Journal of Food and Nutrition Research
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Journal of Food and Nutrition Research. 2016, 4(4), 258-266
DOI: 10.12691/jfnr-4-4-10
Open AccessReview Article

Erosion of the Mediterranean Diet in Apulia Region, South-eastern Italy: Exploring Socio-cultural and Economic Dynamics

Francesco Bottalico1, 2, , Xavier Medina3, Roberto Capone1, Hamid El Bilali1 and Philipp Debs1

1Sustainable Agriculture, Food and Rural Development department, International Centre for Advanced Mediterranean Agronomic Studies of Bari (CIHEAM-Bari), Valenzano (Bari), Italy

2Department of Science and Technology, Parthenope University of Naples, Naples, Italy

3Department of Food Systems, Culture and Society, Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain

Pub. Date: May 30, 2016

Cite this paper:
Francesco Bottalico, Xavier Medina, Roberto Capone, Hamid El Bilali and Philipp Debs. Erosion of the Mediterranean Diet in Apulia Region, South-eastern Italy: Exploring Socio-cultural and Economic Dynamics. Journal of Food and Nutrition Research. 2016; 4(4):258-266. doi: 10.12691/jfnr-4-4-10


Global food systems are changing rapidly with profound implications for culinary systems and diets. In this scenario, the Mediterranean diet (MD), a lifestyle recognized by UNESCO in 2010 as intangible cultural heritage of humanity, is no exception. The MD is a dynamic heritage of millennia of exchanges in the Mediterranean basin, but currently is progressively being rapidly transformed. The aim of this review paper is to contribute to a deeper understanding of the main factors, especially socio-cultural and economic ones, that have determined the rapid transformation and, consequently, the erosion of the traditional idea of the MD and the major concerns arising from decline of the adherence to this dietary pattern in Apulia region (south-eastern Italy). Different socio-cultural and economic factors such as income increase, changes in intergenerational and gender (role of women in society) relationships, different organization of working time, urbanization and globalization have had important effects on Mediterranean lifestyles thus leading to a decrease in adherence to the Mediterranean local dietary pattern. With rising incomes and urbanization, food habits with pronounced cultural differences specific to the Mediterranean region are being more westernised with increasing animal products consumption. The increased consumption of energy-dense and high-calorie products leads to an increase of obesity and diet-related diseases incidence. In fact, data of the Italian National Institute of Statistics (Istat) show a progressive increase in overweight and obesity prevalence in the adult population of Apulia; approximately 39% and 13% of adult population is overweight and obese, respectively. These data are moderately higher than the Italian average. Despite its increasing popularity worldwide, adherence to the MD model is decreasing in Apulia region under various influences. These influences seriously threaten the preservation of the local MD heritage and its transmission to future generations. Therefore, today’s main challenge is to counter these influences and reverse the trends in the MD by implementing appropriate policies supported by research activities and bottom-up and multi-stakeholder initiatives.

