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by
  • Gonca Yıldırım1,
  • Esra Tansu Sarıyer2 and
  • Elvan Yılmaz Akyüz2,*

Reviewer 1: Yangyue Ding Reviewer 2: Anonymous Reviewer 3: Anonymous Reviewer 4: Anonymous

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors
  1. The introduction could further strengthen the differential analysis between Türkiye and other Mediterranean countries, clarifying the unique contradiction that Türkiye, as a Mediterranean coastal country with agricultural production advantages, still faces insufficient MD affordability, thereby providing a more compelling rationale for the study’s necessity.
  2. Price data were only collected in December 2024, without considering seasonal price fluctuations of core MD ingredients (e.g., olive oil, fresh fruits and vegetables, fish). It is recommended to clearly state the potential bias of data from this time point in the limitations section and propose future improvements through time-series data.
  3. The nutritional adequacy assessment only focuses on whether energy intake meets requirements, without analyzing the adequacy of key nutrients in the MD (e.g., dietary fiber, monounsaturated fatty acids, antioxidants). It is recommended to supplement the calculation results of these nutrients to more comprehensively verify the nutritional rationality of the food basket.
  4. The results section does not specify the sample size and data distribution characteristics of different income groups (quintiles), and lacks statistical significance tests. It is recommended to supplement statistical analysis of inter-group differences to enhance the reliability and persuasiveness of the results.
  5. The legend of Figure 1 is unclear (e.g., repeated symbols such as “=Dairy =Fruits” without corresponding specific colors). It is recommended to optimize the figure design and clarify the color coding and name correspondence of each food group to improve readability.
  6. The comparison with Australia’s Planetary Health Diet in the discussion only lists cost differences, without in-depth analysis of the underlying reasons such as agricultural policies, food supply chains, and dietary culture. It is recommended to supplement the mechanism analysis of cross-country differences to enrich the depth of the discussion.
  7. The policy recommendations are relatively general, only mentioning food subsidies and income support. It is recommended to combine the cost composition of the food basket (e.g., vegetables, nuts, and fish accounting for the highest proportion) to propose targeted policies (such as production subsidies for core ingredients and price regulation in open-air markets) to enhance policy operability.
  8. The discussion mentions that legumes are “low-cost but underconsumed”, and attributing this solely to economic factors is insufficient. It is recommended to supplement the analysis of non-economic factors such as cooking convenience, taste preferences, and nutritional awareness to make the discussion more comprehensive.

Author Response

 

Response to Reviewer 1 Comments

 

1. Summary

 

 

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

 

2. Questions for General Evaluation

Reviewer’s Evaluation

Response and Revisions

Is the content succinctly described and contextualized with respect to previous and present theoretical background and empirical research (if applicable) on the topic?

Can be improved

We thank the reviewer for the constructive evaluation. In response, the introduction has been expanded to provide stronger contextual background and updated with additional relevant references. The relevance and coherence of the cited literature have been improved throughout the manuscript. The research design and methodological procedures have been clarified with more explicit descriptions to enhance transparency and replicability. The presentation of results has been reorganized for clarity, and the conclusions have been refined to ensure stronger alignment with the findings. We believe these revisions collectively address the reviewer’s concerns and substantially strengthen the overall quality of the manuscript.

Are the research design, questions, hypotheses and methods clearly stated?

Can be improved

Are the arguments and discussion of findings coherent, balanced and compelling?

Can be improved

For empirical research, are the results clearly presented?

Can be improved

Is the article adequately referenced?

Can be improved

Are the conclusions thoroughly supported by the results presented in the article or referenced in secondary literature?

Can be improved

3. Point-by-point response to Comments and Suggestions for Authors

Comments 1: The introduction could further strengthen the differential analysis between Türkiye and other Mediterranean countries, clarifying the unique contradiction that Türkiye, as a Mediterranean coastal country with agricultural production advantages, still faces insufficient MD affordability, thereby providing a more compelling rationale for the study’s necessity.

 

Response 1: Thank you very much for this insightful and constructive comment. We fully agree that the introduction required a clearer explanation of Türkiye’s unique position as a Mediterranean coastal country with strong agricultural production capacity yet limited affordability of Mediterranean Diet components. In line with your suggestion, we have revised the introduction to strengthen the differential analysis between Türkiye and other Mediterranean countries. (Lines 97-104). The revisions highlighted in yellow in the text file.

 

Comments 2: Price data were only collected in December 2024, without considering seasonal price fluctuations of core MD ingredients (e.g., olive oil, fresh fruits and vegetables, fish). It is recommended to clearly state the potential bias of data from this time point in the limitations section and propose future improvements through time-series data.

