Abstract
Background and objectives: Current dietary patterns are the leading cause of morbidity and mortality worldwide, in addition to significantly contributing to natural resource scarcity, environmental degradation, and biodiversity loss. The general adoption of healthy diets with a low environmental impact is timely. While dietary screeners have been used widely to assess the nutritional adequacy of diets, no simple tool that considers both human and environmental dimensions has been developed. Methods: We developed REFRESH (Rapid Evaluation FoR an Environmentally Sustainable and Healthy diet), a 10-item screener that briefly assesses the dietary environmental sustainability and healthiness at once by evaluating habitual consumption of key food groups for a healthy and environmentally sustainable diet. The scoring criteria are based on the EAT-Lancet Commission, FAO, and WHO recommendations. Overall, REFRESH score ranges from 0 to 10 points, with 0 being the lowest and 10 being the highest for adopting an environmentally sustainable healthy diet. Subsequently, we conducted a validation study to evaluate the reliability and validity of REFRESH. In this study, 100 participants were asked to complete the screener’s questionnaire. The results were then compared with a 7-day food record completed in the following week. The questionnaire’s reliability was evaluated by comparing reported servings in both dietary assessments. Additionally, we evaluated the capacity of REFRESH´s scoring system to capture dietary quality and environmental impact. Results: Preliminary validation study results indicated a mean REFRESH score of 5.73 points (range: 1–8) among the participants. Comparing the REFRESH data to the food records, we found a good correlation among both dietary tools. However, we identified that participants tended to slightly overestimate their consumption of legumes, fruits, and vegetables while underestimating their consumption of highly processed foods. The diet of participants who scored higher included a larger proportion of whole plant-based foods. This pattern led to a higher intake of fiber, a lower intake of saturated fats, and a 20% lower environmental impact. Discussion: REFRESH is a valid instrument for rapid estimation of healthy and environmentally sustainable diets and, thus, can be useful for research and clinical practice. The availability of such a validated screener is crucial for promoting environmentally sustainable healthy dietary changes in the general population.
Author Contributions
Conceptualization, U.F., A.B. and G.C.; methodology, U.F., A.B. and G.C.; software, U.F., G.M. and A.B.; formal analysis, U.F.; investigation U.F. and A.B. resources, M.B.-R. and I.Z.; writing—original draft preparation, U.F. and A.B.; writing—review and editing, U.F., A.B., G.M., M.B.-R., I.Z., R.D.l.T. and G.C. All authors have read and agreed to the published version of the manuscript.
Funding
U.F. and G.C. acknowledge support from the Spanish Ministry of Science and Innovation and State Research Agency through the “Centro de Excelencia Severo Ochoa 2019–2023” program (CEX2018-000806-S) and support from the Generalitat de Catalunya through the Centres de Recerca de Catalunya program. GC has also been awarded with the grant RYC2021-033537-I, supported by MCIN/AEI/10.13039/501100011033 and by the European Union NextGenerationEU/PRTR.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki, and approved by the Comité de Ética de la Investigación con medicamentos del Parc de Salut Mar (observational study number 2023/10861) on Barcelona, 10 May 2023.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
The data sets generated during or analyzed during this study will be available at Open Science Framework.
Conflicts of Interest
The authors declare no conflict of interest.
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