protocol and feasibility data from the SMILES trial. Nutr. Neurosci. 2017;21:487–501. doi: 10.1080/1028415X.2017.1312841.
    1. Grosso G., Marventano S., D’Urso M., Mistretta A., Galvano F. The Mediterranean healthy eating, ageing, and lifestyle (MEAL) study: Rationale and study design. Int. J. Food Sci. Nutr. 2016;68:577–586. doi: 10.1080/09637486.2016.1262335.
    1. World Health Organization . Promoting Mental Health. Concepts. Emerging Evidence. World Health Organization; Geneva, Switzerland: 2005.
    1. Diener E. Subjective well-being. Psychol. Bull. 1984;95:542–575. doi: 10.1037/0033-2909.95.3.542.
    1. Ryff C.D. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J. Pers. Soc. Psychol. 1989;57:1069–1681. doi: 10.1037/0022-3514.57.6.1069.
    1. Shapiro A., Keyes C.L.M. Marital Status and Social Well-Being: Are the Married Always Better Off? Soc. Indic. Res. 2008;88:329–346. doi: 10.1007/s11205-007-9194-3.
    1. Diener E., Lucas R.E., Oishi S. Advances and Open Questions in the Science of Subjective Well-Being. Collabra Psychol. 2018;4:15. doi: 10.1525/collabra.115.
    1. Diener E., Oishi S., Tay L. Advances in subjective well-being research. Nat. Hum. Behav. 2018;2:253–260. doi: 10.1038/s41562-018-0307-6.
    1. Ryff C.D. Know yourself and become who you are: A eudaimonic approach to well-being. J. Happiness Stud. 2008;9:13–39. doi: 10.1007/s10902-006-9019-0.
    1. Ryff C.D. Psychological Well-Being Revisited: Advances in the Science and Practice of Eudaimonia. Psychother. Psychosom. 2014;83:10–28. doi: 10.1159/000353263.
    1. Keyes C.L.M. The Mental Health Continuum: From Languishing to Flourishing in Life. J. Health Soc. Behav. 2002;43:207–222. doi: 10.2307/3090197.
    1. Ryff C.D., Boylan J.M., Kirsch J.A. Eudaimonic and Hedonic Well-Being: An Integrative Perspective with Linkages to Socio-demographic Factors and Health. In: Lee M.T., Kubzansky L.D., VanderWeele T.J., editors. Measuring Well-being: Interdisciplinary Perspectives from the Social Sciences and the Humanities. Oxford University Press; Oxford, UK: 2021.
    1. Radler B.T., Rigotti A., Ryff C.D. Persistently high psychological well-being predicts better HDL cholesterol and triglyceride levels: Findings from the midlife in the U.S. (MIDUS) longitudinal study. Lipids Health Dis. 2018;17:1. doi: 10.1186/s12944-017-0646-8.
    1. Ryff C.D. The Benefits of Purposeful Life Engagement on Later-Life Physical Function. JAMA Psychiatry. 2017;74:1046–1047. doi: 10.1001/jamapsychiatry.2017.2136.
    1. Munoz M.A. Regicor and hermes investigators. Adherence to the Mediterranean diet is associated with better mental and physical health. Br. J. Nutr. 2009;101:1182–1821. doi: 10.1017/S0007114508143598.
    1. Costarelli V., Koretsi E., Georgitsogianni E. Health-related quality of life of Greek adolescents: The role of the Mediterranean diet. Qual. Life Res. 2013;22:951–956. doi: 10.1007/s11136-012-0219-2.
    1. Grao-Cruces A., Nuviala A., Fernández-Martínez A., Porcel-Gálvez A.M., Moral-García J.E., Martínez-López E.-J. Adherence to the Mediterranean diet in rural and urban adolescents of southern Spain, life satisfaction, anthropometry, and physical and sedentary activities. Nutr. Hosp. 2013;28:1129–1135.
