Background/Objectives: Even with solid proof of its benefits for cardiovascular health and metabolism, adherence to the Mediterranean Diet (MD) in Spain has noticeably declined in recent years. The socioeconomic changes occurring in recent decades have prompted shifts in cooking habits and in how food is socially experienced, particularly among children and adolescents. The MD is more than just food: it is a cultural tradition and a lifestyle, rich in food and cooking skills, and food wisdom passed down over generations. When these practices fade, it affects both health and the environment, making them vital components in strengthening support for food knowledge, cooking abilities, and a healthier lifestyle. Considering these shifting dietary patterns and the growing need for targeted educational strategies, the present study aimed to investigate the association between cooking skills, MD-related health literacy, and adherence to the Mediterranean Diet across different developmental stages: childhood, adolescence, and adulthood in a sample of the Spanish population. Additionally, a secondary objective was to identify potential critical windows for intervention based on the strength of these associations. Methods: This cross-sectional study included 832 Spanish participants grouped by age: children and early adolescents (n = 408), older adolescents (n = 136), and adults (n = 288). Cooking skills were assessed using CooC11 for children and FCSk for older groups. Adults also completed Lit_MEDiet to assess MD-related health literacy. Adherence was measured with KIDMED (children/adolescents) and MEDAS (adults). Spearman correlations and standardized linear regressions were used. All statistical tests were two-sided, and statistical significance was set at p < 0.05. Results: In children, no significant association was found between cooking skills (CooC11) and KIDMED scores (β = 0.008; p = 0.875). Among adolescents, a strong positive association emerged between FCSk and KIDMED (β = 0.313; p < 0.001; ρ = 0.371), indicating a large, standardized effect and suggesting that this stage is particularly sensitive to food skills. In adults (18+), both food and cooking skills (FCSk) (β = 0.189; p = 0.001) and MD-related health literacy (Lit_MEDiet) (β = 0.187; p = 0.004) were moderately associated with MEDAS scores. Conclusions: These findings suggest that mid-adolescence could represent a favourable developmental window where food skills may hold potential to influence positive dietary behaviours. Regarding adults, the results indicate that combining practical and educational components appears to beneficial for dietary quality. Overall, this study supports the relevance of age-tailored public health strategies to potentially enhance long-term adherence to the Mediterranean Diet.

Reference budgets (RB) are illustrative priced baskets containing the minimum goods and services necessary for well-described types of families to have adequate social participation. Cross-country comparable food RB with the minimum cost were previously developed in 26 EU countries. However, sustainability was not considered. The aim of this paper is to present the development of healthy and sustainable food baskets for Spanish adults. This work follows the steps proposed in previous European projects to build RB: (1) revision of guidelines on healthy and sustainable eating and expert consultations, (2) translation into a concrete list of foods, (3) pricing. The results indicate that a sustainable diet can be cheaper than current recommendations when only the dietary content is considered, representing monthly savings of about EUR 7.27. This is mainly explained by the shift towards more plant-based proteins. Adding constraints on origin, packaging and seasonality increases the overall cost of the food basket by EUR 12.22/month compared with current recommendations. The Spanish Sustainable Food Reference Budget illustrates the cost of applying different criteria to improve dietary sustainability in the Spanish context, and can be useful to support the ecological transition, since providing different levels of adherence to a sustainable dietary pattern can ease its access across socioeconomic groups.

The Mediterranean diet, featuring sourdough bread, shows promise in managing metabolic syndrome. This study explored the effects of two sourdough breads, with differing fermentation times but similar nutritional profiles, on inflammation, satiety, and gut microbiota composition in adults with metabolic syndrome. In a double-blind clinical trial, participants were randomized to consume either Elias Boulanger^® long-fermentation (48 h) sourdough bread (EBLong) or Elias Boulanger^® short-fermentation (2 h) sourdough bread (EBShort) over a two-month period. We assessed clinical parameters, inflammatory biomarkers, satiety-related hormones, and the richness and abundance of gut microbiota at baseline and follow-up. The participants included 31 individuals (mean age, 67, 51.6% female). EBShort was associated with reduced levels of soluble intercellular adhesion molecule (sICAM), and all participants, regardless of the intervention, exhibited a decrease in sICAM and diastolic pressure from baseline (p < 0.017). At follow-up, plasminogen activator inhibitor-1 (PAI-1) levels were lower in EBShort (−744 pg/mL; 95%CI: −282 to −1210 pg/mL) compared to EBLong. No differences in microbiota richness or abundance were observed. EBShort bread was effective in reducing some inflammation markers. The consumption of sourdough bread may offer potential benefits in reducing inflammation markers in individuals with metabolic syndrome; however, longer fermentation times did not show additional benefits.

