A Novel Dietary Assessment Method to Measure a Healthy and Sustainable Diet Using the Mobile Food Record: Protocol and Methodology.

A range of metrics have been developed and used to measure components of dietary patterns (e.g., adequacy, quality, diversity). However, no existing dietary metric simultaneously captures the three key dimensions of sustainable healthy diets recommended by the Food and Agriculture Organization of the United Nations and the World Health Organization: food processing; dietary diversity; and intake of animal products(1). This study aimed to identify indicators of a global sustainable healthy diet and translate these features into a multidimensional diet quality score (SUSDIET). Informed by our scoping review(1), a Delphi method was adopted in the form of a three-round online survey of 13 national and international experts in nutritional epidemiology, environmental health, dietary assessment and/or food and nutrition policy. Surveys were conducted between November 2022 and May 2023. Participants were asked about procedures to establish an operational definition for a global sustainable healthy diet. Based on consensus from global experts, we developed the SUSDIET, a food-based diet quality score incorporating variety of plant foods, intake of animal products, and dietary contribution of ultra-processed foods (the ‘dimensions’). Categories and amounts of foods consumed were informed by the Global Diet Quality Score(2), EAT Lancet Planetary Health(3) and a meta-analysis of the relationship between ultra-processed foods and all-cause mortality(4). The variety of plant foods is measured based on 12 food groups (citrus fruits, deep orange fruits, other fruits, dark green leafy vegetables, cruciferous vegetables, deep orange vegetables, other vegetables, legumes, deep orange tubers, nuts and seeds, whole grains, white roots and tubers), animal intake based on 5 food groups (egg, dairy, poultry, fish and seafood, red meat), and ultra-processed foods as one food group. Three categories of consumed amounts (in grams per day) are defined for variety of plant foods and animal intake, scoring as 0, 0.5 or 1. Ultra-processed food consumption is scored as 0 or 1 using ≤10% or >10% of total dietary intake as cut-offs. The components of each dimension are weighted so the three dimensions equally range from 0-5. SUSDIET overall score ranges from 0-15 (up to 5 points per dimension), with a higher score indicating a more healthy and sustainable diet. SUSDIET will be of immediate use for research aiming to assess the impact of diets on both health and environmental sustainability outcomes among the general adult population. This multidimensional diet quality score can also be used to inform and assess the effectiveness of policy actions that promote sustainable healthy diets, including the monitoring and surveillance of diets globally.

Region-specific nutritious, environmentally friendly, and affordable diets in India

Healthy and sustainable diets promote individual health and well-being while minimizing environmental impact. Although the concept of sustainable diets has gained increasing attention, the extent to which nutritional adequacy aligns with overall dietary sustainability remains unclear, particularly in the Portuguese context, where dietary patterns reflect both Mediterranean and Western influences. The study aims to assess the association between sustainable and healthy diet adherence and nutritional adequacy among Portuguese adults. Data was gathered using a self-administered questionnaire between October and December 2022 from 347 adults. The Sustainable and Healthy Eating Diet index was used to assess adherence to a sustainable and healthy diet. A semi-quantitative food frequency questionnaire was used to record dietary consumption. Nutrient inadequacy was defined as an intake below the dietary reference values set by the European Food Safety Authority for 18 selected nutrients. The prevalence of inadequacy for dietary fibre, vitamins A, E, C, folate and potassium was higher in participants with low adherence to a sustainable and healthy diet. After adjusting for confounders, participants with higher adherence to a sustainable and healthy diet were less likely to have inadequate intake of dietary fibre (OR = 0.14, 95% CI: 0.06,0.32), vitamin A (OR = 0.11, 95% CI: 0.02, 0.54), vitamin E (OR = 0.13, 95% CI: 0.06, 0.29), B6 (OR = 0.26, 95% CI: 0.09, 0.81), folate (OR = 0.14, 95% CI: 0.06, 0.31), vitamin C (OR = 0.19, 95% CI: 0.09, 0.43), selenium (OR = 0.35, 95% CI: 0.12, 0.99), and potassium (OR = 0.19, 95% CI: 0.07, 0.51). Participants with higher adherence to a sustainable and healthy diet were also less likely to have six or more inadequacies in nutrient intake (OR: 0.08, 95% CI: 0.03, 0.23). Individuals who more closely follow a sustainable and healthy diet tend to achieve better nutritional adequacy.