    1. Bonaccio M., Di Castelnuovo A., Bonanni A., Costanzo S., de Lucia F., Pounis G., Zito F., Donati M.B., de Gaetano G., Iacoviello L. Adherence to a Mediterranean diet is associated with a better health-related quality of life: A possible role of high dietary antioxidant content. BMJ Open. 2013;3:e003003. doi: 10.1136/bmjopen-2013-003003.
    1. Sánchez P.H., Ruano C., De Irala J., Ruiz-Canela M., Martínez-González M.A., Sánchez-Villegas A. Adherence to the Mediterranean diet and quality of life in the SUN Project. Eur. J. Clin. Nutr. 2012;66:360–368. doi: 10.1038/ejcn.2011.146.
    1. Holt M.E., Lee J.W., Morton K.R., Tonstad S. Mediterranean diet and emotion regulation. Mediterr. J. Nutr. Metab. 2014;7:163–172. doi: 10.3233/MNM-140016.
    1. Galilea-Zabalza I., Buil-Cosiales P., Salas-Salvadó J., Toledo E., Ortega-Azorín C., Díez-Espino J., Vázquez-Ruiz Z., Zomeño M.D., Vioque J., Martínez J.A., et al. Mediterranean diet and quality of life: Baseline cross-sectional analysis of the predimed-plus trial. PLoS ONE. 2018;13:e0198974. doi: 10.1371/journal.pone.0198974.
    1. Bonaccio M., On Behalf of the MOLI-SANI Study Investigators. Di Castelnuovo A., Costanzo S., Pounis G., Persichillo M., Cerletti C., Donati M.B., De Gaetano G., Iacoviello L. Mediterranean-type diet is associated with higher psychological resilience in a general adult population: Findings from the Moli-sani study. Eur. J. Clin. Nutr. 2017;72:154–160. doi: 10.1038/ejcn.2017.150.
    1. Veronese N., Stubbs B., Noale M., Solmi M., Luchini C., Maggi S. Adherence to the Mediterranean diet is associated with better quality of life: Data from the Osteoarthritis Initiative. Am. J. Clin. Nutr. 2016;104:1403–1409. doi: 10.3945/ajcn.116.136390.
    1. Crichton G.E., Bryan J., Hodgson J.M., Murphy K.J. Mediterranean diet adherence and self-reported psychological functioning in an Australian sample. Appetite. 2013;70:53–59. doi: 10.1016/j.appet.2013.06.088.
    1. Perez-Tasigchana R.F., León-Muñoz L.M., López-García E., Banegas J.R., Rodríguez-Artalejo F., Guallar-Castillón P. Mediterranean diet and health-related quality of life in two cohorts of community-dwelling older adults. PLoS ONE. 2016;11:e0151596.
    1. Muros J.J., Cofre-Bolados C., Arriscado D., Zurita F., Knox E. Mediterranean diet adherence is associated with lifestyle, physical fitness, and mental wellness among 10-y-olds in Chile. Nutrition. 2017;35:87–92. doi: 10.1016/j.nut.2016.11.002.
    1. López-Gil J.F., Oriol-Granado X., Izquierdo M., Ramírez-Vélez R., Fernández-Vergara O., Olloquequi J., García-Hermoso A. Healthy Lifestyle Behaviors and Their Association with Self-Regulation in Chilean Children. Int. J. Environ. Res. Public Health. 2020;17:5676. doi: 10.3390/ijerph17165676.
    1. Fava G.A., Ruini C. Development and characteristics of a well-being enhancing psychotherapeutic strategy: Well-being therapy. J. Behav. Ther. Exp. Psychiatry. 2003;34:45–63. doi: 10.1016/S0005-7916(03)00019-3.
    1. Ruini C., Fava G.A. Well-being therapy for generalized anxiety disorder. J. Clin. Psychol. 2009;65:510–519. doi: 10.1002/jclp.20592.
    1. Ruini C., Fava G.A. Role of Well-Being Therapy in Achieving a Balanced and Individualized Path to Optimal Functioning. Clin. Psychol. Psychother. 2012;19:291–304. doi: 10.1002/cpp.1796.
