Miranda Agustín R, Vieux Florent, Maillot Matthieu, Verger Eric O
MoISA, University of Montpellier, CIHEAM-IAMM, CIRAD, INRAE, Institut Agro, IRD, Montpellier, France.
MS-Nutrition, Marseille, France.
Curr Dev Nutr. 2025 Feb 7;9(3):104565. doi: 10.1016/j.cdnut.2025.104565. eCollection 2025 Mar.
Measuring adherence to EAT-Lancet recommendations for healthy and sustainable diets is challenging, leading to diverse methods and a lack of consensus on standardized metrics. Available indices vary mainly in scoring systems, food components, units, energy adjustments, and cut-off points.
To evaluate and compare the measurement performance of 9 dietary indices for assessing adherence to EAT-Lancet reference diet.
This cross-sectional study utilized repeated 24-h dietary recall data from 1723 adults in the French Third Individual and National Study on Food Consumption Survey (INCA3, 2014-2015). Sociodemographic, nutritional, and environmental variables were analyzed to assess the validity and reliability of dietary indices.
The 4 indices assessing their food components with proportional scoring captured dietary variability, were less dependent on energy intake and converged to a large extent with nutritional indicators. Although the 3 binary indices showed a stronger correlation with environmental indicators, 1 proportional index converged with both domains. Indices had valid unidimensional structures, meaning that the combination of food components within each index accurately reflected the same construct, supporting the use of total scores. Furthermore, the indices differed between sociodemographic groups, demonstrating concurrent-criterion validity. Higher scores were associated with higher nutritional quality and lower environmental impact, but with unfavorable results for zinc intake, vitamin B12, and water use. A low concordance rate (32%-43%) indicated that indices categorized individuals differently.
Researchers must align study objectives with the applicability, assumptions, and significance of chosen indices. Indices using proportional scoring allow a global understanding of dietary health and sustainability, being advantageous in precision-focused research (for example, clinical trials or epidemiological research). Conversely, indices based on binary scoring offer a simplified perspective, serving as valuable tools for surveys, observational studies, and public health. Recognizing their strengths and limitations is crucial for a comprehensive assessment of diets and their implications.
衡量对《柳叶刀 - 饮食》健康和可持续饮食建议的依从性具有挑战性，导致方法多样且在标准化指标上缺乏共识。现有指数主要在评分系统、食物成分、单位、能量调整和切点方面存在差异。
评估和比较9种饮食指数在评估对《柳叶刀 - 饮食》参考饮食依从性方面的测量性能。
这项横断面研究利用了来自法国第三次个人和全国食物消费调查（INCA3，2014 - 2015年）中1723名成年人的重复24小时饮食回忆数据。分析了社会人口统计学、营养和环境变量，以评估饮食指数的有效性和可靠性。
4种通过比例评分评估其食物成分的指数能够捕捉饮食变异性，对能量摄入的依赖性较小，并且在很大程度上与营养指标趋同。虽然3种二元指数与环境指标的相关性更强，但1种比例指数在两个领域都有趋同。指数具有有效的单维结构，这意味着每个指数内食物成分的组合准确反映了相同的结构，支持总分的使用。此外，指数在社会人口统计学群体之间存在差异，证明了同时效度。较高的分数与较高的营养质量和较低的环境影响相关，但锌摄入量、维生素B12和用水量的结果不佳。较低的一致性率（32% - 43%）表明指数对个体的分类不同。
研究人员必须使研究目标与所选指数的适用性、假设和意义保持一致。使用比例评分的指数能够全面了解饮食健康和可持续性，在以精准为重点的研究（例如临床试验或流行病学研究）中具有优势。相反，基于二元评分的指数提供了一个简化的视角，是调查、观察性研究和公共卫生的宝贵工具。认识到它们的优势和局限性对于全面评估饮食及其影响至关重要。
