樱花视频

Skip to main content
Download PDF
  • Research
  • Published:

Evaluation of the relationship between nutrition literacy, Mediterranean diet compliance, ecological footprint and sustainable environmental attitudes in adolescents

樱花视频 volume听25, Article听number:听130 (2025) Cite this article

Abstract

Objective

This study aimed to evaluate the relationship between nutrition literacy, Mediterranean diet compliance, ecological footprint and sustainable environmental attitudes in adolescents.

Methods

This descriptive and cross-sectional study was conducted with 673 adolescents aged 14鈥�18听years. The individuals' general characteristics were questioned. Sustainable environmental attitudes, nutritional literacy status and compliance with the Mediterranean diet were assessed with the help of scales. An ecological footprint calculator was used for the calculation of the ecological footprint.

Results

The mean age of the individuals was 16.5鈥壜扁��1.42听years. Adolescent Nutrition Literacy Scale score and Sustainable Environmental Attitude Scale score were higher in female adolescents than in males (p鈥�&濒迟;鈥�0.05). Ecological Footprint score was higher in male adolescents than in females (p鈥�&濒迟;鈥�0.05). A statistically significant positive correlation was found between Adolescent Nutrition Literacy Scale score, Sustainable Environmental Attitude Scale score and Mediterranean Diet Quality Index (KIDMED) score (p鈥�&濒迟;鈥�0.05). It was determined that sex and Sustainable Environmental Attitude Scale score affected the Ecological Footprint total score (p鈥�&濒迟;鈥�0.05). It was determined that sex, Adolescent Nutrition Literacy Scale score and Ecological Footprint total score affected the Sustainable Environmental Attitude Scale score (p鈥�&濒迟;鈥�0.05). Also, it was determined that Adolescent Nutrition Literacy Scale score affected the KIDMED score (p鈥�&濒迟;鈥�0.05).

Conclusions

Girls have higher nutritional literacy and sustainable environmental attitude. Nutrition literacy, sustainable environmental attitude and KIDMED total scores showed a significant positive correlation with each other. Nutritional literacy is effective on sustainable environmental attitude and compliance with the Mediterranean diet. Sustainable environmental attitude is effective in reducing the ecological footprint.

Peer Review reports

Introduction

The biophysical limits of our planet represent one key aspect of sustainability. Earth's regenerative capacity for natural resources should not be exceeded by human harvesting rates and that waste emission rates should not exceed the natural assimilative capacity [1]. It is predicted that the world population will reach 9.7 billion by 2050 and a 60% increase in agricultural production is required to provide sufficient food. And therefore the environmental burden of food production is expected to increase [2]. Ecological footprint, which stands out as a concept related to sustainability, is an indicator that measures ecological sustainability in certain categories, and it is a calculation made by comparing human needs with the availability of natural resources and collecting the necessary areas for providing renewable resources, infrastructure and waste disposal [3]. The food we eat and the way it is produced has effects on both health and the environment. It has been determined that healthy food choices and a healthy diet can reduce the ecological footprint [4]. Measures need to be taken to reduce the ecological footprint and in recent years, the relationship between sustainable nutrition, healthy eating patterns and habits, and a sustainable environment has become an important research topic [5,6,7,8]. Sustainable environmental behavior refers to actions and practices that individuals and communities adopt to minimize their ecological footprint and promote the health of the environment. This concept encompasses a wide range of behaviors, from reducing waste and conserving energy to adopting sustainable transportation methods and supporting eco-friendly policies. In this area sustainable environmental behavior refers to actions and practices that individuals and communities adopt to minimize their ecological footprint and promote the health of the environment. This concept encompasses a wide range of behaviors, from reducing waste and conserving energy to adopting sustainable transportation methods and supporting eco-friendly policies. Sustainable environmental behavior is a multifaceted concept that involves individual and collective actions aimed at protecting the environment [9, 10]. Nutritional behavior is also an important issue that affects the sustainable environment [11]. In this context, sustainable dietary patterns gain importance as they contribute to both environmental preservation and human well-being. The Mediterranean diet is a sustainable diet model recommended by the Food and Agriculture Organization in terms of both health and environment [12]. The Mediterranean diet, characterized by high consumption of fresh vegetables and fruits, whole grains, legumes, nuts, fish and olive oil, and low consumption of meat, is considered one of the healthiest dietary patterns [13]. At this point, it is thought that improving compliance to the Mediterranean diet may have an effect on the ecological footprint and sustainable environment.

Improving nutritional literacy during adolescence is one of the health-promoting strategies. Nutrition literacy is defined as an individual's ability to access, process and understand nutritional information and its impact on health. It encompasses a range of skills, including the capacity to read food labels, understand dietary guidelines, and critically evaluate nutritional information from various sources [14]. Healthy eating habits, on the other hand, are defined as dietary patterns that contribute to health, including the consumption of a variety of foods rich in essential nutrients, moderation in portion sizes, and an overall balance between food intake and physical activity. These habits are influenced by individual knowledge, attitudes, beliefs, and the environment in which individuals operate [15, 16]. Therefore, nutritional literacy is an important parameter that affects individuals' healthy eating habits and food consumption [17]. The Mediterranean diet embodies a range of healthy eating habits that are integral to promoting overall health and well-being [18]. Adolescence is considered the best period to develop lifelong positive health behaviors. Healthy eating habits maintained during this period are very important in terms of their effects on both health and the environment in the following periods. Nutritional literacy can also be important for a sustainable environment by encouraging healthy dietary habits and adherence to the Mediterranean diet [19, 20]. This study evaluated the effects of nutritional literacy on Mediterranean diet compliance, sustainable environmental attitudes, and ecological footprint, and discussed whether nutritional literacy has an impact on environmental health in addition to human health.