Response 2: Thank you for this valuable observation. We agree that collecting price data exclusively in December 2024 may introduce seasonal bias, particularly for key Mediterranean Diet components such as olive oil, fresh fruits and vegetables, and fish. In response to your suggestion, we have revised the Limitations section to explicitly acknowledge this potential bias and clarify that cost estimates derived from a single-month snapshot may not fully reflect seasonal variation. We have also elaborated on the need for future studies to incorporate regular data collection intervals and time-series analyses to better capture seasonal price dynamics. We appreciate the reviewer’s insight, which has strengthened the clarity and rigor of the manuscript (Lines 513-517). The revisions highlighted in yellow in the text file.

 

Comments 3: The nutritional adequacy assessment only focuses on whether energy intake meets requirements, without analyzing the adequacy of key nutrients in the MD (e.g., dietary fiber, monounsaturated fatty acids, antioxidants). It is recommended to supplement the calculation results of these nutrients to more comprehensively verify the nutritional rationality of the food basket.

Response 3: Thank you for this helpful suggestion. As recommended, the additional nutrients have now been incorporated into the analysis. These values have been included in the Supplementary Materials to ensure clarity and avoid overloading the main text and tables (Lines 186-187, 258-259). The revisions highlighted in yellow in the text file.

 

Comments 4: The results section does not specify the sample size and data distribution characteristics of different income groups (quintiles), and lacks statistical significance tests. It is recommended to supplement statistical analysis of inter-group differences to enhance the reliability and persuasiveness of the results.

Response 4: We appreciate the reviewer’s emphasis on clarifying income-group characteristics. In the revised manuscript, we have added the number of households represented in each income quintile based on Turkstat statistics, and we now describe the socioeconomic gradient in affordability across quintiles in greater detail (Lines 298-300)

Regarding statistical significance testing, we would like to respectfully clarify an important methodological constraint. Income quintile data provided by Turkstat are aggregated population-level statistics, not microdata. Each quintile is represented by a single equivalised income value, and therefore within-group variance cannot be estimated. Because variance and individual observations are prerequisites for inferential statistical analysis (e.g., ANOVA, Kruskal–Wallis), such tests cannot be applied to this type of aggregated data without violating fundamental statistical assumptions.

For this reason, affordability differences across quintiles are appropriately analysed descriptively, which is the standard approach in national-level affordability studies using population-aggregated income statistics. Following the reviewer’s suggestion, we have strengthened the descriptive comparison to clearly illustrate the pronounced socioeconomic gradient in affordability (Q1: 214%, Q3: 91.9%, Q5: 37.3%).

We hope this clarification adequately addresses the reviewer’s concern and demonstrates the methodological robustness of the chosen analytical approach.

The revisions highlighted in yellow in the text file.

 

Comments 5: The legend of Figure 1 is unclear (e.g., repeated symbols such as “=Dairy =Fruits” without corresponding specific colors). It is recommended to optimize the figure design and clarify the color coding and name correspondence of each food group to improve readability.

Response 5: We have revised Figure 1.

 

Comments 6: The comparison with Australia’s Planetary Health Diet in the discussion only lists cost differences, without in-depth analysis of the underlying reasons such as agricultural policies, food supply chains, and dietary culture. It is recommended to supplement the mechanism analysis of cross-country differences to enrich the depth of the discussion.

Response 6: Thank you for this insightful comment. We agree that highlighting only cost differences may not sufficiently explain the cross-country variability between Türkiye and Australia. In the revised Discussion, we have added a mechanism-oriented explanation (Lines 484-493). The revisions highlighted in yellow in the text file.

 

Comments 7: The policy recommendations are relatively general, only mentioning food subsidies and income support. It is recommended to combine the cost composition of the food basket (e.g., vegetables, nuts, and fish accounting for the highest proportion) to propose targeted policies (such as production subsidies for core ingredients and price regulation in open-air markets) to enhance policy operability.

Response 7: We agree that the initial policy recommendations were broad and did not fully reflect the cost structure of the MD basket. In the revised Conclusion section, we have incorporated targeted and evidence-based policy measures (545-560). The revisions highlighted in yellow in the text file.

 

Comments 8: The discussion mentions that legumes are “low-cost but underconsumed”, and attributing this solely to economic factors is insufficient. It is recommended to supplement the analysis of non-economic factors such as cooking convenience, taste preferences, and nutritional awareness to make the discussion more comprehensive.

Response 8: Thank you for this important comment. We agree that low legume intake cannot be attributed to economic factors alone. In the revised Discussion, we now incorporate evidence from recent studies showing that long preparation and cooking times, lack of familiarity with legume preparation, taste-related concerns, digestive discomfort, and limited nutrition knowledge are key non-economic barriers to pulse consumption. We also emphasize that policy and public health strategies to promote legumes in Türkiye should therefore combine economic measures with interventions targeting culinary skills, taste preferences, and nutrition education. (Lines 386-397). The revisions highlighted in yellow in the text file.

