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A narrative review in Applied Sciences says modern urban conditions—including limited time, food costs and the availability of ultra-processed meals—make the Mediterranean lifestyle harder to maintain. It describes interventions that improved diet scores in some settings, but its literature selection was not systematic, and the findings do not establish that modern diets alone caused rising disease rates.
A new narrative review in the journal Applied Sciences says long working hours, food costs and the availability of ultra-processed meals are making the Mediterranean diet and its associated lifestyle harder to follow, particularly for urban and lower-income groups. The authors also summarize workplace, school and food-access interventions that improved diet measures in some studies, while warning that their review method cannot establish that dietary changes caused wider health trends.
The review was conducted by researchers from Bragança Polytechnic University, the University of Vigo, the Galicia Sur Health Research Institute, and the Polytechnic University of Guarda. They searched PubMed, Web of Science, ScienceDirect and Google Scholar from October 2024 to December 2025, focusing on English-language research and giving added attention to work from the previous decade. The final reference list included 116 sources, including journal articles, book chapters and online resources.
The authors describe the Mediterranean diet as centered on vegetables, fruit, legumes, nuts, whole grains and olive oil, with more modest amounts of fish, dairy and eggs and little red meat. They present traditional wine consumption as a cultural practice, not a health recommendation. The review treats the eating pattern as part of a wider lifestyle that can include shared meals and everyday physical activity.
Among the cited examples, a workplace study followed 96 male workers who ate Mediterranean-style canteen lunches for 12 months. Their diet score rose from 4.8 to 7.4, while the share classified as having metabolic syndrome fell from 24% to 15.6%. A separate U.S. trial involving 485 firefighters combined supermarket discounts, free samples, online education and chef demonstrations; researchers reported a 10% improvement in adherence. A Cyprus school program for 150 sixth-graders used food tasting and cooking lessons and reported gains in nutritional knowledge and diet-quality scores.
How Food Environments Shape Daily Choices
The review frames adherence as a matter of time, affordability and access, not simply individual knowledge or willpower. When work schedules limit time to prepare meals and ready-to-eat products are easier to obtain, people may find it harder to maintain a pattern built around minimally processed foods and regular shared meals. The authors report lower adherence among groups including people with lower incomes, urban residents, people under high stress and those with low physical activity.
That framing matters for public health because it points toward changes in workplaces, schools and food supply alongside nutrition education. The cited programs suggest that discounts, food demonstrations and cooking lessons can affect diet-related measures in particular settings. They do not, on their own, show that such interventions will work equally well for all populations or produce lasting health benefits.
The review also cites an estimate that about 3 billion people cannot afford a healthy diet, and a comparison placing ultra-processed foods at $0.55 per 100 calories versus $1.45 for unprocessed foods. Those figures highlight the price barrier described by the authors; the article does not provide enough detail to treat the comparison as a universal price relationship across countries or food categories.
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A Lifestyle Under Urban Pressure
The authors place the dietary shift within wider changes in how people work, move and buy food. They say adherence to the Mediterranean diet has declined since the 1960s, especially among younger, urban and lower-income groups, as longer work hours and convenience foods have become more prominent. Some ready-to-eat products contain high levels of sugar, fat or sodium and provide few micronutrients, according to the review.
The source report notes that global obesity rates have more than doubled since 1990 and that 2022 figures indicate roughly 2.5 billion adults were living with overweight. These are global figures, not evidence that declining Mediterranean-diet adherence caused the change. The review also considered World Health Organization data on noncommunicable disease mortality in several Mediterranean countries from 1960 to 2020. Its authors cautioned that mortality changes may reflect population aging and other risk factors, as well as diet.
The review is narrative rather than a systematic review: the authors did not use predefined exclusion criteria or a systematic screening protocol. They say papers were selected according to how closely their full text matched the review’s aims. That approach allows a broad discussion of the topic but leaves room for selection bias and limits how firmly the findings can be generalized.
“The traditional Mediterranean way of eating is increasingly difficult to sustain in modern urban lifestyles.”
— The review authors
Limits of the Review Evidence
The review does not provide a systematic assessment of study quality or use a predefined screening process. Its conclusions summarize selected research rather than establish a single causal explanation for declining adherence or changes in disease rates. The cited interventions also differ in participants, setting and design, so their results cannot be directly compared as if they measured the same outcome.
It is also unclear from the reported findings how durable the improvements were after each program ended, or whether they led to fewer cases of chronic disease over time. The source report does not give full details of every intervention’s comparison group or follow-up period. The authors’ discussion of aging and other risk factors further means that the relationship between dietary change and national mortality trends remains unresolved.
Testing Practical Food Changes
The review does not announce a new trial or a policy deadline. Its proposed direction is to adapt food and lifestyle strategies to present-day settings, including workplace and school food environments, more affordable healthy choices, ready-to-eat products designed with nutrition in mind, and opportunities for everyday movement and communal meals.
The next evidence needed would come from well-designed studies that compare such approaches, track whether people sustain changes after support ends and measure health outcomes over time. Until then, the review’s examples show possible routes for improving diet adherence in specific groups, not a guarantee that one program or product will reproduce the same results elsewhere.
Key Questions
What did the new review examine?
It reviewed research on why the Mediterranean diet and lifestyle can be difficult to maintain in modern urban settings, and considered strategies involving food access, schools, workplaces and physical activity.
What makes the diet harder to follow, according to the review?
The authors point to limited time, food costs and convenient ultra-processed meals, alongside less physical activity and changing social routines such as fewer shared meals.
Did the review prove that diet changes caused rising disease rates?
No. It discusses dietary change alongside obesity and noncommunicable disease trends, but says mortality patterns may also reflect population aging and other risk factors. The review does not establish a direct cause.
Did any interventions improve Mediterranean-diet adherence?
The review reports improved diet scores or quality measures in examples involving workplace lunches, firefighter food incentives and a school cooking and tasting program. The examples were conducted in different settings, and the reported results do not establish that the same approach will work everywhere.
How strong is the evidence in this review?
It is a narrative review of 116 sources, not a systematic review with predefined exclusion criteria and screening. The authors acknowledge that their selection process leaves room for bias.
Source: news-medical.net
