{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T11:37:31Z","timestamp":1777894651346,"version":"3.51.4"},"reference-count":60,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T00:00:00Z","timestamp":1760227200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["CIBEROBN CB12\/03\/30038"],"award-info":[{"award-number":["CIBEROBN CB12\/03\/30038"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Fundaci\u00f3 La Marat\u00f3 TV3","award":["201630.10"],"award-info":[{"award-number":["201630.10"]}]},{"name":"IDISBA Grants"},{"DOI":"10.13039\/501100004837","name":"Red EXERNET-Red de Ejercicio F\u00edsico y Salud","doi-asserted-by":"publisher","award":["RED2022-134800-T"],"award-info":[{"award-number":["RED2022-134800-T"]}],"id":[{"id":"10.13039\/501100004837","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011033","name":"Agencia Estatal de Investigaci\u00f3n","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100011033","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) and climate change are major global health challenges. Aim: Our aim was to assess the relationship between intrahepatic fat content (IFC) and diet-related environmental impact in a Mediterranean diet (MD)-based intervention. Design: The design included a six-month longitudinal analysis within the frame of a FLIPAN randomized controlled trial, including 60 participants aged 40\u201360 years with MASLD, metabolic syndrome and obesity. Methods: IFC expressed as a percentage (%IFC) was measured by magnetic resonance imaging, and dietary intake was assessed via a validated food frequency questionnaire (FFQ). Environmental impacts of diets were estimated using life cycle assessment data from the Agribalyse\u00ae database, focusing on greenhouse gas (GHG) emissions, water use, energy use and land use. A composite sustainability score was also calculated. Changes in liver fat and environmental footprints were analyzed using a general linear model (GLM) adjusted for within-subject variability and partial correlation analysis adjusted for energy intake, MD adherence and body weight. Results: The participants with the highest %IFC reduction group in the GLM showed the highest decreases in GHG emissions and land use. Water use increased in this same group. Energy use and the composite sustainability score did not differ significantly between groups. Higher %IFC reductions were also associated with higher MD adherence and lower visceral fat. When the adjusted partial correlation analysis for the environmental parameters was performed, only water use remained significant. Conclusions: Higher reductions in %IFC were linked to dietary patterns with lower GHG emissions and land use and higher water use. However, when adjusted by energy intake, MD adherence and body weight in continuous modeling, only higher water use was related to lower %IFC. These findings highlight the complexity of achieving environmentally sustainable and health-promoting diets.<\/jats:p>","DOI":"10.3390\/nu17203206","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T07:51:28Z","timestamp":1760428288000},"page":"3206","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Metabolic Dysfunction-Associated Steatotic Liver Disease Is Linked to Environmental Sustainability: The Role of the Mediterranean Diet"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3534-1588","authenticated-orcid":false,"given":"Silvia","family":"Garc\u00eda","sequence":"first","affiliation":[{"name":"Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"},{"name":"CIBEROBN (Physiopathology of Obesity and Nutrition CB12\/03\/30038), Institute of Health Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1407-8461","authenticated-orcid":false,"given":"Cristina","family":"Bouzas","sequence":"additional","affiliation":[{"name":"Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"},{"name":"CIBEROBN (Physiopathology of Obesity and Nutrition CB12\/03\/30038), Institute of Health Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0954-039X","authenticated-orcid":false,"given":"Marina","family":"R\u00f3denas-Munar","sequence":"additional","affiliation":[{"name":"Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"},{"name":"CIBEROBN (Physiopathology of Obesity and Nutrition CB12\/03\/30038), Institute of Health Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Violeta","family":"Cepeda","sequence":"additional","affiliation":[{"name":"Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luc\u00eda","family":"Ugarriza","sequence":"additional","affiliation":[{"name":"Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"},{"name":"CIBEROBN (Physiopathology of Obesity and Nutrition CB12\/03\/30038), Institute of Health Carlos III, 28029 Madrid, Spain"},{"name":"Primary Health Care Center Camp Red\u00f3, IBSalut, 07010 Palma de Mallorca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel","family":"Casares","sequence":"additional","affiliation":[{"name":"Radiodiagnosis Service, Red Asistencial Juaneda, 07011 Palma de Mallorca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9776-4730","authenticated-orcid":false,"given":"Cristina","family":"G\u00f3mez","sequence":"additional","affiliation":[{"name":"Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"},{"name":"Clinical Analysis Service, University Hospital Son Espases, 07120 Palma de Mallorca, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Mateos","sequence":"additional","affiliation":[{"name":"Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"},{"name":"CIBEROBN (Physiopathology of Obesity and Nutrition CB12\/03\/30038), Institute of Health Carlos III, 28029 Madrid, Spain"},{"name":"Hospital of Manacor, 07500 Manacor, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6940-0761","authenticated-orcid":false,"given":"Josep A.","family":"Tur","sequence":"additional","affiliation":[{"name":"Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, 07122 Palma de Mallorca, Spain"},{"name":"Health Research Institute of Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain"},{"name":"CIBEROBN (Physiopathology of Obesity and Nutrition CB12\/03\/30038), Institute of Health Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/nrgastro.2017.109","article-title":"Global burden of NAFLD and NASH: Trends, predictions, risk factors and prevention","volume":"15","author":"Younossi","year":"2018","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Habibullah, M., Jemmieh, K., Ouda, A., Haider, M.Z., Malki, M.I., and Elzouki, A.N. (2024). Metabolic-associated fatty liver disease: A selective review of pathogenesis, diagnostic approaches, and therapeutic strategies. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1291501"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e0754","DOI":"10.1097\/HC9.0000000000000754","article-title":"Diet composition impacts the natural history of steatotic liver disease","volume":"9","author":"Callans","year":"2025","journal-title":"Hepatol. Commun."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Montemayor, S., Mascar\u00f3, C.M., Ugarriza, L., Casares, M., Llompart, I., Abete, I., Zulet, M.\u00c1., Mart\u00ednez, J.A., Tur, J.A., and Bouzas, C. (2022). Adherence to Mediterranean Diet and NAFLD in Patients with Metabolic Syndrome: The FLIPAN Study. Nutrients, 14.","DOI":"10.3390\/nu14153186"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Montemayor, S., Bouzas, C., Mascar\u00f3, C.M., Casares, M., Llompart, I., Abete, I., Angullo-Martinez, E., Zulet, M.\u00c1., Mart\u00ednez, J.A., and Tur, J.A. (2022). Effect of Dietary and Lifestyle Interventions on the Amelioration of NAFLD in Patients with Metabolic Syndrome: The FLIPAN Study. Nutrients, 14.","DOI":"10.3390\/nu14112223"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1053\/j.gastro.2019.11.312","article-title":"MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease","volume":"158","author":"Eslam","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"164417","DOI":"10.1016\/j.scitotenv.2023.164417","article-title":"Ultra-processed foods consumption as a promoting factor of greenhouse gas emissions, water, energy, and land use: A longitudinal assessment","volume":"891","author":"Pastor","year":"2023","journal-title":"Sci. Total Environ."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2050","DOI":"10.1017\/S1368980017000763","article-title":"Are more environmentally sustainable diets with less meat and dairy nutritionally adequate?","volume":"20","author":"Seves","year":"2017","journal-title":"Public Health Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S380","DOI":"10.1093\/advances\/nmz019","article-title":"Vegetarian Diets: Planetary Health and Its Alignment with Human Health","volume":"10","year":"2019","journal-title":"Adv. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12940-022-00956-7","article-title":"Carbon dioxide (CO2) emissions and adherence to Mediterranean diet in an adult population: The Mediterranean diet index as a pollution level index","volume":"22","author":"Bouzas","year":"2023","journal-title":"Environ. