{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:41:04Z","timestamp":1792597264739,"version":"4.5.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Food literacy and sustainable patterns may be associated with metabolic disease risk. Therefore, it is important to determine the potential impact of sustainable dietary concepts, as well as the development of food literacy, on the risk of metabolic syndrome (MetS) and diabetes. The aim of this study was to investigate the associations of sustainable dietary concepts and sustainable food literacy with the risk of MetS and diabetes in adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study included a total of 6,364 healthy Turkish adults. To determine the extent to which sustainable dietary concepts affect MetS and diabetes in participants, the status of participants was assessed with the following scales: the Sustainable and Healthy Eating Behaviors Scale (SHEBS), the Sustainable Food Literacy Scale (SFLS), the Mediterranean Diet Adherence Screener (MEDAS), the Metabolic Syndrome Index (MSI), the Metabolic Syndrome Research Form (MSAF), and the Finnish Diabetes Risk Score (FINDRISC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most participants were found to have a low risk of diabetes (62.6%), 49.8% had a moderate risk of MetS (based on the MSAF), and 21.3% had a high risk of MetS (based on the MSI). Participants with a high level of MEDAS had a lower MSI score than did those with a moderate or low level (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001), whereas those with a low level of MEDAS had a significantly higher MSAF score than did those with a moderate or high level (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). As participants\u2019 MSI and FINDRISC levels decreased, their SHEBS and SFLS scores significantly increased (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). As MSAF levels increased, participants\u2019 MEDAS scores significantly decreased (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). SFLS and MEDAS had a negative and significant effect on the MSAF (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f\u22120.03, \u03b2\u202f=\u202f\u22120.04; <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05, respectively), whereas SHEBS had a stronger and negatively significant effect (\u03b2\u202f=\u202f\u22120.08; <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). The MEDAS (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f\u22120.03; <jats:italic>p<\/jats:italic>\u202f=\u202f0.007), SHEBS (\u03b2\u202f=\u202f\u22120.08; <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001), and especially the SFLS (\u03b2\u202f=\u202f\u22120.13; <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001) were found to be negative and significant predictors of MetS risk (for MSI), whereas the SFLS was a negatively significant predictor of diabetes risk (\u03b2\u202f=\u202f\u22120.11; <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The effects of sustainable healthy eating behaviors, sustainable food literacy and Mediterranean diet on preventing the risk of MetS are significant, and the most important negative predictor of diabetes risk is SFLS.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1693180","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T05:30:04Z","timestamp":1759469404000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Predictive effect of sustainable dietary and literacy patterns on metabolic syndrome and diabetes risk in Turkish adults: Mediterranean diet, sustainable healthy eating behaviors, and sustainable food literacy perspective"],"prefix":"10.3389","volume":"12","author":[{"given":"Serap","family":"\u0130ncedal Irgat","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hande","family":"Bak\u0131rhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunus Emre","family":"Bak\u0131rhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/s40101-020-00250-w","article-title":"The associations of eating behavior and dietary intake with metabolic syndrome in Japanese: Saku cohort baseline study","volume":"39","author":"Morita","year":"2020","journal-title":"J Physiol Anthropol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"28","DOI":"10.4103\/njcp.njcp_88_18","article-title":"Assessment of knowledge of metabolic syndrome and health literacy level among adults in Western Turkey","volume":"24","author":"Emiral","year":"2021","journal-title":"Niger J Clin Pract"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"5887","DOI":"10.3390\/ijms26125887","article-title":"Comparison of the Mediterranean diet and other therapeutic strategies in metabolic syndrome: a systematic review and meta-analysis","volume":"26","author":"Bruna-Mejias","year":"2025","journal-title":"Int J Mol Sci"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"591","DOI":"10.5543\/tkda.2018.00878","article-title":"Data on prevalence of metabolic