    1. Ruini C., Ryff C.D. The Wiley Handbook of Positive Clinical Psychology. Wiley; Hoboken, NJ, USA: 2016. Using eudaimonic well-being to improve lives; pp. 153–166.
    1. Friedman E.M., Ruini C., Foy C.R., Jaros L., Love G., Ryff C.D. Lighten UP! A Community-Based Group Intervention to Promote Eudaimonic Well-Being in Older Adults: A Multi-Site Replication with 6 Month Follow-Up. Clin. Gerontol. 2019;42:387–397. doi: 10.1080/07317115.2019.1574944.
    1. Sin N. Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: A practice-friendly meta-analysis. J. Clin. Psychol. 2009;65:467–487. doi: 10.1002/jclp.20593.
    1. Bolier L., Haverman M., Westerhof G.J., Riper H., Smit F., Bohlmeijer E. Positive psychology interventions: A meta-analysis of randomized controlled studies. BMC Public Health. 2013;13:119. doi: 10.1186/1471-2458-13-119.
    1. Weiss L.A., Westerhof G.J., Bohlmeijer E.T. Can We Increase Psychological Well-Being? The Effects of Interventions on Psychological Well-Being: A Meta-Analysis of Randomized Controlled Trials. PLoS ONE. 2016;11:e0158092. doi: 10.1371/journal.pone.0158092.
    1. Unützer J., Katon W.J., Fan M.-Y., Schoenbaum M.C., Lin E.H.B., Della Penna R.D., Powers D. Long-term cost effects of collaborative care for late-life depression. Am. J. Manag. Care. 2008;14:95–100.
    1. Mancuso C.A., Choi T.N., Westermann H., Wenderoth S., Hollenberg J.P., Wells M.T., Isen A., Jobe J.B., Allegrante J.P., Charlson M.E. Increasing Physical Activity in Patients With Asthma Through Positive Affect and Self-affirmation. Arch. Intern. Med. 2012;172:337. doi: 10.1001/archinternmed.2011.1316.
    1. Ogedegbe G.O. A randomized controlled trial of positive affect intervention and medication adher-ence in hypertensive African Americans. Arch. Intern. Med. 2012;172:322–326. doi: 10.1001/archinternmed.2011.1307.
    1. Peterson J.C., Charlson M.E., Hoffman Z., Wells M.T., Wong S.-C., Hollenberg J.P., Jobe J.B., Boschert K.A., Isen A.M., Allegrante J.P. A Randomized Controlled Trial of Positive-Affect Induction to Promote Physical Activity After Percutaneous Coronary Intervention. Arch. Intern. Med. 2012;172:329–336. doi: 10.1001/archinternmed.2011.1311.
    1. Celano C.M. Optimizing a Positive Psychology Intervention to Promote Health Behaviors After an Acute Coronary Syndrome: The Positive Emotions After Acute Coronary Events III (PEACE-III) Random-ized Factorial Trial. Psychosom. Med. 2018;80:526–534. doi: 10.1097/PSY.0000000000000584.
    1. Massey C.N., Feig E.H., Duque L., Wexler D., Moskowitz J.T., Huffman J.C. Well-being interventions for individuals with diabetes: A systematic review. Diabetes Res. Clin. Pract. 2019;147:118–133. doi: 10.1016/j.diabres.2018.11.014.
    1. WHO . Sustainable Healthy Diets—Guiding Principles. FAO; Rome, Italy: 2019.
    1. Mbow C. Special Report on Climate Change, Desertification, Land Degradation, Sustainable Land Management, Food Security, and Greenhouse Gas Fluxes in Terrestrial Ecosystems. IPCC; Ginevra, Switzerland: 2019. Food Security.
    1. Fardet A., Rock E. Ultra-Processed Foods and Food System Sustainability: What are the Links? Sustainability. 2020;12:6280. doi: 10.3390/su12156280.
