Culturally adapting the Mediterranean Diet pattern - a way of promoting more "sustainable" dietary change?

Average diet quality is low in the UK and is socioeconomically patterned, contributing to risk of non-communicable disease and poor health. Achieving meaningful dietary change in the long-term is challenging, with intervention required on a number of difference levels which reflect the multiple determinants of dietary choice. Dietary patterns have been identified which contribute positively to health outcomes; one of these is the Mediterranean Diet which has been demonstrated to be associated within reduced non-communicable disease risk. Most research exploring the health benefits of the Mediterranean Diet has been conducted in Mediterranean regions but, increasingly, research is also being conducted in non-Mediterranean regions. The MD is a dietary pattern that could have positive impacts on both health and environmental outcomes, while being palatable, appetising and acceptable. In this review, we consider the studies that have explored transferability of the Mediterranean Diet. To achieve long-term dietary change towards a Mediterranean Diet it is likely that the dietary pattern will have to be culturally adapted, yet preserving the core health-promoting elements and nutritional composition, while considering the food system transition required to support changes at population-level. Population-specific barriers need to be identified and ways sought of overcoming these barriers, for example, key food availability and cost. This should follow a formal cultural adaptation framework. Such an approach is likely to enhance the extent of adherence in the longer-term, thus having an impact on population health.