A Nationwide Survey of Italian University Students: Exploring the Influences of Sustainable Dietary Behaviors, Lifestyle, and Sociodemographic Factors on Adherence to the Mediterranean Diet

Background/Objectives: Recent decades have seen a remarkable westernization of diets and a decline in adherence to the Mediterranean diet (MD). This study examined the eating habits of a representative sample of Italian university students to identify the determinants of adherence to the MD and the most relevant actions to improve their well-being. Methods: The Mediterranean Diet Quality Index for Children and Adolescents (KIDMED) and Sustainable Healthy Diet (SHED) index questionnaires were used to explore MD adherence as the primary outcome, and dietary behavior sustainability, respectively. Sociodemographic, anthropometric, and lifestyle information was also collected. Results: The final sample included 1434 subjects (18-24; 60% female). The median (IQR) KIDMED score was 6.0 (4.0-8.0) and 33% showed a high adherence to the MD. Having breakfast, eating fruit and vegetables at least once a day, consuming pasta or other grains almost daily, and using olive oil at home were among the most common positive aspects of students' diets. However, regular consumption of fish, nuts, legumes, dairy products, and a second serving of fruit and vegetables was less prevalent. Having an active lifestyle, eating more plant products, and having more sustainable dietary behaviors in terms of the SHED index, were the main determinants of a high KIDMED score. Likewise, graduate students, daily consumers of plant-based meat alternatives, and students attending university canteens daily were more likely to adopt healthier diets. Conclusions: Future actions are crucial to create a food environment that facilitates healthy and sustainable dietary choices among young adults, such as improving the nutritional quality of processed products and regulating their promotion, as well as implementing initiatives to improve university food services and encourage the use of campus dining facilities.