In this study, generally the relationship between sustainable nutrition, sustainable environmental behavior and nutrition literacy in adolescents was examined. Lifestyle habits during adolescence are also very important for later periods. By calculating individuals' ecological footprints, it was aimed to evaluate the relationship between the Mediterranean diet compliance, which is a sustainable nutrition model, and sustainable environmental attitude and nutritional literacy in this study.

Materials and methods

This descriptive and cross-sectional study was conducted with 673 adolescents aged 14鈥�18听years between October 2023 and January 2024. 710 families were reached in the study, but 37 families dropped out because they did not want to fill out the survey form. Adolescents were reached by snowball sampling method through parents who lived in Ankara. The inclusion criteria for the study were as follows: Individuals who had children between the ages of 14 and 18, agreed to participate in the study, and did not have any missing information in the survey form were included in the study. Voluntary consent forms were signed by the parents. Before starting the study, ethical approval was obtained from University of Health Sciences Gulhane Scientific Research Ethics Committee with the decision number 2023/296 dated 22.08.2023. All procedures in the study were carried out in accordance with the Declaration of Helsinki. Study data were collected by face-to-face interview method. The individuals' general characteristics were questioned with the questionnaire form. Sustainable environmental attitude, nutritional literacy and compliance with the Mediterranean diet were assessed using scales. An ecological footprint calculator was used for the calculation of the ecological footprint.

Ecological footprint

An ecological footprint calculator prepared by the World Wide Fund for Nature (WWF) was used (). The calculator includes questions about dietary preferences, food waste, local food consumption, travel and transportation, location, heating and energy expenditure, and general expenses. The questions in the calculator were converted into a form and asked to individuals and the answers were recorded. Then, the answers given by individuals were entered into the calculation tool on the website, and individual ecological footprint results were obtained based on the calculation of the tool. As a result of the calculation, individuals' ecological footprints are estimated for 4 different categories (home, food, travel and stuff).

Sustainable environmental attitude

Individuals' sustainable environmental attitudes were evaluated with the "Sustainable Environmental Attitude Scale" developed and validated by Y谋ld谋z [21] for individuals aged 14鈥�18. The scale includes questions related to the use of water and energy resources, waste and the concept of sustainability. The 5-point Likert type scale consists of 23 items, and the highest score that can be obtained for each item is 5 and the lowest score is 1. The lowest score that can be obtained from the scale is 23 and the highest score is 115. An increase in the score indicates that individuals have higher sustainable environmental attitudes.

Nutrition literacy

The 'Adolescent Nutrition Literacy Scale' was developed by Bari [22] in 2012 to determine the nutritional literacy of adolescents. The Turkish validity and reliability study of the scale was conducted by Sonay T眉rkmen et al. [23] in adolescents aged 14 and over. The scale contains various questions regarding nutrition, diet, food and health. The Cronbach's alpha value of the scale is 0.80. The scale consists of 22 items. Each item is scored between 1 and 5 (1鈥�=鈥塻trongly disagree, 2鈥�=鈥塪isagree, 3鈥�=鈥塽ndecided, 4鈥�=鈥塧gree, 5鈥�=鈥塩ompletely agree). The lowest total score that can be obtained from the scale is 22 and the highest score is 110. An increase in the score obtained from the scale indicates that the level of nutrition literacy has increased.

Compliance with the Mediterranean diet

Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Quality Index (KIDMED). The index was developed by Serra-Majem et al. [24] to evaluate the suitability of the nutritional intake of individuals aged 2鈥�24 with the Mediterranean diet. There are 16 questions in the index. 12 of the questions in the index are positive and 4 are negative. Questions answered "Yes" are given鈥�+鈥�1 point if they are positive questions, and 鈭�1 point if they are negative questions. According to the total score obtained as a result of the evaluation,鈥夆墺鈥�8 points are considered as optimal Mediterranean diet (high), 4鈥�7 points are considered as compliance with the Mediterranean diet should be improved (moderate), and鈥夆墹鈥�3 points are considered as very low nutritional quality (low). The Turkish validity and reliability study of the scale was conducted by Akar 艦ahing枚z et al. [25]. The Cronbach alpha value of the scale is 0.72.

Statistical analysis

The Statistical Package for the Social Sciences (version 22.0) software was used for all analyses. Data were evaluated with descriptive statistics such as mean, standard deviation, number and percentage. Differences in mean values between groups (by sex) were evaluated with the Independent t test. Chi-square analysis was used to compare qualitative data between groups. The relationships between the variables are given with the Pearson correlation coefficient. Linear regression analysis was performed for prediction of ecological footprint, sustainable environmental attitude, and compliance with the Mediterranean diet. The results were evaluated at the 95% confidence interval, p鈥�<鈥�0.05, and p鈥�<鈥�0.001 significance level.

