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Article

Assessing Gender and Age Differences in the Adoption of Sustainable Diets: Insights from an Intervention of the Mediterranean Diet

by
Mauro Lombardo
Department for the Promotion of Human Science and Quality of Life, San Raffaele Open University, Via di Val Cannuta, 247, 00166 Rome, Italy
Sustainability 2025, 17(5), 1962; https://doi.org/10.3390/su17051962
Submission received: 25 January 2025 / Revised: 19 February 2025 / Accepted: 24 February 2025 / Published: 25 February 2025
(This article belongs to the Section Sustainable Food)
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Abstract

:
Introduction: Sustainable nutrition is integral to environmental health and conservation. Gender and age differences influence dietary patterns, but their impact on the adoption of sustainable diets remains unclear. This study investigates the effects of a Mediterranean diet intervention on diet sustainability, focusing on gender and age differences. Methods: A cross-sectional study was conducted on 1666 participants (58.2% women) aged 18–75 years. Dietary preferences were assessed through food diaries and sustainability indices before and after the intervention. Participants followed a low-calorie Mediterranean diet for two months, with food diaries tracking their weekly consumption. Changes in sustainable and non-sustainable food consumption were analysed using paired t-tests and stratified by gender and age groups. Results: Men consumed significantly more meat and processed meat (p < 0.001), while women preferred low-fat yoghurt and whole grains (p < 0.01). Despite an increase in legume consumption (3.2%, p < 0.001), the overall sustainability index decreased due to a compensatory rise in meat consumption among men (p < 0.001), particularly in younger (<30) and older (>50) participants. Gender-related differences were observed, with female participants reporting a higher intake of foods classified as sustainable. However, significant cultural and palatability barriers limited the uptake of some sustainable foods such as tofu. Discussion: The intervention highlighted the challenges in promoting sustainable eating habits. Gender-targeted and age-specific strategies are critical to overcome barriers and support dietary improvements. Future interventions should incorporate cultural preferences and provide long-term support to achieve significant changes in behaviour. Conclusions: The Mediterranean diet intervention, conducted within an Italian cohort, highlighted both opportunities and challenges in promoting sustainable dietary transitions. Tailor-made approaches are essential to meet the different needs of various demographic groups. However, the effectiveness of nutrition programmes focusing on sustainability may depend on local food availability, cultural acceptance and dietary traditions.

Graphical Abstract

1. Introduction

Sustainable nutrition is crucial for human health and environmental conservation [1,2]. Food preferences differ between men and women, influencing the ecological footprint of diets [3,4]. Although gender differences in dietary patterns are recognised, it is still unclear how these differences influence the consumption of sustainable versus less sustainable foods, especially when analysed through food diaries [5]. Understanding these dynamics is particularly important in the Mediterranean region, where traditional dietary patterns are evolving in response to modern challenges.
In Italy, adherence to the MD has declined in recent years, raising concerns about its long-term sustainability [6,7]. Although traditionally associated with environmental and health benefits, recent studies indicate that modern adaptations of the diet may incorporate resource-intensive foods, such as meat and dairy products, affecting its overall sustainability [8]. National diet surveys suggest that although Italian consumers recognise the MD as a healthy model, barriers such as cost, accessibility and changing food preferences influence adherence [9]. While extensive research has examined the health benefits of the MD, fewer studies have focused on its sustainability aspects, particularly in relation to dietary adherence in specific populations [10]. In the Italian context, little is known about how factors such as gender and age influence the sustainability of dietary choices within the Mediterranean diet. This gap in knowledge highlights the need to further investigate how individual factors influence adherence to sustainable diets.
Several reviews have examined the role of gender and age in shaping sustainable food choices. For example, a systematic review by Modlinska et al. [11] analysed gender differences in attitudes towards plant-based diets and found that women are more likely to adopt sustainable eating habits due to ethical and environmental concerns. Similarly, Alcorta et al. [12] explored cultural and sensory barriers to plant-based alternatives, particularly among men, reinforcing the need for targeted interventions. Despite these insights, few studies have evaluated the effectiveness of dietary interventions in changing these patterns, particularly in the context of the Mediterranean diet (MD).
The consumption of sustainable foods, such as legumes and soy, is essential to reduce environmental impact and promote health [13,14,15]. Many interventions aim to increase the intake of plant-based foods and reduce meat consumption, but their effectiveness in improving the overall sustainability of the diet, particularly among specific genders and age groups, remains debated [16].
This study aims to evaluate the impact of a structured intervention on dietary sustainability, with a focus on gender and age differences. The MD is widely recognised for its sustainability benefits, but its effectiveness in different populations may vary compared to other dietary patterns [17], this study examines the extent to which the intervention enhances participants’ adherence to sustainable food choices. Previous studies have highlighted gender differences in food preferences, with women generally more inclined towards plant-based foods for ethical and health reasons [11,18,19]. However, the effectiveness of dietary interventions in changing these patterns remains poorly explored. By assessing changes in diet before and after the intervention using a sustainability index, this research seeks to determine whether gender-specific and age-related factors influence the adoption of more sustainable eating habits. The results will provide insights into the effectiveness of personalised nutrition strategies in facilitating sustainable dietary transitions in different demographic groups.