 

4. Response to Comments on the Quality of English Language

 

 

5. Additional clarifications

We sincerely thank the reviewers and the editor for their thorough evaluation and constructive feedback. Their insightful comments significantly improved the clarity, analytical depth, and overall scientific quality of our manuscript. We hope that the revisions made fully address all concerns and bring the paper to a publishable standard.

 

Reviewer 2 Report

Comments and Suggestions for Authors

This study conducts a rigorous and timely analysis of the affordability of the Mediterranean Diet (MD) in Türkiye, addressing a critical gap between the diet’s well-recognized health benefits and its economic accessibility for Turkish households. The research design is systematic, with a clear four-step analytical framework, and the use of nationally representative income data and region-specific price collection enhances the study’s relevance and reliability. The findings, highlighting profound socioeconomic disparities in MD affordability, provide valuable insights for public health policies and dietary interventions. However, several areas require clarification and refinement to strengthen the manuscript’s academic rigor and readability.

 

  1. The manuscript consistently uses "Mediterranean diet (MD)", "Mediterranean diet" and "MD" interchangeably. It is recommended that after defining the abbreviation "MD" for the first time, "MD" be used consistently throughout the rest of the text.
  2. The description of price data collection lacks critical methodological rigor.
  3. Using only December 2024 prices fails to capture seasonal volatility in fresh produce and staples, which significantly impacts affordability estimates. Please acknowledge this limitation explicitly in the Discussion.
  4. The limitations section mentions potential regional price differences, but it does not address how urban-focused price collection (e.g., supermarket chains, open-air markets) might overlook rural households’ dietary access—please comment on the implications for rural applicability.
  5. The manuscript states that legumes are economically accessible but underconsumed—please provide more analysis on why cultural or behavioral barriers persist despite their low cost, to complement the economic focus.
  6. Table A1 uses commas for decimal points. Please convert all numerical values to standard period decimal separators.

Author Response

 

 

Response to Reviewer 2 Comments

 

1. Summary

 

 

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

 

2. Questions for General Evaluation

Reviewer’s Evaluation

Response and Revisions

Is the content succinctly described and contextualized with respect to previous and present theoretical background and empirical research (if applicable) on the topic?

Can be improved

We thank the reviewer for the constructive evaluation. In response, the introduction has been expanded to provide stronger contextual background and updated with additional relevant references. The relevance and coherence of the cited literature have been improved throughout the manuscript. The research design and methodological procedures have been clarified with more explicit descriptions to enhance transparency and replicability. The presentation of results has been reorganized for clarity, and the conclusions have been refined to ensure stronger alignment with the findings. We believe these revisions collectively address the reviewer’s concerns and substantially strengthen the overall quality of the manuscript.

Are the research design, questions, hypotheses and methods clearly stated?

Can be improved

Are the arguments and discussion of findings coherent, balanced and compelling?

Can be improved

For empirical research, are the results clearly presented?

Yes

Is the article adequately referenced?

Yes

Are the conclusions thoroughly supported by the results presented in the article or referenced in secondary literature?

Can be improved

3. Point-by-point response to Comments and Suggestions for Authors

Comments 1: The manuscript consistently uses "Mediterranean diet (MD)", "Mediterranean diet" and "MD" interchangeably. It is recommended that after defining the abbreviation "MD" for the first time, "MD" be used consistently throughout the rest of the text.

Response 1: Thank you for this comment. We have revised the manuscript to ensure consistent use of the abbreviation. After defining Mediterranean diet (MD) at first mention, we now use MD throughout the manuscript, except in the title and section headings where the full term is retained for clarity.

Comments 2: The description of price data collection lacks critical methodological rigor.

Response 2: Thank you for this helpful comment. We have revised the Price Data Collection section to provide a clearer and more rigorous description of how prices were obtained (Lines 188-204). The explanation of the corrections you requested is provided below and is highlighted in pink in the text file.

 

Comments 3: Using only December 2024 prices fails to capture seasonal volatility in fresh produce and staples, which significantly impacts affordability estimates. Please acknowledge this limitation explicitly in the Discussion.