    1. Nelson M., Hamm M.W., Hu F.B., Abrams S., Griffin T.S. Alignment of Healthy Dietary Patterns and Environmental Sustainability: A Systematic Review. Adv. Nutr. 2016;7:1005–1025. doi: 10.3945/an.116.012567.
    1. Grosso G., Fresán U., Bes-Rastrollo M., Marventano S., Galvano F. Environmental Impact of Dietary Choices: Role of the Mediterranean and Other Dietary Patterns in an Italian Cohort. Int. J. Environ. Res. Public Health. 2020;17:1468. doi: 10.3390/ijerph17051468.
    1. Rosi A., Biasini B., Donati M., Ricci C., Scazzina F. Adherence to the Mediterranean Diet and Environmental Impact of the Diet on Primary School Children Living in Parma (Italy) Int. J. Environ. Res. Public Health. 2020;17:6105. doi: 10.3390/ijerph17176105.
    1. Vanham D., Mekonnen M.M., Hoekstra A.Y. Treenuts and groundnuts in the EAT-Lancet reference diet: Concerns regarding sustainable water use. Glob. Food Secur. 2020;24:100357. doi: 10.1016/j.gfs.2020.100357.
    1. González-García S., Esteve-Llorens X., Moreira M.T., Feijoo G. Carbon footprint and nutritional quality of different human dietary choices. Sci. Total Environ. 2018;644:77–94. doi: 10.1016/j.scitotenv.2018.06.339.
    1. Ruini L.F., Ciati R., Pratesi C.A., Marino M., Principato L., Vannuzzi E. Working toward Healthy and Sustainable Diets: The Double Pyramid Model Developed by the Barilla Center for Food and Nutrition to Raise Awareness about the Environmental and Nutritional Impact of Foods. Front. Nutr. 2015;2:9. doi: 10.3389/fnut.2015.00009.
    1. Serra-Majem L. The Mediterranean diet as an example of food and nutrition sustainability: A multi-disciplinary approach. Nutr. Hosp. 2018;35:96–101.
    1. Berry E.M. Sustainable Food Systems and the Mediterranean Diet. Nutrients. 2019;11:2229. doi: 10.3390/nu11092229.
    1. FAO. FIDA. OMS. PMA. UNICEF . Executive Summary of El Estado de la Seguridad Alimentaria y la Nutrición en el Mundo 2020. Transformación de los Sistemas Alimentarios para que Promuevan Dietas Asequibles y Saludables. FAO; Roma, Italy: 2020.
    1. Toti E., Di Mattia C., Serafini M. Metabolic Food Waste and Ecological Impact of Obesity in FAO World’s Region. Front. Nutr. 2019;6:126. doi: 10.3389/fnut.2019.00126.
    1. Edwards P., Roberts I. Population adiposity and climate change. Int. J. Epidemiol. 2009;38:1137–1140. doi: 10.1093/ije/dyp172.
    1. Rosi A., Mena P., Pellegrini N., Turroni S., Neviani E., Ferrocino I., Di Cagno R., Ruini L., Ciati R., Angelino D., et al. Environmental impact of omnivorous, ovo-lacto-vegetarian, and vegan diet. Sci. Rep. 2017;7:1–9. doi: 10.1038/s41598-017-06466-8.
    1. Dernini S., Berry E., Serra-Majem L., La Vecchia C., Capone R., Medina F., Aranceta-Bartrina J., Belahsen R., Burlingame B., Calabrese G., et al. Med Diet 4.0: The Mediterranean diet with four sustainable benefits. Public Health Nutr. 2017;20:1322–1330. doi: 10.1017/S1368980016003177.
    1. Gastronomía y Marca País Informe Final. Gerencia de Estudios Imagen Chile. [(accessed on 20 July 2020)];2016 Available online:
    1. D’Innocenzo S., Biagi C., Lanari M. Obesity and the Mediterranean Diet: A Review of Evidence of the Role and Sustainability of the Mediterranean Diet. Nutrients. 2019;11:1306. doi: 10.3390/nu11061306.
