Advances in Nutrition 14 (2023) 570–582

journal homepage: [Link]

Review

Assessing the Interlinkage between Biodiversity and Diet through the

Mediterranean Diet Case
Konstadinos Mattas 1, *, Elena Raptou 2, Ahmed Alayidi 3, Gizem Yener 3, George Baourakis 4
1
Department of Agricultural Economics, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2 Department of Agricultural Development,
Democritus University of Thrace, Orestiada, Greece; 3 Department of Business Economics and Management, CIHEAM Mediterranean Agronomic
Institute of Chania, Chania, Greece; 4 CIHEAM Mediterranean Agronomic Institute of Chania, Chania, Greece

A B S T R A C T

The adoption of healthy and sustainable diets and the transition to sustainable food systems is of principal importance in order to counteract
the double burden of climate change and noncommunicable diseases. The Mediterranean diet (MD) has been widely recognized as a
biodiversity and healthy nutrition resource to support sustainable development and food security. This study explored biodiversity in terms
of food plants species, subspecies, varieties, and races, and also addressed food plant diversity differences between the MD and Western-type
consumption patterns. It was funded by the EU BioValue Project, aiming to promote the integration of underutilized crops into the food
value chains. Using a 2-stage scheme, data were selected from MEDUSA and EuroþMed databases (including 449 species, 2366 subspecies,
varieties, and races). Furthermore, 12 countries from North Africa and Europe were classified in 2 groups according to their subregional
attributes and their traditionally most prevalent dietary pattern (MD or Western-type diets). Statistical analysis showed that the mean of the
majorly cultivated food plants in the MD was significantly higher than its counterpart in the Western diet. Furthermore, no statistical
difference was detected in the averages of native food plants between the MD group and the Western diet group, implying that the higher
diversity in food plants observed in the MD seems to be attributed to crop utilization rather than crop availability. Our findings indicated the
interlinkage between biodiversity and prevailing dietary patterns and further underlined that biodiversity could constitute a prerequisite for
dietary diversity and hence nutrition security. In addition, this study demonstrated that diets and nutrition should be approached in a
broader way within the context of both agro-food and ecological systems.

Keywords: biodiversity, food plants, prevailing dietary pattern, Mediterranean diet, Western diet, sustainable food systems

Introduction resources through overexploitation, intensive farming, and land

fragmentation [5]. Besides feeding the population, the current
The question of how to feed people and provide adequate and agro-food system has also been considered as a major driver of
healthy food to eliminate hunger and malnutrition constitutes a environmental degradation and climate change [6–8]. Agricul-
crucial social challenge [1], since the world population is tural production occupies approximately 40% of the global land,
steadily increasing and it is expected to rise from 7.7 billion whereas livestock and livestock-feed production represent 75%
worldwide in 2019 to around 9.7 billion by 2050, and up to 10.9 of all agricultural land [2,9]. Subsequently, agricultural land
billion by the end of the century [2,3]. Food and Agriculture expansion and the associated extensive usage of inputs, such as
Organization (FAO) estimates showed that agro-food production irrigation, fertilizers, and pesticides, may result in fragmentation
will have to increase by almost 50% in order to accomplish of habitats, natural resources depletion, and environmental
consumers’ requirements and satisfy the increasing demand, degradation. In addition, food production constitutes the prin-
especially for meat and processed meat products [4]. This con- cipal consumer of fresh water and accounts for up to 30% of
stant population growth may be considered as an underlying global greenhouse gas (GHG) emissions [10–13]. Awuchi et al.
threat to sustainable development because it stresses natural [14] provided an analytical report on the environmental impacts

Abbreviations: CBD, Convention on Biological Diversity; FSN, Food security and nutrition; GHG, Greenhouse gas; MD, Mediterranean diet; NUPs, Neglected and
underutilized plant species; SFS, Sustainable food system.
* Corresponding author. E-mail address: mattas@[Link] (K. Mattas).

[Link]
Received 10 August 2022; Received in revised form 2 March 2023; Accepted 24 March 2023; Available online 28 March 2023
2161-8313/© 2023 The Authors. Published by Elsevier Inc. on behalf of American Society for Nutrition. This is an open access article under the CC BY-NC-ND license
([Link]
K. Mattas et al. Advances in Nutrition 14 (2023) 570–582

of the agro-food industry, noting that these impacts in terms of 34–37]. Dietary guidelines have to combine the health-nutrition
environmental pressures may obstruct agro-food production, aspect with the environmental aspect for providing food for all in
especially in the future. a healthy and sustainable way [9,36]. Toward a more sustainable
Intensified management practices in the agro-food businesses dietary option, the traditional MD addresses both health and
together with the overexploitation of inputs may endanger the environmental issues because recent evidence showed that
conservation of the terrestrial ecosystems and have severe im- plant-based dietary patterns with low consumption of animal foods
pacts on biodiversity [15–19]. It has been argued that biodi- contribute to health maintenance and can help mitigate biodiver-
versity is declining partially due to several drivers associated sity degradation [2,38,39] compared to Western dietary patterns.
with the current conventional agriculture, such as intensifica- In particular, the Med Diet 4.0 framework evaluated the MD as a
tion, monocropping, and the use of chemicals, among others food consumption pattern with sustainability outcomes, incorpo-
[20]. According to the Article 2 of the Convention on Biological rating the following components: 1) well-established major health
Diversity (CBD), biological diversity is defined as “the variability and nutrition benefits, prevention of chronic diseases, decrease in
among living organisms from all sources including, inter alia, terres- public health costs, and overall improvement of well-being; 2) low
trial, marine and other aquatic ecosystems and the ecological com- environmental impacts and biodiversity conservation, reduction of
plexes of which they are part; this includes diversity within species, pressure on natural resources, and climate change mitigation; 3)
between species and of ecosystems” [21]. Wood and Lenne [22] local economic returns, sustainable territorial development,
also defined agrobiodiversity as “the diversity of living organisms, reduction in rural poverty, and food waste and food loss reduction;
including animals, plants, bacteria, etc., used in agriculture.” Both 4) high social and cultural food value and identity, social interac-
definitions noted that the quantitative measurement of food tion, and consumer empowerment [2,8,40].
plant species and subspecies within a particular food system In light of biodiversity decline, this study sought to investi-
comprises a strong indicator of biodiversity [22]. gate biodiversity in terms of food plants species, subspecies,
Although intensification in agricultural production systems varieties, and races and address food plant diversity differences
can substantially increase yields and at the same time reduce the between the MD and Western-type consumption patterns. In
area of the cultivated land, there is a high risk for biodiversity particular, this study explored whether the dietary pattern that
loss due to fertilizer and pesticide pollution [19]. Agricultural traditionally prevails in the country of reference (MD or Western-
expansion and intensification may increase evapotranspiration type diets) is influenced by biodiversity in food plants (including
[23], which in turn can reduce the amount of freshwater runoff species, subspecies, varieties, and races). To the best of our
and aquifer recharge [24,25], putting extra pressure on ecosys- knowledge, this is the first study to explore the biodiversity of
tems and biodiversity. Furthermore, irrigated agriculture may the MD at the plant species, subspecies, variety, and race level
decrease the availability of water in surrounding rivers and lakes within the Mediterranean basin. Therefore, the cultivation status
and generate trade-offs between ecosystems regarding the usage of 449 food plant species and their 2366 related subspecies,
of freshwater [26,27], whereas excessive use of fertilizers con- varieties, and races was investigated within 12 countries in the
tributes to water bodies eutrophication and the subsequent Mediterranean region and the rest of Europe, out of which 6
degradation of aquatic ecosystems [27]. Livestock, and espe- countries traditionally present a greater adherence to the MD,
cially meat production, has also been associated with natural whereas the remaining 6 countries have adopted a Western-type
ecosystems degradation and biodiversity decline because it dietary pattern. The research was funded by the EU BioValue
constitutes a water and land-intense sector and also accounts for Project, aiming to promote the integration of underutilized crops
higher GHG emissions per unit of energy or protein than other into the food value chains.
foods [13,19]. Future expansion and intensification in agro-food
production practices will put extra burden, especially in bio- Sustainability in the food sector
diverse regions [28]. On the other hand, the production of plant Sustainable food systems and sustainable diets.
foods accounts for lower GHG emissions compared with animal Modern food systems have to compromise the increasing food
foods, denoting that a shift toward plant-based diets could help demand due to global population growth while competing for
preserve biodiversity [8,29]. resources [36]. This dual challenge forces dietary interventions
In an effort to address biodiversity decline, the great majority and nutrition programs to move from the traditional
of the world’s governments adopted the Global Strategic Plan for nutrients-health approach to a new one that puts on the table
Biodiversity 2011–2020 and its 20 Aichi Biodiversity Targets, a sustainable development and its sociocultural, environmental,
10-y framework for action designed by the CBD, to safeguard and economic aspects [2,41]. To enhance the sustainability of the
biodiversity [30]. Unfortunately, none of these targets were fully food systems and achieve food security, there has been a
met, whereas the Fifth Global Biodiversity Outlook 5, published concerted effort to broad the sustainability perspective along 3
in September 2020, reported limited progress [31]. The axes, emphasizing the transition from 1) the production approach
Post-2020 Global Biodiversity Framework will be presented for to a more holistic food system approach, 2) the environmental
consideration in December 2022, aiming to restrain biodiversity approach to an integrated and wider approach incorporating both
loss by 2030 and achieve recovery by 2050 [32]. Within the the sociocultural and economic perspective as well, and 3) the
framework of the EU Green Deal, the European Commission “global availability” perspective of food security to a new
published the EU Biodiversity Strategy for 2030 in order to pro- perspective encompassing the dimensions of food accessibility,
tect natural ecosystems after recognizing “the multiple benefits of nutrition, and stability to the individual level [42,43].
biodiversity for society and, more broadly, for life on earth” [33]. According to the 2014 High Level Panel of Experts on Food
There is a great body of literature linking food consumption and Security and Nutrition Report, a sustainable food system (SFS) is
diet with both human health and environmental sustainability [12, the “food system that ensures food security and nutrition (FSN)