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.jhep.2021.10.016","article-title":"Exposure to air pollution is associated with an increased risk of metabolic dysfunction-associated fatty liver disease","volume":"76","author":"Guo","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Dolce, A., and Della Torre, S. (2023). Sex, Nutrition, and NAFLD: Relevance of Environmental Pollution. Nutrients, 15.","DOI":"10.3390\/nu15102335"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/j.jhep.2024.09.033","article-title":"Association of metabolic signatures of air pollution with MASLD: Observational and Mendelian randomization study","volume":"82","author":"Ran","year":"2025","journal-title":"J. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s12992-023-00948-3","article-title":"Metabolic syndrome criteria and severity and carbon dioxide (CO2) emissions in an adult population","volume":"19","author":"Pastor","year":"2023","journal-title":"Global. Health"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Grosso, G., Fres\u00e1n, U., Bes-Rastrollo, M., Marventano, S., and Galvano, F. (2020). Environmental Impact of Dietary Choices: Role of the Mediterranean and Other Dietary Patterns in an Italian Cohort. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17051468"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1017\/S1368980017003986","article-title":"The Mediterranean diet, an environmentally friendly option: Evidence from the Seguimiento Universidad de Navarra (SUN) cohort","volume":"21","year":"2018","journal-title":"Public Health Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"100322","DOI":"10.1016\/j.advnut.2024.100322","article-title":"Environmental and Health Sustainability of the Mediterranean Diet: A Systematic Review","volume":"15","year":"2024","journal-title":"Adv. Nutr."},{"key":"ref_18","unstructured":"(2025, September 22). \u00bfQu\u00e9 es la dieta Mediterr\u00e1nea?\u2014Fundaci\u00f3n Dieta Mediterr\u00e1nea. Barcelona. Available online: https:\/\/dietamediterranea.com\/nutricion-saludable-ejercicio-fisico\/."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Quetglas-Llabr\u00e9s, M.M., Monserrat-Mesquida, M., Bouzas, C., Garc\u00eda, S., Argelich, E., Casares, M., Ugarriza, L., Llompart, I., Tur, J.A., and Sureda, A. (2024). Impact of Adherence to the Mediterranean Diet on Antioxidant Status and Metabolic Parameters in NAFLD Patients: A 24-Month Lifestyle Intervention Study. Antioxidants, 13.","DOI":"10.3390\/antiox13040480"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"759","DOI":"10.3390\/antiox9080759","article-title":"Oxidative Stress and Pro-Inflammatory Status in Patients with Non-Alcoholic Fatty Liver Disease","volume":"9","author":"Abbate","year":"2020","journal-title":"Antioxidants"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Quetglas-Llabr\u00e9s, M.M., Monserrat-Mesquida, M., Bouzas, C., Garc\u00eda, S., Mateos, D., Casares, M., Ugarriza, L., Llompart, I., Tur, J.A., and Sureda, A. (2024). Effects of a Two-Year Lifestyle Intervention on Intrahepatic Fat Reduction and Renal Health: Mitigation of Inflammation and Oxidative Stress, a Randomized Trial. Antioxidants, 13.","DOI":"10.3390\/antiox13070754"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Quetglas-Llabr\u00e9s, M.M., Monserrat-Mesquida, M., Bouzas, C., G\u00f3mez, C., Mateos, D., Ripoll-Vera, T., Tur, J.A., and Sureda, A. (2022). Inflammatory and Oxidative Stress Markers Related to Adherence to the Mediterranean Diet in Patients with Metabolic Syndrome. Antioxidants, 11.","DOI":"10.3390\/antiox11050901"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/1476-069X-12-118","article-title":"Environmental footprints of Mediterranean versus Western dietary patterns: Beyond the health benefits of the Mediterranean diet","volume":"12","author":"Obrador","year":"2013","journal-title":"Environ. Health"},{"key":"ref_24","unstructured":"(2025, September 22). NCT04442620. Prevention and Reversion of NAFLD in Obese Patients with Metabolic Syndrome by Mediterranean Diet and Physical Activity (FLIPAN) ClinicalTrials.gov, Available online: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04442620."},{"key":"ref_25","unstructured":"The International Diabetic Federation (IDF) (2025, September 22). The IDF Consensus Worldwide Definition of Definition of the Metabolic Syndrome. Available online: https:\/\/idf.org\/media\/uploads\/2023\/05\/attachments-30.pdf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1002\/hep.20701","article-title":"Design and validation of a histological scoring system for nonalcoholic fatty liver disease","volume":"41","author":"Kleiner","year":"2005","journal-title":"Hepatology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1093\/ije\/22.3.512","article-title":"Development and validation of a food frequency questionnaire in Spain","volume":"22","author":"Boyle","year":"1993","journal-title":"Int. J. Epidemiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1017\/S0007114509993837","article-title":"Relative validity of a semi-quantitative food-frequency questionnaire in an elderly Mediterranean population of Spain","volume":"103","author":"Zazpe","year":"2010","journal-title":"Br. J. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1017\/S1368980009993065","article-title":"Reproducibility of an FFQ validated in Spain","volume":"13","author":"Ruiz","year":"2010","journal-title":"Public Health Nutr."},{"key":"ref_30","unstructured":"Moreiras, O., Carbajal, A., Cabrera, L., and Cuadrado, C. (2015). Tablas de Composici\u00f3n de Alimentos, Gu\u00eda de Pr\u00e1cticas (Spanish Food Composition Tables), Piramide Ediciones Sa. [17th ed.]."},{"key":"ref_31","unstructured":"Mataix, J., Manas, M., Llopis, J., Martinez de Victoria, E., Juan, J., and Borregon, A. (2013). Tablas de Composici\u00f3n de Alimentos (Spanish Food Composition Tables), Universidad de Granada. [5th ed.]."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.3945\/jn.110.135566","article-title":"A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women","volume":"141","author":"Estruch","year":"2011","journal-title":"J. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4971","DOI":"10.1016\/j.clnu.2021.06.030","article-title":"Validity of the energy-restricted Mediterranean Diet Adherence Screener","volume":"40","author":"Corella","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_34","unstructured":"(2006). Environmental Management\u2014Life Cycle Assessment\u2014Principles and Framework (Standard No. ISO 14040:2006)."},{"key":"ref_35","unstructured":"(2006). Environmental Management\u2014Life Cycle Assessment\u2014Requirements and Guidelines (Standard No. ISO 14044:2006)."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Garc\u00eda, S., Monserrat-Mesquida, M., Argelich, E., Ugarriza, L., Salas-Salvad\u00f3, J., Bautista, I., Vioque, J., Zome\u00f1o, M.D., Corella, D., and Pint\u00f3, X. (2024). Association between Beverage Consumption and Environmental Sustainability in an Adult Population with Metabolic Syndrome. Nutrients, 16.","DOI":"10.32920\/26520559.v1"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1111\/gcbb.12294","article-title":"Environmental costs and benefits of growing Miscanthus for bioenergy in the UK","volume":"9","author":"McCalmont","year":"2017","journal-title":"Glob. Change Biol. Bioenergy"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"6117","DOI":"10.1021\/es200130u","article-title":"Environmental impacts of cultured meat production","volume":"45","author":"Tuomisto","year":"2011","journal-title":"Environ. Sci. Technol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Aleksandrowicz, L., Green, R., Joy, E.J., Smith, P., and Haines, A. (2016). The Impacts of Dietary Change on Greenhouse Gas Emissions, Land Use, Water Use, and Health: A Systematic Review. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0165797"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jclepro.2014.12.008","article-title":"Environmental impact of dietary change: A systematic review","volume":"91","year":"2015","journal-title":"J. Clean. Prod."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"23357","DOI":"10.1073\/pnas.1906908116","article-title":"Multiple health and environmental impacts of foods","volume":"116","author":"Clark","year":"2019","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_42","unstructured":"The National Aeronautics and Space Administration (NASA) (2025, June 22). \u00bfQu\u00e9 es el efecto invernadero?, Available online: https:\/\/climate.nasa.gov\/faq\/70\/que-es-el-efecto-invernadero\/."},{"key":"ref_43","unstructured":"United Nations (UN) (2018). OMM: Los Niveles de Gases de Efecto Invernadero en la Atm\u00f3sfera Alcanzan un Nuevo R\u00e9cord, UN. Available online: https:\/\/unfccc.int\/es\/news\/omm-los-niveles-de-gases-de-efecto-invernadero-en-la-atmosfera-alcanzan-un-nuevo-record."},{"key":"ref_44","unstructured":"(2025, September 22). Ministerio para la Transici\u00f3n Ecol\u00f3gica y el Reto Demogr\u00e1fico. Objetivos de Reducci\u00f3n de Emisiones de Gases de Efecto Invernadero. Madrid. Available online: https:\/\/www.miteco.gob.es\/es\/cambio-climatico\/temas\/mitigacion-politicas-y-medidas\/objetivos.html."