Mediterranean diet Apulia region Italy diet erosion food system

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[1]  Kearney J., “Food consumption trends and drivers”. Phil. Trans. R. Soc, 365: 2793-2807, 2010.
[2]  Reisch L., Eberle U., Lorek S., “Sustainable food consumption: an overview of contemporary issues and policies”. Sust Sci Pract & Policy; 9(2); 7-25, 2013.
[3]  Guyomard H., Darcy-Vrillon B., Esnouf C., Marin M., Momot A., Russel M., Guillou M., Eating patterns and food systems: critical knowledge requirements for policy design and implementation. INRA, 2011. Document prepared for the Commission on Sustainable Agriculture and Climate Change. Available: _systems.pdf.
[4]  Buttriss J. and Riley H., “Sustainable diets: Harnessing the nutrition agenda”. Food Chemistry; 140: 402-407, 2013.
[5]  Clonan A. and Holdsworth M., “The challenge of eating a healthy and sustainable diet”. Am J Clin Nutr; 96/3:459-460, 2012.
[6]  Berry EM., Dernini S., Burlingame B., Meybeck A., Conforti P., “Food security and sustainability: can one exist without the other?” Public Health Nutrition, 18(13):2293-302, 2015.
[7]  HLPE, Food losses and waste in the context of sustainable food systems. A report by the High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security, Rome, 2014.
[8]  FAO, The State of Food and Agriculture. Food systems for better nutrition. FAO, Rome, 2013.
[9]  FAO, Food Security and Nutrition in the Southern and Eastern Rim of the Mediterranean Basin. FAO, Cairo, 2013.
[10]  Garnett T., “Food sustainability: problems, perspectives and solutions”. Proceedings of the Nutrition Society; 72:29-39, 2013.
[11]  FAO, Greening the economy with agriculture. Working paper 4: utilization. Improving food systems for sustainable diets in a green economy. FAO, Rome, 2012. Available:
[12]  FAO (2012b). Towards the future we want. End hunger and make the transition to sustainable agricultural and food systems. FAO, Rome, 2012. Available:
[13]  CIHEAM, 10th meeting of the Ministers of Agriculture of CIHEAM’s Member Countries: Final declaration. February 6, 2014, Algiers (Algeria). Available:
[14]  Marlow JH., Hayes WK., Soret S., Carter R., Schwab E., Sabate J., “Diet and the environment: does what you eat matter?” Am J Clin Nutr; 89(suppl): 1699s-703, 2009.
[15]  Macdiarmid JI., Kyle J., Horgan GW., Loe J., Fyfe C., Johnstone A., McNeil G., “Sustainable diets for the future: can we contribute to reducing greenhouse gas emissions by eating a healthy diet?” Am J ClinNutr; 96(3):632-9, 2012.
[16]  Dernini S., “The erosion and the Renaissance of the Mediterranean Diet: A sustainable cultural resource”. Quaderns de la Mediterrània; 16:75-82, 2011.
[17]  Medina F.X., “Food consumption and civil society: Mediterranean diet as a sustainable resource for the Mediterranean area”. Public Health Nutr; 14(12A): 2346-2349, 2011.
[18]  Medina F.X., Assessing sustainable diets in the context of sustainable food systems – socio-cultural dimensions. In, Assessing diets within the sustainability of food systems, Proceedings of an international FAO/CRA/FQH workshop. A. Meybeck, S. Redfern, F. Paoletti, C. Strassner, eds. FAO, Rome, 2015. 163-166.
[19]  Lacirignola C., Dernini S., Capone R., Meybeck A., Burlingame B., Gitz V., El Bilali H., Debs Ph., Belsanti V., Towards the development of guidelines for improving the sustainability of diets and food consumption patterns: the Mediterranean Diet as a pilot study. CIHEAM/FAO – Options Méditerranéennes, Series B: Studies and Research, N° 70; Bari, 2012. 67 p. Available: (en).pdf.
[20]  Bach-Faig A., Berry E.M., Lairon D., Reguant J., Trichopoulou A., Dernini S., Medina F.X., Battino M., Miranda G., Serra-Majem L., “Mediterranean Diet Pyramid Today”. Science and Cultural Updates. Public Health Nutrition; 14(12A): 2274-2284, 2011.
[21]  Nestle M., “Mediterranean diets: historical and research overview”. American Journal Clinical Nutrition; 61(suppl.):1313S-20S, 1995