571
K. Mattas et al. Advances in Nutrition 14 (2023) 570–582

for all in such a way that the economic, social, and environ- consumption of 1) minimally refined plant foods (fruits, vege-
mental bases to generate FSN for future generations are not tables, breads and other cereals, potatoes, beans, nuts and seeds),
compromised” [43,44]. Therefore, the concepts of FSN and SFS 2) minimally processed, seasonally fresh, and locally cultivated
seem to be interrelated and the existence of “food security and foods, 3) fresh fruits as typical dessert, with sweets containing
nutrition for all, worldwide” over time can only be achieved sugars or honey for a few times per wk, 4) a high intake of olive
within the frames of a sustainable food system [45]. The sus- oil (especially virgin and extra-virgin olive oil) comprising the
tainability concept includes a time dimension to ensure that its principal source of fat, 5) a moderate intake of dairy products
environmental, sociocultural, and economic aspects will interact (mostly cheese and yogurt), 6) up to 4 eggs per wk, 7) fish and
with the dimensions of food security (i.e., food availability, ac- poultry in low to moderate amounts and red meat in low
cess, utilization, and stability). amounts, and 8) wine during meals, in moderate amounts [68].
The necessity for the transition to sustainable diets has been However, it should be noticed that there is no single MD, and
widely discussed and fostered within the context of sustainable different countries in the Mediterranean regions may have their
food systems. Numerous studies underline that diets that exploit own diets, varying in some elements but also presenting a
the physical constraints of an environment with finite resources common base (for instance, in all the Mediterranean countries,
stress the biodiversity and produce unnecessary gas emissions the most common source of dietary lipids is monounsaturated fat
that disrupt environmental quality and conservation [46–49]. [69]). Besides the balance of foods in the dietary pyramid, the
Furthermore, current food consumption is characterized by a MD is also associated with regular consumption of home-cooked
global shift from basic plant-based food components toward meals, meals as social events, low temperature cooking methods,
higher-value foods (i.e., meat, dairy) and more processed food reduced snacking, fasting, owning a vegetable garden, using
items, resulting in increasing rates of diet-related chronic dis- traditional foods and recipes, and a post-lunch nap [70,71].
eases (i.e., cardiovascular disorders, diabetes) and overweight Furthermore, the MD pattern is also characterized by a balanced
and obesity [35,50]. Modern food industries through marketing consumption of diverse foods, promoting locally produced and
strategies have substantially influenced consumers’ food choice consumed plants with seasonal character [71,72].
by directing their preferences toward food products without Since 2010, UNESCO has recognized the Mediterranean diet
considering their seasonality or promote less healthy foods, as an Intangible Heritage of the Humanity, stating that it “con-
highly polluting with low nutritive value [51,52]. stitutes a set of skills, knowledge, practices and traditions
A universal healthy reference diet can be defined as a plant- ranging from the landscape to the table” [73]. This UNESCO
based diet that mostly includes fruits and vegetables, whole confirmation highlighted the social dimension of the food cul-
grains, nuts, pulses, and unsaturated fatty acids; low quantities of ture, which is irrelevant to the nutritional pyramid and concerns
fish products and white meat; negligible quantities of red meat, the enhancement of social interactions, the conservation of
processed meat, added sugar, refined grains, and starchy vege- traditional activities, and the way in which foods are produced,
tables [36,53]. Well-documented evidence showed that cooked, and consumed [52,73,74]. The MD is more than just the
plant-based dietary patterns with low quantities of animal source composition and distribution of a bundle of foods consumed by
foods promote a mutual beneficial co-existence of both in- individuals and societies; rather, it has been incorporated into
dividual’s health improvement and environmental safety the MD the concept of lifestyle, as determined by local, social,
[54–60]. In spite of the healthy reference diet, FAO and Biodi- cultural, and socioeconomic influences [75].
versity International defined sustainable diets as “those diets A great body of the literature emphasized the health benefits
with low environmental impacts which contribute to food and associated with the adherence to the MD, noting that it seems to
nutrition security and to healthy live for present and future protect from cardiovascular diseases [52,75,76–79], the meta-
generations. Sustainable diets are protective and respectful of bolic syndrome and obesity [80,81], diabetes [82], hypertension
biodiversity and ecosystems, culturally acceptable, accessible [75,83], and various types of cancer [84]. However, despite the
and economically fair and affordable; nutritionally adequate, certain health benefits of the MD, recent evidence underlined a
safe and healthy; while optimizing natural and human resources” significant decline in MD adherence in the Mediterranean basin,
[61]. Lairon [62] also introduced a 6-factor model to describe mainly attributed to socioeconomic changes and emerging new
sustainable diets, comprising the following 6 dimensions as 1) lifestyles that put at risk the preservation and transmission of the
food security and accessibility, 2) healthy food, 3) respect for MD to future generations [71,85–88]. In a thorough review,
environment and biodiversity, 4) fair trade, 5) local- Obeid et al. [67] explored MD adherence among populations in
ity/seasonality, and 6) protection of culture, heritage, and skills. the Mediterranean basin and showed that individuals living in
the Mediterranean countries seem to have altered their nutri-
The MD: health impacts tional habits and their dietary principles, shifting away from the
Following a debate on how food systems and diets should be traditional MD plant-based diet. However, the authors noted that
oriented toward a more sustainable perspective, the MD has been there are variations among groups with different sociodemo-
widely recognized as a sustainable dietary pattern [52,63–65]. graphic characteristics and/or lifestyle factors, which may affect
Originally, the MD has been described as the dietary pattern the estimation of MD adherence scores. A significant body of the
adopted by populations of olive tree-growing areas around the recent literature in the field reported moderate scores in MD
Mediterranean basin (Albania, Algeria, Bosnia, Croatia, Cyprus, adherence [67,88,89,90–92], sounding the alarm for subsequent
Egypt, France, Gibraltar, Greece, Israel, Italy, Lebanon, Libya, health and environmental impacts and rendering necessary the
Morocco, Malta, Monaco, Montenegro, Palestinian territory, design and the implementation of various strategies directed to
Slovenia, Spain, Syria, Turkey, and Tunisia) [66,67]. The tradi- the promotion of the MD and its healthier and more sustainable
tional MD is a mainly plant-based diet and it is based on the plant-based dietary patterns [88].

572
K. Mattas et al. Advances in Nutrition 14 (2023) 570–582

The MD: biodiversity and environmental impacts vegetables and fruits require less than 1000 L of water and about
As a traditional sustainable dietary pattern, the MD exerts a 3 m2/kg, whereas beef needs about 19,000 L and 144 m2/kg [52,
lower environmental impact and has a better ecological footprint 101]. Several recent studies also demonstrated that the contri-
compared to Western diets [2] because it is associated with bution of animal products (meat, poultry, dairy, egg, and fish)
lower GHG emissions, water consumption, land use, and energy constituted the greatest contributor to GHG emissions [19,65,96,
requirements [71]. Despite a noticeable increase in interventions 102].
and actions to support biodiversity, the food system comprises a
major driver of biodiversity decline as a consequence of pres- Rationale and Methodology
sures on natural resources, GHG emissions, and eutrophication
[8,19].
Rationale
In a thorough review, Bo ^to et al. [93] examined the envi-
Farmers have a crucial role in utilizing biodiversity for crops’
ronmental dimension of the MD after assessing various envi-
adaptation to various and changing environments of production.
ronmental indicators. The authors came to the conclusion that
At the same time, they face competing pressures to increase yield
the MD had a lower environmental impact compared to
efficacy and produce more food while restoring, conserving, and
Western-type diets, and showed a Carbon Footprint between 0.9
enhancing biodiversity in their farms. Farmers are more likely to
and 6.88 kg CO2/d per capita, a Water Footprint between 600
pursue their interests by cultivating available food crop species
and 5280 m3/d per capita, and an ecological footprint between
and also respond to consumers’ preferences and needs in order to
2.8 and 53.42 m2/d per capita [93]. Aleksandrowicz et al. [54]
sell their yield and increase profitability. This interaction be-
also found that shifting from Western to sustainable diets could
tween producer decision and consumer demand can help in-
decrease more than 70% of GHG emissions and land use and up
crease the market’s efficiency by creating added value to
to 50% of water usage. These results were also supported by a
agricultural products, increasing consumer’s satisfaction, and
significant body of the recent literature, noting that high
providing a greater share of consumer price to farmers [103].
adherence to the MD pattern was linked with lower GHG emis-
Thus, a farmer’s decision to grow a particular crop species is
sions and resources consumption (land, water, energy) [65,
highly associated with the utilization of that crop by consumers,
94–96]. Using data on dietary consumption patterns from a
and hence the prevalence of that specific dietary pattern within a
group of European Mediterranean pioneer countries and a group
specific geographic region.
of EU28 countries, Castaldi et al. [97] explored adherence to the
However, to date, no previous study has explored the asso-
MD to global GHG emission reduction targets. The authors noted
ciation between dietary patterns and agrobiodiversity at plant
that the GHG emissions associated with the ideal MD pattern are
species, subspecies, varieties, and races level. As there is no
in accordance with the planetary GHG emissions climate targets.
direct method to investigate the relationship between dietary
However, they underlined that the analysis of the actual food
patterns and food plants, we developed the following set of ar-
consumption patterns in the Mediterranean region indicates that
guments: 1) if a food plant species (x) has been cultivated in a
the dietary habits significantly diverged from the ideal MD
geographic unit (y), then the latter’s population has consumed
health and environmental objectives, since emissions were up to
this food plant species (x) as part of their diet; 2) if in the
4.46 kg CO2eq capita1 d1 [97].
geographic unit (y), diet (z) is more prevalent compared to other
The MD has also been acknowledged as one of the most
dietary patterns, then the food plant (x) is utilized in diet (z); 3) if
prominent sustainable dietary patterns with a significant
the geographic unit, in which dietary pattern (z1 ) is prevalent,
contribution to biodiversity protection [65,72,74,98,99]. In a
includes, on average more food plant species compared to the
recent study, Belgacem et al. [8] explored the pressures of the
geographic unit in which dietary pattern (z2 ) is prevalent, then
MD, the European diet, and the Western diet on biodiversity in
based on the previous argument, diet (z1 ) utilizes a more diverse
terms of land and water usage, GHG emissions, and eutrophi-
mix of food plant species compared to dietary pattern (z2 ).
cation impact indicators. The authors indicated the link between
dietary patterns and biodiversity and underlined that the
plant-based MD had the lowest values of biodiversity indicators Data selection
compared with the other 2 dietary patterns. On the other side, This study employed a 2-stage data selection scheme. First, a
Vega Mejía et al. [100] indicated that the Western diet is based filtered search on the MEDUSA plant database was performed to
on agricultural production methods that harm ecosystems, in- collect species used as food and food additives over the period
crease the use of fossil fuels, and increase GHG emissions. In January to February 2022. The MEDUSA database has been
particular, processed foods in the Western dietary pattern have a developed at the Mediterranean Institute of Chania as an inte-
high environmental cost since they emit high levels of GHGs, grated and coordinated project of the MEDUSA network, aiming
accelerate land-use change to support agriculture and intensive to identify the native and naturalized plants of the Mediterra-
livestock activities, and necessitate large amounts of water and nean region that are currently or potentially useful to people.
agrochemicals. The MEDUSA network information includes details on plants’
The pressures on resources and the emissions of GHGs vary conservation status and their potential utilization as alternative
according to the food consumed. In particular, meat and dairy minor crops, geography, habitat description and usage. The
foods have the largest carbon, water, and ecological footprint. classes of usage may encompass food, food additives, animal
They account for 14% of the GHGs produced by human activities food, bee plants, food for useful invertebrates, materials, fuels,
because of the large quantity in animal feed resources required social uses, vertebrate poisons, nonvertebrate poisons, medi-
[101]. For instance, poultry meat produces 4000 g/kg of CO2, cines, environmental uses, and gene sources. Furthermore, the
whereas seasonal vegetables produce 815 g/kg of CO2. Similarly, MEDUSA network provides a regional information system