Response 3: Thank you for this valuable observation. We agree that collecting price data exclusively in December 2024 may introduce seasonal bias, particularly for key Mediterranean Diet components such as olive oil, fresh fruits and vegetables, and fish. In response to your suggestion, we have revised the Limitations section to explicitly acknowledge this potential bias and clarify that cost estimates derived from a single-month snapshot may not fully reflect seasonal variation. We have also elaborated on the need for future studies to incorporate regular data collection intervals and time-series analyses to better capture seasonal price dynamics. We appreciate the reviewer’s insight, which has strengthened the clarity and rigor of the manuscript. (Lines 513-517). The explanation of the corrections you requested is provided below and is highlighted in yellow in the text file. This suggestion has been marked in yellow because another reviewer also requested it.

 

Comments 4: The limitations section mentions potential regional price differences, but it does not address how urban-focused price collection (e.g., supermarket chains, open-air markets) might overlook rural households’ dietary access—please comment on the implications for rural applicability.

Response 4: We have revised the limitations section to clarify the implications of using urban-based price data. In addition to noting urban–rural differences in food environments, we now also acknowledge evidence showing that urban food access is heterogeneous (Lines 517-532). The explanation of the corrections you requested is provided below and is highlighted in pink in the text file.

Comments 5: The manuscript states that legumes are economically accessible but underconsumed—please provide more analysis on why cultural or behavioral barriers persist despite their low cost, to complement the economic focus.

Response 5: Thank you for this insightful comment. We agree that explaining the underconsumption of legumes solely through economic factors was insufficient. In response, we have expanded the Discussion to incorporate non-economic determinants identified in the literature. (Lines 386-397). The explanation of the corrections you requested is provided below and is highlighted in yellow in the text file. This suggestion has been marked in yellow because another reviewer also requested it.

 

Comments 6: Table A1 uses commas for decimal points. Please convert all numerical values to standard period decimal separators.

Response 6: We revised.

4. Response to Comments on the Quality of English Language

 

 

5. Additional clarifications

We sincerely thank the reviewers and the editor for their thorough evaluation and constructive feedback. Their insightful comments significantly improved the clarity, analytical depth, and overall scientific quality of our manuscript. We hope that the revisions made fully address all concerns and bring the paper to a publishable standard.

 

 

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

Deat Authors, the MD topic is highly relevant from both public health and sustainability perspectives, and the paper is well-structured, with clear methodology and extensive descriptive analysis. However, despite the strong narrative and contextual discussion, the work presents some methodological limitations, assumptions that require clearer justification, and interpretative claims that should be moderated. With revisions, the manuscript could offer a robust contribution to the literature on diet affordability and nutrition economics.

Major Concerns

1. Key methodological assumptions require stronger justification

  • The selection of TR62 (Adana–Mersin) as the representative region is based solely on the P80/P20 income ratio (p. 4) but does not consider regional price heterogeneity. I think that in Türkiye has marked inter-regional variation in food costs; this choice influences affordability estimates.

  • The reference household composition is justified by national poverty-line conventions, yet its relevance for MD affordability specifically should be better explained.

2. Use of lowest-priced commercial products may distort realism

The basket uses the lowest-cost brand available in each supermarket (p. 4), which:

  1. may underestimate true average household expenditure,

  2. does not account for brand preferences, food quality variability, or availability.

This should be acknowledged as a limitation.

3. Nutritional adequacy is assessed only by energy

The authors calculate energy adequacy (p. 6) but do not evaluate:

  1. macronutrient distribution,

  2. micronutrient sufficiency,

  3. fibre, sodium, or fat quality.

Given that the MD is defined by nutritional quality, energy alone is insufficient to claim the basket is nutritionally adequate. (doi: 10.3390/nu17132066. doi: 10.1111/bph.14778. Epub 2019 Jul 25.)

4. Affordability metric needs conceptual refinement

The formula in the Methods (p. 5) confuses the directionality of the ratio. The text says affordability (%) = income ÷ cost × 100, yet the narrative interprets results as “basket cost is X% of income.” These are not equivalent.
The authors should:

  • choose one metric, for example: preferably cost ÷ income × 100)

  • apply it consistently.

5. Interpretation overstates “inaccessibility”

The findings indeed show low affordability (e.g., 98% of income in scenario 1; p. 7) but:

  • food expenditure never equals 100% of income in real life;

  • households substitute foods, reduce quantities, or modify diets.

Thus the manuscript should avoid absolutist terms such as complete economic inaccessibility (p. 7–8) and instead frame results as indicating very low affordability under the modeled scenario, not absolute inability to eat an MD.

6. Lack of sensitivity analyses on basket construction

Several assumptions greatly influence cost:

  • use of fresh fish vs. cheaper preserved fish,

  • specific nuts selected,

  • serving sizes for adolescents,

  • inclusion of specialty items like kiwi, mushrooms, or pomegranate

Yet no scenario analysis evaluates:

  • seasonal variations,

  • substitution with cheaper alternatives,

  • lower-cost olive oil grades.

