The global food system, currently, fails to meet the need of the population, classifying it as being unsustainable [1,2], generating challenges in public health, environment, food safety, nutrition, and health [3]. On the other hand, mortality levels increase concerning all forms of malnutrition [4][5][6]. The most current statistics show that 2 billion adults are overweight or obese [1], while 820 million are undernourished or hungry [7]. It has been shown that the economy, culture, and social resources contribute to uneven development in health outcomes [8] such as weight gain and the development of Non-Communicable Diseases (NCDs) [9][10][11] with repercussions on the diet of the population. The mass commercialization of processed foods and the rapid distribution into low and middleincome markets [12][13][14] has resulted in the abandonment of traditional diets and the adoption of highly processed diets, which lack in nutritional quality [15]. In terms of a healthy and sustainable diet, the Mediterranean Diet (MD) meets all established standards.It is recognized as a healthy, affordable, and environmentally sustainable eating model [16][17][18] being a Healthy and Sustainable Diet (HSD). It is widely documented that its adherence is linked to multiple health benefits in humans [19]. Recent meta-analyses have associated high adherence to MD and a reduction in general ARTICLE INFO ABSTRACTThe poor eating habits in the first year of college could trigger health problems and academic performance in students. The change of environment when moving from their home or country to the university could contribute to the adoption of those inadequate habits, where nutritional educational interventions can improve the student's habits. There was evaluate the association of eating behaviors with adherence to a healthy and sustainable diet in multinational university students, establishing a foundational framework to create interventions that promote healthy eating habits. A cross-sectional study was conducted using print questionnaires to adherence to the Mediterranean diet and eating behaviors. The participants consist of three hundred university students from sixteen countries who voluntarily completed the surveys. The only eligibility criterion was to be a first-year student. The analysis was made by a descriptive statistic, correlational, ANOVA, and regression. The mean adherence for 300 students was 7.68 (low adherence). A total of 172 first-year students showed unhealthy and very unhealthy eating behaviors (57.3%). High adherence was observed only in four countries: Ecuador (n = 2; 3.1%), Guatemala (n = 1; 2.7%), Honduras (n = 3; 2.6%), and other countries (n = 1; 9.1%). Eating behaviors were the only predictor variable. These variables accounted for 15.3% of the variance in adherence to Mediterranean diet scores. In conclusion, Interventions and regulatory standards are needed, including policies supporting the development of healthful dietary behaviors using sustainable principles.