573
K. Mattas et al. Advances in Nutrition 14 (2023) 570–582

covering scientific plant names and authority, vernacular the rows and the chosen countries in the columns. An entry of 1
names, chemical data, trade, marketing and distribution, and in ði1 ;j1 Þindicated that species i1 is native to country j1 , while an
references to literature sources [104]. All this information has entry of 2 in ði1 ; j2 Þ implied that the species i1 is majorly culti-
been incorporated to the up-to-date online MEDUSA database vated in country j2 . This procedure resulted in the identification
designed to overcome inconsistencies in the taxonomy and of an asymmetric matrix of size (281512). Therefore, 449
usage of regional plants. In addition, it provides a solid basis for species and 2366 subspecies, varieties, and races were examined
projects oriented to explore methods for the socioeconomic, in this study. Finally, the overall number of cultivated species
health and nutrition development of rural areas in the Medi- was obtained through summation. A table was constructed to
terranean region under sustainable management systems that indicate dietary region (Western/Mediterranean), country
will evaluate the usage and conservation of plant resources in (name of the country), and number of majorly cultivated and
the area [104,105]. The Mediterranean countries that partici- native species, subspecies, varieties, and races, respectively
pate in the MEDUSA project are: Greece, Turkey, Syria, (Supplemental Table 2). Figure 1 summarizes the data sources
Lebanon, Cyprus, Egypt, Tunisia, Algeria, Morocco, Malta, and the data selection process.
Portugal, Spain, France, and Italy. In the context of the present For the purposes of the present study, we selected 12 coun-
research, the data included the list of food crops attained after tries from North Africa and Europe (N¼12), out of which 6
the application of 2 filters concerning usage (i.e., “food” and countries (Greece, Italy, Malta, Morocco, Algeria, and Lebanon)
“food additive”). All the displayed species were categorized in a are geographically included in the Mediterranean basin and their
separate Excel file, resulting to an overall of 449 species. Sup- populations traditionally show a greater adherence to the MD
plemental Table 1 presents in detail the species and their usage pattern [66,67,106]; the remaining 6 countries (Belgium,
as edible plants. Switzerland, Germany, Austria, Denmark, and Sweden) follow a
Second, the EuroþMed plant database was employed to select Western-type diet [86,107,108]. The selection of the countries
information on the geographical location of different species, was random to avoid selection biases. In addition, the Mediter-
subspecies, varieties, and landraces ([Link] ranean region was further distinguished into Western Mediter-
consulted from March to April 2022). The search for each species ranean, Central Mediterranean, and Eastern Mediterranean
resulted in all the subspecies, varieties, and races that were regions, whereas the Western-diet region was classified into
available on the database in the regions of Europe and the Mediterranean borders, Central European, and Northern Euro-
Mediterranean basin. In particular, each taxonomic subdivision’s pean regions. Because there is no direct method to investigate
page revealed its geographic distribution, the nativity status, and the relationship between dietary pattern prevalence and biodi-
the cultivation status within Europe and the Mediterranean versity, we expect that there is a more diverse mix of food plants
basin. For instance, if a variety is majorly cultivated in Greece, in the selected countries in the Mediterranean basin compared
the map of the country is marked with yellow color, whereas for with the 6 Central-Northwestern European countries. Besides, as
native but not cultivated varieties, the map of the country is Mattavelli et al. [109] note, “it is important to associate the term
pictured in green color. ‘Mediterranean diet’ not only with the food quality and meal
The aforementioned approach was adopted for all the 449 composition, but also with a particular way of cooking, eating
species obtained from the MEDUSA database on a species-by- and more.” The MD includes a variety of traditions and lifestyle
species basis. The results were registered in a matrix that factors that characterize countries in the Mediterranean basin
included food plant species, subspecies, varieties, and races in and reinforce the cultural identity in the region [109,110]. All

FIGURE 1. Data selection process.

574
K. Mattas et al. Advances in Nutrition 14 (2023) 570–582

these factors that construct the frame of the MD extend beyond  Assumption 4: The dependent variable should be approximately
dietary patterns, and for this reason the MD has been inscribed normally distributed for each category of the independent
since 2013 in the Representative List of the Intangible Cultural variable. To assess potential departures from normality, the
Heritage of Humanity Countries in the Mediterranean basin Shapiro-Wilk test was employed, which comprises the most
[109,110]. Table 1 demonstrates the dietary and subregional appropriate procedure for small sample sizes (N<50) [113].
attributes of the selected countries. This test was adopted to examine the following hypothesis:

Statistical analysis H0 : the data are normally distributed; (3)

Τhis study investigated potential differences in the mean
number of majorly cultivated and native food plant species, H1 : the data are not normally distributed (4)
subspecies, varieties, and races between countries in which the
In case P < 0.05, assumption of normality is violated,
Mediterranean diet constitutes the basic dietary pattern and
implying that the data are not normally distributed.
countries in which a Western-type diet is the most prevalent
among their population. Thus, an independent samples t-test was  Assumption 5: The Levene’s test for homogeneity of variances
applied to compare the means of 2 independent groups and was applied to check for equality of variances. In case data
determine whether there is statistical evidence that the associ- does not meet this assumption, the independent samples t-test
ated population means are significantly different [111]. The in- is not a suitable statistical test. The Levene’s test for homo-
dependent samples t-test is defined as: geneity of variances is defined as follows:
H0 : μ1 ¼ μ2 (1)
H0 : σ 21 ¼ σ 22 (5)

H1 : μ1 6¼ μ2 (2)
H1 : σ 21 6¼ σ 22 (6)
where μ1 and μ2 are the population means for group 1 and group In case P < 0.05, the null hypothesis is rejected, and the
2, respectively. The null hypothesis tests that the population variances are not equal. Once all the assumption tests are veri-
means from 2 independent groups are equal. In case the null fied, we, in accordance with the requirements of the independent
hypothesis H0 is rejected (P < 0.05), then the population means samples t-student test, may accomplish this procedure as previ-
are not equal and the alternative hypothesis H1 is accepted. ously described.
To perform the independent samples t-test, there are several
assumptions that should be considered [112]: Results
 Assumption 1: The dependent variable should be measured
The number of majorly cultivated and native food plants
on a continuous scale (i.e., interval or ratio level). In the
(species, subspecies, varieties, and races) in selected countries
context of the present study, the dependent variable meets
was considered a proxy for the food plant diversity in dietary
Assumption 1 since it describes the number of majorly culti-
patterns. Data elaboration showed that Italy had the most diverse
vated food plant species, subspecies, varieties, and races.
cuisine in both majorly cultivated and native food plants
 Assumption 2: The independent variable should consist of 2
compared to the rest countries of our sample, whereas Denmark
categorical, independent groups. In the context of the present
presented the lowest diversity in food plants (Figure 2). The
study, the independent variable is a dichotomous indicator
group of the Mediterranean countries had a higher average of
representing 2 distinct and independent subsamples; the
both majorly cultivated (29.33 compared with 19.17) and native
group of countries in which the MD is the most prevalent
food plants (1508.83 compared with 1198.17) than the “Western
dietary pattern, and the group of countries with a Western-
diet” group. In the Mediterranean sample, Algeria and Greece,
type diet culture (West).
and Algeria, Lebanon, and Malta were ranked below-the-average
 Assumption 3: The independence of observations assumption
in terms of diversity in majorly cultivated and native food plants,
states that there is no relationship between the observations
respectively. Furthermore, biodiversity in majorly cultivated
in each group or between the groups themselves. In the
food plants was lower in Belgium, Denmark, and Sweden
context of the present study, the independence of observa-
compared to the other selected countries.
tions is confirmed because each country is classified to a
The Shapiro-Wilk test application showed that the numbers of
specific category according to the prevalent dietary pattern
both majorly cultivated and native food plants are normally
among its population (i.e., either Mediterranean-type or
distributed for both dietary groups (Table 2). In addition, the
Western-type).