Results

The general characteristics of the individuals were given in Table听1. The mean age of the individuals was 16.5鈥壜扁��1.42听years. 67.9% of the adolescents were female and 32.1% were male. The mean Adolescent Nutrition Literacy Scale score was 68.7鈥壜扁��9.22. 68.5% of the individuals had high compliance with the Mediterranean diet. The mean Sustainable Environmental Attitude Scale score was 88.8鈥壜扁��17.03, and the mean Ecological Footprint score was 9.8鈥壜扁��2.97. Adolescent Nutrition Literacy Scale score and Sustainable Environmental Attitude Scale score were higher in female adolescents than in males (p鈥�&濒迟;鈥�0.05). Ecological Footprint score was higher in male adolescents than in females (p鈥�&濒迟;鈥�0.05).

Table 1 General characteristics of individuals
Full size table

The relationship between the Adolescent Nutrition Literacy Scale, Sustainable Environmental Attitude Scale, Mediterranean Diet Quality Index and Ecological Footprint score was given in Table听2. A statistically significant positive correlation was found between Adolescent Nutrition Literacy Scale score, Sustainable Environmental Attitude Scale score and KIDMED score. A statistically significant negative correlation was found between Sustainable Environmental Attitude Scale score and Ecological Footprint total score and and sub-scores except home. There was a statistically significant negative correlation between KIDMED score and Ecological Footprint sub-score of Food (p鈥�&濒迟;鈥�0.05).

Table 2 The relationship between the adolescent nutrition literacy scale, sustainable environmental attitude scale, Mediterranean diet quality index and ecological footprint score
Full size table

Linear regression analyzes for ecological footprint and sustainable environmental attitude prediction were given in Table听3. When the factors that could affect the Ecological Footprint total score were evaluated with linear regression analysis, the model was deemed important (R2鈥�=鈥�0.276;p鈥�<鈥�0.001). It was determined that sex and Sustainable Environmental Attitude Scale score affected the Ecological Footprint total score (p鈥�&濒迟;鈥�0.05). When the factors that could affect the Sustainable Environmental Attitude Scale score were evaluated with linear regression analysis, the model was deemed important (R2鈥�=鈥�0.354;p鈥�<鈥�0.001). It was determined that sex, Adolescent Nutrition Literacy Scale score and Ecological Footprint total score affected the Sustainable Environmental Attitude Scale score (p鈥�&濒迟;鈥�0.05).

Table 3 Linear regression model for ecological footprint and sustainable environmental attitude prediction
Full size table

When the factors that could affect the KIDMED score were evaluated with linear regression analysis, the model was deemed important (R2鈥�=鈥�0.218;p鈥�<鈥�0.001). It was determined that Adolescent Nutrition Literacy Scale score affected the KIDMED score (p鈥�<鈥�0.05) (Table听4).

Table 4 Linear regression model for compliance with the Mediterranean diet prediction
Full size table

Discussion

According to the World Health Organization, the adolescent period is defined as the life stage between the ages of 10鈥�19 between childhood and adulthood. This period is one of the important stages in human development and is effective in laying the foundations of health. Adolescents show faster physical, cognitive and psychosocial development compared to other life stages. This contributes to their thoughts, feelings, decisions and interactions with their environment. In this stage, adolescents form behavior patterns such as nutrition and physical activity that may have an impact on their own health and that of their relatives [26].

Improving food intake and nutritional behaviors in this stage of life has an impact on health, chronic diseases and quality of life in adulthood. During adolescence, nutritional sensitivity increases due to increased nutritional requirements, but the eating habits and diet quality of this age group generally tend to deteriorate. Low-quality diets and inadequate nutrient intakes are common among adolescents worldwide. Malnutrition during adolescence may lead to more undesirable conditions such as micronutrient deficiencies, obesity due to weight gain and cardiometabolic risk factors, and health consequences in adulthood [27].

Raising awareness about proper and sustainable nutrition in adolescents during this period is extremely important in terms of contributing to individual, environmental and social health. Therefore, the aim of this cross-sectional study was to examine the relationship between sustainable nutrition, sustainable environmental behavior and nutrition literacy in adolescents. In addition, the ecological footprints of adolescents were calculated and compliance with the Mediterranean diet, a sustainable nutrition model, was also evaluated. Accordingly, the main findings of our study are as follows; 1) Among adolescents, girls have higher nutritional literacy and sustainable environmental attitude scores than boys, while boys have higher mean ecological footprint scores. 2) Nutrition literacy, sustainable environmental attitude and KIDMED total scores showed a significant positive correlation with each other. 3) Sustainable environmental attitude and ecological footprint score showed a significant negative correlation. 4) Factors affecting ecological footprint are sex and sustainable environmental attitude. 5) Factors affecting sustainable environmental attitude are sex, nutritional literacy and ecological footprint burden. 6) The factor affecting adherence to the Mediterranean diet was identified as nutritional literacy.