Without these, the cost estimate represents just one possible MD model.

7. Some parts of Discussion rely on speculation

For example:

  • Linkage between perishability and shopping frequency (p. 9),

  • Assertions on practical barriers for households.

These statements are plausible but need citation.

Minor Concerns

1. Clarity and consistency

  • Minor inconsistencies in equivalence scale (S = 2.1 in Table 2 vs. 2.3 described earlier) require correction (p. 7)

2. Tables and figures

  • Figure 1 and Figure 2 are referenced correctly but would benefit from clearer legends explaining units and calculation basis (pp. 7–8)

  • Table 1 could indicate gram equivalents directly to improve clarity.

3. Statistical presentation

The manuscript is descriptive; however, stating confidence intervals or price ranges (min–max) would enhance robustness. 

Author Response

 

Response to Reviewer 3 Comments

 

1. Summary

 

 

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

 

2. Questions for General Evaluation

Reviewer’s Evaluation

Response and Revisions

Is the content succinctly described and contextualized with respect to previous and present theoretical background and empirical research (if applicable) on the topic?

Must be improved

We thank the reviewer for the constructive evaluation. In response, the introduction has been expanded to provide stronger contextual background and updated with additional relevant references. The relevance and coherence of the cited literature have been improved throughout the manuscript. The research design and methodological procedures have been clarified with more explicit descriptions to enhance transparency and replicability. The presentation of results has been reorganized for clarity, and the conclusions have been refined to ensure stronger alignment with the findings. We believe these revisions collectively address the reviewer’s concerns and substantially strengthen the overall quality of the manuscript.

Are the research design, questions, hypotheses and methods clearly stated?

Can be improved

Are the arguments and discussion of findings coherent, balanced and compelling?

Must be improved

For empirical research, are the results clearly presented?

Can be improved

Is the article adequately referenced?

Can be improved

Are the conclusions thoroughly supported by the results presented in the article or referenced in secondary literature?

Can be improved

3. Point-by-point response to Comments and Suggestions for Authors

Comments 1: The selection of TR62 (Adana–Mersin) as the representative region is based solely on the P80/P20 income ratio (p. 4) but does not consider regional price heterogeneity. I think that in Türkiye has marked inter-regional variation in food costs; this choice influences affordability estimates.

The reference household composition is justified by national poverty-line conventions, yet its relevance for MD affordability specifically should be better explained.

 

Response 1: Thank you for raising these important points. We agree that both the selection of TR62 and the definition of the reference household require clearer justification. In the revised Methods and Limitations sections, we now provide additional explanation. First, TR62 was selected because its P80/P20 income ratio places it at the median of all NUTS-2 regions, making it methodologically appropriate for representing a “typical” socioeconomic context. We also acknowledge that Türkiye exhibits substantial inter-regional variation in food prices, and we now clarify that the cost estimates primarily reflect the food environment of this median-income region rather than the national average. This point has been explicitly incorporated into the limitations.(Lines 493-498).

Second, we have strengthened the rationale for the reference household structure. The composition (two adults, one adolescent, and one young child) reflects the most common nuclear-family pattern in Türkiye and is widely used in national poverty-line calculations. We now explain that this structure is also appropriate for MD affordability assessment because it ensures representation of different age- and sex-specific energy and portion requirements, aligning with international reference-budget methodologies. The revised text provides this clarification. (Lines 229-233). The explanation of the corrections you requested is provided below and is highlighted in blue in the text file.

 

Comments 2: The basket uses the lowest-cost brand available in each supermarket (p. 4), which:

may underestimate true average household expenditure, does not account for brand preferences, food quality variability, or availability.

This should be acknowledged as a limitation.

Response 2: Thank you for this thoughtful comment. We agree that households differ in their brand choices and quality preferences. However, the use of the lowest-cost commercially available products is not intended to represent actual household expenditure; rather, it reflects the standard methodological approach in food affordability research. International costing frameworks—such as the FAO Cost and Affordability of a Healthy Diet methodology (2020), the World Bank minimum-cost diet models (2023), and the OECD reference budget approach—define affordability in terms of the minimum cost at which a nutritionally adequate diet can be achieved. The goal of our analysis was therefore to model the least-cost version of the Mediterranean Diet, consistent with these established practices.

We have now added a clarifying sentence in the Methods section to reflect this rationale:

In line with international affordability frameworks, the basket was constructed using the lowest-cost commercially available options. (Lines 192-194).

The explanation of the corrections you requested is provided below and is highlighted in pink in the text file. This suggestion has been marked in pink because another reviewer also requested it.

Comments 3: The authors calculate energy adequacy (p. 6) but do not evaluate:

 

macronutrient distribution,

 

micronutrient sufficiency,

 

fibre, sodium, or fat quality.