syndrome in Turkey: systematic review, meta-analysis and meta-regression of epidemiological studies on cardiovascular risk factors","volume":"46","author":"Abac\u0131","year":"2018","journal-title":"Turk Kardiyol Dern Ars"},{"key":"ref5","year":"2025"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"6562","DOI":"10.3390\/ijerph19116562","article-title":"Relationship between dietary behaviors and physical activity and the components of metabolic syndrome: a case-control study","volume":"19","author":"Godala","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2983","DOI":"10.3390\/nu12102983","article-title":"Dietary strategies for metabolic syndrome: a comprehensive review","volume":"12","author":"Castro-Barquero","year":"2020","journal-title":"Nutrients"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1080\/27697061.2024.2435039","article-title":"Are nutrition literacy and sustainable dietary habits associated with cardiovascular disease and diabetes developmental risks?","volume":"44","author":"Kalkan","year":"2025","journal-title":"J Am Nutr Assoc"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"3547","DOI":"10.1186\/s12889-024-21091-7","article-title":"Determining food choice motivations in Turkish adults: sustainable and healthy eating behavior, ecological footprint awareness, and food insecurity perspective","volume":"24","author":"Irgat","year":"2024","journal-title":"BMC Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2611","DOI":"10.18502\/ijph.v52i12.14322","article-title":"Dietary patterns and cardiovascular risk: are the Mediterranean diet, the heart-healthy diet, and phytochemicals associated with lower cardiovascular risks?","volume":"52","author":"Bak\u0131rhan","year":"2023","journal-title":"Iran J Public Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1186\/s13098-023-01052-7","article-title":"Mediterranean diet lowers all-cause and cardiovascular mortality for patients with metabolic syndrome","volume":"15","author":"Fan","year":"2023","journal-title":"Diabetol Metab Syndr"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"4","DOI":"10.3390\/diabetology6010004","article-title":"Mediterranean diet and metabolic syndrome","volume":"6","author":"Radi\u0107","year":"2025","journal-title":"Diabetology"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"358","DOI":"10.3390\/nu17020358","article-title":"Effects of the Mediterranean diet on the components of metabolic syndrome concerning the cardiometabolic risk","volume":"17","author":"Scaglione","year":"2025","journal-title":"Nutrients"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"920S","DOI":"10.3945\/jn.115.218487","article-title":"Protective effects of the Mediterranean diet on type 2 diabetes and metabolic syndrome","volume":"146","author":"Salas-Salvad\u00f3","year":"2015","journal-title":"J Nutr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1024\/0300-9831\/a000462","article-title":"Effect of the Mediterranean diet in combination with exercise on metabolic syndrome parameters: 1-year randomized controlled trial","volume":"89","author":"Pavi\u0107","year":"2019","journal-title":"Int J Vitam Nutr Res"},{"key":"ref16","year":"2022"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"725","DOI":"10.2337\/diacare.26.3.725","article-title":"The diabetes risk score: a practical tool to predict type 2 diabetes risk","volume":"26","author":"Lindstr\u00f6m","year":"2003","journal-title":"Diabetes Care"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1186\/s12889-025-21304-7","article-title":"Metabolic syndrome index measurement tool (MSI): scale development, reliability and validity study","volume":"25","author":"Akeren","year":"2025","journal-title":"BMC Public Health"},{"key":"ref19","first-page":"13","article-title":"Manisa ili sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131nda metabolik sendrom riski","volume":"2","author":"Karadeniz","year":"2007","journal-title":"F\u0131rat Sa\u011fl\u0131k Hizmetleri Derg"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"9","DOI":"10.5543\/khd.2022.210905","article-title":"\u00dcniversite \u00f6\u011frencilerinde metabolik sendrom riski, fiziksel aktivite, uyku kalitesi ve yorgunluk aras\u0131ndaki ili\u015fki","volume":"13","author":"Arslan","year":"2022","journal-title":"Turk J Card Nur"},{"key":"ref21","first-page":"72","article-title":"Bir sa\u011fl\u0131k oca\u011f\u0131na ba\u015fvuran eri\u015fkinlerde metabolik sendrom risk d\u00fczeyleri ve ili\u015fkili fakt\u00f6rler","volume":"18","author":"Mollao\u011flu","year":"2010","journal-title":"Florence Nightingale J Nurs"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e43134","DOI":"10.1371\/journal.pone.0043134","article-title":"A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial","volume":"7","author":"Mart\u00ednez-Gonz\u00e1lez","year":"2012","journal-title":"PLoS One"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"160","DOI":"10.20515\/otd.504188","article-title":"Turkish