Fresán Ujué, Boronat Anna, Zazpe Itziar, Bes-Rastrollo Maira, Buekers Joren, de la Torre Rafael, Chevance Guillaume
ISGlobal, Barcelona, Spain.
Integrative Pharmacology and Systems Neurosciences Research Group, Neurosciences Research Program, Hospital del Mar Research Institute, Barcelona, Spain.
J Nutr. 2025 Jul;155(7):2122-2131. doi: 10.1016/j.tjnut.2025.05.029. Epub 2025 May 24.
The urgency of promoting sustainable diets, coupled with limited knowledge of dietary sustainability among health professionals, highlights the need for simple tools to assist in advocating for such diets in clinical settings.
We aimed to design a dietary screener to assess dietary healthiness and environmental sustainability, and validate it.
Rapid Evaluation FoR Environmentally Sustainable and Healthy diets (REFRESH) is a dichotomous tool targeting 10 key food groups for healthy diets with low environmental impacts. Each food group is scored as either 0 or 1 point, resulting in a total score ranging from 0 to 10-where 0 indicates the lowest and 10 the highest adherence to an environmentally sustainable and healthy diet. Internal consistency was assessed using the Kuder Richardson-20 (KR-20) coefficient. REFRESH's relative validity was compared against food diaries, evaluating item agreement, and using Bland-Altman analysis for the total REFRESH score. Cross-classification was tested in low, medium, and high adherence to sustainable healthy diets, along with weighted kappa index. Construct validity was evaluated through Pearson correlation between REFRESH-derived scores and health-promoting and detrimental food groups and nutrients, and environmental impact indicators, as derived from food diaries.
REFRESH had a KR-20 coefficient of 0.70, indicating good internal consistency. It showed high agreement with food diaries (60%-88% item agreement), and Bland-Altman analysis indicated that mean REFRESH scores were 1.1 points higher than food diaries. Cross-classification showed 59% agreement between methods, with only 1% of participants misclassified in the opposite category. REFRESH-derived scores positively correlated with health-promoting food groups and nutrients, and negatively with detrimental ones. Higher scores were linked to reduced environmental impacts.
REFRESH has demonstrated good validity for assessing dietary healthiness and environmental sustainability, helping identify individuals with suboptimal diets. REFRESH can be downloaded from https://osf.io/avby9/.
推广可持续饮食的紧迫性，加上健康专业人员对饮食可持续性的了解有限，凸显了在临床环境中需要简单工具来协助倡导此类饮食的必要性。
我们旨在设计一种饮食筛查工具，以评估饮食的健康程度和环境可持续性，并对其进行验证。
快速评估环境可持续和健康饮食（REFRESH）是一种二分法工具，针对对环境影响较小的健康饮食的10个关键食物组。每个食物组的得分是0分或1分，总得分范围为0至10分，其中0分表示对环境可持续和健康饮食的最低依从性，10分表示最高依从性。使用库德·理查森-20（KR-20）系数评估内部一致性。将REFRESH的相对效度与食物日记进行比较，评估项目一致性，并对REFRESH总分进行布兰德-奥特曼分析。在对可持续健康饮食的低、中、高依从性以及加权kappa指数中测试交叉分类。通过REFRESH得出的分数与从食物日记中得出的促进健康和有害的食物组、营养素以及环境影响指标之间的皮尔逊相关性来评估结构效度。
REFRESH的KR-20系数为0.70，表明内部一致性良好。它与食物日记显示出高度一致性（项目一致性为60%-88%），布兰德-奥特曼分析表明，REFRESH的平均得分比食物日记高1.1分。交叉分类显示方法之间的一致性为59%，只有1%的参与者被错误分类到相反类别。REFRESH得出的分数与促进健康的食物组和营养素呈正相关，与有害的食物组和营养素呈负相关。得分越高与环境影响降低相关。
REFRESH在评估饮食健康程度和环境可持续性方面已证明具有良好的效度，有助于识别饮食不理想的个体。REFRESH可从https://osf.io/avby9/下载。
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