The Mediterranean Diet as a Sustainable Dietary Pattern: A State-of-the-Art Narrative Review of Health, Environmental and Socioeconomic Dimensions

Background/Objectives: The increasing burden of non-communicable diseases, together with accelerating environmental degradation, highlights the urgent need for sustainable dietary patterns that promote both human and planetary health. The Mediterranean diet (MedDiet), traditionally followed in countries bordering the Mediterranean basin, has gained recognition as a model of sustainable nutrition due to its well-documented health benefits and relatively low environmental impact. However, its broader role within sustainable food systems requires comprehensive and interdisciplinary evaluation. The aim of this review is to provide a state-of-the-art synthesis of the evidence on the MedDiet as a sustainable dietary pattern, integrating its health, environmental, economic, and socio-cultural dimensions. Methods: This state-of-the-art narrative review synthesizes evidence from peer-reviewed literature on the MedDiet and sustainability. Relevant studies were identified through major scientific databases, focusing on publications addressing nutritional, environmental, economic, and socio-cultural dimensions. Both observational and interventional studies, as well as modeling and life cycle assessment analyses, were included. Additional sources from international organizations and policy reports were incorporated to contextualize global trends and challenges. Results: High adherence to the MedDiet is consistently associated with a reduced risk of cardiovascular disease, type 2 diabetes, cancer, and all-cause mortality. From an environmental perspective, the MedDiet is associated with lower greenhouse gas emissions, reduced land and water use, and enhanced biodiversity conservation compared with Western dietary patterns. Economically, it may represent a cost-effective dietary model and support local food systems when grounded in traditional practices, although affordability varies across contexts. Socio-culturally, the MedDiet promotes food heritage, culinary skills, and social cohesion. Nevertheless, globalization, urbanization, and the increasing consumption of ultra-processed foods have contributed to declining adherence, posing significant challenges to its sustainability and scalability. Moreover, the sustainability benefits of the MedDiet seem to be context-dependent rather than intrinsic, raising several challenges and limitations for its adoption. Conclusions: The MedDiet should be viewed not as a definitive solution to global food-system challenges but as a valuable reference model that illustrates how dietary practices can contribute simultaneously to human health, environmental sustainability, and cultural continuity. Modern sustainable dietary strategies should build upon the strengths of the MedDiet while recognizing its limitations, embracing contextual adaptation, and addressing the structural determinants that shape food choices.