Background/Objectives: To promote sustainable and healthy diets, increased consumption of pulses (the edible grains of legumes) is recommended. Adolescence is a period in which perceptions and behaviours develop that can impact lifelong dietary behaviours. Therefore, this study aimed to understand how Australian adolescents perceive healthy, sustainable diets and perceive and consume pulses. Methods: Students (11-17 years old, median = 15 years, n = 33) in Brisbane, Australia, participated in school-based face-to-face focus groups and an online survey. Results: Students' perceptions of healthy and sustainable dietary behaviours largely focused on the health aspects of food and consideration of food waste. The main factors that adolescents identified as influencing the health and sustainability of their diet were a lack of perceived responsibility for the impact of their meal choices and lack of knowledge of what constitutes a healthy and sustainable diet. Most students were unfamiliar with the term 'pulses' and lacked a desire to consume pulses more often. Consumption of pulses was below recommendations in national and international dietary guidelines. The main factors that adolescents identified as influencing pulse consumption related to students' lack of capability to prepare pulses and the limited opportunities to access pulse-based foods. Conclusions: Perceptions of sustainable diets and pulses were very limited, and a lack of knowledge, skills, and limited availability were identified as barriers to their consumption. Education and cooking classes, in conjunction with increased availability of tasty pulse foods, are recommended to increase students' pulse consumption as part of a healthy and sustainable diet.

BackgroundEarly adulthood represents the transition to independent living which is a period when changes in diet and body weight are likely to occur. This presents an ideal time for health interventions to reduce the effect of health problems and risk factors for chronic disease in later life. As young adults are high users of mobile devices, interventions that use this technology may improve engagement. The Connecting Health and Technology study aimed to evaluate the effectiveness of tailored dietary feedback and weekly text messaging to improve dietary intake of fruit, vegetables and junk food over 6 months among a population-based sample of men and women (aged 18–30 years).MethodsA three-arm, parallel, randomized control trial was conducted. After baseline assessments, participants were randomized to one of three groups: A) dietary feedback and weekly text messages, B) dietary feedback only or C) control group. Dietary intake was assessed using a mobile food record App (mFR) where participants captured images of foods and beverages consumed over 4-days at baseline and post-intervention. The primary outcomes were changes in serves of fruits, vegetables, energy-dense nutrient-poor (EDNP) foods and sugar-sweetened beverages (SSB). The intervention effects were assessed using linear mixed effect models for change in food group serves.ResultsYoung adults (n = 247) were randomized to group A (n = 82), group B (n = 83), or group C (n = 82). Overall, no changes in food group serves for either intervention groups were observed. An unanticipated outcome was a mean weight reduction of 1.7 kg (P = .02) among the dietary feedback only. Men who received dietary feedback only, significantly reduced their serves of EDNP foods by a mean of 1.4 serves/day (P = .02). Women who received dietary feedback only significantly reduced their intake of SSB (P = .04) by an average of 0.2 serves/day compared with controls.ConclusionsTailored dietary feedback only resulted in a decrease in EDNP foods in men and SSB in women, together with a reduction in body weight. Using a mobile food record for dietary assessment and tailored feedback has great potential for future health promotion interventions targeting diet and weight in young adults.Trial RegistrationAustralian Clinical Trials Registry Registration number: ACTRN12612000250831.

Adopting a sustainable diet is an alternative to address the pandemics of obesity, undernutrition and climate change that are threatening human health. Sustainable diet considers the health aspect as well as the environmental impact of diets. There is a scarcity of research on sustainable diet and lack validated tools for its measurement. This article aimed to describe the protocol on the development and validation of a Sustainable Diet Index (SDI) among Malaysian adults. A Sustainable Diet Index (SDI) was developed based on previous studies and available dietary guidelines on sustainable diet. Five indicators (rice, animal-based food, plant-based food, food waste and packaging) were included in the SDI. The index will be validated among Malaysian adults using mobile food record as the dietary assessment tool. The index has the potential to measure the level of healthy and sustainable diet behaviour of an individual. The use of mobile food record provides images of each eating occasion for the evaluation of serving size and the information on waste management. Health and environmental impacts from the diet can be evaluated through the integration of all indicators in the SDI. The index developed is novel and expected to provide a feasible measurement to assess the level of sustainable diet of an individual.