2. Materials and Methods

2.1. Cohort Demographics

A cross-sectional study was conducted in a specialised medical centre in Rome, Italy, with a focus on nutrition and metabolic health. The study design follows established protocols used in previous research examining dietary behaviour and sustainability indices [20,21]. To ensure methodological rigour, recruitment followed standardised procedures commonly employed in epidemiological and nutritional studies, minimising selection bias and ensuring a structured approach to participant inclusion.
Participants were recruited through doctor visits, targeted advertising in healthcare facilities and social media awareness campaigns, following strategies similar to those employed in large-scale dietary intervention studies [22]. The initial recruitment group consisted of 1800 people and eligibility was determined through a standardised screening process. To participate, people had to be aged between 18 and 75 years, be able to complete an online food diary and a questionnaire in Italian and provide informed consent. Exclusion criteria were pre-defined and included pregnancy or breastfeeding, the use of drugs that affect weight regulation, such as glucocorticoids, oestrogen and anticonvulsants, and chronic conditions such as alcoholism, chronic kidney disease and diabetes. Additional exclusion criteria ensured the reliability of the data by eliminating individuals with incomplete food diaries or who reported a caloric intake of less than 100% of their basal metabolic rate (BMR).
Following the application of these criteria, 134 individuals were excluded: 87 due to missing food diary data and 47 due to implausible caloric intake. The final sample consisted of 1666 participants who successfully completed all assessments. Although data on nationality were not explicitly collected, all participants were resident in Italy and completed the survey in Italian, ensuring the relevance of the study in the Italian dietary context. The study design, including participant recruitment, eligibility screening, data collection, and intervention details, is summarised in Figure 1.
All study procedures, including informed consent, were approved by the IRCCS San Raffaele ethics committee (registration number RP 23/13, approval date: 5 May 2023), ensuring compliance with the ethical standards outlined in the Declaration of Helsinki.

2.2. Food Preferences

Participants completed a comprehensive questionnaire prior to the initial visit to the medical centre. The questionnaire was administered electronically and was designed to align with validated dietary assessment tools used in previous research [22,23,24]. Although the specific questionnaire used in this study was not independently validated as a stand-alone instrument, its structure closely resembles validated food preference questionnaires widely applied in epidemiological nutrition research.
The questionnaire was structured in four sections, but the analysis in this study focused mainly on food preferences. Participants were asked to express their liking for a range of foods, choosing from the available options. The list included cow’s milk, plant-based alternatives such as soya milk, yoghurt with reduced fat and sugar content, fresh cheese, different types of meat, processed meat products such as ham, fish, eggs, pulses, vegetables both cooked and raw, fruit, cereals such as spelt and barley, products made with whole wheat flour, dried fruit, soya tofu and dark chocolate with a cocoa percentage above 75 percent.
Internal consistency of the food preference questionnaire was assessed using Cronbach’s alpha, a measure of scale reliability that evaluates the correlation between responses across different food items. Each item represented a reported preference for a specific food, and responses were numerically coded. Cronbach’s alpha was calculated as:
α = N N − 1 1 − ∑ σ i 2 σ t 2
N is the number of food items included in the analysis, σ i 2 is the variance of each individual food preference response, and σ t 2 is the variance of the total score across all food preference items.
Cronbach’s alpha reflects how strongly food preferences within the questionnaire are related to each other. The computed Cronbach’s alpha of 0.74 indicates an acceptable level of internal consistency. This measure aligns with validated tools used in studies examining patterns of food preference and eating habits [25]. Similar scales have been applied in large-scale studies on taste preferences and food acceptance. In addition, the methodology used to assess diet is aligned with the structured self-reported food intake protocols commonly used in epidemiological studies.

2.3. Body Composition

Body composition (BC) was assessed by bioelectrical impedance analysis (BIA) using the (TANITA Corporation, Sportlife Tokyo, Japan, range of 0–200 kg, accuracy: 100 g), device. The analysis determined fat mass (FM), lean body mass (FFM) and total body water (TBW). To ensure reliable measurements, participants followed specific pre-test instructions: fasting for at least three hours after waking up, abstaining from physical activity in the previous 12 h and limiting food and fluid intake in the same time interval. An earlier study showed that the Tanita BC-420 MA provides reliable estimates of BC, with a good correlation with DXA for the assessment of FM and FFM, making it a valid method in both clinical and research settings [26].