TABLE 1
Prevalent dietary pattern and subregional selection
Diet Mediterranean diet Western diet
Region Western med Central med Eastern med Bordering med Central EU Northern EU
Countries Morocco Italy Greece Belgium Germany Denmark
Algeria Malta Lebanon Switzerland Austria Sweden

EU, European Union; Med, Mediterranean.

575
K. Mattas et al. Advances in Nutrition 14 (2023) 570–582

FIGURE 2. (A) Number of majorly cultivated food plants (species, subspecies, varieties, and races); (B) Number of native food plants (species,
subspecies, varieties, and races) in the selected countries.

Levene’s test application indicated that the variances are equal, After the verification of the normality and the homogeneity of
and the homogeneity of variances assumption is not violated variances assumptions, the application of the independent sam-
(Table 3). ples t-test showed that the mean of majorly cultivated food plant
species, subspecies, varieties, and races in the MD sample was
TABLE 2 significantly higher than its counterpart in the Western diet
Shapiro-Wilk test application – normality assumption sample (29.33 compared with 19.17, t ¼ -2.856, P < 0.05)
(Table 4). Therefore, it seems that the countries that traditionally
Variable Diet S-W statistic P
show a higher adherence to the MD support biodiversity in food
Number of majorly Mediterranean 0.929 0.573 plant cultivation to a greater extent compared to the “Western
cultivated food plants Western 0.896 0.354
diet” countries. The analysis procedure also indicated that there
Number of native Mediterranean 0.902 0.387
food plants Western 0.911 0.440 is no statistical difference in the averages of native food plants
between the MD group and the Western diet group (1508.83

576
K. Mattas et al. Advances in Nutrition 14 (2023) 570–582

TABLE 3 of genetically improved nonnative varieties [117]. In particular,

Levene’s test application – homogeneity of variances assumption Vavilov had identified over 80 cultivated crops, mostly cereals,
Variable F P pulses, fruit trees, and vegetables, in a previous study [118,119].
Today, only 30 plant species, including major staple crops, pro-
Number of majorly Equal variances 3.259 0.101
cultivated food plants assumed
vide 95% of dietary energy or protein used for human nutrition
Equal variances not — — [120], whereas food systems rely on just 3 crops (rice, wheat,
assumed and maize) to cover more than 50% of consumers’ plant-derived
Number of native food Equal variances 0.817 0.387 calories [121]. Although the Mediterranean basin is considered a
plants assumed biodiversity center for many cultivated food crops, the current
Equal variances not — —
assumed
industrial farming approach is putting at risk agricultural
biodiversity and food diversity in the area. Food value chains
have favored farms that can provide large quantities of a single
compared with 1198.17, t ¼ 1.964, P > 0.05), and the 2 groups product, but this shift of agricultural production to monocrop-
include similar means of native food plants (species, subspecies, ping systems has destroyed the habitat of diverse species in
varieties, and races) (Table 4). This implies that although previous mixed-farming systems. In addition, the increasing
countries with a higher adherence to the MD present similar demand in agricultural water and fertilizers, and pest outbreaks,
diversity in native food plants compared with the countries which may increase with climate change, put extra burdens in
having adopted Western-type diets, the utilization of the avail- agro-ecosystems and food security [119,122]. According to the
able food crops seems to differ between the 2 clusters. Thus, this Bioversity International, intensive agricultural systems consti-
higher diversity in food plants observed in the MD countries tute a major driver of global and local biodiversity loss, water
seems to be attributed to crop utilization rather than crop pollution, and soil degradation, and also fail to provide access to
availability. balanced and healthy diets to all consumers [121].
Recent innovations in the agricultural production systems
Discussion have moved toward the development and the adoption of more
sustainable approaches to offset the severe impacts of intensified
Our findings further emphasized the increased agricultural agriculture, protect biodiversity, and reinforce environmentally
biodiversity in the Mediterranean region and the higher diversity resilient agro-food systems. In a thorough review, Dong notes
in food plants species subspecies, varieties, and races in the MD, that “such efforts are making a paradigm shift in agriculture
supporting a great body of recent studies that has linked sus- value chains” [123]. Furthermore, maintaining and fostering
tainable diets, and especially the MD, with biodiversity [2,8,19, diversity in agricultural production is crucial for the transition to
74,93,96,98]. The Mediterranean basin is characterized by high sustainable food systems. Policies to preserve agricultural
biodiversity attributed to its location at the intersection of Africa biodiversity should motivate farmers to adopt alternative
and Eurasia, its topographical diversity, and several social, po- farming practices that will support sustainable agricultural pro-
litical, ecological, and climatic factors [114,115]. Furthermore, duction. Policy measures and interventions might include eco-
the MD, as a plant-based dietary pattern, presents high agro- nomic incentives (e.g., loans, subsidies) to farmers for converting
biodiversity resulting from the adaptation of plants brought from to sustainable production techniques and training programs that
different geographical locations that became indigenous and will inform them how to effectively adopt environmentally
further diverged into cultivars [72]. Approximately one-third of friendly agricultural practices. Agricultural diversification ap-
the foodstuffs used for feeding the population is originated from proaches can enhance biodiversity, pollination, and pest control,
the Mediterranean basin [116]. and also regulate resources without compromising crop yields
[124]. Agricultural cooperatives and farmer’s unions could also
have a vital role in disseminating knowledge on sustainable
Implications for farmers
agricultural practices to producers. In particular, agricultural
Although biodiversity enables agricultural systems to evolve,
consultants could act as opinion leaders for convincing farmers
the genetic diversification of food crops is continually
to use sustainable agricultural production methods.
decreasing. It has been reported that only 10% of the variety of
cultivated crops in the past are still being grown in farm systems,
and many local varieties have been replaced by a small number Implications for consumers and food marketing
Today’s food systems are under pressure to meet the
TABLE 4 increasing population’s nutrition demand. Dietary diversifica-
Independent samples t-test application – differences in food plant di- tion is considered necessary for providing nutritional efficiency
versity between MD and Western diet to consumers and helping them avoid micronutrient malnutri-
tion resulting from monotonous diets [125]. Although mono-
Variable T P Lower 95% CI Upper 95% CI
of difference of difference cropping production systems have raised both food production
and energy intake, reliance on a few major crops for population
Number of -2.856 0.017 -18.098 -2.235
majorly
feeding has led to micronutrient deficiencies [126]. This study
cultivated food showed that the MD pattern offers a higher diversity in majorly
plants cultivated food plant species subspecies, varieties, and races
Number of native 1.964 0.078 -41.748 663.081 compared to the Western-type diets. More specifically, 29
food plants
majorly cultivated food plants on average are grown in the
MD, Mediterranean diet. Mediterranean countries of our sample, whereas the mean of the

577
K. Mattas et al. Advances in Nutrition 14 (2023) 570–582

majorly cultivated food crops in the other European countries is healthy plant-based food products could help reinforce adher-
about 19. The MD, as the most prevalent dietary pattern in the ence to MD patterns in children and adolescents. In addition, the
Mediterranean region, offers a higher food plant diversification supply of healthy meals and snacks in workplace canteens could
to meet consumers’ requirements for the recommended intakes affect adults’ food choices and urge their engagement with a
of nutrients. With respect to the diversity in native food plants, more sustainable lifestyle.
no statistical difference was detected in the averages of the
native food plants between the “MD” countries and the “Western Study limitations and directions for future research
diet” countries, indicating that this higher food plant diversity in Although the present study employed a 2-stage selection
the MD pattern seems to be more strongly associated with crop scheme to include data from 2 large and valid databases, there
utilization rather than crop availability. are still some limitations in data availability that should be re-
Despite the extensive food plant usage in local Mediterranean ported. First, our data set lacked information on restraints in
economies, agro-food production is substantially affected by food plant accessibility due to limitations in the food value chain
environmental degradation and climate change, over- (e.g., price increases, losses throughout the value chain, culti-
exploitation of resources, and monoculture. To mitigate the vation practices, seasonal shortages). Future research should
environmental impacts and the pressures on resources, it is take into consideration these parameters to provide a broader
necessary to adopt improved crops and new food plant species, picture of the relationship between biodiversity and diet in the
which could adjust to actual or future climate and augment the agro-food system. Further research might also elaborate data on
stability of agro-ecosystems [127]. Furthermore, the increasing food plants market and trade, and explore whether food imports
demand for healthy and sustainable food, the adoption of the MD and exports can influence food choices and the adoption of
pattern from new generations and its transmission to other sustainable eating habits. Second, we investigated the associa-
geographic regions makes crucial the sustainable management of tion between biodiversity and diet using the prevailing dietary
plant genetic resources [128–130]. Libiad et al. [127] noted that patterns and the subregional characteristics of 6 Mediterranean
the introduction of neglected and underutilized plant species countries and 6 countries of the rest of the European region. Data
(NUPs) in the agro-food systems would benefit both consumers expansion to a larger geographic area could enhance the validity
and producers and would also contribute to biodiversity pres- of our findings and describe the relationship between diet and
ervation. The usage of NUPs with resistance to pests and adap- biodiversity with greater accuracy.
tation ability to difficult environmental conditions could provide
cultivation alternatives for poor and degraded soils [131]. Concluding remarks
Furthermore, several studies underlined the importance of the To further support previous studies, our findings underlined
domestication and cultivation of NUPs, especially for supporting the higher agricultural biodiversity in the Mediterranean region
the household income of marginalized farmers in local econo- and the higher diversity in food plants species subspecies, vari-
mies [132,133]. Several studies have highlighted the increased eties, and races in the MD compared with Western-type dietary
demand for diversity and novelty in foods and consumers’ patterns. The statistical analysis underpinned that this higher food
awareness of NUPs because of their richness in micronutrients, plant diversity in the MD pattern seems to be more strongly
vitamins, and proteins [127,134]. Following modern trends in associated with crop utilization rather than food plant availability
food markets, domesticated wild edible plants and vegetable in the Mediterranean region. Therefore, this study notes that
local landraces are used in sustainable cultivation systems for the biodiversity could constitute a prerequisite for dietary diversity,
production of functional foods [128,130,135,136]. These novel and hence nutrition security. Furthermore, the analysis demon-
and high added-value food products create new market oppor- strated that nutrition and diets should be approached with a
tunities, especially for small-scale farms, and stimulate con- broader and more integrated view due to the interlinkages be-
sumers’ interest on their functional attributes [130,137,138]. tween the agro-food system and the prevailing dietary patterns. It
Therefore, the reinforcement of the demand for such com- is also implied that adopting a more diverse diet in today’s
modities through the appropriate marketing channels could help modern society could support the establishment of a more bio-
consumers adopt more diverse and healthy food consumption diverse rural environment and mitigate the adverse effects of
patterns, and could also motivate producers to explore alterna- climate change in the long run. Given the well-documented ben-
tive cultivation opportunities to ensure sustainability in agri- efits of the sustainable food systems, reaching any biodiversity
cultural production systems. Recent studies showed a trend of target will require a combination of initiatives to include all
reduced adherence to the MD across all countries in the Medi- involved agents. Since biodiversity is strongly related with both
terranean region [71,85]. Socioeconomic changes and new life- human and environmental health, nutrition interventions, envi-
styles have significantly altered food habits and food ronmental preservation strategies and public health protection
consumption patterns. Nutrition and public health scholars measures should involve multi-stakeholder partnership in order to
should design appropriate intervention strategies to inform make food systems sustainable along the entire food chain, “from
consumers on the benefits of the sustainable diets in order to farm to fork,” and also protect ecosystems as a whole. Strength-
enhance the consumption of plant-based functional foods and ening agricultural practices to conform with sustainable agro-
plant-based meals. Besides the production of novel functional ecosystem practices protects the right of all to have access to
foods, the food industry should invest on the production and nutritious, adequate, and affordable food, whereas, at the same
promotion of novel meals. For instance, plant-based snacks in time, protects the right of all to live and develop themselves
school cafeterias and the installation of vending machines with within environmentally healthy and safe places.