Sex is one of the factors affecting food preferences of adolescents [28]. In this study, nutritional literacy and sustainable environmental attitude scores were found to be higher in girls than in boys. In similar studies, a difference was found between male and female adolescents in terms of nutritional literacy and the scores of female students were found to be higher [22, 28,29,30]. In another study, it was found that girls gave more importance to healthy eating or healthy nutrition than boys [31]. In similar studies conducted on adolescents in T眉rkiye [28, 32] and other countries [30, 33, 34], sex was determined to be one of the factors affecting nutrition literacy, and it was observed that nutritional literacy was higher in girls than in boys. One possible explanation for sex disparities is that females focus on the nutritional value of food and prioritize healthy eating more than men. Female tend to have greater knowledge of nutrition and perceive it as an essential factor in their overall health [30, 35]. In addition to these possible reasons, in this study higher level of nutrition literacy among females can be explained with traditional sex-specific social roles in our country.

In this study, sustainable environmental attitude scores were also found to be higher in females than in males. Research on sex differences in sustainable eating among adolescents indicates that female adolescents tend to demonstrate more environmentally conscious food choices than their male counterparts. Studies show that girls are generally more inclined towards plant-based diets and reducing meat intake, driven by greater concern for health and environmental impacts. These preferences are likely influenced by societal norms and a stronger focus on appearance-related health, which contribute to healthier and more sustainable choices like minimizing food waste and selecting eco-friendly options [36, 37]. Furthermore it is an expected situation that sustainable environmental attitude is also higher in girls than in boys due to higher nutritional literacy in girls in the study results.

In our study, nutritional literacy, sustainable environmental attitude and KIDMED total scores showed a significant positive correlation with each other and this was supported by linear regression analyses. Recently, it is thought that nutritional literacy affects nutrition-related behavioral disorders in adolescents [38]. Sustainable nutrition behaviors are accepted as an indicator parameter that positively affects both the planet and individual health with its strong effects [39]. These behaviors, which are one of the important elements of nutrition literacy, have been associated with lower mortality rates and reduced environmental impacts in prospective studies with large samples [40,41,42]. In addition, sustainable dietary models, which are recommended due to their low environmental impact, are more cost-effective for both the planet and human health and can be easily implemented in undeveloped and developing countries [16]. The concept of sustainable nutrition emphasizes the long-term impacts of food systems that contribute more than 25% of global greenhouse gas emissions and cause environmental damage such as freshwater eutrophication and soil acidification. In this context, as the world population grows, it is increasingly critical to promote dietary patterns that give equal priority to human and environmental health [16, 39, 40].

The Mediterranean diet is considered an example of a healthy and sustainable diet as it includes key sustainable components such as food security and accessibility, respect for the environment and biodiversity, fair trade, locality and seasonality, and preservation of cultural heritage and skills [43]. The Mediterranean diet has a structure that mainly includes abundant consumption of plant-based products such as cereals, fruits, vegetables, legumes, nuts and herbs, moderate consumption of white meat, fish, eggs and dairy products, low intake of red meat and processed meat, and the use of olive oil as the main seasoning [44]. Furthermore, the Mediterranean diet contributes to the preservation of biodiversity by promoting local, fresh and seasonal foods, resulting in low ecological environmental impact [45].

Recently, adolescents have been reported to move away from the Mediterranean diet, which is a sustainable dietary model [38]. Various studies have reported that adolescents are more likely to adhere to the Western-style dietary model, which is high in energy and saturated fat content and deficient in micronutrients, rather than the Mediterranean diet [46,47,48]. In this study, 68.5% of adolescents showed high compliance with the Mediterranean diet. Contrary to the literature, this study found greater adherence to the Mediterranean diet. When the factors affecting the Mediterranean diet were examined in the study, it was thought that this was due to nutrition literacy. As a result of both our correlation and regression analyses, as nutrition literacy in the study group increased, adherence to the Mediterranean diet also increased. In the study, it was observed that the group with low and medium adherence to the Mediterranean diet had high energy and sugar content, high fast food consumption frequency and more Western-style diet habits, similar to the literature [46,47,48]. In the study, it was observed that the group with low and medium adherence to the Mediterranean diet had high energy and sugar content, high fast food consumption frequency and more Western-style diet habits, similar to the literature.

Considering the relationship of nutritional literacy with sustainable eating behavior and the Mediterranean diet, which is also supported by our study results, another cross-sectional study showed a significant relationship between nutritional literacy and adherence to the Mediterranean diet [49]. In the study conducted with female adolescents, it was found that nutritional knowledge was associated with higher adherence to the Mediterranean diet [50]. In another study conducted with adolescents, it was observed that the frequency of consumption of packaged and processed snacks decreased as nutritional literacy scores increased and adolescents preferred smaller fast food portions [51]. Similarly, in another study, it was emphasized that nutritional literacy had an effect on daily lifestyle behaviors and eating habits of adolescents [28].