2.4. Dietary Intervention

Participants followed a low-calorie MD for two months, with a daily energy deficit of 600–800 kcal, calculated from total energy expenditure. This approach is consistent with that reported by Dominguez et al. [27], who show an inverse association between adherence to the MD and obesity, with positive effects on weight management and metabolic health. The composition of the diet was structured according to established Mediterranean patterns, including a high intake of olive oil, fibre-rich foods and plant-based proteins, with a macronutrient balance of approximately 50–55% carbohydrates, 15–20% protein and 25–30% fat, predominantly monounsaturated from olive oil. Tapsell [28] documented the effectiveness of the MD in reducing cardiovascular risk and improving metabolic indicators, attributing these benefits to its high content of polyphenols, healthy fats and anti-inflammatory compounds. To ensure an accurate distribution of macronutrients and micronutrients, the diet was formulated using Winfood 2.8 (Medimatica Srl, Martinsicuro, Italy) nutritional software, a validated tool for dietary planning. The MD followed in this study consisted of cereals (50–59%), extra virgin olive oil (13–17%), vegetables (2.2–3.6%), potatoes (2.3–3.6%), legumes (3–6%), fruit (2.6–3.6%), fish (1.6–2%), red wine (1–6%), meat (2.6–5%), dairy products (2–4%), eggs and very low animal fats, with a macronutrient distribution comprising about 51% carbohydrates, 29% fat, 19% protein and fibre > 30 g.

2.5. Tracking Progress: Weekly Food Diaries and Protein Intake

To assess food intake, participants completed a weekly food diary at baseline and throughout the follow-up period. The diaries, which included two weekend days, classified meals into ‘breakfast’, ‘morning snack’, ‘lunch’, ‘afternoon snack’, ‘dinner’ and ‘evening snack’. The data for the analysis were collected approximately 3–4 weeks after the diet was prescribed. We examined the participants’ food diaries and extracted the weekly frequencies of protein-rich food consumption. This allowed us to assess adherence to the prescribed diet plan and to analyse protein intake patterns at the beginning of the intervention.

2.6. Sustainability Assessment and Index Calculation

A dataset comprising self-reported food consumption was analysed. Foods were divided into sustainable (e.g., legumes, tofu, nuts) and non-sustainable groups (e.g., meat, dairy products, processed meats). The average consumption of each category was calculated separately for men and women. Independent t-tests were used to compare the averages between genders, with a significance level set at p < 0.05.
A retrospective analysis was conducted on the dietary data of patients who completed pre- and post-diet assessments. Preferences were recorded as ‘Yes’, ‘No’ or ‘Rarely’ before the diet, while post-diet consumption was documented in weekly diaries. Patients who answered ‘Yes’ to specific foods before the diet and did not record any consumption after the diet were identified. The proportions of these transitions were analysed using a binomial test and the standard error of the mean (SEM) was calculated to represent variability.
The analysis considered all food categories and divided them into sustainable (legumes and tofu in the pre-diet period; legumes and soya in the post-diet period), moderately sustainable (fish and eggs) and non-sustainable (meat, fresh cheese and processed meat). These categories were integrated into the calculation of the sustainability index to reflect the combined effect of the dietary intervention. The sustainability index was calculated for each participant using the following formula:
S u s t a i n a b i l i t y   I n d e x = S u s t a i n a b l e × 2 + M o d e r a t e l y   S u s t a i n a b l e × 1 − N o n   S u s t a i n a b l e × 1 / T o t a l   C o n s u m p t i o n
The index was compared between the pre- and post-diet period using a paired t-test and p-values were calculated for the total sample and separately for men, women and different age groups (<30 years, 30–50 years, >50 years).
The sustainability index used in the study was developed ad hoc, drawing inspiration from established tools such as the Healthy and Sustainable Diet Index (HSDI) [29] and the Sustainable Diet Index of the United States (SDI-US) [30], which integrate environmental and nutritional components into diet assessment. The index’s calculation method considers the proportion of plant and animal foods, the consumption of ultra-processed foods and the seasonality of products, assigning higher scores to diets with a more sustainable profile. Although the formula was developed specifically for this study, it is based on principles already applied in the scientific literature assessing the sustainability of eating habits.