578
K. Mattas et al. Advances in Nutrition 14 (2023) 570–582

Acknowledgments [11] W. Steffen, K. Richardson, J. Rockstr€ om, S.E. Cornell, I. Fetzer,

E.M. Bennett, et al., Sustainability. Planetary boundaries: guiding
human development on a changing planet, Science 347 (6223) (2015),
The authors’ responsibilities were as follows—all authors: 1259855, [Link]
contributed to conceiving and designing the study; KM: super- [12] C. Chen, A. Chaudhary, A. Mathys, Dietary change scenarios and
implications for environmental, nutrition, human health and economic
vised the study, directed, contextualized and had primary re- dimensions of food sustainability, Nutrients 11 (4) (2019) 856,
sponsibility for final content; ER: extended the paper to [Link]
additional dimensions and drafted the extended paper; AA, GY: [13] H. Ritchie, P. Rosado, M. Roser, Environmental Impacts of Food Production
extracted and analyzed the data and drafted the relative to data [Internet], Our World in Data, 2022 [cited April 6, 2022]. Available from:
[Link]
parts; GB: took responsibility for the integrity of the data, the [14] C.G. Awuchi, C.G. Awuchi, A.E. Ukpe, C.R. Asoegwu, C.N. Uyo,
accuracy of the data analysis and editing; and all authors: read E. Kelechi, Environmental impacts of food and agricultural production:
and approved the final manuscript. a systematic review, Eur. Acad. Res. 8 (2) (2020) 1120–1135.
[15] B. Machovina, K.J. Feeley, Taking a bite out of biodiversity, Science
343 (6173) (2014) 838, [Link]
Appendix A. Supplementary data 838-a.
[16] S.L. Pimm, C.N. Jenkins, R. Abell, T.M. Brooks, J.L. Gittleman,
L.N. Joppa, et al., The biodiversity of species and their rates of
Supplementary data to this article can be found online at https:// extinction, distribution, and protection, Science 344 (6187) (2014),
[Link]/10.1016/[Link].2023.03.011. 1246752, [Link]
[17] B. Machovina, K.J. Feeley, W.J. Ripple, Biodiversity conservation: the
key is reducing meat consumption, Sci. Total Environ. 536 (2015)
Funding 419–431, [Link]
[18] E. Crenna, T. Sinkko, S. Sala, Biodiversity impacts due to food
consumption in Europe, J. Clean. Prod. 227 (2019) 378–391, https://
The research is part of the BioValue (grant agreement ID: [Link]/10.1016/[Link].2019.04.054.
101000499) project, funded by the European Union through its [19] R.C. Henry, P. Alexander, S. Rabin, P. Anthoni, M.D.A. Rounsevell,
Horizon 2020 program. A. Arneth, The role of global dietary transitions for safeguarding
biodiversity, Glob. Environ. Change 58 (2019), 101956, https://
[Link]/10.1016/[Link].2019.101956.
Author disclosures [20] T. Benton, C. Bieg, H. Harwatt, R. Pudasaini, Food system impacts on
biodiversity loss: three levers for food system transformation in
support of nature, Chatham House, London, 2021.
The authors report no conflicts of interest. [21] Convention on Biological Diversity (CBD), Article 2. Use of Terms
[Internet], 2006 [cited February 6, 2022]. Available from: https://
[Link]/convention/articles/?a¼cbd-02.
References [22] D. Wood, J.M. Lenne, Agrobiodiversity: characterization, utilization,
and management, CABI Publishing, New York, 1999.
[1] M. Van Dijk, T. Morley, M.L. Rau, Y. Saghai, A meta-analysis of [23] G. Destouni, F. Jaramillo, C. Prieto, Hydroclimatic shifts driven by
projected global food demand and population at risk of hunger for the human water use for food and energy production, Nat. Clim. Change 3
period 2010-2050, Nat. Food 2 (7) (2021) 494–501, [Link] (3) (2013) 213–217, [Link]
10.1038/s43016-021-00322-9. [24] G. Ceballos, P.R. Ehrlich, A.D. Barnosky, A. García, R.M. Pringle,
[2] L. Serra-Majem, L. Tomaino, S. Dernin, E. Berry, D. Lairon, J. Ngo de la T.M. Palmer, Accelerated modern human-induced species losses:
Cruz, et al., Updating the Mediterranean diet pyramid towards entering the sixth mass extinction, Sci. Adv. 1 (5) (2015), e1400253,
sustainability: focus on environmental concerns, Int. J. Environ. Res. [Link]
Public Health 17 (23) (2020) 8758, [Link] [25] J.S. Albert, G. Destouni, S.M. Duke-Sylvester, A.E. Magurran,
ijerph17238758. T. Oberdoff, R.E. Reis, et al., Scientists’ warning to humanity on the
[3] D. Adam, How far will global population rise? Researchers can’t agree, freshwater biodiversity crisis, Ambio 50 (1) (2021) 85–94, https://
Nature 597 (7877) (2021) 462–465, [Link] [Link]/10.1007/s13280-020-01318-8.
d41586-021-02522-6.  Perni, J.M. Martínez-Paz, Measuring conflicts in the management of
[26] A.
[4] Food and Agriculture Organization, The Future of Food and anthropized ecosystems: evidence from a choice experiment in a
Agriculture—Trends and Challenges, Food and Agriculture human-created Mediterranean wetland, J. Environ. Manage. 203 (1)
Organization of the United Nations, Rome, Italy, 2017. (2017) 40–50, [Link]
[5] M.M. Maja, S.F. Ayano, The impact of population growth on natural [27] F. Alcon, J.A. Zabala, V. Martínez-García, J.A. Albaladejo, E.I. L opez-
resources and farmers’ capacity to adapt to climate change in low- Becerra, M.D. de-Miguel, et al., The social wellbeing of irrigation
income countries, Earth Syst. Environ. 5 (2) (2021) 271–283, https:// water. A demand-side integrated valuation in a Mediterranean
[Link]/10.1007/s41748-021-00209-6. agroecosystem, Agric. Water Manag. 262 (2022), 107400, https://
[6] N. Dudley, S. Alexander, Agriculture and biodiversity: a review, [Link]/10.1016/[Link].2021.107400.
Biodiversity 18 (2-3) (2017) 45–49, [Link] [28] L. Kehoe, A. Romero-Mu~ noz, E. Polaina, L. Estes, H. Kreft,
14888386.2017.1351892. T. Kuemmerle, Biodiversity at risk under future cropland expansion
[7] S. Sala, A. Anton, S.J. McLaren, B. Notarnicola, E. Saouter, and intensification, Nat. Ecol. Evol. 1 (8) (2017) 1129–1135, https://
U. Sonesson, In quest of reducing the environmental impacts of food [Link]/10.1038/s41559-017-0234-3.
production and consumption, J. Clean. Prod. 140 (2017) 387–398, [29] World Health Organization (WHO), Plant-based diets and their impact on
[Link] health, sustainability and the environment: a review of the evidence: WHO
[8] W. Belgacem, K. Mattas, G. Arampatzis, G. Baourakis, Changing European Office for the Prevention and Control of Noncommunicable
dietary behavior for better biodiversity preservation: a preliminary Diseases, WHO Regional Office for Europe, Copenhagen, 2021.
study, Nutrients 13 (6) (2021) 2076, [Link] [30] Convention on Biological Diversity (CBD), Aichi biodiversity targets
nu13062076. [Internet]. [cited May 20, 2022]. Available from: [Link]
[9] C. Dalin, C.L. Outhwaite, Impacts of global food systems on .[Link]/sp/targets.
biodiversity and water: the vision of two reports and future aims, One [31] Secretariat of the Convention on Biological Diversity, Global
Earth 1 (3) (2019) 298–302, [Link] Biodiversity Outlook 5 – Summary for Policy Makers, Montreal, 2020.
[Link].2019.10.016. [32] International Union for Conservation of Nature (IUCN), Issues Brief -
[10] S.J. Vermeulen, B.M. Campbell, J.S.I. Ingram, Climate change and food Post-2020 global biodiversity framework, October 2021 [cited May 5,
systems, Annu. Rev. Environ. Resour. 37 (1) (2012) 195–222, https:// 2022]. Available from: [Link]
[Link]/10.1146/annurev-environ-020411-130608. brief/post-2020-global-biodiversity-framework.