European welfare states are facing a growing demand for charitable food aid in the current economic and political climate. While efforts have been made to enhance the dignity of food aid and address limited access, it is crucial to consider the impact of food aid on health, given the detrimental consequences of inadequate nutrition across the lifespan. This study aims to assess the nutritional contribution of food packages distributed by food aid organizations in Barcelona (Spain) to the needs of four types of households. The data were collected biweekly for two months from three food aid organizations in Barcelona. Nutritional information was retrieved from the product label and food composition databases and compared to the European Food Safety Authority’s dietary reference values for four types of households. Results indicate that nutrient adequacy depends on the organization’s food provisioning capacity and household size, with larger households facing higher food insecurity risks. One-person households lacked protein, calcium, zinc, and vitamin D, while households with two or more people failed to meet most micronutrient needs. Additionally, the packages often exceeded recommendations for fat and sodium. These findings underscore the vulnerability of food aid recipients to nutritional insufficiency, particularly in households with children who may experience compromised growth and development. Limited resources and high demand generate food packages that do not meet users’ nutritional needs. This research in Spain emphasizes the urgency for policymakers to intervene in food aid organizations and guarantee the supply of food that meets minimum nutrient requirements.

Diet‐related challenges in primary care and community settings increasingly reflect the convergence of health, social and environmental pressures. Although dietitians routinely navigate this complexity, their system‐level contributions often remain implicit. This paper proposes a conceptual framework that positions dietitians as system builders and synthesises insights from systems science, health promotion and ecological models to articulate this role. Three interconnected roles illustrate how dietitians influence system behaviour: as integrators , they embed nutrition within institutional routines, information flows and care pathways; as connectors , they strengthen relationships across health, social, education, and food system actors; and as advocates , they shape organisational priorities and policy agendas related to equity, sustainability, and health. The analysis identifies enabling conditions, including supportive organisational structures, intersectoral collaboration, relevant policy frameworks and enhanced competencies in systems thinking and equity. It also notes common constraints such as siloed systems, workload pressures and role overload. Several leverage points emerge where targeted action can exert significant system‐level impact (e.g. through changes in care‐pathway information flows or links to community food resources). Recognising and consolidating these system‐building roles can enhance the visibility, legitimacy and effectiveness of dietitians' contributions. A systems‐oriented professional identity, supported by education, practice environments and policy infrastructures, can strengthen the profession's ability to influence the conditions shaping dietary behaviour, equity and sustainability.

Mediterranean diet, featuring sourdough bread, shows promise in managing metabolic syndrome. This study explored the effects of two sourdough breads with differing fermentation times but similar nutritional profiles on inflammation, satiety, and gut microbiota composition in adults with metabolic syndrome. The double-blind clinical trial randomized participants to consume over two-months Elias Boulanger® long fermentation (48h) sourdough bread (EBLong) or Elias Boulanger® short fermentation (2h) sourdough bread (EBShort). We assessed clinical parameters, inflammatory- and satiety-related biomarkers; and richness and abundance of gut microbiota at baseline and follow-up. 31 individuals (mean age: 67, 55.7% female) participated. EBShort was associated with reduced soluble intercellular adhesion molecule (sICAM) levels, and irrespective of the adjudicated intervention, all participants had a decrease in sICAM and diastolic pressure relative to baseline (p<0.017). At follow-up, plasminogen activator inhibitor-1 (PAI-1) levels were lower in EBShort (-744 pg/mL; 95%CI: -282 to -1210 pg/mL) compared to EBLong. High-quality sourdough bread may offer mild benefits in blood pressure and inflammation for those with metabolic syndrome, however, only EBLong was associated to reduced Enterobacteriaceae abundance. Further research is needed to understand potential benefits and mechanisms of sourdough bread in managing metabolic syndrome and improving cardiovascular health.