2.7. Statistics

All statistical analyses were performed using SPSS v.28 (IBM Corporation, Armonk, NY, USA). The normality of continuous variables was checked with the Shapiro–Wilk test, given that the number of observations was less than 2000. For the comparison between independent groups, Student’s t-test was applied when the data followed a normal distribution, while the Mann–Whitney U test was used otherwise. Pre–post analyses were conducted using the t-test for paired data if the data were normally distributed, otherwise the Wilcoxon signed rank test was applied. Categorical variables were compared using the chi-square test, while differences between age and BMI groups were assessed by one-way ANOVA or the Kruskal–Wallis test, depending on the distribution of the data. For the analysis of transitions in pre–post food consumption, the binomial test was used to determine significant changes. The level of statistical significance was set at p < 0.05 and all p-values were reported accordingly.

3. Results

The demographic and clinical characteristics of the study population are summarised in Table 1. The total sample consisted of 1666 individuals, with a gender distribution of 58.2% females (n = 970) and 41.8% males (n = 696). With regard to age groups, 25.0% of the participants were under 30 years old, 47.7% were between 30 and 50 years old and 27.3% were over 50 years old, with no significant differences between the sexes (p > 0.05). Smokers made up 22.5% of the population, with 13.3% women and 9.2% men, with no significant differences between genders (p = 0.7725). Anthropometric measurements revealed significant differences between the sexes: males had a higher BMI (28.7 ± 5.1 vs. 27.6 ± 5.2 kg/m2, p < 0.001), lower fat mass (23.1 ± 10. 9 vs. 26.2 ± 10.3 kg, p < 0.001), and higher arm circumference (101.1 ± 14.3 vs. 93.6 ± 13.2 cm, p < 0.001) and fat mass (62.6 ± 8.5 vs. 44.3 ± 5.3 kg, p < 0.001). The income distribution showed that 66.7% of the participants earned between EUR 40,000 and 60,000 per year, while 18.7% earned less than EUR 20,000.
The radar graph (Figure 2) shows the average consumption of different food categories among male and female participants. Males showed a higher consumption of meat, red meat, processed meat and eggs, while females reported a higher intake of whole grains, cooked vegetables and raw vegetables. No significant differences were observed in the consumption of cow’s milk, tofu and fresh cheese. The graph highlights sustainable foods in green and non-sustainable foods in brown, visually representing gender-based dietary patterns.
The analyses (Figure 3) show that there are no significant differences between men and women in the consumption of legumes (p = 0.242) and soya (p = 0.743). Men consumed significantly more meat (p < 0.001) and processed meat (p < 0.001) than women. There were no significant differences in dairy consumption (p = 0.679).
The results revealed varying percentages of patients transitioning from “Yes” consumption pre-diet to 0 consumption post-diet (Figure 4). Notable examples include tofu at 6.6% (p = <0.001), meat at 3.2% (p = <0.001) and fish at 3.1% (p = 0).
The analysis demonstrated significant increases in consumption across several food items (Figure 5). Legumes showed a transition rate of 3.2% with p < 0.001, tofu exhibited a transition rate of 2.2% with a p-value of 0, while fish had a transition rate of 5.8% with p < 0.001. These findings highlight the potential of dietary interventions to encourage consumption of less commonly consumed food items.
The mean sustainability index decreased significantly after the intervention (Figure 6). In the total sample, it went from 0.28 to 0.22 (Δ = −0.06). In men, the index decreased from 0.27 to 0.20 (Δ = −0.07), while in women it decreased from 0.29 to 0.24 (Δ = −0.05).
In all analysed age groups, the average sustainability index decreased significantly after the intervention (Figure 7). In participants aged <30 years, the index decreased from 0.27 to 0.19 (Δ = −0.08). In participants aged 30–50 years, the index decreased from 0.30 to 0.25 (Δ = −0.05). In participants >50 years, the index decreased from 0.27 to 0.19 (Δ = −0.08).
Among men, the pre-diet mean was 0.62, and the post-diet mean was 0.75. Significant differences were observed in the <30 (p = 0.0087) and >50 (p = 0.0028) age groups, while the 30–50 group showed a non-significant trend (p = 0.0948). Among women, the pre-diet mean was 0.55, and the post-diet mean was 0.68. Significant differences were observed in the >50 group (p = 0.0375), while the <30 (p = 0.0764) and 30–50 (p = 0.0626) groups did not reach significance. Boxplots illustrate these results, highlighting the stratified differences across gender and age groups (Figure 8 and Figure 9).

