The EAT-Lancet Commission has proposed a planetary health diet. We propose the development of the Planetary Health Diet Index (PHDI) based on this proposed reference diet. We used baseline dietary data obtained through a 114-item FFQ from 14,779 participants of the Longitudinal Study on Adult Health, a multicenter cohort study conducted in Brazil. The PHDI has 16 components and a score from 0 to 150 points. Validation and reliability analyses were performed, including principal component analyses, association with selected nutrients, differences in means between groups (for example, smokers vs. non-smokers), correlations between components and total energy intake, Cronbach’s alpha, item-item correlations, and linear regression analysis between PHDI with carbon footprint and overall dietary quality. The mean PHDI was 60.4 (95% CI 60.2:60.5). The PHDI had six dimensions, was associated in an expected direction with the selected nutrients and was significantly (p < 0.001) lower in smokers (59.0) than in non-smokers (60.6). Cronbach’s alpha value was 0.51. All correlations between components were low, as well as between components and PHDI with total energy intake. After adjustment for age and sex, the PHDI score remained associated (p < 0.001) with a higher overall dietary quality and lower carbon footprint. Thus, we confirmed the PHDI validity and reliability.

Diets are simultaneously connected with population health and environment. The EAT-Lancet Commission proposed a sustainable reference diet to improve population health and respect the planetary boundaries. Recently, the Planetary Health Diet Index (PHDI) has been developed to assess the adherence to this reference diet. In the present study, we aimed to evaluate the adherence to the EAT-Lancet diet through the PHDI in a nationwide population-based study carried out in Brazil. We used data from the National Dietary Survey conducted through the Household Budget Survey in 2017–2018, with 46,164 Brazilians aged over 10 years old. Food consumption was evaluated with a 24 h dietary recall. The average PHDI total score in the Brazilian population was 45.9 points (95% CI 45.6:46.1) on a total score that can range from 0 to 150 points. The adherence to EAT-Lancet diet was low among all Brazilian regions. Women, elderly, those overweighed/obese, with higher per capita income and living in the urban area had higher scores in the PHDI. In general, the Brazilian population presented low adherence to a healthy and sustainable dietary pattern and seems far from meeting the EAT-Lancet recommendations.

OBJETIVO: Avaliar a evolução da ingestão de energia e nutrientes e a prevalência de inadequação da ingestão de micronutrientes segundo características sociodemográficas e regiões brasileiras. MÉTODOS: Foi analisado o consumo alimentar de 32.749 indivíduos do Inquérito Nacional de Alimentação da Pesquisa de Orçamentos Familiares de 2008–2009, por dois registros alimentares, e de 44.744 indivíduos a partir de dois recordatórios de 24 horas em 2017–2018. Estimaram-se a ingestão usual e o percentual de indivíduos com consumo abaixo da necessidade média para cálcio, magnésio, fósforo, cobre e zinco, vitaminas A, C, D, E, tiamina, riboflavina, piridoxina e cobalamina. A ingestão de sódio foi comparada ao valor de referência para reduzir risco de doenças crônicas. As análises foram estratificadas por sexo, faixa etária, região e renda. RESULTADOS: A ingestão energética diária média foi de 1.753 kcal em 2008–2009 e 1.748 kcal em 2017–2018. As prevalências de inadequação mais elevadas (> 50%) nos dois períodos foram de cálcio, magnésio, vitaminas A, D e E, piridoxina e, somente entre adolescentes, fósforo. Houve aumento na prevalência de inadequação de vitamina A, riboflavina, cobalamina, magnésio e zinco entre as mulheres, e de riboflavina entre os homens. A prevalência de inadequação diminuiu para a tiamina. A ingestão de sódio foi excessiva em aproximadamente 50% da população nos dois períodos. As variações mais altas (cerca de 50%) nas prevalências de inadequação entre os extremos de renda (< 0,5 salário-mínimo e > 2 salários-mínimos per capita) foram observadas para vitamina B12 e C nos dois períodos. As regiões Norte e Nordeste apresentaram maiores prevalências de inadequação. CONCLUSÃO: Ambos os inquéritos verificaram prevalências elevadas de inadequação de ingestão de nutrientes e consumo excessivo de sódio. A inadequação varia de acordo com os estratos de renda, aumentando nas regiões mais pobres do país.

Predictive iron bioavailability (FeBio) methods aimed at evaluating the association between diet and body iron have been proposed, but few studies explored their validity and practical usefulness in epidemiological studies. In this cross-sectional study involving 127 women (18–42 years) with presumably steady-state body iron balance, correlations were checked among various FeBio estimates (probabilistic approach and meal-based and diet-based algorithms) and serum ferritin (SF) concentrations. Iron deficiency was defined as SF < 15 µg/L. Pearson correlation, Friedman test, and linear regression were employed. Iron intake and prevalence of iron deficiency were 10.9 mg/day and 12.6%. Algorithm estimates were strongly correlated (0.69≤ r ≥0.85; p < 0.001), although diet-based models (8.5–8.9%) diverged from meal-based models (11.6–12.8%; p < 0.001). Still, all algorithms underestimated the probabilistic approach (17.2%). No significant association was found between SF and FeBio from Monsen (1978), Reddy (2000), and Armah (2013) algorithms. Nevertheless, there was a 30–37% difference in SF concentrations between women stratified at extreme tertiles of FeBio from Hallberg and Hulthén (2000) and Collings’ (2013) models. The results demonstrate discordance of FeBio from probabilistic approach and algorithm methods while suggesting two models with best performances to rank individuals according to their bioavailable iron intakes.

Existing methods for assessing food consumption are subject to measurement errors, especially the underreporting of energy intake, characterized by reporting energy intake below the minimum necessary to maintain body weight. This study aimed to compare the identification of energy intake underreporters using different predictive equations and instruments to collect dietary data. The study was conducted with 101 selected participants in the third wave of the Longitudinal Study of Adult Health (ELSA-Brasil) at the University Hospital of the University of São Paulo. For the dietary assessment, we applied a food frequency questionnaire (FFQ), two 24-hour diet recall (24hR) using the GloboDiet software, and two 24hR using the Brasil-Nutri software. The energy intake underreport obtained from the FFQ was 13%, 16%, and 1% using the equations proposed by Goldberg et al. (1991), Black (2000), and McCrory et al. (2002), respectively. With these same equations, the 24hR described an underreport of 9.9%, 14.9%, and 0.9% respectively with the GloboDiet software and 14.7%, 15.8%, and 1.1% respectively with the Brasil-Nutri software. We verified a low prevalence of underreported energy intake among the three self-report-based dietary data collection methods (FFQ, 24hR with GloboDiet, and Brasil-Nutri). Though no statistically significant differences were found among three methods, the equations for each method differed among them. The agreement of energy intake between the methods was very similar, but the best was between GloboDiet and Brasil-Nutri.