 

Given that the MD is defined by nutritional quality, energy alone is insufficient to claim the basket is nutritionally adequate. (doi: 10.3390/nu17132066. doi: 10.1111/bph.14778. Epub 2019 Jul 25.)

Response 3: Thank you for this helpful suggestion. As recommended, the additional nutrients have now been incorporated into the analysis. These values have been included in the Supplementary Materials to ensure clarity and avoid overloading the main text and tables (Lines 186-187, 258-259). The explanation of the corrections you requested is provided below and is highlighted in blue and yellow in the text file. This suggestion has been marked in yellow because another reviewer also requested it.

We appreciate your valuable contribution. Calculations have been made and are shown in Appendix (Table A2) The Turkish Nutrition Guide (TÜBER) was used to assess nutrient adequacy. TÜBER includes the reference intake amounts recommended by EFSA and IOM. For energy calculations, the Average Requirement (AR) was used according to age and gender; for protein, fat, and carbohydrate micronutrient distributions, the Acceptable Macronutrient Distribution Ranges (AMDR) were used; PRI (Population Reference Intake) was used for vitamin A, B6, vitamin C, folate, thiamine, B2, calcium, iron, and zinc; AI (Adequate Intake) was used for dietary fiber, sodium, and potassium. Calculations were performed using the BeBiS program.

  • Ebispro for Windows, Stuttgart, Germany; Turkish Version (BeBiS 9), Pasifik Elektirik Elektronik Ltd. Şti. (www.bebis.com.tr); Istanbul, 2021.
  • Databases: (Bundeslebensmittelschluessel; German Food Code and Nutrient Data Base; Version 3.01B [http://www.bfr.bund.de/cd/801]).
  • Ministry of Health of the Republic of Turkey. (2022). Turkey Nutrition Guide TÜBER 2022, Publication No: 1031, Ankara.

 

Comments 4: The formula in the Methods (p. 5) confuses the directionality of the ratio. The text says affordability (%) = income ÷ cost × 100, yet the narrative interprets results as “basket cost is X% of income.” These are not equivalent.

The authors should: choose one metric, for example: preferably cost ÷ income × 100) apply it consistently.

Response 4: Thank you very much for this insightful observation. We agree that the directionality of the affordability ratio required clarification. In line with your recommendation, we have revised the formula in the Methods section and now consistently use the standard metric—basket cost ÷ household income × 100—throughout the manuscript. This correction improves both the clarity and interpretability of the results. We sincerely appreciate your careful reading and constructive guidance. (Line 242). The explanation of the corrections you requested is provided below and is highlighted in blue in the text file.

Comments 5: The findings indeed show low affordability (e.g., 98% of income in scenario 1; p. 7) but:

food expenditure never equals 100% of income in real life; households substitute foods, reduce quantities, or modify diets. Thus the manuscript should avoid absolutist terms such as complete economic inaccessibility (p. 7–8) and instead frame results as indicating very low affordability under the modeled scenario, not absolute inability to eat an MD.

Response 5: Thank you very much for this valuable comment. We agree that the wording required refinement to avoid absolutist language. In accordance with your suggestion, we have removed the term “complete” from the phrase “complete economic inaccessibility” in both instances where it appears in the manuscript. The revised text now uses a more accurate and nuanced expression that reflects very low affordability under the modelled scenario without implying absolute inability. We sincerely appreciate your careful reading and constructive feedback.

 

Comments 6: Several assumptions greatly influence cost:

  • use of fresh fish vs. cheaper preserved fish,
  • specific nuts selected,
  • serving sizes for adolescents,
  • inclusion of specialty items like kiwi, mushrooms, or pomegranate

Yet no scenario analysis evaluates:

  • seasonal variations,
  • substitution with cheaper alternatives,
  • lower-cost olive oil grades.

Without these, the cost estimate represents just one possible MD model.

Response 6: Thank you very much for this comment. We agree that the construction of a Mediterranean Diet basket involves several choices that may influence overall cost. However, we would like to clarify that these modelling decisions—and the rationale behind them—are already explicitly described in the Methods section. Specifically:

Fresh vs. preserved fish: The basket includes both canned and fresh fish in accordance with the UNESCO Mediterranean Diet Pyramid and national dietary guidelines, which emphasise fresh seafood as the standard component of the MD.

Nut selection: The specific nut varieties included reflect foods most commonly consumed in Türkiye according to national dietary surveys (TNSH).

Adolescent serving sizes: Age- and sex-specific portion requirements for adolescents were adapted directly from Turkey Nutrition Guide (TÜBER) and the New Mediterranean Lifestyle Pyramid for Children and Youth.