<scp>IFST</scp> vision for a <scp>UK</scp>‐wide national food strategy

Adherence of Gambian Diets to EAT-Lancet Diet Recommendations for Health and Sustainability

Providing a growing global population with healthy and sustainable diets is an immediate challenge. In the current study, estimates were obtained for the environmental footprints (land, water, and greenhouse gas (GHG) emissions) in association with the Mediterranean diet (MED) and the EAT-Lancet reference diet, which represents a healthy diet derived from sustainable food systems. We used a newly developed Sustainable Healthy Diet (SHED) index that was validated for the Israeli population by Tepper et al. in 2020.MethodsA group of 525 participants were recruited via social media, email, and phone. Demographic characteristics, quality of life, and answers to the SHED-index questionnaire were obtained. Dietary assessment was performed using the 116-item Food Frequency Questionnaire (FFQ), which was developed for the Israeli population. Adherence to the MED was calculated using a 9-point score. Adherence to the EAT-Lancet reference diet was assessed through the consumption of 14 food components. The environmental pressure of these dietary patterns was determined based on the “footprint family indicators,” which include land, water, and carbon footprints per unit of agricultural and food products. We assigned values for each food comprising the FFQ and calculated the environmental load for each dietary pattern. Statistical analyses were performed using the R package version 4.1.1 to compare environmental footprint values according to tertiles of the MED score, EAT-Lancet score, and SHED score.ResultsThe participants (n = 525) were 49% women, educated (82% had academic education), and physically active, and only 13% were smokers. The highest tertiles of adherence to the MED, adherence to the EAT-Lancet reference diet, and the SHED index were associated with the lowest GHG emissions and land use, as well as higher water use. Meat consumption contributed the most to land use, while dairy contributed the most to GHG emissions, and fruits contributed the most to water use.ConclusionsOur analysis reveals that animal protein is the highest contributor to GHG emissions and land use, while fruits and vegetables contribute the most to water consumption. Nevertheless, most of the fruits and vegetables are grown using treated wastewater, which reduces environmental pressure. Given these findings, we suggest that MED and EAT-Lancet dietary patterns should be included in national dietary guidelines.

There are limited methods to assess how dietary patterns adhere to a healthy and sustainable diet. The aim of this study was to develop a theoretically derived Healthy and Sustainable Diet Index (HSDI). The HSDI uses 12 components within five categories related to environmental sustainability: animal-based foods, seasonal fruits and vegetables, ultra-processed energy-dense nutrient-poor foods, packaged foods and food waste. A maximum of 90 points indicates the highest adherence. The HSDI was applied to 4-day mobile food records (mFRTM) from 247 adults (18–30 years). The mean HSDI score was 42.7 (SD 9.3). Participants who ate meat were less likely to eat vegetables (p < 0.001) and those who ate non-animal protein foods were more likely to eat more fruit (p < 0.001), vegetables (p < 0.05), and milk, yoghurt and cheese (p < 0.05). After adjusting for age, sex and body mass index, multivariable regression found the strongest predictor of the likelihood of being in the lowest total HSDI score tertile were people who only took a bit of notice [OR (95%CI) 5.276 (1.775, 15.681) p < 0.005] or did not pay much/any attention to the health aspects of their diet [OR (95%CI) 8.308 (2.572, 26.836) p < 0.0001]. HSDI provides a new reference standard to assess adherence to a healthy and sustainable diet.

The Food and Agriculture Organization of the United Nations and the World Health Organization recommend reducing the intake of ultra-processed foods whilst promoting diets rich in diverse plant foods and with appropriate amounts of animal products. Yet no existing metric simultaneously captures these dimensions of sustainable healthy diets. This study aimed to develop and evaluate a multidimensional diet quality score for sustainable healthy diets (SUSDIET). Consensus from experts on procedures to establish an operational definition for a global sustainable healthy diet were used for the development of SUSDIET. Data on adults (≥19 years, n=5000) from the Australian National Nutrition and Physical Activity Survey 2011-12 were used to evaluate SUSDIET. Mean scores of the SUSDIET were analysed according to participants characteristics. Regression models were used to assess the associations between SUSDIET and intake of nutrients and cardiometabolic health outcomes (indicators of adiposity and hypertension). We developed SUSDIET, a food-based diet quality score incorporating variety of plant foods (12 food groups), intake of animal products (5 food groups), and ultra-processed foods (1 food group). SUSDIET overall score ranges from 0 to 15, with a higher score indicating a more healthy and sustainable diet. Among Australian adults, SUSDIET overall score was 5.83±0.03 (range 0.21-10.80), and was associated with a healthier nutrient profile and lower odds of obesity and abdominal obesity. SUSDIET will support research aiming to assess the impact of diets on both health and environmental sustainability outcomes among the general adult population and inform diet monitoring globally.

