Adherence to the Mediterranean Diet and Its Association with Sustainable Dietary Behaviors, Sociodemographic Factors, and Lifestyle: An Online Survey in Italian and US University Students

Background and objectives: The declining trend of the adherence to Mediterranean Diet (MD) and shift toward Western-type dietary patterns involve different age groups across the world, including young generations. University students are particularly involved in this process as university life exposes them to the risk of developing unhealthy dietary behaviors and diet-related chronic diseases in later life. In this context, the present cross-sectional study was aimed at investigating the level of adherence to the MD and its association with sociodemographic and anthropometric variables, and lifestyle-related factors, including the adoption of sustainable dietary behaviors, in two national representative samples of university students (18–24 years) living in Italy (IT) and in the United States (US). Methods: The adherence to the MD and sustainability of dietary behaviors were assessed by applying the KIDMED questionnaires and the Sustainable-HEalthy-Diet (SHED) Index, respectively. Both instruments provide a total score. In addition, the SHED Index includes six sub-scores (i.e., Healthy Eating, Sustainable Eating, Place of Purchase of Fruits and Vegetables, Prepared Meals, Water, and Soda). Results: The final samples consisted of 1434 and 1485 Italian and American students, respectively. Most of the participants had an average adherence to the MD (IT: 55%; US: 47%). In both populations, meeting physical activity recommendations, having a high SHED Index score, mainly consuming plant-based foods, being prone to purchase and eat healthy and sustainable dishes, and regularly attending the university canteen were the most powerful predictors of having a high adherence to the MD. Discussion: In this connection, a major promotion of the MD as a sustainable dietary pattern may be an effective strategy for its revitalization. Considering the positive influence that university canteen attendance has on students’ eating habits, campuses and university dining services represent a unique opportunity to build a supportive environment that educates students about the effects of their actions and fosters human and planetary health.