Seasonal produce (kiwi, mushrooms, pomegranate): All fruits and vegetables were selected from seasonal items commonly available in Türkiye during the price-collection month, as detailed in the Basket Construction section.

We also note that substitution scenarios (e.g., lower-cost olive oil grades, preserved fish, or alternative nut choices) were not included because the purpose of this study was to estimate the minimum cost of adhering to the MD as defined by its core principles, rather than to evaluate multiple hypothetical diet variants. This approach is consistent with international reference-budget and minimum-cost diet methodologies.

To avoid ambiguity, we have added a brief clarifying sentence in the Methods section stating that the basket represents one reference MD model based on official guidelines, and that alternative substitutions were intentionally not modelled because they would depart from MD fidelity.

We sincerely appreciate your engagement with these details and thank you for the opportunity to clarify the modelling rationale.

We also added these paragraph in methods section: The basket was designed as a single reference model strictly aligned with the core principles of the Mediterranean Diet, and alternative lower-cost substitutions (e.g., different nut varieties, or lower-grade olive oil) were intentionally not modelled, as these would alter the integrity of the MD pattern rather than represent true within-pattern variation (Line 168-171). The explanation of the corrections you requested is provided below and is highlighted in blue in the text file.

Comments 7: Linkage between perishability and shopping frequency (p. 9), Assertions on practical barriers for households. These statements are plausible but need citation.

Response 7: Thank you for the comment. The statements regarding perishability, shopping frequency, and practical household barriers are already supported by this study: Goulding, T.; Lindberg, R.; Russell, C.G. Affordability of Healthy/Sustainable Diets: Australian Case. Nutr. J. 2020, 19, 109.

 

Minor Concerns

1. Clarity and consistency

Minor inconsistencies in equivalence scale (S = 2.1 in Table 2 vs. 2.3 described earlier) require correction (p. 7)

Thank you for noting this. The equivalence scale has been corrected to S = 2.3 in Table 2 to ensure full consistency across the manuscript.

2. Tables and figures

Figure 1 and Figure 2 are referenced correctly but would benefit from clearer legends explaining units and calculation basis (pp. 7–8)

The legends for Figure 1 and Figure 2 have been revised to clearly specify the units and calculation basis, as suggested.

 

Table 1 could indicate gram equivalents directly to improve clarity.

These values have been included in the Supplementary Materials to ensure clarity and avoid overloading the main text and tables.

3. Statistical presentation

The manuscript is descriptive; however, stating confidence intervals or price ranges (min–max) would enhance robustness.

We fully agree that confidence intervals or price ranges can strengthen statistical presentations. However, confidence intervals are not applicable in this study because the price data do not originate from a probabilistic sample or repeated measurements, but rather from a single structured price-collection exercise across predefined retail sources. Since the dataset does not represent a sample drawn from a larger distribution, CI estimation would not be statistically meaningful. Minimum-maximum price values have been included in the Supplementary Material to ensure clarity and avoid overloading the main text and tables.

 

4. Response to Comments on the Quality of English Language

 

 

5. Additional clarifications

We sincerely thank the reviewers and the editor for their thorough evaluation and constructive feedback. Their insightful comments significantly improved the clarity, analytical depth, and overall scientific quality of our manuscript. We hope that the revisions made fully address all concerns and bring the paper to a publishable standard.

 

 

Author Response File: Author Response.docx

Reviewer 4 Report

Comments and Suggestions for Authors

The main scientific focus of the reviewed manuscript by Yıldırım et al. (Sustainability-4027718) is the Mediterranean Diet,  particularly its affordability, which is the focus of the authors' research. The Mediterranean diet is a dietary pattern with well-established and scientifically proven beneficial effects on overall health, primarily due to its anti-inflammatory and antioxidant properties and high dietary fibre content. Although numerous studies indicate that following a Mediterranean diet can reduce the risk of chronic diseases (heart disease, stroke, and type 2 diabetes), support weight management, improve cognitive function, and contribute to overall longevity, adherence to the Mediterranean diet has declined significantly in Mediterranean countries (Italy, Spain, Greece) over the past decade, as the Authors rightly note. The main factors contributing to this trend include increased consumption of fast food and processed foods, lifestyle differences between generations, but mainly the socioeconomic status. In this manuscript, the authors evaluate the affordability of the Mediterranean diet in Turkish settings, using nationally representative data for a typical Turkish household. To do this, the authors developed a Mediterranean diet-adapted food basket for a typical four-person household, calculated the cost of this diet, and assessed its affordability by comparing it with the average share of household income allocated to food.