validation and reliability of Mediterranean diet adherence screener","volume":"42","author":"\u00d6zkan Pehlivano\u011flu","year":"2020","journal-title":"Osmangazi J Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"123","DOI":"10.26579\/jocrehes.13.2.2","article-title":"Sustainable nutrition, nutrition knowledge and Mediterranean diet adherence levels of university students","volume":"13","author":"I\u015f\u0131ker","year":"2023","journal-title":"J Curr Research Health Sector"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"95","DOI":"10.3390\/nu11010095","article-title":"Searching for a measure integrating sustainable and healthy eating behaviors","volume":"11","author":"\u017bakowska-Biemans","year":"2019","journal-title":"Nutrients"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/S0007114522002525","article-title":"Validity and reliability of the Turkish version of the sustainable and healthy eating behaviors scale","author":"K\u00f6ksal","year":"2022","journal-title":"Br J Nutr"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1016\/j.spc.2022.01.008","article-title":"Sustainable food literacy: a measure to promote sustainable diet practices","volume":"30","author":"Teng","year":"2022","journal-title":"Sustain Prod Consum"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1562","DOI":"10.37989\/gumussagbil.1367727","article-title":"Validity and reliability study of the Turkish adaptation of the sustainable food literacy scale","volume":"12","author":"Kubilay","year":"2023","journal-title":"G\u00fcm\u00fc\u015fhane Sa\u011fl\u0131k Bilimleri Dergisi"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"E56","DOI":"10.15167\/2421-4248\/jpmh2022.63.2S3.2747","article-title":"Effects of the Mediterranean diet on the components of metabolic syndrome","volume":"63","author":"Dayi","year":"2022","journal-title":"J Prev Med Hyg"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1948","DOI":"10.3390\/nu16121948","article-title":"Relationship between the Mediterranean diet and metabolic syndrome and each of the components that form it in Caucasian subjects: a cross-sectional trial","volume":"16","author":"G\u00f3mez-S\u00e1nchez","year":"2024","journal-title":"Nutrients"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2236","DOI":"10.3390\/nu12082236","article-title":"Mediterranean diet effects on type 2 diabetes prevention, disease progression, and related mechanisms. a review","volume":"12","author":"Mart\u00edn-Pel\u00e1ez","year":"2020","journal-title":"Nutrients"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1087985","DOI":"10.3389\/fnut.2022.1087985","article-title":"High adherence to the Mediterranean diet and alternative healthy eating index are associated with reduced odds of metabolic syndrome and its components in participants of the ORISCAV-LUX2 study","volume":"9","author":"Al Kudsee","year":"2022","journal-title":"Front Nutr"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1080\/09637486.2025.2450452","article-title":"Association between Mediterranean diet and metabolic syndrome: analysis of NHANES 2007-2020","volume":"76","author":"Kang","year":"2025","journal-title":"Int J Food Sci Nutr"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1186\/s12933-023-01994-2","article-title":"Yearly attained adherence to Mediterranean diet and incidence of diabetes in a large randomized trial","volume":"22","author":"Mart\u00ednez-Gonz\u00e1lez","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.3390\/nu10081067","article-title":"Impact of a Mediterranean dietary pattern and its components on cardiovascular risk factors, glucose control, and body weight in people with type 2 diabetes: a real-life study","volume":"10","author":"Vitale","year":"2018","journal-title":"Nutrients"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/s40795-024-00836-y","article-title":"The effects of Mediterranean diet on cardiovascular risk factors, glycemic control and weight loss in patients with type 2 diabetes: a meta-analysis","volume":"10","author":"Zheng","year":"2024","journal-title":"BMC Nutr"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e14768","DOI":"10.1111\/dme.14768","article-title":"Mediterranean diet and diabetes risk in a cohort study of individuals with prediabetes: propensity score analyses","volume":"39","author":"Cea-Soriano","year":"2022","journal-title":"Diabet Med"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1093\/advances\/nmac046","article-title":"Association between adherence to the Mediterranean diet and risk of type 2 diabetes: an updated systematic review and dose-response meta-analysis of prospective cohort studies","volume":"13","author":"Sarsangi","year":"2022","journal-title":"Adv Nutr"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1080\/27697061.2023.2272257","article-title":"The relationship of food literacy and sustainable consumption behaviors with anthropometric measurements during the Covid-19 pandemic period: a sample from Turkey","volume":"43","author":"\u00c7elik","year":"2024","journal-title":"J Am Nutr Assoc."