    1. Drewnowski A., Monsivais P. Taste, cost, convenience, and food choices. Present Knowl. Nutr. 2020;2:185–200. doi: 10.1016/b978-0-12-818460-8.00010-1.
    1. Garnett T., Mathewson S., Angelides P., Borthwick F. Policies and actions to shift eating patterns: What works? Foresight. 2015;515:518–522.
    1. FAO. IFAD. UNICEF. WFP. WHO . The State of Food Security and Nutrition in the World 2019 Safeguarding Against Economic Slowdowns and Downturns. FAO; Rome, Italy: 2019.
    1. Saulle R., Semyonov L., la Torre G. Cost and Cost-Effectiveness of the Mediterranean Diet: Results of a Systematic Review. Nutrients. 2013;5:4566–4586. doi: 10.3390/nu5114566.
    1. Drewnowski A., Eichelsdoerfer P. The Mediterranean diet: Does it have to cost more? Public Health Nutr. 2009;12:1621–1628. doi: 10.1017/S1368980009990462.
    1. Vlismas K., Panagiotakos D.B., Pitsavos C., Chrysohoou C., Skoumas Y., Sitara M., Yfantopoulos J.N., Stavrinos V., Stefanadis C. Quality, but not cost, of diet is associated with 5-year incidence of CVD: The ATTICA study. Public Health Nutr. 2010;13:1890–1897. doi: 10.1017/S1368980010000649.
    1. Lopez C.N. Costs of Mediterranean and western dietary patterns in a Spanish cohort and their relationship with prospective weight change. J. Epidemiol. Community Health. 2009;63:920–927. doi: 10.1136/jech.2008.081208.
    1. Schröder H., Marrugat J., Covas M. High monetary costs of dietary patterns associated with lower body mass index: A population-based study. Int. J. Obes. 2006;30:1574–1579. doi: 10.1038/sj.ijo.0803308.
    1. Goulet J., Lamarche B., Lemieux S. A Nutritional Intervention Promoting a Mediterranean Food Pattern Does Not Affect Total Daily Dietary Cost in North American Women in Free-Living Conditions. J. Nutr. 2008;138:54–59. doi: 10.1093/jn/138.1.54.
    1. OECD . The Heavy Burden of Obesity and the Economics of Prevention. Organisation for Economic Co-Operation and Development (OECD); Paris, France: 2019. p. 13.
    1. Dalziel K.M., Segal L., De Lorgeril M. A Mediterranean Diet Is Cost-Effective in Patients with Previous Myocardial Infarction. J. Nutr. 2006;136:1879–1885. doi: 10.1093/jn/136.7.1879.
    1. Dalziel K.M., Segal L. Time to give nutrition interventions a higher profile: Cost-effectiveness of 10 nutrition interventions. Health Promot. Int. 2007;22:271–283. doi: 10.1093/heapro/dam027.
    1. Panagiotakos D. Estimating the 10-year risk of cardiovascular disease and its economic consequences, by the level of adherence to the Mediterranean diet: The ATTICA study. J. Med. Food. 2007;10:239–243. doi: 10.1089/jmf.2006.251.
    1. Catastro Nacional de Ferias Libres. [(accessed on 23 July 2020)];2016 Available online: .
    1. Vilarnau C., Stracker D.M., Funtikov A., da Silva R., Estruch R., Bach-Faig A. Worldwide adherence to Mediterranean Diet between 1960 and 2011. Eur. J. Clin. Nutr. 2018;72:83–91. doi: 10.1038/s41430-018-0313-9.
    1. Belahsen R., Rguibi M. Population health and Mediterranean diet in southern Mediterranean countries. Public Health Nutr. 2006;9:1130–1135. doi: 10.1017/S1368980007668517.
    1. Willett W., Rockström J., Loken B., Springmann M., Lang T., Vermeulen S., Garnett T., Tilman D., Declerck F., Wood A., et al. Food in the Anthropocene: The EAT–Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393:447–492. doi: 10.1016/S0140-6736(18)31788-4.

Source: PubMed

3
Prenumerera