4. Discussion

The results of this study showed significant gender differences in the consumption of sustainable and non-sustainable foods. Differences in food consumption between men and women were observed, with men consuming more meat and processed meat (p < 0.001), while women consumed more low-fat yoghurt and whole-grain cereals (p < 0.001). These patterns are in line with previous findings suggesting that cultural and dietary norms shape individual food choices, rather than reflecting intrinsic preferences or superior eating behaviours [31,32,33,34]. For example, Sayon-Orea et al. [34] showed that yoghurt consumption is linked to better weight management and a reduced risk of metabolic syndrome, supporting its role as a preferred dietary choice for individuals focusing on weight control. Similarly, the benefits of whole grains, particularly in the context of the MD, include reduced cardiovascular risk and increased longevity, as noted by Capurso [32]. Furthermore, Tammi et al. [33] confirmed that a higher intake of whole grains correlated with better overall diet quality and reduced risk factors for chronic diseases, particularly among women who often prioritise these foods for their health benefits.
An interesting result is the lack of significant differences in the consumption of legumes and soya. This suggests that the consumption of these foods, often considered symbols of a sustainable diet, may not be influenced by gender-related factors. This contrasts with evidence from previous studies indicating that women are more open to plant-based foods. For example, Modlinska et al. [11] found that women have more positive attitudes towards plant-based diets, often driven by ethical and environmental concerns. Similarly, Rosenfeld and Tomiyama [18] reported that women are more likely to adopt vegetarian or reduced-meat diets, influenced by health motivations and less adherence to traditional social norms associating meat consumption with masculinity. However, as Alcorta et al. [12] point out, the acceptance of plant-based alternatives varies significantly depending on cultural and individual factors, which could explain the absence of gender differences in legume and soy consumption observed in this study. The discrepancy could reflect cultural specificities or the impact of the recruitment context, such as the focus on a specialised medical centre.
Our intervention assessed the influence of gender and age on adherence to sustainable food choices within the MD. Results showed that men increased their consumption of meat and processed meat after the intervention (p < 0.001), whereas women showed a greater preference for whole grains and low-fat dairy products (p < 0.01). Despite a slight increase in consumption of legumes (3.2%, p < 0.001), the overall sustainability index decreased, particularly among participants under 30 and over 50 years of age (p < 0.001). This suggests that although MD is widely recognised as a sustainable dietary pattern, its implementation in a calorie-restricted context does not necessarily improve sustainability, especially when accompanied by an increased intake of high-impact foods such as meat. The reduction in the sustainability index appears to be driven by this shift in meat consumption, which offsets the benefits of an increased intake of legumes. These results confirm the difficulty of changing established dietary habits, such as meat consumption, through short-term interventions [19,35]. The analysis by age showed that participants under the age of 30 and over the age of 50 showed the greatest reductions in the sustainability index, while those between the ages of 30 and 50 showed the smallest reduction. This trend is in line with the findings of Fagerli and Wandel [36], who reported greater openness to dietary change in adulthood than younger and older individuals. A key finding concerns food transitions; while legume consumption increased (3.2%, p < 0.001), tofu intake decreased in 6.6% of participants, suggesting that some sustainable foods may face cultural or palatability barriers [37].
Finally, it is important to note that the intervention had a limited impact on women between the ages of 30 and 50 and on men in the same age group, with insignificant changes in the sustainability index. This underlines the need for customised interventions that take into account not only gender differences, but also the specific needs of age groups. Research highlights the importance of targeted strategies to improve eating behaviour. For example, Sharkey et al. [38] demonstrated that gender-targeted interventions are more effective in increasing fruit and vegetable intake than gender-neutral approaches, especially among women. Similarly, Lara et al. [39] found that interventions during life transitions, such as retirement, significantly increase fruit, vegetable and fish intake, emphasising the value of age-specific programmes. Furthermore, Reinders et al. [40] highlighted the benefits of combining dietary counselling and oral nutritional supplements, which showed greater improvements in energy intake and weight gain among women and older adults at risk of malnutrition. Finally, Navas-Carretero et al. [41] demonstrated that high-protein diets are particularly beneficial for weight maintenance and cardiovascular risk reduction, with women showing better metabolic outcomes than men. These findings reinforce the need for tailored interventions that take into account gender- and age-specific needs, such as nutrition education, dietary counselling and facilitated access to sustainable foods, to improve the overall effectiveness of dietary programmes. The results show distinct dietary transitions, influenced by gender and age, with varying adherence to sustainable food choices. Table 2 summarises the key findings and their potential applications, highlighting how dietary interventions can be tailored to different demographic groups to improve sustainability outcomes.
This study has several limitations that must be considered when interpreting the results. Firstly, the absence of a validated instrument for the assessment of food preferences may have introduced a bias into the data collected. Although the questionnaire used was structured in a manner consistent with other validated instruments, the lack of formal validation limits the generalisability of the results. Secondly, the sample was recruited from a specialised medical centre, which may have selected individuals who were already motivated to change their eating habits, reducing representativeness compared to the general population. Finally, the relatively short duration of the intervention may not have been sufficient to observe sustainable long-term changes, suggesting the need for future studies with longer follow-up periods.