Recent studies have shown that nutritional literacy is one of the important factors in shaping the eating behaviors of children and adolescents [52, 53]. Nutrition literacy can be conceptualized as an element that facilitates healthy eating. In a study, it was shown that high nutrition literacy scores in cognitive and skill domains were associated with healthy and sustainable eating behaviors [51]. These findings were also supported by the results of studies showing that high nutritional literacy was associated with healthy food preferences, decreased fast-food portions and decreased frequency of consumption of packaged or processed snacks among adolescents [54, 55]. Children's food preferences may be influenced by family, cultural preferences, beliefs, eating environment and peer relationships at an early age. Nutritional literacy plays an important role in children's formation of healthy life and nutritional preferences [51].

One of the main findings of this study was that sustainable environmental attitude and ecological footprint score showed a significant negative correlation and this was supported by linear regression analysis. It is thought that the lower nutrition literacy and sustainable environmental attitude scores of male adolescents compared to girls affect the higher ecological footprint score in boys. Indeed, in the regression analysis, sex and sustainable environmental attitude were among the factors affecting the ecological footprint burden. In order to evaluate, compare and control the effects on the environment, a number of measurement tools including environmental indicators have been developed and these measurement tools are used in the analysis of environmental footprints [56]. The analysis of environmental footprints is also related to the concept of healthy and sustainable diets. Several studies have shown the environmental impact of dietary patterns in terms of environmental footprints and have drawn attention to sustainability [57,58,59]. All these data supported the negative correlation and relationship between sustainable eating attitude and ecological footprint score.

The present study has some strengths. First of all, to the best of our knowledge, this is the first large cross-sectional study that raises both individual and social awareness by addressing important issues such as compliance with the Mediterranean diet, sustainable environmental attitudes, nutritional literacy and ecological footprint in the adolescent group. Especially considering the recent climate change and its effects on nutrition, it is thought that the study, which draws attention to sustainable nutrition and supports the results with ecological footprint, supports environmental health as well as human health. However, this study has various limitations. Firstly, the lack of a causal link due to its cross-sectional structure is a limitation of the study. Therefore, it is thought that longitudinal studies are needed as a next step to investigate the direction of the relationship between nutritional literacy, environmental attitudes and ecological footprints. Secondly, the use of snowball sampling method in the study may have caused bias in sample selection. Nevertheless, the findings of our study will shed light on future studies.

Conclusion

In conclusion, this study showed significant positive relationships between nutritional literacy, sustainable environmental attitude and compliance with the Mediterranean diet. It was also found that individuals with high sustainable environmental attitudes have less ecological footprint. Adolescence is of critical importance to improve the quality of life now and in the future and health awareness should be raised. Considering that adolescents are less likely to adhere to the Mediterranean diet, which represents a healthy and sustainable diet for all age groups, and have a tendency towards unhealthy food consumption and dietary patterns, it is extremely important to provide education in this age group. The balance between environmental sustainability in the diets of adolescents and nutrient adequacy that affects ecological balance requires special attention. In this regard, it is recommended to develop educational programs that integrate nutritional literacy with environmental sustainability, and these programs can be implemented in schools to support not only individual health but also planetary health. On the other hand, nutrition literacy is seen as an effective method to ensure the continuity of the food system, which significantly affects both public and environmental health. Determining nutrition literacy status and understanding the determinants of healthy eating and lifestyle behaviors is seen as an effective strategy to promote health during adolescence.

Data availability

No datasets were generated or analysed during the current study.

References

  1. Mancini MS, Galli A, Niccolucci V, Lin D, Bastianoni S, Wackernagel M, et al. Ecological footprint: refining the carbon footprint calculation. Ecol Ind. 2016;61:390鈥�403.

    听 听

  2. Galli A, Iha K, Halle M, El Bilali H, Grunewald N, Eaton D, et al. Mediterranean countries鈥� food consumption and sourcing patterns: an ecological footprint viewpoint. Sci Total Environ. 2017;578:383鈥�91.

    听 听 听

  3. Mengi 脟elik 脰, K枚ksal E, Akpinar 艦, Kocaadam Bozkurt B, Erdo臒an G枚vez N, 脟谋tar Daz谋ro臒lu ME, et al. Association between ecological footprint awareness and health literacy in adults: a population-based study from Turkey. Int J Environ Health Res. 2024;34(1):295鈥�304.

    听 听 听

  4. Frey S, Barrett J, editors. Our health, our environment: the ecological footprint of what we eat. International Ecological Footprint Conference, Cardiff. 2007.

  5. Alsaffar AA. Sustainable diets: The interaction between food industry, nutrition, health and the environment. Food Sci Technol Int. 2016;22(2):102鈥�11.

    听 听 听

  6. Meier T, Wittenberg H. Sustainable nutrition between the poles of health and environment. Potentials of altered diets and avoidable food losses. Ernahrungs Umschau. 2015;62(2):22鈥�33.

    听

  7. Berry EM. Sustainable food systems and the Mediterranean diet. Nutrients. 2019;11(9):2229.

    听 听 听 听

  8. Germani A, Vitiello V, Giusti AM, Pinto A, Donini LM, del Balzo V. Environmental and economic sustainability of the Mediterranean Diet. Int J Food Sci Nutr. 2014;65(8):1008鈥�12.