[22]  Maillot M., Issa C., Vieux F., Lairon D., Darmon N., “The shortest way to reach nutritional goals is to adopt Mediterranean food choices. Evidence from computer-generated personalized diets”. Am J Clin Nutr; 94(4):1127-37, 2011.
[23]  Trichopoulou A., Bamia C., Trichopoulos D., “Mediterranean diet and survival among patients with coronary heart disease in Greece”. Arch Intern Med; 25; 165(8):929-35, 2005.
[24]  Trichopoulou A., Bamia C., Trichopoulos D., “Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study”. BMJ; 338: 2337, 2009.
[25]  Estruch R., Ros E., Salas-Salvadó J., Covas M.-I., Corella D., Arós F., Gómez-Gracia E., Ruiz-Gutiérrez V., Fiol M., Lapetra J., Lamuela-Raventos R. M., Serra-Majem Ll., Pintó X., Basora J., Angel Muñoz M., Sorlí J. V., Alfredo Martínez J., and Martínez-González M. A., “Primary Prevention of Cardiovascular Disease with a Mediterranean Diet”. N Engl J Med, 368/14:1279-1290, 2103.
[26]  Salas-Salvadó J., Bulló., M., Babio N., Martínez-González MÁ., Ibarrola-Jurado N., Basora J., Estruch R., Covas MI., Corella D., Arós F., Ruiz-Gutiérrez V., Ros E., PREDIMED Study Investigators., “Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial”. Diabetes Care; 34: 14-19, 2011.
[27]  Mendez MA., Popkin BM., Jakszyn P., Berenguer A., Tormo MJ., Sanchez MJ., Quiros JR., Pera G., Navarro C., Martinez C., Larranaga N., Dorronsoro M., Chirlaque MD., Barricarte A., Ardanaz E., Amiano P., Agudo A., Gonzalez CA., “Adherence to a Mediterranean Diet is Associated with Reduced 3-year Incidence of Obesity”. Journal of Nutrition; 136:2934-2938, 2006.
[28]  Panagiotakos DB., Chrysohoou C., Pitsavos C., Stefanadis C., “Association between the Prevalence of Obesity and Adherence to the Mediterranean Diet: the ATTICA Study”. Nutrition; 22:449-456, 2006.
[29]  Tortosa A., Bes-Rastrollo M., Sanchez-Villegas A., Basterra-Gortari F.J., Nunez-Cordoba J.M., Martinez-Gonzalez M.A. “Mediterranean diet inversely associated with the incidence of metabolic syndrome: the SUN prospective cohort”. Diabetes Care; 30(11):2957-2959, 2007.
[30]  La Vecchia C, “Mediterranean diet and cancer”. Public Health Nutr, 7(7):965-968, 2004
[31]  Vernele L., Bach-Faig A., Buckland G. and Serra-Majem L., “Association between the Mediterranean diet and cancer risk: a review of observational studies”. Nutr Cancer, 62(7): 860-870, 2010.
[32]  Tukker A., Goldbohm R.A., De Koning A., Verheijden M., Kleijn R., Wolf O., Pérez-Domínguez I., Rueda-Cantuche JM., “Environmental impacts of changes to healthier diets in Europe”. Ecological Economics; 70: 1776-1788, 2011.
[33]  Capone R., Lamaddalena N., Lamberti L., Elferchichi A., El Bilali H., “Food consumption patterns and sustainable natural resources management in the Mediterranean region”. Journal of Food Science and Engineering; 2(8): 437-451, 2012.
[34]  Capone R., Iannetta M., El Bilali H., Colonna N., Debs P., Dernini S., Maiani G., Intorre F., Polito A., Turrini A., Cardone G., Lorusso F., Belsanti V., “A preliminary assessment of the environmental sustainability of the current Italian dietary pattern: water footprint related to food consumption”. Journal of Food and Nutrition Research, 1/4, 59-67, 2013. Available online at:
[35]  Capone R., Debs P., El Bilali H., Cardone G., Lamaddalena N., “Water Footprint in the Mediterranean food chain: implications of food consumption patterns and food wastage”. International Journal of Nutrition and Food Sciences; 3(2): 26-36, 2014.
[36]  Capone R., El Bilali H., Debs P., Cardone G., Driouech N., “Food system sustainability and food security: connecting the dots”. Journal of Food Security; 2(1): 13-22, 2014a.
[37]  Gerbens-Leenes W. and Nonhebel S., “Food and land use. The influence of consumption patterns on the use of agricultural resources”. Appetite; 45:24-31, 2005.