5. Conclusions

The study shows significant gender and age differences in diet sustainability; men consume more meat and processed foods, while women show a greater preference for plant-based options. Despite a slight increase in the consumption of legumes after the intervention, the overall sustainability index decreased, especially among participants under 30 and over 50 years of age. The results indicate that dietary transitions are influenced by cultural and behavioural factors, with men being more resistant to adopting sustainable food choices. The results suggest that nutritional interventions should be tailored to specific demographic needs, emphasising gender-sensitive approaches to improve adherence to sustainable diets.

Funding

This research received no external funding.

Institutional Review Board Statement

The participants provided their written informed consent to participate in this study. The studies were conducted in accordance with local legislation and institutional requirements. This study received approval from the Lazio area 5 territorial ethics committee (approval code: N.57/SR/23; approval date: 7 November 2023).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data supporting the findings of this study are available from the corresponding author upon reasonable request. All data will be shared in a de-identified format to protect participant confidentiality.

Acknowledgments

I would like to thank Arianna Lombardo and Tommaso Lombardo for their valuable help in compiling the subject database. I would also like to thank the centre’s dieticians Giovanni Aulisa and Marzia Comità for their crucial cooperation and support in implementing the dietary intervention.

Conflicts of Interest

The author declares no conflict of interest.

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Figure 1. Study design and data collection flow chart. The diagram illustrates the recruitment process, eligibility screening, data collection at baseline and after the intervention, the Mediterranean diet intervention and the statistical analysis conducted. Initially, 1800 participants were recruited, 1666 of whom were included after suitability screening. Exclusions (n = 134) were due to missing food diary data (n = 87) and implausible calorie intake ratios (n = 47). Data collection included food diaries and sustainability index assessments, both at baseline and after the two-month diet.
Figure 1. Study design and data collection flow chart. The diagram illustrates the recruitment process, eligibility screening, data collection at baseline and after the intervention, the Mediterranean diet intervention and the statistical analysis conducted. Initially, 1800 participants were recruited, 1666 of whom were included after suitability screening. Exclusions (n = 134) were due to missing food diary data (n = 87) and implausible calorie intake ratios (n = 47). Data collection included food diaries and sustainability index assessments, both at baseline and after the two-month diet.
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Figure 2. Radar chart representing the average consumption of various food categories among male and female participants. Sustainable foods, such as legumes, whole grains and vegetable milk, are highlighted in green, while non-sustainable foods, such as red meat, processed meat and dairy products, are highlighted in brown. The graph illustrates gender differences in eating habits, with female participants reporting higher consumption of sustainable foods. The statistical significance of gender differences in food consumption was assessed using Welch’s t-test. The p-values for all food categories were as follows: cow’s milk (p = 0.9521), vegetable beverages (p = 0.0617), low-fat white yoghurt (p = 0.1433), fresh cheese (p = 0.7632), meat (p < 0.001), red meat (p < 0.001), processed meat (p < 0.001), fish (p < 0.001), fish (p = 0.2512), eggs (p < 0.001), pulses (p = 0.1053), cooked vegetables (p < 0.001), raw vegetables (p = 0.0066), fruit (p = 0.6449), cereals (p = 0.0396), whole grains (p < 0.001), nuts (p = 0.4591) and tofu (p = 0.9672).
Figure 2. Radar chart representing the average consumption of various food categories among male and female participants. Sustainable foods, such as legumes, whole grains and vegetable milk, are highlighted in green, while non-sustainable foods, such as red meat, processed meat and dairy products, are highlighted in brown. The graph illustrates gender differences in eating habits, with female participants reporting higher consumption of sustainable foods. The statistical significance of gender differences in food consumption was assessed using Welch’s t-test. The p-values for all food categories were as follows: cow’s milk (p = 0.9521), vegetable beverages (p = 0.0617), low-fat white yoghurt (p = 0.1433), fresh cheese (p = 0.7632), meat (p < 0.001), red meat (p < 0.001), processed meat (p < 0.001), fish (p < 0.001), fish (p = 0.2512), eggs (p < 0.001), pulses (p = 0.1053), cooked vegetables (p < 0.001), raw vegetables (p = 0.0066), fruit (p = 0.6449), cereals (p = 0.0396), whole grains (p < 0.001), nuts (p = 0.4591) and tofu (p = 0.9672).