579
K. Mattas et al. Advances in Nutrition 14 (2023) 570–582

[33] European Commission, EU Biodiversity Strategy for 2030: Bringing and healthy diet, Prog. Nutr. 22 (1) (2020) 395–402, [Link]
Nature Back into our Lives; COM (2020) 380, European Commission, 10.23751/pn.v22i2.8632.
Brussels, Belgium, 2020. [53] B. Biasini, A. Rosi, F. Giopp, R. Turgut, F. Scazzina, D. Menozzi,
[34] M. Perignon, F. Vieux, L.G. Soler, G. Masset, N. Darmon, Improving Understanding, promoting and predicting sustainable diets: a
diet sustainability through evolution of food choices: review of systematic review, Trends Food Sci. Technol. 111 (2021) 191–207,
epidemiological studies on the environmental impact of diets, Nutr. [Link]
Rev. 75 (1) (2017) 2–17, [Link] [54] L. Aleksandrowicz, R. Green, E.J. Joy, P. Smith, A. Haines, The impacts
[35] A. Blas, A. Garrido, O. Unver, B. Willaarts, A comparison of the of dietary change on greenhouse gas emissions, land use, water use,
Mediterranean diet and current food consumption patterns in Spain and health: a systematic review, PLoS ONE 11 (11) (2016), e0165797,
from a nutritional and water perspective, Sci. Total Environ. 664 [Link]
(2019) 1020–1029, [Link] [55] M. Springmann, H.C.J. Godfray, M. Rayner, P. Scarborough, Analysis
[36] W. Willett, J. Rockstr€om, B. Loken, M. Springmann, T. Lang, and valuation of the health and climate change cobenefits of dietary
S. Vermeulen, et al., Food in the Anthropocene: the EAT–Lancet change, Proc. Natl. Acad. Sci. U. S. A. 113 (15) (2016) 4146–4151,
Commission on healthy diets from sustainable food systems, Lancet [Link]
393 (10170) (2019) 447–492, [Link] [56] S. Clune, E. Crossin, K. Verghese, Systematic review of greenhouse gas
6736(18)31788-4. emissions for different fresh food categories, J. Clean. Prod. 140
[37] J. Yin, D. Yang, X. Zhang, Y. Zhang, T. Cai, Y. Hao, et al., Diet shift: (2017) 766–783, [Link]
considering environment, health and food culture, Sci. Total Environ. [57] M. Springmann, K. Wiebe, D. Mason-D'Croz, T. Sulser, M. Rayner,
719 (2020), 137484, [Link] P. Scarborough, Health and nutritional aspects of sustainable diet
[Link].2020.137484. strategies and their association with environmental impacts: a global
[38] J. Baudry, P. Pointereau, L. Seconda, R. Vidal, B. Taupier-Letage, modelling analysis with country-level detail, Lancet Planet Health 2
B. Langevin, et al., Improvement of diet sustainability with increased (10) (2018) e451–e461, [Link]
level of organic food in the diet: findings from the BioNutriNet cohort, 30206-7.
Am. J. Clin. Nutr. 109 (4) (2019) 1173–1188, [Link] [58] M. Tziva, S.O. Negro, A. Kalfagianni, M.P. Hekkert, Understanding the
10.1093/ajcn/nqy361. protein transition: the rise of plant-based meat substitutes, Environ.
[39] G.L. Russo, A. Siani, V. Fogliano, J.M. Geleijnse, R. Giacco, Innov. Soc. Transit 35 (2020) 217–231, [Link]
S. Giampaoli, et al., The Mediterranean diet from past to future: key [Link].2019.09.004.
concepts from the second “Ancel Keys” International Seminar, Nutr. [59] S. Jarmul, A.D. Dangour, R. Green, Z. Liew, A. Haines,
Metab. Cardiovasc. Dis. 31 (3) (2021) 717–732, [Link] P.F.D. Scheelbeek, Climate change mitigation through dietary change:
10.1016/[Link].2020.12.020. a systematic review of empirical and modelling studies on the
[40] A. Mazzocchi, L. Leone, C. Agostoni, I. Pali-Sch€ oll, The secrets of the environmental footprints and health effects of ‘sustainable diets,
Mediterranean diet. Does [only] olive oil matter? Nutrients 11 (12) Environ. Res. Lett. 15 (12) (2020), 123014, [Link]
(2019) 2941, [Link] 1748-9326/abc2f7.
[41] E.M. Berry, S. Dernini, B. Burlingame, A. Meybeck, P. Conforti, Food [60] C. Alae-Carew, R. Green, C. Stewart, B. Cook, A.D. Dangour,
security and sustainability: can one exist without the other? Public P.F.D. Scheelbeek, The role of plant-based alternative foods in
Health Nutr 18 (13) (2015) 2293–2302, [Link] sustainable and healthy food systems: consumption trends in the UK,
S136898001500021X. Sci. Total Environ. 807 (3) (2022), 151041, [Link]
[42] T. Garnett, Three perspectives on sustainable food security: efficiency, [Link].2021.151041.
demand restraint, food system transformation. What role for life cycle [61] J. Fanzo, Healthy and sustainable diets and food systems: the key to
assessment? J. Clean. Prod. 73 (2014) 10–18, [Link] achieving Sustainable Development Goal 2? Food Ethics 4 (2) (2019)
10.1016/[Link].2013.07.045. 159–174, [Link]
[43] HLPE - High Level Panel of Experts on Food Security and Nutrition, [62] D. Lairon, Biodiversity and sustainable nutrition with a food-based
Food losses and waste in the context of sustainable food systems, approach, in: Sustainable Diets and Biodiversity – Direction and
HLPE, Rome, Italy, 2014. solutions for policy, research and action, FAO, Rome, Italy, 2012,
[44] E.M. Berry, Sustainable food systems and the Mediterranean diet, pp. 30–35.
Nutrients 11 (9) (2019) 2229, [Link] [63] L.M. Donini, S. Dernini, D. Lairon, L. Serra-Majem, M.J. Amiot, V. Del
[45] A. Meybeck, V. Gitz, Sustainable diets within sustainable food systems, Balzo, et al., A consensus proposal for nutritional indicators to assess
Proc. Nutr. Soc. 76 (1) (2017) 1–11, [Link] the sustainability of a healthy diet: the Mediterranean diet as a case
S0029665116000653. study, Front. Nutr. 3 (2016) 37, [Link]
[46] D. Tilman, M. Clark, Global diets link environmental sustainability and fnut.2016.00037.
human health, Nature 515 (7528) (2014) 518–522, [Link] [64] S. Dernini, E.M. Berry, L. Serra-Majem, C. La Vecchia, R. Capone,
10.1038/nature13959. F.X. Medina, et al., Med Diet 4.0: the Mediterranean diet with four
[47] L.F. Ruini, R. Ciati, C.A. Pratesi, M. Marino, L. Principato, sustainable benefits, Public Health Nutr 20 (7) (2017) 1322–1330,
E. Vannuzzi, Working toward healthy and sustainable diets: the [Link]
“Double Pyramid Model” developed by the Barilla Center for Food [65] U. Grosso, G. Fresan, M. Bes-Rastrollo, S. Marventano, F. Galvano,
and Nutrition to raise awareness about the environmental and Environmental impact of dietary choices: role of the Mediterranean
nutritional impact of foods, Front. Nutr. 2 (2015) 9, [Link] and other dietary patterns in an Italian cohort, Int. J. Environ. Res.
10.3389/fnut.2015.00009. Public Health 17 (5) (2020) 1468, [Link]
[48] M. Lawrence, P. Baker, K. Wingrove, R. Lindbert, Sustainable diets: the ijerph17051468.
Public Health Perspective, in: B. Barlingame, S. Dernini (Eds.), [66] A. Trichopoulou, M.A. Martínez-Gonzalez, T.Y. Tong, N.G. Forouhi,
Sustainable Diets: Linking Nutrition and Food Systems, CAB S. Khandelwal, D. Prabhakaran, et al., Definitions and potential health
International, London, UK, 2019, pp. 13–21. benefits of the Mediterranean diet: views from experts around the
[49] L. Fink, C. Strassner, A. Ploeger, Exploring external factors affecting world, BMC Med 12 (2014) 112, [Link]
the intention-behavior gap when trying to adopt a sustainable diet: a 12-112.
think aloud study, Front. Nutr. 8 (2021), 511412, [Link] [67] C.A. Obeid, J.S. Gubbels, D. Jaalouk, S.P.J. Kremers, A. Oenema,
10.3389/fnut.2021.511412. Adherence to the Mediterranean diet among adults in Mediterranean
[50] FAO, IFAD, UNICEF, WFP, WHO, The State of Food Security and countries: a systematic literature review, Eur. J. Nutr. 61 (7) (2022)
Nutrition in the World 2018 [Internet], Building Climate Resilience for 3327–3344, [Link]
Food Security and Nutrition, Rome, Italy, 2018 [cited May 10, 2022]. [68] M. Guasch-Ferre, W.C. Willett, The Mediterranean diet and health: a
Available from: [Link] comprehensive overview, J. Intern. Med. 290 (3) (2021) 549–566,
ecurity-and-nutrition-world-sofi-report. [Link]
[51] V.J.P.D. Martinho, Food marketing as a special ingredient in consumer [69] M. Georgoulis, M.D. Kontogianni, N. Yiannakouris, Mediterranean diet
choices: the main insights from existing literature, Foods 9 (11) (2020) and diabetes: prevention and treatment, Nutrients 6 (4) (2014)
1651, [Link] 1406–1423, [Link]
[52] M.L. Truzzi, M. Ballerini Puviani, A. Tripodi, S. Toni, A. Farinetti, [70] S. Radd-Vagenas, A. Kouris-Blazos, M.F. Singh, V.M. Flood, Evolution
M. Nasi, et al., Mediterranean diet as a model of sustainable, resilient of Mediterranean diets and cuisine: concepts and definitions, Asia Pac,

