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Implementing nutritional guidelines: a public health perspective An often-overlooked yet important limitation in nutritional research and in the development of guidelines is the study of individual dietary patterns as determined by food systems, food environment and the availability and affordability of healthy foods.From a research perspective, Mediterranean cities present unique characteristics in terms of diversity of small food stores and public markets, whose accessibility is paramount if we want to effectively stir dietary and lifestyle habits toward healthier profiles [77,78] (Fig.Within the Heart Healthy Hoods (HHH) project (https:// hhhproject.eu, funded by the European Research Council), researchers are studying the association between the Mediterranean food environment, adherence to the Mediterranean diet, and related chronic diseases [78,79].Different urban characteristics relate to heart disease and its risk factors including dietary patterns, hypertension, diabetes and obesity [76]. 1).

Implementing nutritional guidelines: a public health
perspective
An often-overlooked yet important limitation in nutritional research and in the development of guidelines is the
study of individual dietary patterns as determined by food
systems, food environment and the availability and
affordability of healthy foods.
Food systems refer to the elements and activities
related to the production, processing, distribution, preparation and consumption of food, and its related health,
socio-economic, and environmental outcomes [73]. The
local food environment is defined as the physical and
socio-cultural context in which consumers engage with
the food system to acquire, prepare and consume food. The
key elements of the food environment are: physical and
economic food access; food promotion and advertising;
and food quality and safety [74]. Thereby, food environments shape people’s diets, and their diet-related health
outcomes [75]. Different urban characteristics relate to
heart disease and its risk factors including dietary patterns,
hypertension, diabetes and obesity [76]. In this respect,
cities offer great opportunities to improve food environments and residents’ dietary patterns. It is noteworthy that
66% of the world population will live in cities by 2050.
From a research perspective, Mediterranean cities present
unique characteristics in terms of diversity of small food
stores and public markets, whose accessibility is
paramount if we want to effectively stir dietary and lifestyle habits toward healthier profiles [77,78] (Fig. 1).
Within the Heart Healthy Hoods (HHH) project (https://
hhhproject.eu, funded by the European Research Council),
researchers are studying the association between the
Mediterranean food environment, adherence to the
Mediterranean diet, and related chronic diseases [78,79].
An important gap in the current literature is the study of
healthy food affordability, in terms of Mediterranean diet
costs, and its influence on diet quality.