Choosing a healthy and sustainable diet: A three-level approach for understanding the drivers of the Italians' dietary regime over time.

Dietary patterns play key roles in health promotion and in preserving the environment. A growing number of studies show the importance of individual factors on food consumption choices, such as socio-economic status, lifestyle variables and contextual and social factors that characterize the geographical area in which individuals reside. The Mediterranean Diet is a sustainable diet that respects the environment, thus reducing per capita emissions from food production in respect to less sustainable diet. The aim of this paper is to determine the Italians' prevailing food patterns using a composite indicator and to identify which factors determine a higher adherence to the Mediterranean Diet in Italy. By using 15 waves of the ISTAT "Aspect of Daily Life" survey, we constructed an original data set and referred to the multilevel approach which enabled us to distinguish between temporal and cross-sectional effects thus providing valuable insights to policy makers and stakeholders in order to promote the Mediterranean Diet and reap environmental and public health. The results show that education plays an important role in determining food consumption behavior while the tendency to practice sports on a regular basis and to have breakfast and lunch at home positively influence people's adherence to this diet.