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"2109","DOI":"10.1186\/s12889-025-23353-4","article-title":"Digital healthy eating literacy: its role in sustainable food choices and Mediterranean diet adherence","volume":"25","author":"Aslan Gonul","year":"2025","journal-title":"BMC Public Health"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.3390\/nu14071507","article-title":"Development of a food literacy assessment tool for healthy, joyful, and sustainable diet in South Korea","volume":"14","author":"Yoo","year":"2022","journal-title":"Nutrients"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"70","DOI":"10.25048\/tudod.1639291","article-title":"Effect of perceived food literacy on eating behavior pattern, glycemic parameters, and lipid profile in patients with type 2 diabetes: structural equation modeling","volume":"9","author":"\u00c7etinkaya \u00d6zdemir","year":"2025","journal-title":"Turk J Diab Obes"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"105429","DOI":"10.1016\/j.foodqual.2025.105429","article-title":"Exploring the intersection of food literacy and consumer research: a review, conceptualisation, and agenda for sustainability-focused research","volume":"126","author":"McManus","year":"2025","journal-title":"Food Qual Prefer"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"795","DOI":"10.3390\/jpm11080795","article-title":"Educational interventions for promoting food literacy and patient engagement in preventing complications of type 2 diabetes: a systematic review","volume":"11","author":"Savarese","year":"2021","journal-title":"J Pers Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1146\/annurev-nutr-080508-141200","article-title":"Management of the metabolic syndrome and type 2 diabetes through lifestyle modification","volume":"29","author":"Magkos","year":"2009","journal-title":"Annu Rev Nutr"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1093\/advances\/nmaa167","article-title":"Use of the healthy eating index in intervention studies for Cardiometabolic risk conditions: a systematic review","volume":"12","author":"Brauer","year":"2021","journal-title":"Adv Nutr"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s12902-023-01270-0","article-title":"The association between healthy lifestyle score and risk of metabolic syndrome in Iranian adults: a cross-sectional study","volume":"23","author":"Vajdi","year":"2023","journal-title":"BMC Endocr Disord"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1017\/S0007114525000376","article-title":"Cross-sectional associations between healthy and unhealthy plant-based diets and metabolic syndrome in three distinct French populations: a meta-analysis","volume":"133","author":"Prioux","year":"2025","journal-title":"Br J Nutr"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"862","DOI":"10.3390\/nu17050862","article-title":"The role of the planetary diet in managing metabolic syndrome and cardiovascular disease: a narrative review","volume":"17","author":"Muszalska","year":"2025","journal-title":"Nutrients"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"107468","DOI":"10.1016\/j.cdnut.2025.107468","article-title":"Adherence to the EAT-lancet planetary health diet and cardiometabolic risk markers in the mediators of atherosclerosis in south Asians living in America (MASALA) study","volume":"9","author":"Nair","year":"2025","journal-title":"Curr Dev Nutr"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1038\/s41430-022-01246-8","article-title":"EAT-lancet healthy reference diet score and diabetes incidence in a cohort of Mexican women","volume":"77","author":"L\u00f3pez","year":"2023","journal-title":"Eur J Clin Nutr"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"784018","DOI":"10.3389\/fnut.2021.784018","article-title":"Association between the EAT-lancet diet pattern and risk of type 2 diabetes: a prospective cohort study","volume":"8","author":"Xu","year":"2022","journal-title":"Front Nutr"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"3407","DOI":"10.1016\/j.tjnut.2024.06.018","article-title":"The EAT-lancet diet index is associated with lower obesity and incidence of type 2 diabetes in the multiethnic cohort","volume":"154","author":"Klapp","year":"2024","journal-title":"J Nutr"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1693180\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T05:30:05Z","timestamp":1759469405000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1693180\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,3]]},"references-count":53,"alternative-id":["10.3389\/fmed.2025.1693180"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1693180","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,3]]},"article-number":"1693180"}}