Background/Objectives: The cultural and socioeconomic changes to which societies are exposed can alter individuals’ lifestyles and dietary habits. The nutritional patterns of Mediterranean countries may also be affected by these factors at varying levels, depending on the changing social characteristics of the countries. This study aimed to determine Mediterranean diet (MedDiet) adherence among family members from four Mediterranean countries (Türkiye, Spain, Italy, and Lebanon). Methods: The survey was structured around sociodemographic data, family relationships, the Mediterranean diet adherence screener (MEDAS), the Mediterranean lifestyle index (MEDLIFE), the Mediterranean diet quality index (KIDMED), and the obstacles and drivers of MedDiet adherence. Results: The data were obtained from adults (n = 812), with the contribution of their children (n = 500) if they had any. According to the MEDAS, 22% of the adults strongly adhered to the MedDiet. Similar results were obtained when Mediterranean lifestyle adherence was analyzed using the MEDLIFE score, with 20% of the adults presenting a strong adherence, while significantly stronger adherence was found in Lebanon than in the other countries. Regarding the children and adolescents, around 30% presented strong adherence to the MedDiet. Price, availability, and accessibility were significant obstacles, whereas the perceptions of health and diet quality were identified as the drivers of the MedDiet. Conclusions: Overall, our results highlight the need for national policies to reduce the economic burden of healthy food options while encouraging equitable access to re-popularize the MedDiet pattern. Future research should focus on intervention strategies tailored to different age groups and socioeconomic backgrounds, the long-term impact of family-based strategies, and the cultural influences on MedDiet adherence.

Background/Objectives: Populations in Mediterranean countries are abandoning the traditional Mediterranean diet (MD) and lifestyle, shifting towards unhealthier habits due to profound cultural and socioeconomic changes. The SWITCHtoHEALTHY project aims to demonstrate the effectiveness of a multi-component nutritional intervention to improve the adherence of families to the MD in three Mediterranean countries, thus prompting a dietary behavior change. Methods: A parallel, randomized, single-blinded, and controlled multicentric nutritional intervention study will be conducted over 3 months in 480 families with children and adolescents aged 3–17 years from Spain, Morocco, and Turkey. The multi-component intervention will combine digital interactive tools, hands-on educational materials, and easy-to-eat healthy snacks developed for this study. Through the developed SWITCHtoHEALTHY app, families will receive personalized weekly meal plans, which also consider what children eat at school. The engagement of all family members will be prompted by using a life simulation game. In addition, a set of activities and educational materials for adolescents based on a learning-through-playing approach will be codesigned. Innovative and sustainable plant-based snacks will be developed and introduced into the children’s dietary plan as healthy alternatives for between meals. By using a full-factorial design, families will be randomized into eight groups (one control and seven interventions) to test the independent and combined effects of each component (application and/or educational materials and/or snacks). The impact of the intervention on diet quality, economy, and the environment, as well as on classical anthropometric parameters and vital signs, will be assessed in three different visits. The COM-B behavioral model will be used to assess essential factors driving the behavior change. The main outcome will be adherence to the MD assessed through MEDAS in adults and KIDMED in children and adolescents. Conclusions: SWITCHtoHEALTHY will provide new insights into the use of sustained models for inducing dietary and lifestyle behavior changes in the family setting. It will facilitate generating, boosting, and maintaining the switch to a healthier MD dietary pattern across the Mediterranean area. Registered Trial, National Institutes of Health, ClinicalTrials.gov (NCT06057324).

Background/Objectives: Modern families face challenges in maintaining healthy and sustainable diets due to time constraints and busy lifestyles. The Mediterranean diet (MD), known for its benefits to both personal health and environmental sustainability, is often difficult to apply consistently within households. This paper presents and validates the SWITCHtoHEALTHY AI-based Family Nutrition Recommendation System, designed to generate meal plans aligned with MD guidelines. Methods: Two complementary recommendation engines were developed: the AI-based Family Nutritional Recommender, which creates personalized meal plans for adults that include shared family meals, and the Child Nutritional Recommender, which generates meal plans for children that could also incorporate school menus or proposals from the school cafeteria. Both systems rely on an expert-validated dataset of Mediterranean foods and are designed to comply with the expert-validated nutritional rules based on MD principals and national dietary guidelines. Results: The recommendation systems were validated using data from a real-world family intervention, achieving 90% accuracy in generating meal plans for all family members, while meeting the expert validated dietary rules for both adults and children. Moreover, AI-based Family Nutritional Recommender exceeds 90% accuracy in estimating calorie and nutrient content for adults. Conclusions: The results demonstrate the preliminary potential of AI-based recommendation systems to facilitate healthier and more sustainable dietary habits within modern households by generating personalized, nutritionally balanced family meal plans consistent with MD principles.

Adolescents are increasingly moving away from the Mediterranean Diet (MD), raising concerns for their long-term health. Since adolescence is crucial for shaping eating habits, school-based interventions offer an opportunity to promote healthier choices. Nutrition and sensory education can influence food attitudes and behaviors, but their combined effects are not well understood. This study tested school-based nutrition and sensory education programs, alone or combined, with daily exposure to a healthy, unfamiliar snack, on Italian adolescents' food knowledge, attitudes, and behaviour. A total of 197 students (aged 14-17) were assigned to one of four groups: Control, Nutrition, Sensory, or Nutrition and Sensory. Over four weeks, participants received targeted lessons and were offered a healthy snack each day. Data were collected at baseline, post-intervention, and at a two-month follow-up. Key outcomes included nutritional knowledge, adherence to the MD (KIDMED), food neophobia, picky eating, food choices, and acceptance of healthy snacks. Nutrition education improved nutritional knowledge and the ability to identify MD foods, with partial retention at follow-up. However, daily dietary habits showed little changes. Sensory education increased snack consumption and willingness to try unfamiliar foods. No significant changes were observed in food neophobia or picky eating. These findings highlight the value of integrating diverse, experience-based strategies into school settings to support the development of food knowledge and healthier food choices in adolescence.