[38]  Lundqvist J., de Fraiture C. and Molden D., Saving Water: From Field to Fork – Curbing Losses and Wastage in the Food Chain. SIWI Policy Brief, Stockholm International Water Institute (SIWI), Stockholm, 2008.
[39]  Tukker A., Bausch-Goldbohm S., Verheijden M., de Koning A., Kleijn R., Wolf O., Pérez Domínguez I., Environmental impacts of diet changes in the EU. Technical Report, European Commission (EC), Joint Research Centre (DG JRC). Institute for Prospective Technological Studies, 2009. Available:
[40]  Belahsen R., “Cultural diversity of sustainable diets. Nutrition transition and food sustainability”. Proc Nutr Soc; 73: 385-388, 2014.
[41]  Padilla M., Ensuring Food Security and Food Safety. In CIHEAM (ed.), Mediterra 2008. The Future of Agriculture and Food in Mediterranean Countries, Paris, 2008, Presses de Sciences Po-CIHEAM. 228-245.
[42]  Gil M.J., “Mediterranean diet and health”. New Medit, 1/2009, 2-3, 2009.
[43]  Da Silva R., Bach-Faig A., Raido Quintana B., Buckland G., Vaz de Almeida MD., Serra-Majem L., “World variation of adherence to the Mediterranean diet, in 1961-1965 and 2000-2003”. Public Health Nutr; 12(9A):1676-84, 2009.
[44]  Ferro-Luzzi A., Branca F., “Mediterranean diet, Italian-style: prototype of a healthy diet”. Am J Clin Nutr 61(Suppl): 1338S-45S, 1995.
[45]  Alberti-Fidanza A., Fidanza F., Chiuchiu M., Verducci G., Fruttini D., “Dietary studies on two rural Italian population groups of the Seven Countries Study. 3. Trend of food and nutrient intake from 1960 to 1991”. Eur J Clin Nutr. 53:854-60, 1999.
[46]  Garcia-Closas R., Berenguer A., Gonzalez C., “Changes in food supply in Mediterranean countries from 1961 to 2001”. Public Health Nutr 9(1):53-60, 2006
[47]  UNEP/MAP, Mediterranean Strategy For Sustainable Development: A Framework for Environmental Sustainability and Shared Prosperity. Tenth Meeting of the Mediterranean Commission on Sustainable Development (MCSD), Athens, 2005.
[48]  Dernini S., Meybeck A., Burlingame B., Gitz V., Lacirignola C., Debs P., Capone R., El Bilali H., “Developing a methodological approach for assessing the sustainability of diets: The Mediterranean diet as a case study”. New Medit; 12(3): 28-36, 2013
[49]  Serra-Majem L., Ribas L., Ngo J., Aranceta J., Garaulet M., Carazo E., Mataix J., Pérez-Rodrigo C., Quemada M., Tojo R., et al. “Risk of inadequate intake of vitamins A, B1, B6, C, E, folate, iron and calcium in the Spanish population aged 4 to 18”. Int. J. Vitam. Nutr. Res. 2001; 71: 325-331.
[50]  Serra-Majem L., Ribas L., Pérez-Rodrigo C., García-Closas R., Peña-Quintana L., Aranceta J. “Factors associated to nutrient intake among children and adolescents: Results from the EnKid study”. Ann. Nutr. Metab. 2002; 46:31-38.
[51]  FAO and Bioversity, Sustainable Diets and Biodiversity. Directions and Solutions for Policy, Research and Action. Rome, 2012. Available:
[52]  Burlingame B., Dernini S., “Sustainable Diets: The Mediterranean Diet Exemple”. Public Health Nutrition; 14 (12A): 2285-2287, 2011.
[53]  FAO and CIHEAM, Towards the Development of Guidelines for Improving the Sustainability of Diets and Food Consumption Patterns in the Mediterranean Area. Discussion Paper. FAO, Rome, 2012. Available:
[54]  FAO and CIHEAM, Mediterranean food consumption patterns: diet, environment, society, economy and health. A White Paper of Priority 5. Expo Milan 2015 Feeding Knowledge Programme. CIHEAM-Bari/FAO, Rome 2015.
[55]  CIHEAM, Final declaration. 9th meeting of the Ministers of Food, Agriculture and Fisheries of the Member Countries of CIHEAM; International Centre for Advanced Mediterranean Agronomic Studies (CIHEAM), Valletta, 2012. Available:
[56]  Medina F.X., “Mediterranean diet, culture and heritage: challenges for a new conception”. Public Health Nutr; 12:1618-20, 2009.
[57]  Regione Puglia, Il contesto socioeconomico dell’agricoltura e dei territori rurali della Regione Puglia (The socio-economic context of agriculture and rural areas of Apulia region), Assessorato alle risorse agroalimentari, 2013.
