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Many Mediterranean countries, including Lebanon, are experiencing a shift in food consumption away from the traditional Mediterranean diet (MD), concomitant with the escalating burden of non-communicable diseases and dwindling environmental resources. Objective: to examine the adherence to the MD and its association with environmental footprints (EFPs), including water use, energy use, and greenhouse gas (GHG) emissions, among Lebanese adults. Data of Lebanese adults were drawn from the national food consumption survey (n = 2610). Assessment of dietary intake was conducted using a food-frequency questionnaire. Adherence to the MD was examined using four published MD scores. Metrics for the EFPs were calculated using a review of existing life cycle assessments (LCAs). For all MD scores, less than 13% of participants were in the highest tertile. After adjustments for covariates, two of the MD scores were associated with lower water use. For GHG, significant inverse associations were observed with all MD scores. Energy use was not associated with MD scores. Overall, low adherence to the MD among Lebanese adults was observed, together with an inverse association between adherence to the MD and water use and GHG emissions. These findings support and enforce ongoing efforts that aim to increase adherence to the MD in order to address health issues, as well as tackle environmental sustainability.

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