    听 听 听

  9. Pedro 脕S, Pedro VM. Developing sustainable environmental behavior in secondary education students (12鈥�16) Analysis of a didactic strategy. Procedia Soc Behav Sci. 2010;2(2):3568鈥�74.

    听 听

  10. Atta MHR, Zoromba MA, El-Gazar HE, Loutfy A, Elsheikh MA, El-Ayari OSM, et al. Climate anxiety, environmental attitude, and job engagement among nursing university colleagues: a multicenter descriptive study. 樱花视频 Nurs. 2024;23(1):133.

    听 听 听 听

  11. Metin ZE, 脟elik 脰M, Ko莽 N. Relationship between adherence to the Mediterranean diet, sustainable and healthy eating behaviors, and climate change awareness: A cross-sectional study from Turkey. Nutrition. 2024;118: 112266.

    听 听 听

  12. Yardimci H, Demirer B. Is high adaptation to the Mediterranean diet effective in increasing ecological footprint awareness? A cross-sectional study from Turkey. J Sci Food Agric. 2022;102(9):3724鈥�9.

    听 听 听

  13. Peng W, Goldsmith R, Shimony T, Berry EM, Sinai T, Trends in the adherence to the Mediterranean diet in Israeli adolescents: Results from two national health and nutrition surveys,. and 2016. Eur J Nutr. 2003;2021:1鈥�14.

    听

  14. Velardo S. The nuances of health literacy, nutrition literacy, and food literacy. J Nutr Educ Behav. 2015;47(4):385-9. e1.

    听 听 听

  15. Mostafazadeh P, Jafari MJ, Mojebi MR, Nemati-Vakilabad R, Mirzaei A. Assessing the relationship between nutrition literacy and eating behaviors among nursing students: a cross-sectional study. 樱花视频. 2024;24(1):18.

    听 听 听 听

  16. Morta艧 H, Navruz-Varl谋 S, 脟谋tar-Daz谋ro臒lu ME, Bilici S. Can unveiling the relationship between nutritional literacy and sustainable eating behaviors survive our future? Sustainability. 2023;15(18):13925.

    听 听

  17. Abreu F, Hernando A, Goul茫o LF, Pinto AM, Branco A, Cerqueira A, et al. Mediterranean diet adherence and nutritional literacy: an observational cross-sectional study of the reality of university students in a COVID-19 pandemic context. BMJ Nutr Prev Health. 2023;6(2):221.

    听 听 听 听

  18. Maderuelo-Fernandez JA, Recio-Rodr铆guez JI, Patino-Alonso MC, P茅rez-Arechaederra D, Rodriguez-Sanchez E, Gomez-Marcos MA, et al. Effectiveness of interventions applicable to primary health care settings to promote Mediterranean diet or healthy eating adherence in adults: A systematic review. Prev Med. 2015;76:S39鈥�55.

    听 听 听

  19. Taylor MK, Sullivan DK, Ellerbeck EF, Gajewski BJ, Gibbs HD. Nutrition literacy predicts adherence to healthy/unhealthy diet patterns in adults with a nutrition-related chronic condition. Public Health Nutr. 2019;22(12):2157鈥�69.

    听 听 听 听

  20. Vaitkeviciute R, Ball LE, Harris N. The relationship between food literacy and dietary intake in adolescents: a systematic review. Public Health Nutr. 2015;18(4):649鈥�58.

    听 听 听

  21. Yildiz 艦. 脰臒retmenlerin, 枚臒retmen adaylar谋n谋n ve 枚臒rencilerin s眉rd眉r眉lebilir 莽evre ile ilgili kavramsal anlamalar谋 ve tutumlar谋. 2011.

  22. Ndahura NB. Nutrition literacy status of adolescent students in Kampala district, Uganda: H酶gskolen i Oslo og Akershus. 2012.

  23. Sonay T眉rkmen A, Kalkan 陌, Fi虈li虈z E. Adaptation of adolescent nutrition literacy scale into Turkish: a validity and reliability study. Int Peer Rev J Nutr Res. 2017(10). .

  24. Serra-Majem L, Ribas L, Ngo J, Ortega RM, Garc铆a A, P茅rez-Rodrigo C, et al. Food, youth and the Mediterranean diet in Spain. Development of KIDMED, Mediterranean Diet Quality Index in children and adolescents. Pub Health Nutr. 2004;7(7):931鈥�5.

    听 听

  25. 艦ahing枚z SA, 脰zgen L, Yal莽谋n E, editors. Akdeniz diyet kalitesi 枚l莽e臒inin (Mediterranean Diet Quality-KIDMED) ge莽erlik ve g眉venirlik 莽al谋艧mas谋. Proceedings Book of 5th International Eurasian Congress on Natural Nutrition, Healthy Life & Sport. 2019.

  26. Organization WH. The adolescent health indicators recommended by the Global Action for Measurement of Adolescent health: guidance for monitoring adolescent health at country, regional and global levels: World Health Organization. 2024.

  27. Heslin AM, McNulty B. Adolescent nutrition and health: characteristics, risk factors and opportunities of an overlooked life stage. Proc Nutr Soc. 2023;82(2):142鈥�56.

