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Introduction: This article aims to provide an updated overview of the scientific knowledge regarding the interplay between the Mediterranean diet (MedD), sustainability, and cardiovascular and metabolic health. Methodology: A systematic review was conducted following the PRISMA guidelines, succeeded by a narrative synthesis of data extracted from original research articles in English and Spanish. These articles, indexed in the Scopus and PubMed databases from inception to 31 December 2024, addressed the relationship between MedD, sustainability, and cardiovascular and metabolic health. The methodological quality of the included studies was assessed for bias using the JBI critical appraisal tools. This review was registered in PROSPERO (ID CRD42024476408). Results: The search identified 11 relevant articles. A primary focus on obesity was evident (nine articles), followed by chronic inflammation and metabolic syndrome (two articles each), and cardiovascular health (one article). Regarding sustainability, climate change was the most frequently addressed concern (eight articles). Discussion: A clear trend emerged, indicating a direct association between environmental sustainability, positive health outcomes, and adherence to the MedD. These findings underscore the benefits of the MedD, demonstrating its potential not only to reduce the environmental impact but also to improve health markers such as BMI, metabolic syndrome risk, and chronic inflammation levels. Full article