Overall, the topic of this manuscript is original, well-defined, and addresses the socioeconomic disparities in Turkey (which are also observed in other countries). The authors point out that, for these reasons, the ability to adopt a health-promoting, high-quality diet is limited, primarily due to economic constraints. The authors illustrate this issue using the Mediterranean diet as an example, which remains unaffordable for most households in Turkey.

The manuscript structure is coherent and clear, the study design and methodology is appropriate, and the language used in the manuscript is appropriate and clear, facilitating reading and interpretation of the results. The discussion is clear and comprehensive, and the drawn conclusions are consistent. Most of the cited sources are not older than 10 years. Self-citations are present but not overused.

I have only a few small suggestions that might be helpful in better interpreting the results:

-             Line 69: please explain the abbreviation MEDAs and a KIDMED

-             Line 212: “…typical income level of four-person nuclear families in Türkiye” – I’m not familiar with the term “nuclear families”, could you explain this?

-             Results section: lines 247, 261, 263 – I suggest that, in addition to the value in TRY, also provide the equivalent values in euros (maybe in brackets), which will make the interpretation of the results easier

Author Response

 

 

Response to Reviewer 4 Comments

 

1. Summary

 

 

Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.

 

2. Questions for General Evaluation

Reviewer’s Evaluation

Response and Revisions

Is the content succinctly described and contextualized with respect to previous and present theoretical background and empirical research (if applicable) on the topic?

 

We thank the reviewer for the constructive evaluation. In response, the introduction has been expanded to provide stronger contextual background and updated with additional relevant references. The relevance and coherence of the cited literature have been improved throughout the manuscript. The research design and methodological procedures have been clarified with more explicit descriptions to enhance transparency and replicability. The presentation of results has been reorganized for clarity, and the conclusions have been refined to ensure stronger alignment with the findings. We believe these revisions collectively address the reviewer’s concerns and substantially strengthen the overall quality of the manuscript.

Are the research design, questions, hypotheses and methods clearly stated?

 

Are the arguments and discussion of findings coherent, balanced and compelling?

 

For empirical research, are the results clearly presented?

 

Is the article adequately referenced?

 

Are the conclusions thoroughly supported by the results presented in the article or referenced in secondary literature?

 

3. Point-by-point response to Comments and Suggestions for Authors

 

Comments 1: please explain the abbreviation MEDAs and a KIDMED

Response 1: Thank you for the comment. We have now provided the full names of the indices in the manuscript: MEDAS (Mediterranean Diet Adherence Screener), MEDLIFE (Mediterranean Lifestyle Index), and KIDMED (Mediterranean Diet Quality Index for Children and Adolescents). Lines 118-121. The explanation of the corrections you requested is provided below and is highlighted in green in the text file.

Comments 2: typical income level of four-person nuclear families in Türkiye” – I’m not familiar with the term “nuclear families”, could you explain this

Response 2: Thank you for raising this point. To avoid ambiguity, we now provide a brief clarification in the manuscript. The term “nuclear family” has been revised to “nuclear (parents and dependent children) family” to clearly indicate the household structure referred to in our analysis. (Line 229). The explanation of the corrections you requested is provided below and is highlighted in blue in the text file. This suggestion has been marked in blue because another reviewer also requested it.

Comments 3: Results section: lines 247, 261, 263 – I suggest that, in addition to the value in TRY, also provide the equivalent values in euros (maybe in brackets), which will make the interpretation of the results easier

Response 3: Thank you very much for this helpful suggestion. In the initial version of the manuscript, we chose to present all cost values exclusively in Turkish lira (TRY) due to substantial exchange-rate volatility, which may lead to misleading interpretations when converting into euros. Following the reviewer’s recommendation, we have now added the corresponding euro values in brackets to facilitate international readability (Line 265-271 and Line 279- 287). The explanation of the corrections you requested is provided below and is highlighted in pink in the text file.

To ensure transparency, we have also clarified this issue in the Limitations section, noting that euro conversions should be interpreted cautiously given the high short-term variability of exchange rates in Türkiye.

We appreciate the reviewer’s insight, which has improved the clarity and accessibility of the Results section. (Lines 529-533). The explanation of the corrections you requested is provided below and is highlighted in pink in the text file. This suggestion has been marked in pink because another reviewer also requested it.

 

4. Response to Comments on the Quality of English Language

 

 

5. Additional clarifications

We sincerely thank the reviewers and the editor for their thorough evaluation and constructive feedback. Their insightful comments significantly improved the clarity, analytical depth, and overall scientific quality of our manuscript. We hope that the revisions made fully address all concerns and bring the paper to a publishable standard.

 

 

 

 

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

accept

Reviewer 3 Report

Comments and Suggestions for Authors The authors have sufficiently implemented their work as suggested by the various reviewers. I have nothing else to add.