It is widely upheld that global food systems are unsustainable. Sustainable diets are gaining prominence as key components to entangle global food system challenges, as well as to transition towards the pathway of the 2030 Agenda and the Sustainable Development Goals (SDGs). Hence, sustainable and healthy diets are at the core of much research with the aim to bring together nutritional adequacy, cultural acceptability, environmental sustainability, economic affordability, and shape future consumption patterns. This article contributes to advancing knowledge on sustainable diets by proposing a True Cost Accounting method to assess the cost and impact of the adoption of a more sustainable and healthier diet, using Italy as an illustration. The research analyses the complexity of a diet from an environmental, health, and socioeconomic point of view and defines a new assessment framework that can be replicated and adapted to other contexts. Results show that in Italy, the adoption of a sustainable and healthy diet has a 47% lower carbon footprint and 25% lower water footprint than the current diet, while impacting 13% less on the average income and food monthly expenditure. Also, the desirable diet has a 21% lower impact on the sanitary costs related to cardiovascular disease. This study corroborates that the consumption of the desirable diet would provide a total cost saving of 741 EUR per year per capita, if we consider its impact on the environment, health, and socio-economic costs.

Toward a healthy and sustainable diet in Mexico: where are we and how can we move forward?

PurposeWe developed a diet quality index based on the Planetary Health Diet (PHD) to assess healthy and sustainable diets. The index was applied alongside socio-demographic characteristics in five regions across Europe and North Africa.MethodsThe Sustainable Healthy Diet Index (SHDI) was designed using existing and validated healthy diet indexes. A total of 2,210 respondents from five case study territories (CST)—Cilento (Italy), Copenhagen (Denmark), North Hessia (Germany), Kenitra (Morocco) and Warsaw (Poland)—completed a food-group frequency questionnaire. Reported consumption frequencies for 24 food groups were converted to grams to assess compliance with PHD recommendations. A higher SHDI score indicates a more sustainable and healthier diet, although the environmental and health impacts are not directly assessed but are estimated based on intake at the food group level.ResultsCopenhagen and Warsaw showed the highest SHDI scores, indicating better adherence to the PHD. In North Hessia, males had significantly better diet quality than females (p < 0.001). In Poland, female respondents with higher income and education had significantly better diet quality (p < 0.05). Compared to national studies, some food group intakes were unexpected, for example, high legume consumption in Copenhagen and high meat intake in Kenitra. Despite the Mediterranean diet being typical for Cilento, vegetable intake there was low.ConclusionSome regions, such as Copenhagen, Kenitra, and Cilento, show beneficial eating patterns, particularly high legume intake. However, meat remains overconsumed in most CSTs. Our study highlights the need for further research to promote cultural acceptance of healthier and more sustainable dietary habits, such as increasing vegetable consumption and reducing meat intake.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00394-025-03793-9.

BackgroundSustainable nutrition is based on foods with a low environmental impact, accessible and affordable, ensuring protection of the biodiversity, while including the cultural elements of each geographical region. The present cross-sectional study aimed to evaluate adherence to a sustainable diet and the perceived environmental benefit of adopting a sustainable diet among adults in Greece.MethodsThe Sustainable HEalthy Diet (SHED) questionnaire evaluated sustainable nutrition practices and awareness in a sample of 607 adult Greeks recruited through social media.ResultsA positive association was revealed between healthy eating, a plant-based diet and organic awareness. Healthy eating was related to the consumption of low-salt and low-sugar products, avoiding added salt and ultra-processed foods (UPFs), as well as limiting sweets and soft drinks. Most participants (94.6%) were flexitarians, consuming meat instead of plant-based foods, although showing a preference for legumes over meat products. Most (86.8%) failed to meet the 5-a-day recommendations for fruit and vegetables, which were bought mainly from supermarket chains, with men resolving to electronic commerce purchases, while women preferring small, local grocery shops. Most responders consumed tap water (54.9%) and homemade meals daily (75.0%). Many participants (32.8%) reported separating and recycling food scraps at home, using neighborhood composters. When organic produce was selected, this involved mainly fruits and vegetables. Between men and women, the latter adopted a plant-based diet to a greater extent, consumed fewer soft drinks, were keener to consume local produce, limit meat intake and eat crops that are pesticide- and herbicide-free. Overall, Greek consumers show preference to local products. Most of them fail to compost and cut down on meat intake. The tool’s internal consistency measured by Cronbach alpha was 0.702 and 0.736 for the healthy eating and sustainable eating domains respectively, 0.798 for the environmental domain, while the other domains had lower scores due to contradictory questions. Our Confirmatory Factor Analysis (CFA) demonstrated a good fit (CFI = 0.896, TLI = 0.87) with strong positive relationships between healthy eating, a plant-based diet and organic awareness.ConclusionsThe results indicate that adult Greeks more easily implement some aspects of sustainable nutrition (organic, local foods), while others appear more difficult (compost, reduce meat intake). Nonetheless, the results can be useful in designing interventions to increase dietary sustainability awareness among Greeks, including educational programs and improved infrastructures.