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Figure 3. Food consumption in the diary by gender. Heatmap representing the average weekly consumption of sustainable and less sustainable foods between men (M) and women (F). The p-values associated with the t-tests for gender differences are as follows. Legumes—p = 0.242; soy—p = 0.743; meat—p < 0.001; processed meat—p < 0.001; dairy—p = 0.679. Significant differences (p < 0.05) are evident for the consumption of meat and processed meat.
Figure 3. Food consumption in the diary by gender. Heatmap representing the average weekly consumption of sustainable and less sustainable foods between men (M) and women (F). The p-values associated with the t-tests for gender differences are as follows. Legumes—p = 0.242; soy—p = 0.743; meat—p < 0.001; processed meat—p < 0.001; dairy—p = 0.679. Significant differences (p < 0.05) are evident for the consumption of meat and processed meat.
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Figure 4. Percentage of patients transitioning from pre-diet ‘Yes’ to 0 consumption post-diet (with p-values). The bar chart displays the percentage of patients who transitioned from “Yes” consumption pre-diet to 0 consumption post-diet for each food item. Error bars represent the standard error of the mean (SEM). The p-values for the binomial test were calculated as follows: for legumes p = 0, for tofu p = 4.56 × 10−17, for fresh cheeses p = 0, for meat p = 4.94 × 10−324, for processed meat p = 4.14 × 10−145, for fish p = 0 and for eggs p = 3.53 × 10−187.
Figure 4. Percentage of patients transitioning from pre-diet ‘Yes’ to 0 consumption post-diet (with p-values). The bar chart displays the percentage of patients who transitioned from “Yes” consumption pre-diet to 0 consumption post-diet for each food item. Error bars represent the standard error of the mean (SEM). The p-values for the binomial test were calculated as follows: for legumes p = 0, for tofu p = 4.56 × 10−17, for fresh cheeses p = 0, for meat p = 4.94 × 10−324, for processed meat p = 4.14 × 10−145, for fish p = 0 and for eggs p = 3.53 × 10−187.
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Figure 5. Percentage of patients transitioning from “No” or “Rarely” to any consumption post-diet. The bar chart illustrates the percentage of patients who transitioned from “No” or “Rarely” consumption pre-diet to any consumption post-diet for each food item. Error bars represent the standard error of the mean (SEM). p-values for the binomial test for each food item are as follows: legumes p = 0, tofu p = 4.56 × 10−17, fresh cheeses p = 0, meat p = 4.94 × 10−324, processed meat p = 4.14 × 10−145, fish p = 0 and eggs p = 3.53 × 10−187. These results highlight significant transitions in dietary habits across several food categories.
Figure 5. Percentage of patients transitioning from “No” or “Rarely” to any consumption post-diet. The bar chart illustrates the percentage of patients who transitioned from “No” or “Rarely” consumption pre-diet to any consumption post-diet for each food item. Error bars represent the standard error of the mean (SEM). p-values for the binomial test for each food item are as follows: legumes p = 0, tofu p = 4.56 × 10−17, fresh cheeses p = 0, meat p = 4.94 × 10−324, processed meat p = 4.14 × 10−145, fish p = 0 and eggs p = 3.53 × 10−187. These results highlight significant transitions in dietary habits across several food categories.
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Figure 6. Comparison of pre- and post-diet sustainability index for total, men and women. Boxplots show the pre- and post-diet sustainability index for total, male and female samples. The median decreases significantly in all groups: total (p < 0.001), men (p < 0.001) and women (p = 0.001). Bars represent interquartile ranges and points outside the whiskers indicate outliers.
Figure 6. Comparison of pre- and post-diet sustainability index for total, men and women. Boxplots show the pre- and post-diet sustainability index for total, male and female samples. The median decreases significantly in all groups: total (p < 0.001), men (p < 0.001) and women (p = 0.001). Bars represent interquartile ranges and points outside the whiskers indicate outliers.
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Figure 7. Comparison of pre- and post-diet sustainability index stratified by age group. Boxplots show the pre- and post-diet sustainability index stratified by age groups (<30, 30–50, >50 years). The median decreases significantly in all groups: <30 years (p = 0.0019), 30–50 years (p = 0.0123) and >50 years (p = 0.0005). Bars represent interquartile values and points outside the whiskers indicate outliers.
Figure 7. Comparison of pre- and post-diet sustainability index stratified by age group. Boxplots show the pre- and post-diet sustainability index stratified by age groups (<30, 30–50, >50 years). The median decreases significantly in all groups: <30 years (p = 0.0019), 30–50 years (p = 0.0123) and >50 years (p = 0.0005). Bars represent interquartile values and points outside the whiskers indicate outliers.
