To characterize the multiple dimensions and benefits of the Mediterranean diet as a sustainable diet, in order to revitalize this intangible food heritage at the country level; and to develop a multidimensional framework – the Med Diet 4.0 – in which four sustainability benefits of the Mediterranean diet are presented in parallel: major health and nutrition benefits, low environmental impacts and richness in biodiversity, high sociocultural food values, and positive local economic returns.

A narrative review was applied at the country level to highlight the multiple sustainable benefits of the Mediterranean diet into a single multidimensional framework: the Med Diet 4.0.

We included studies published in English in peer-reviewed journals that contained data on the characterization of sustainable diets and of the Mediterranean diet. The methodological framework approach was finalized through a series of meetings, workshops and conferences where the framework was presented, discussed and ultimately refined.

The Med Diet 4.0 provides a conceptual multidimensional framework to characterize the Mediterranean diet as a sustainable diet model, by applying principles of sustainability to the Mediterranean diet.

By providing a broader understanding of the many sustainable benefits of the Mediterranean diet, the Med Diet 4.0 can contribute to the revitalization of the Mediterranean diet by improving its current perception not only as a healthy diet but also a sustainable lifestyle model, with country-specific and culturally appropriate variations. It also takes into account the identity and diversity of food cultures and systems, expressed within the notion of the Mediterranean diet, across the Mediterranean region and in other parts of the world. Further multidisciplinary studies are needed for the assessment of the sustainability of the Mediterranean diet to include these new dimensions.

To position the concept of sustainability within the context of food security.

An overview of the interrelationships between food security and sustainability based on a non-systematic literature review and informed discussions based principally on a quasi-historical approach from meetings and reports.

International and global food security and nutrition.

The Rome Declaration on World Food Security in 1996 defined its three basic dimensions as: availability, accessibility and utilization, with a focus on nutritional well-being. It also stressed the importance of sustainable management of natural resources and the elimination of unsustainable patterns of food consumption and production. In 2009, at the World Summit on Food Security, the concept of stability/vulnerability was added as the short-term time indicator of the ability of food systems to withstand shocks, whether natural or man-made, as part of the Five Rome Principles for Sustainable Global Food Security. More recently, intergovernmental processes have emphasized the importance of sustainability to preserve the environment, natural resources and agro-ecosystems (and thus the overlying social system), as well as the importance of food security as part of sustainability and vice versa.

Sustainability should be considered as part of the long-term time dimension in the assessment of food security. From such a perspective the concept of sustainable diets can play a key role as a goal and a way of maintaining nutritional well-being and health, while ensuring the sustainability for future food security. Without integrating sustainability as an explicit (fifth?) dimension of food security, today’s policies and programmes could become the very cause of increased food insecurity in the future.