},{"key":"ref_45","doi-asserted-by":"crossref","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":"ref_46","doi-asserted-by":"crossref","unstructured":"Garc\u00eda, S., Monserrat-Mesquida, M., Mas-Fontao, S., Cuadrado-Soto, E., Ortiz-Ramos, M., Mat\u00eda-Mart\u00edn, P., Daimiel, L., V\u00e1zquez, C., Tur, J.A., and Bouzas, C. (2025). Body composition and CO2 dietary emissions. Front. Pub. Health, 12.","DOI":"10.3389\/fpubh.2024.1432109"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1007\/s00394-024-03396-w","article-title":"Environmental impact of the diet of young Portuguese and its relationship with adherence to the Mediterranean Diet","volume":"63","author":"Carvalho","year":"2024","journal-title":"Eur. J. Nutr."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1186\/s12937-024-01050-z","article-title":"Greater adherence to the Mediterranean diet pattern in the United States is associated with sustainability trade-offs","volume":"23","author":"Conrad","year":"2024","journal-title":"Nutr. J."},{"key":"ref_49","first-page":"178924","article-title":"Health and environmental dietary impact: Planetary health diet vs. Mediterranean diet","volume":"968","author":"Kales","year":"2025","journal-title":"Nationwide Cohort Spain. Sci. Total Environ."},{"key":"ref_50","unstructured":"Water Footprint Calculator (2025, September 22). Food\u2019s Big Water Footprint. EcoRise. Available online: https:\/\/watercalculator.org\/footprint\/foods-big-water-footprint\/."},{"key":"ref_51","unstructured":"World Economic Forum (WEF) (2025, September 22). Which Foods Need the Most Water to Produce?. Available online: https:\/\/www.weforum.org\/stories\/2021\/06\/water-footprint-food-sustainability\/."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.spc.2024.06.028","article-title":"The effect of dietary changes on the water and carbon footprints in China","volume":"49","author":"Wang","year":"2024","journal-title":"Sustain. Prod. Consum."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"100357","DOI":"10.1016\/j.gfs.2020.100357","article-title":"Treenuts and groundnuts in the EAT-Lancet reference diet: Concerns regarding sustainable water use","volume":"24","author":"Vanham","year":"2020","journal-title":"Glob. Food Sec."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Intergovernmental Panel on Climate Change (IPCC) (2022). Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change, IPCC. Available online: https:\/\/www.ipcc.ch\/report\/ar6\/wg2\/downloads\/report\/IPCC_AR6_WGII_FullReport.pdf.","DOI":"10.1017\/9781009325844"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.jhep.2019.04.013","article-title":"The beneficial effects of Mediterranean diet over low-fat diet may be mediated by decreasing hepatic fat content","volume":"71","author":"Gepner","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1111\/nbu.12707","article-title":"Mediterranean diet for the management of metabolic dysfunction-associated steatotic liver disease in non-Mediterranean, Western countries: What\u2019s known and what\u2019s needed?","volume":"49","author":"Sualeheen","year":"2024","journal-title":"Nutr. Bull."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Zelicha, H., Kloting, N., Kaplan, A., Yaskolka Meir, A., Rinott, E., Tsaban, G., Chassidim, Y., Bluher, M., Ceglarek, U., and Isermann, B. (2022). The effect of high-polyphenol Mediterranean diet on visceral adiposity: The DIRECT PLUS randomized controlled trial. BMC Med., 20.","DOI":"10.1186\/s12916-022-02525-8"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez N\u00fa\u00f1ez, S., Rub\u00edn-Garc\u00eda, M., Mart\u00edn-S\u00e1nchez, V., \u00c1lvarez-\u00c1lvarez, L., and Molina, A.J. (2025). Mediterranean Diet, Obesity-Related Metabolic Cardiovascular Disorders, and Environmental Sustainability: A Systematic Review. Nutrients, 17.","DOI":"10.3390\/nu17122005"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Serra-Majem, L., Tomaino, L., Dernini, S., Berry, E.M., Lairon, D., de la Cruz, J.N., Bach-Faig, A., Donini, L.M., Medina, F.X., and Belahsen, R. (2020). Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17238758"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1017\/S0029665112002893","article-title":"Is a healthy diet an environmentally sustainable diet?","volume":"72","author":"Macdiarmid","year":"2013","journal-title":"Proc. Nutr. Soc."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/20\/3206\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T04:33:08Z","timestamp":1760502788000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/20\/3206"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,12]]},"references-count":60,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["nu17203206"],"URL":"https:\/\/doi.org\/10.3390\/nu17203206","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,12]]}}}