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Figure 8. Males: sustainability index by age group and diet phase. Graph for males: comparison of pre- and post-diet sustainability indices in males shows p-values for age groups <30 (p = 0.0087), 30–50 (p = 0.0948) and >50 (p = 0.0028).
Figure 8. Males: sustainability index by age group and diet phase. Graph for males: comparison of pre- and post-diet sustainability indices in males shows p-values for age groups <30 (p = 0.0087), 30–50 (p = 0.0948) and >50 (p = 0.0028).
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Figure 9. Females: sustainability index by age group and diet phase. Graph for females: the comparison of pre- and post-diet sustainability indices in females shows p-values for the age groups <30 (p = 0.0764), 30–50 (p = 0.0626) and >50 (p = 0.0375).
Figure 9. Females: sustainability index by age group and diet phase. Graph for females: the comparison of pre- and post-diet sustainability indices in females shows p-values for the age groups <30 (p = 0.0764), 30–50 (p = 0.0626) and >50 (p = 0.0375).
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Table 1. Demographic and clinical characteristics of the study population.
Table 1. Demographic and clinical characteristics of the study population.
Variable UnitTotalMFp
Total Sample n (%)1666696 (41.8)970 (58.2)
Age<30 yearsn (%)416 (25.0)184 (13.2)232 (12.0)0.2652
30–50 yearsn (%)795 (47.7)337 (24.2)458 (23.6)0.6635
>50 yearsn (%)454 (27.3)175 (12.6)279 (14.4)0.114
Smokersn (%)375 (22.5)154 (9.2)221 (13.3)0.7725
BMIkg/m228.1 ± 5.228.7 ± 5.127.6 ± 5.2<0.001
Fat Masskg24.9 ± 10.723.1 ± 10.926.2 ± 10.3<0.001
ACcm96.8 ± 14.2101.1 ± 14.393.6 ± 13.2<0.001
FFMkg52.0 ± 11.362.6 ± 8.544.3 ± 5.3<0.001
Yearly income<EUR 20,000n (%)311 (18.7%)119 (7.1%)192 (11.5%)-
EUR 20,000–EUR 40,000n (%)46 (2.8%)20 (1.2%)26 (1.6%)-
EUR 40,000–EUR 60,000n (%)1111 (66.7%)468 (28.1%)643 (38.6%)-
>EUR 60,000n (%)196 (11.8%)88 (5.3%)108 (6.5%)0.4802
The table presents the demographic and clinical characteristics of the study population, including gender distribution, age groups, smoking status and anthropometric measures (BMI, fat mass, arm circumference [AC] and free fat mass [FFM]). Income categories are also reported, with means ± standard deviations and percentages where applicable. Statistical significance (p-values) was determined using chi-square tests for categorical variables and independent t-tests for continuous variables.
Table 2. Key findings and practical applications for sustainable dietary transitions.
Table 2. Key findings and practical applications for sustainable dietary transitions.
Key FindingsPotential Applications
Men consumed significantly more meat and processed meat (p < 0.001), while women preferred whole grains and low-fat yoghurt (p < 0.01).Nutritionists and dietitians can develop targeted interventions promoting plant-based alternatives, particularly among men.
Despite an increase in legume consumption post-intervention (3.2%, p < 0.001), the sustainability index decreased overall.Policy makers can design incentives to support sustainable food consumption, particularly in younger and older populations.
The largest declines in the sustainability index were observed in participants under 30 and over 50 years old (p < 0.001).Public health campaigns can emphasise sustainability aspects of the Mediterranean diet to improve adherence across all age groups.
Tofu consumption dropped in 6.6% of participants, while legume intake increased (p < 0.001), suggesting cultural barriers to some sustainable foods.Researchers can explore interventions that integrate cultural and sensory aspects to improve acceptance of sustainable foods like tofu.
Dietary transitions showed gender-specific trends, with women maintaining more sustainable choices, while men increased meat consumption post-intervention.Gender-specific nutrition programmes can be refined to prevent post-intervention dietary regressions, particularly in men.
Summary of key findings on gender- and age-specific dietary transitions and their practical applications. The table highlights how dietary interventions, policy strategies and public health initiatives can be adapted to improve adherence to sustainable food choices.
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Lombardo, M. Assessing Gender and Age Differences in the Adoption of Sustainable Diets: Insights from an Intervention of the Mediterranean Diet. Sustainability 2025, 17, 1962. https://doi.org/10.3390/su17051962

AMA Style

Lombardo M. Assessing Gender and Age Differences in the Adoption of Sustainable Diets: Insights from an Intervention of the Mediterranean Diet. Sustainability. 2025; 17(5):1962. https://doi.org/10.3390/su17051962

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Lombardo, Mauro. 2025. "Assessing Gender and Age Differences in the Adoption of Sustainable Diets: Insights from an Intervention of the Mediterranean Diet" Sustainability 17, no. 5: 1962. https://doi.org/10.3390/su17051962

APA Style

Lombardo, M. (2025). Assessing Gender and Age Differences in the Adoption of Sustainable Diets: Insights from an Intervention of the Mediterranean Diet. Sustainability, 17(5), 1962. https://doi.org/10.3390/su17051962

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