[58]  Eurostat, Statistiscs explained, Employment rates for selected population groups, 2004-14 (%), Italy. Available:,_2004%E2%80%9314 _(%25)_YB16.png#file.
[59]  García Álvarez-Coque and López-García Usach, Mediterra 2012 Chapter 4 Mutations in mediterranean societies Senén Florensa and Xavier Aragall European Institute of the Mediterranean, Spain, 2009.
[60]  Piccinelli R., Arcella D., Buonocore P., D’Addezio L., Le Donne C., Mistura L., Sette S., Turrini A., Leclercq C., L’indagine nazionale sui consumi alimentari in Italia INRAN-SCAI 2005-06, (National survey on food consumption in Italy INRAN-SCAI 2005-06). Parte A: I metodi (Part A: Methods). Osservatorio Consumi Alimentari, INRAN. Rome, Jenuary 2010. Available: _rilevatori_22_1_10.pdf.
[61]  World Health Organization, Nutrition, Physical Activity and Obesity: Italy, WHO, 2013. Available:
[62]  OKkio alla Salute, Risultati dell’indagine 2008, 2010 e 2012 (Survey results in 2008, 2010 and 2012). Regione Puglia, Bari, 2012.
[63]  HBSC, Health Behavior in School-Aged Children. World Health Organization Collaborative Cross-National Survey, 2010.
[64]  Sistema sorveglianza PASSI (2009). Rapporto Regione Puglia e primo semestre 2009. (Regione Puglia Report and the first semester of 2009), Regione Puglia, 2009. ISBN 88-6020-026-6. Available:
[65]  Adinolfi F., Capone R., El Bilali H., “Assessing diets, food supply chains and food systems sustainability: towards a common understanding of economic sustainability”. In, Meybeck A., Redfern S., Paoletti F. and Strassner C. (eds); Proceedings of International Workshop “Assessing sustainable diets within the sustainability of food systems - Mediterranean diet, organic food: new challenges”; 15–16 September 2014, Rome. FAO, Rome. pp: 167-175. Available:
[66]  González Turmo I., The Mediterranean diet: consumption, cuisine and food habits. In Mediterra 2012: The Mediterranean diet for sustainable regional development. Paris: CIHEAM SciencesPo Les Presses. 115-32, 2012.
[67]  Lacirignola C. and Capone R., “Mediterranean Diet: territorial identity and food safety”. New Medit 4/2009, 2-3, 2009.
[68]  Padilla M., Capone R., Palma G., “Sustainability of the food chain from field to plate: case of the Mediterranean diet”. In Sustainable diets and biodiversity: United against hunger. FAO and Bioversity International, Rome; 230-241.
[69]  Pozzolo A.F., I consumi alimentari in Italia in periodo di crisi (Food consumption in Italy in times of crisis). In, Cersosimo D. (ed.), “I consumi alimentari: evoluzione strutturale, nuove tendenze, risposte alla crisi" (Food consumption: structural changes, new trends, responses to the crisis). Edizioni Tellus, Rome, 2011.
[70]  Romano D., L’evoluzione strutturale dei consumi alimentari in Italia (Structural evolution of food consumption in Italy). In Cersosimo D., I consumi alimentari: evoluzione strutturale, nuove tendenze, risposte alla crisi (Food consumption: structural changes, new trends, responses to the crisis). Edizioni Tellus, Rome, 2011.
[71]  Istat, 6o Censimento Agricoltura 2010 (6th Agriculture Census). Rome, 2010.
[72]  Istat, I consumi delle famiglie (Households expenditure). National Institute of Statistics (Istat), Rome, 2004. Available:
[73]  Peta E.A., Consumi agro-alimentari in Italia e nuove tecnologie (Agro-food consumption in Italy and new technologies). Italian Ministry of Economic Development, Rome, 2007. Available:
[74]  Istat, I consumi delle famiglie (Households expenditure). National Institute of Statistics (Istat), Rome, 2014. Available: +08%2Flug%2F2014+-+Testo+integrale.pdf.
[75]  Ismea, Rapporto Annuale “Evoluzione del sistema agroalimentare italiano” (Annual Report "Evolution of Italian agri-food system"). Volume I. Institute of services for the agricultural and food market (Ismea), Rome, 2006.