580
K. Mattas et al. Advances in Nutrition 14 (2023) 570–582

J. Clin. Nutr. 26 (5) (2017) 749–763, [Link] diet recommendations? Nutrients 13 (5) (2021) 1432, [Link]
apjcn.082016.06. 10.3390/nu13051432.
[71] S.K. Jones, R. Remans, M.E. Dulloo, N. Estrada Carmona, A. Bailey, [89] I. Zazpe, S. Santiago, E. Toledo, M. Bes-Rastrollo, C. De la Fuente-
F. Grazioli, et al., Agrobiodiversity Index Report 2021: Assessing Arrillaga, et al., Diet quality indices in the SUN cohort: observed
Mediterranean food systems, Bioversity International, Rome, Italy, changes and predictors of changes in scores over a 10-year period,
2022, p. 184. [Link] J. Acad. Nutr. Diet 121 (10) (2021) 1948–1960.e7, [Link]
[72] V.C. Barros, A.M. Delgado, Mediterranean diet, a sustainable cultural 10.1016/[Link].2021.03.011.
asset, Encyclopedia 2 (2) (2022) 761–777, [Link] [90] M.I. Maraki, M. Yannakoulia, M. Stamelou, L. Stefanis,
encyclopedia2020053. G. Xiromerisiou, M.H. Kosmidis, et al., Mediterranean diet adherence
[73] E. Moro, The Mediterranean diet from Ancel Keys to the UNESCO is related to reduced probability of prodromal Parkinson’s disease,
cultural heritage. A pattern of sustainable development between myth Mov. Disord. 34 (1) (2019) 48–57, [Link]
and reality, Procedia - Soc. Behav. Sci. 223 (2016) 655–661, https:// mds.27489.
[Link]/10.1016/[Link].2016.05.380. [91] A. Trebuchet, C. Julia, L. Fezeu, M. Touvier, D. Chaltiel, S. Hercberg, et
[74] S. Dernini, E.M. Berry, Mediterranean diet: from a healthy diet to a al., Prospective association between several dietary scores and risk of
sustainable dietary pattern, Front. Nutr. 2 (2015) 15, [Link] cardiovascular diseases: is the Mediterranean diet equally associated
10.3389/fnut.2015.00015. to cardiovascular diseases compared to National Nutritional Scores?
[75] A. Trajkovska Petkoska, A. Trajkovska-Broach, Mediterranean diet: a Am. Heart J. 217 (2019) 1–12, [Link]
nutrient-packed diet and a healthy lifestyle for a sustainable world, [Link].2019.07.009.
J. Sci. Food Agric. 101 (7) (2021) 2627–2633, [Link] [92] E. Mamalaki, C.A. Anastasiou, M.H. Kosmidis, E. Dardiotis,
10.1002/jsfa.10907. G.M. Hadjigeorgiou, P. Sakka, et al., Social life characteristics in
[76] G. Mocciaro, N. Ziauddeen, J. Godos, M. Marranzano, M.Y. Chan, relation to adherence to the Mediterranean diet in older adults:
S. Ray, Does a Mediterranean-type dietary pattern exert a cardio- findings from the Hellenic Longitudinal Investigation of Aging and
protective effect outside the Mediterranean region? A review of Diet (HELIAD) study, Public Health Nutr 23 (3) (2020) 439–445,
current evidence, Int. J. Food Sci. Nutr. 69 (5) (2018) 524–535, [Link]
[Link] [93] J.M. B^ oto, A. Rocha, V. Migueis, M. Meireles, B. Neto, Sustainability
[77] P. Ditano-Vazquez, J.D. Torres-Pe~ na, F. Galeano-Valle, A.I. Perez- dimensions of the Mediterranean diet: a systematic review of the
Caballero, P. Demelo-Rodríguez, J. Lopez-Miranda, et al., The fluid indicators used and its results, Adv. Nutr. 13 (5) (2022) 2015–2038,
aspect of the Mediterranean diet in the prevention and management of [Link]
cardiovascular disease and diabetes: the role of polyphenol content in [94] U. Fresan, M.A. Martínez-Gonzalez, J. Sabate, M. Bes-Rastrollo, The
moderate consumption of wine and olive oil, Nutrients 11 (2019) Mediterranean diet, an environmentally friendly option: evidence
2833, [Link] from the Seguimiento Universidad de Navarra (SUN) cohort, Public
[78] M.A. Martínez-Gonz alez, A. Gea, M. Ruiz-Canela, The Mediterranean Health Nutr 21 (8) (2018) 1573–1582, [Link]
diet and cardiovascular health: a critical review, Circ. Res. 124 (5) S1368980017003986.
(2019) 779–798, [Link] [95] K.V. Gantenbein, C. Kanaka-Gantenbein, Mediterranean diet as an
[79] C. Razquin, M.A. Martinez-Gonzalez, A traditional Mediterranean diet antioxidant: the impact on metabolic health and overall wellbeing,
effectively reduces inflammation and improves cardiovascular health, Nutrients 13 (6) (2021) 1951, [Link]
Nutrients 11 (8) (2019) 1842, [Link] [96] S. Tepper, M. Kissinger, K. Avital, D.R. Shahar, The environmental
[80] C.N. Katsagoni, G. Psarra, M. Georgoulis, K. Tambalis, footprint associated with the Mediterranean diet, EAT-Lancet diet, and
D.B. Panagiotakos, L.S. Sidossis, High and moderate adherence to the sustainable healthy diet index: a population-based study, Front.
Mediterranean lifestyle is inversely associated with overweight, Nutr. 9 (2022), 870883, [Link]
general and abdominal obesity in children and adolescents: the [97] S. Castaldi, K. Dembska, M. Antonelli, T. Petersson, M.G. Piccolo,
MediLIFE-index, Nutr. Res. 73 (2020) 38–47, [Link] R. Valentini, The positive climate impact of the Mediterranean diet
10.1016/[Link].2019.09.009. and current divergence of Mediterranean countries towards less
[81] F.X. Medina, J.M. Sole-Sedeno, A. Bach-Faig, A. Aguilar-Martínez, climate sustainable food consumption patterns, Sci. Rep. 12 (1) (2022)
Obesity, Mediterranean diet, and public health: a vision of obesity in 8847, [Link]
the Mediterranean context from a sociocultural perspective, Int. J. [98] V. Vitiello, A. Germani, E. Capuzzo Dolcetta, L.M. Donini, V. del Balzo,
Environ. Res. Public Health 18 (7) (2021) 3715, [Link] The new modern Mediterranean diet Italian pyramid, Ann. Ig. 28 (3)
10.3390/ijerph18073715. (2016) 179–186, [Link]
[82] L. Cea-Soriano, J. Pulido, J. Franch-Nadal, J.M. Santos, M. Mata-Cases, [99] M. Issaoui, G. Flamini, A. Delgado, Sustainability opportunities for
J. Díez-Espino, et al., Mediterranean diet and diabetes risk in a cohort Mediterranean food products through new formulations based on
study of individuals with prediabetes: propensity score analyses, Diabet. carob flour (Ceratonia siliqua L.), Sustainability 13 (14) (2021) 8026,
Med. 39 (6) (2022), e14768, [Link] [Link]
[83] C.D. Filippou, C.G. Thomopoulos, M.M. Kouremeti, L.I. Sotiropoulou, [100] N. Vega Mejía, R. Ponce Reyes, Y. Martinez, O. Carrasco, R. Cerritos,
P.I. Nihoyannopoulos, D.M. Tousoulis, et al., Mediterranean diet and Implications of the Western diet for agricultural production, health
blood pressure reduction in adults with and without hypertension: a and climate change, Front. Sustain. Food Syst. 2 (2018) 88, https://
systematic review and meta-analysis of randomized controlled trials, [Link]/10.3389/fsufs.2018.00088.
Clin. Nutr. 40 (5) (2021) 3191–3200, [Link] [101] X. Esteve-Llorens, C. Darriba, M.T. Moreira, G. Feijoo, S. Gonzalez-
[Link].2021.01.030. García, Towards an environmentally sustainable and healthy Atlantic
[84] J. Morze, A. Danielewicz, K. Przybyłowicz, H. Zeng, G. Hoffmann, dietary pattern: life cycle carbon footprint and nutritional quality, Sci.
L. Schwingshackl, An updated systematic review and meta-analysis Total. Environ. 646 (2019) 704–715, [Link]
on adherence to Mediterranean diet and risk of cancer, Eur. J. Nutr. 60 [Link].2018.07.264.
(3) (2021) 1561–1586, [Link] [102] S. Triky, M. Kissinger, An integrated analysis of dairy farming: direct
[85] S. D’Innocenzo, C. Biagi, M. Lanari, Obesity and the Mediterranean and indirect environmental interactions in challenging bio-physical
diet: a review of evidence of the role and sustainability of the conditions, Agriculture 12 (4) (2022) 1–11, [Link]
Mediterranean diet, Nutrients 11 (6) (2019) 1306, [Link] agriculture12040480.
10.3390/nu11061306. [103] Y.J. Mgale, Y. Yunxian, Marketing efficiency and determinants of
[86] A. Azzam, Is the world converging to a ‘Western diet, Public Health marketing channel choice by rice farmers in rural Tanzania: evidence
Nutr 24 (2) (2021) 309–317, [Link] from Mbeya region, Tanzania, Aust. J. Agric. Resour. Econ. 64 (4)
S136898002000350X. (2020) 1239–1259, [Link]
[87] J. Karam, M.D.M. Bibiloni, M. Serhan, J.A. Tur, Adherence to [104] M. Skoula, Z. Rakic, N. Boretos, C.B. Johnson, V.H. Heywood, The
Mediterranean diet among Lebanese university students, Nutrients 13 MEDUSA information system: a tool for the identification,
(4) (2021) 1264, [Link] conservation and sustainable use of Mediterranean plant diversity,
[88] S. Quarta, M. Massaro, M. Chervenkov, T. Ivanova, D. Dimitrova, Acta Hortic 598 (2003) 219–225, [Link]
R. Jorge, et al., Persistent moderate-to-weak Mediterranean diet ActaHortic.2003.598.32.
adherence and low scoring for plant-based foods across several [105] V.H. Heywood, M. Skoula, The MEDUSA network: conservation and
southern European countries: are we overlooking the Mediterranean sustainable use of wild plants in the Mediterranean region, in:

581
K. Mattas et al. Advances in Nutrition 14 (2023) 570–582

J. Janick (Ed.), Perspectives on new crops and new uses, ASHS Press, multiple ecosystem services without compromising yield, Sci. Adv. 6
1999, pp. 148–151. (45) (2020), eaba1715, [Link]
[106] F. Naja, N. Hwalla, L. Itani, S.H. Baalbaki, A. Sibai, L. Nasreddine, [125] C. Nkonde, K. Audain, R.N. Kiwanuka-Lubinda, P. Marinda, Effect of
A novel Mediterranean diet index from Lebanon: comparison with agricultural diversification on dietary diversity in rural households
Europe, Eur. J. Nutr. 54 (8) (2015) 1229–1243, [Link] with children under 5 years of age in Zambia, Food Sci. Nutr. 9 (11)
10.1007/s00394-014-0801-1. (2021) 6274–6285, [Link]
[107] H. Helander, M. Bruckner, S. Leipold, A. Petit-Boix, S. Bringezu, Eating [126] A.D. Jones, Critical review of the emerging research evidence on
healthy or wasting less? Reducing resource footprints of food agricultural biodiversity, diet diversity, and nutritional status in low-
consumption, Environ. Res. Lett. 16 (5) (2021), 054033, https:// and middle-income countries, Nutr. Rev. 75 (10) (2017) 769–782,
[Link]/10.1088/1748-9326/abe673. [Link]
[108] J.M.G. Paris, T. Falkenberg, U. N€othlings, C. Heinzel, C. Borgemeister, [127] M. Libiad, A. Khabbach, M. El Haissoufi, I. Anestis, F. Lamchouri,
N. Escobar, Changing dietary patterns is necessary to improve the S. Bourgou, et al., Agro-alimentary potential of the neglected and
sustainability of Western diets from a One Health perspective, Sci. underutilized local endemic plants of Crete (Greece), Rif-
Total Environ. 811 (2022), 151437, [Link] Mediterranean coast of Morocco and Tunisia: perspectives and
[Link].2021.151437. challenges, Plants (Basel) 10 (9) (2021) 1770, [Link]
[109] E. Mattavelli, E. Olmastroni, D. Bonofiglio, A.L. Catapano, A. Baragetti, 10.3390/plants10091770.
P. Magni, Adherence to the Mediterranean diet: impact of [128] S.A. Petropoulos, A.^ Fernandes, N. Tzortzakis, M. Sokovic, A. Ciric,
geographical location of the observations, Nutrients 14 (10) (2022) L. Barros, et al., Bioactive compounds content and antimicrobial
2040, [Link] activities of wild edible Asteraceae species of the Mediterranean flora
[110] M. Bonaccio, L. Iacoviello, M.B. Donati, G. de Gaetano, The tenth under commercial cultivation conditions, Food Res. Int. 119 (2019)
anniversary as a UNESCO world cultural heritage: an unmissable 859–868, [Link]
opportunity to get back to the cultural roots of the Mediterranean diet, [129] S.A. Petropoulos, A.^ Fernandes, M.I. Dias, C. Pereira, R.C. Calhelha,
Eur. J. Clin. Nutr. 76 (2) (2022) 179–183, [Link] A. Chrysargyris, et al., Chemical composition and plant growth of
s41430-021-00924-3. Centaurea raphanina subsp. mixta plants cultivated under saline
[111] National Institute of Standards and Technology, NIST/SEMATECH e- conditions, Molecules 25 (9) (2020) 2204, [Link]
Handbook of Statistical Methods. Two-Sample t-Test for Equal Means molecules25092204.
[Internet]. [cited June 2, 2022]. Available from: [Link] [130] E. Chatzopoulou, M. Carocho, F. Di Gioia, S.A. Petropoulos, The
[Link]/div898/handbook/eda/section3/[Link]. beneficial health effects of vegetables and wild edible greens: the case
[112] Laerd Statistics, Independent t-test using SPSS Statistics [Internet]. of the Mediterranean diet and its sustainability, Appl. Sci. 10 (24)
[cited June 3, 2022]. Available from: [Link] (2020) 9144, [Link]
com/spss-tutorials/[Link]. [131] G. Conversa, C. Lazzizera, A. Bonasia, S. Cifarelli, F. Losavio,
[113] N.M. Razali, Y.B. Wah, Power comparisons of Shapiro-Wilk, G. Sonnante, et al., Exploring on-farm agro-biodiversity: a study case of
Kolmogorov-Smirnov, Lilliefors and Anderson-Darling tests, J. Stat. vegetable landraces from Puglia region (Italy), Biodivers, Conserv 29
Model. Anal. 2 (1) (2011) 21–33. (3) (2020) 747–770, [Link]
[114] S. Jana, Factors contributing to crop diversity in the Mediterranean, [132] S. Padulosi, B. Mal, O.I. King, E. Gotor, Minor millets as a central
Diversity 11 (1) (1995) 15. element for sustainably enhanced incomes, empowerment, and
[115] M.C. Pergent, Marine ecosystem, in: UNEP/MAP-Plan Bleu: State of nutrition in rural India, Sustainability 7 (7) (2015) 8904–8933,
the Environment and Development in the Mediterranean, UNEP/MAP- [Link]
Plan Bleu, Athens, Greece, 2009, pp. 53–59. [133] N. Krigas, G. Tsoktouridis, I. Anestis, A. Khabbach, M. Libiad,
[116] J. Harlan, Agricultural origins and crop domestication in the W. Megdiche-Ksouri, et al., Exploring the potential of neglected local
Mediterranean region, Diversity 11 (1995) 14–16. endemic plants of three Mediterranean regions in the ornamental
[117] E. Millstone, T. Lang, The Atlas of Food, 2nd edition, Earthscan sector: value chain feasibility and readiness timescale for their
Publications, London, 2008. sustainable exploitation, Sustainability 13 (5) (2021) 2539, https://
[118] N.I. Vavilov, Phytogeographic basis of plant breeding - the origin, [Link]/10.3390/su13052539.
variation, immunity and breeding of cultivated plants, Chronica [134] A.W. Ebert, Potential of underutilized traditional vegetables and
Botanica 13 (1951) 1–366. legume crops to contribute to food and nutritional security, income
[119] H. El Bilali, G. O’Kane, R. Capone, E.M. Berry, S. Dernini, Exploring and more sustainable production, Sustainability 6 (1) (2014) 319–335,
relationships between biodiversity and dietary diversity in the [Link]
Mediterranean region: preliminary insights from a literature review, [135] S.A. Petropoulos, A.^ Fernandes, G. Ntatsi, E. Levizou, L. Barros,
Am. J. Food Nutr. 5 (1) (2017) 1–9, [Link] I.C.F.R. Ferreira, Nutritional profile and chemical composition of
1-1. Cichorium spinosum ecotypes, LWT Food. Sci. Technol. 73 (2016)
[120] Food and Agriculture Organization, Promoting neglected and 95–101, [Link]
underutilized crop species [Internet], 2017 [cited June 18, 2022]. [136] F. Di Gioia, N. Tzortzakis, Y. Rouphael, M.C. Kyriacou, S.L. Sampaio,
Available from: [Link] I.C.F.R. Ferreira, S.A. Petropoulos, Grown to be blue-antioxidant
516/icode. properties and health effects of colored vegetables. Part II: Leafy, fruit,
[121] Bioversity International, Mainstreaming Agrobiodiversity in and other vegetables, Antioxidants (Basel) 9 (2) (2020) 97, https://
Sustainable Food Systems: Scientific Foundations for an [Link]/10.3390/antiox9020097.
Agrobiodiversity Index, Bioversity International, Rome, Italy, 2017. [137] T.C.S.P. Pires, M.I. Dias, L. Barros, R.C. Calhelha, M.J. Alves,
[122] F.N. Tubiello, C. Rosenzweig, Developing climate change impact M.B.P.P. Oliveira, et al., Edible flowers as sources of phenolic
metrics for agriculture, Integr. Assess. J. 8 (1) (2008) 165–184. compounds with bioactive potential, Food Res. Int. 105 (2018)
[123] L. Dong, Toward resilient agriculture value chains: challenges and 580–588, [Link]
opportunities, Prod. Oper. Manag. 30 (2021) 666–675, https:// [138] F. Di Gioia, S.A. Petropoulos, M. Ozores-Hampton, K. Morgan,
[Link]/10.1111/poms.13308. E.N. Rosskopf, Zinc and iron agronomic biofortification of
[124] G. Tamburini, R. Bommarco, T.C. Wanger, C. Kremen, M.G.A. van der Brassicaceae microgreens, Agronomy 9 (11) (2019) 677, https://
Heijden, M. Liebman, et al., Agricultural diversification promotes [Link]/10.3390/agronomy9110677.

582