1Global Centre for Preventive Health and Nutrition (GLOBE), Deakin University, Geelong, Australia, 2School of Medicine, Deakin University, Geelong, Australia, 3Biostatistics Unit, Deakin University, Melbourne, Australia, 4Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, Australia, 5Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile.
Introduction. Tools for measuring adherence to sustainable healthy diets among children and adolescents are lacking. Objectives. To advance methods for measuring adherence to sustainable healthy diets among children and adolescents by adapting an existing index, illustrate the index calculation in a sample of Chilean pre-schoolers, and explore its association with diet characteristics. Methods. We adapted the Planetary Health Diet Index (PHDI) so that it better reflected the nutritional needs of children and adolescents. The adapted PHDI for children and adolescents (PHDI-C) comprises 16 components with a total score ranging from 0-150 points. A decision tree and food disaggregation methodology were developed to guide its application. Single 24-hour recalls collected from 958 Chilean children (4-6 years) were used to illustrate the difference between using the original PHDI and the adapted PHDI-C. Linear regression models adjusted by child’s gender and age were fitted to explore associations between total PHDI-C score, dietary recall characteristics, and nutritional composition of children’s diets. Results. Children’s total PHDI and PHDI-C scores were low, indicating low adherence to sustainable healthy diets. Median total score was higher when diets were scored using the adapted PHDI-C compared to the original PHDI (50.0 [IQR 39.5-59.8] vs 40.5 [IQR 32.4-49.0]). Low total scores were largely due to very low scores from the nuts & peanuts, legumes, dark green vegetables, whole cereals, tubers & potatoes, and added sugars components across both indices, and to minimal scores from the dairy products, eggs, and fish & seafood components when the original PHDI was applied. Mean total PHDI-C score was significantly lower on weekends and special occasions, and significantly higher when children reported having a special diet (e.g., vegetarian). Total PHDI-C score was negatively associated with total sugars, saturated fats, trans fats, and animal-based protein intake, and positively associated with total protein, plant-based protein, total carbohydrates, and total fiber intake. Conclusions. This study provides an index for measuring adherence to sustainable healthy diets among children and adolescents that can be used to monitor trends and measure the effectiveness of triple-duty actions aimed at improving child and planetary health.
Keywords: sustainable healthy diets; dietary index; Chilean children.