    听 听

  28. Koca B, Arkan G. The relationship between adolescents鈥� nutrition literacy and food habits, and affecting factors. Public Health Nutr. 2021;24(4):717鈥�28.

    听 听

  29. Guttersrud 脴, Petterson KS. Young adolescents鈥� engagement in dietary behaviour鈥搕he impact of gender, socio-economic status, self-efficacy and scientific literacy. Methodological aspects of constructing measures in nutrition literacy research using the Rasch model. Public Health Nutr. 2015;18(14):2565鈥�74.

    听 听 听 听

  30. Hoteit M, Mansour R, Mohsen H, Bookari K, Hammouh F, Allehdan S, et al. Status and correlates of food and nutrition literacy among parents-adolescents鈥� dyads: findings from 10 Arab countries. Front Nutr. 2023;10:1151498.

    听 听 听 听

  31. Lee C-K, Liao L-L, Lai I-J, Chang L-C. Effects of a healthy-eater self-schema and nutrition literacy on healthy-eating behaviors among Taiwanese college students. Health Promot Int. 2019;34(2):269鈥�76.

    听 听 听

  32. Yilmazel G, Bozdogan S. Nutrition literacy, dietary habits and food label use among Turkish adolescents. Prog Nutr. 2021;23(1):e2021007.

    听

  33. Doustmohammadian A, Omidvar N, Keshavarz-Mohammadi N, Eini-Zinab H, Amini M, Abdollahi M, et al. Low food and nutrition literacy (FNLIT): a barrier to dietary diversity and nutrient adequacy in school age children. 樱花视频 Res Notes. 2020;13:1鈥�8.

    听 听

  34. Ashoori M, Omidvar N, Eini-Zinab H, Shakibazadeh E, Doustmohamadian A, Abdar-Esfahani B, et al. Food and nutrition literacy status and its correlates in Iranian senior high-school students. 樱花视频 Nutr. 2021;7:1鈥�10.

    听 听

  35. Wardle J, Haase AM, Steptoe A. Body image and weight control in young adults: international comparisons in university students from 22 countries. Int J Obes. 2006;30(4):644鈥�51.

    听 听

  36. Deslippe AL, Bergeron C, Cohen TR. Boys and girls differ in their rationale behind eating: a systematic review of intrinsic and extrinsic motivations in dietary habits across countries. Front Nutr. 2023;10:1256189.

    听 听 听 听

  37. Lanham A, van der Pols J. Towards sustainable diets鈥搃nterventions and perceptions amongst adolescents: a scoping review. Proc Nutr Soc. 2024;83(OCE1):E35.

    听 听

  38. Depboylu GY, Kaner G, S眉er M, Kany谋lmaz M, Alpan D. Nutrition literacy status and its association with adherence to the Mediterranean diet, anthropometric parameters and lifestyle behaviours among early adolescents. Public Health Nutr. 2023;26(10):2108鈥�17.

    听 听

  39. Teng C-C, Chih C. Sustainable food literacy: A measure to promote sustainable diet practices. Sustainable Prod Consumption. 2022;30:776鈥�86.

    听 听

  40. Strid A, Johansson I, Bianchi M, Sonesson U, Hallstr枚m E, Lindahl B, et al. Diets benefiting health and climate relate to longevity in northern Sweden. Am J Clin Nutr. 2021;114(2):515鈥�29.

    听 听 听 听

  41. Willett W, Rockstr枚m J, Loken B, Springmann M, Lang T, Vermeulen S, et al. Food in the Anthropocene: the EAT鈥揕ancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447鈥�92.

    听 听 听

  42. Mart铆nez-Gonz谩lez MA, Gea A, Ruiz-Canela M. The Mediterranean diet and cardiovascular health: A critical review. Circ Res. 2019;124(5):779鈥�98.

    听 听 听

  43. Dernini S, Berry EM. Mediterranean diet: from a healthy diet to a sustainable dietary pattern. Front Nutr. 2015;2:15.

    听 听 听 听

  44. Bach-Faig A, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S, et al. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011;14(12A):2274鈥�84.

    听 听 听

  45. Franchini C, Biasini B, Sogari G, Wongprawmas R, Andreani G, Dolgopolova I, et al. Adherence to the Mediterranean Diet and its association with sustainable dietary behaviors, sociodemographic factors, and lifestyle: a cross-sectional study in US University students. Nutr J. 2024;23(1):56.

    听 听 听 听

  46. De Santi M, Callari F, Brandi G, Toscano RV, Scarlata L, Amagliani G, et al. Mediterranean diet adherence and weight status among Sicilian Middle school adolescents. Int J Food Sci Nutr. 2020;71(8):1010鈥�8.

    听 听 听

  47. Alim NE, 脟al谋艧kan G, Be艧ler ZN. Assessment of adherence to the Mediterranean Diet and behaviors of fruit and vegetable consumption in adolescents. Sa臒l谋k Bilimlerinde De臒er. 2022;12(1):152鈥�9.

    听 听

  48. Nota MH, Nicolas S, O鈥橪eary OF, Nolan YM. Outrunning a bad diet: interactions between exercise and a Western-style diet for adolescent mental health, metabolism and microbes. Neurosci Biobehav Rev. 2023;149: 105147.

    听 听 听

  49. Aureli V, Rossi L. Nutrition knowledge as a driver of adherence to the Mediterranean diet in Italy. Front Nutr. 2022;9: 804865.

    听 听 听 听

  50. Neshatbini Tehrani A, Farhadnejad H, Salehpour A, Beyzai B, Hekmatdoost A, Rashidkhani B. The association between nutrition knowledge and adherence to a Mediterranean dietary pattern in Iranian female adolescents. Int J Adolesc Med Health. 2021;33(4):20180188.

    听 听

  51. Doustmohammadinan A, Omidvar N, Keshavarz Mohammadi N, Eini-Zinab H, Amini M, Abdollahi M, et al. Food and nutrition literacy (FNLIT) is associated to healthy eating behaviors in children. Nutr Food Sci Res. 2021;8(3):37鈥�47.

    听 听

  52. Zoellner J, You W, Connell C, Smith-Ray RL, Allen K, Tucker KL, et al. Health literacy is associated with healthy eating index scores and sugar-sweetened beverage intake: findings from the rural Lower Mississippi Delta. J Am Diet Assoc. 2011;111(7):1012鈥�20.

    听 听 听 听

  53. Oti J. Food literacy and dietary behaviour among day students of senior high schools in Winneba, Central Region of Ghana. J Food Nutr Res. 2020;8(1):39鈥�49.

    听

  54. Robson SM, Stough CO, Stark LJ. The impact of a pilot cooking intervention for parent-child dyads on the consumption of foods prepared away from home. Appetite. 2016;99:177鈥�84.

    听 听 听

  55. Hersch D, Perdue L, Ambroz T, Boucher JL. Peer reviewed: the impact of cooking classes on food-related preferences, attitudes, and behaviors of school-aged children: a systematic review of the evidence, 2003鈥�2014. Prev Chronic Dis. 2014;11:E193.

    听 听 听 听

  56. Garzillo JMF, Machado PP, Louzada MLdC, Levy RB, Monteiro CA. Pegadas dos alimentos e das prepara莽玫es culin谩rias consumidos no Brasil. 2019.

  57. Vanham D, Bidoglio G. A review on the indicator water footprint for the EU28. Ecol Ind. 2013;26:61鈥�75.

    听 听

  58. Auclair O, Burgos SA. Carbon footprint of Canadian self-selected diets: Comparing intake of foods, nutrients, and diet quality between low-and high-greenhouse gas emission diets. J Clean Prod. 2021;316:128245.

    听 听

  59. da Silva JT, Garzillo JMF, Rauber F, Kluczkovski A, Rivera XS, da Cruz GL, et al. Greenhouse gas emissions, water footprint, and ecological footprint of food purchases according to their degree of processing in Brazilian metropolitan areas: a time-series study from 1987 to 2018. Lancet Planet Health. 2021;5(11):e775鈥�85.

    听 听 听

Acknowledgements

The authors thank all individuals who participated in the study.听The authors express gratitude to TUBITAK. The听National Undergraduate Student Research Projects Support Program (TUBITAK 2209-A) provided support for this project.

Support

This research did not receive any specific grant from funding agencies in the public,听commercial, or not-for-profit sectors.

Funding

There was no funding or sponsoring organisation for this paper.

Author information

Authors and Affiliations

  1. Department of Nutrition and Dietetics, G眉lhane Health Sciences Faculty, University of Health Sciences, Ankara, Turkey

    脰zge Mengi 脟elik,听Emine Merve Ekici,听Selin Y谋lmaz听&听Ziya Erokay Metin

Authors
  1. 脰zge Mengi 脟elik

    You can also search for this author in 听

  2. Emine Merve Ekici

    You can also search for this author in 听

  3. Selin Y谋lmaz

    You can also search for this author in 听

  4. Ziya Erokay Metin

    You can also search for this author in 听

Contributions

脰.M.脟: Conceptualization, Data Curation, Formal Analysis, Supervision, Validation, Writing 鈥� Original Draft, Writing 鈥� Review & Editing; E.M.E: Conceptualization, Data Curation, Writing 鈥� Original Draft; S.Y.: Conceptualization, Data Curation, Writing 鈥� Original Draft; Z.E.M: Conceptualization, Data Curation, Writing 鈥� Original Draft.

Corresponding author

Correspondence to 脰zge Mengi 脟elik.

Ethics declarations

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was conducted with the approval of the University of Health Sciences Gulhane Scientific Research Ethics Committee, numbered 2023/296. Informed consent was obtained from all participants included in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article鈥檚 Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article鈥檚 Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit .

About this article

Cite this article

Mengi 脟elik, 脰., Ekici, E.M., Y谋lmaz, S. et al. Evaluation of the relationship between nutrition literacy, Mediterranean diet compliance, ecological footprint and sustainable environmental attitudes in adolescents. 樱花视频 25, 130 (2025). https://doi.org/10.1186/s12889-024-20910-1

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12889-024-20910-1

Keywords

樱花视频

ISSN: 1471-2458

Contact us