Miranda Agustin, Murante Anna Maria, Manca Federica, Consalez Fabio, Jani Anant, DeClerck Fabrice, Maillot Matthieu, Verger Eric
MoISA, Univ Montpellier, CIHEAM-IAMM, CIRAD, INRAE, Institut Agro, IRD, Montpellier, France.
Sant'Anna School of Advanced Studies, Institute of Management, Pisa, Italy.
J Nutr. 2025 Jun 30. doi: 10.1016/j.tjnut.2025.06.018.
Ensuring healthy diets within planetary boundaries is essential. However, current instruments measuring adherence to the EAT-Lancet planetary health diet are unsuitable for large-scale surveys. Simplified tools assessing consumption frequency can improve response rates, lower costs, and facilitate administration.
This study aimed to develop a practical and concise index for evaluating relative adherence to the EAT-Lancet diet across large-scale multicountry surveys.
First, the EAT-Lancet Consumption Frequency Index (ELFI) was developed using a brief food propensity questionnaire of 14 food groups representing the planetary health diet from the Food systems that support transitions to hEalthy And Sustainable dieTs survey, which encompassed 27 European countries (n = 27,417). Subsequently, ELFI was further validated using 24-h dietary recalls from the Third French Individual and National Food Consumption Survey (n = 1645), correlating it with the valid EAT-Lancet Index (ELI), which evaluates absolute adherence, as well as with food group consumption, measures of nutritional health (nutrient adequacy and diet quality), and environmental impact. Analyses included assessment of reliability, structural validity, concurrent validity, and nomological validity.
ELFI showed strong reliability (α > 0.80) and factor analysis revealed a 2-factor solution: "foods to encourage" and "foods to balance and to limit." Confirmatory factor analysis demonstrated that ELFI is structurally valid. Concurrent validity was confirmed as it was associated with sex, age, education, income, household size, physical activity, and smoking habit (P < 0.05). ELFI correlated with ELI (0.44, P < 0.0001) and food group consumptions. Regarding nomological validity, the ELFI subscores for "foods to encourage" and "foods to balance and to limit" were associated with better nutritional health (β = 0.62 and 0.23, respectively; P < 0.0001) and a lower environmental impact (β = -0.16 and -0.36, respectively; P < 0.0001).
ELFI approach represents a valuable and easy-to-implement index for evaluating relative adherence to sustainable and healthy diets in large-scale multicountry studies.
在地球边界内确保健康饮食至关重要。然而，目前用于衡量对《柳叶刀》全球健康饮食依从性的工具并不适用于大规模调查。评估消费频率的简化工具可以提高回复率、降低成本并便于管理。
本研究旨在开发一种实用且简洁的指标，用于评估在大规模多国调查中对《柳叶刀》饮食的相对依从性。
首先，利用一份简短的食物倾向问卷开发了《柳叶刀》消费频率指数（ELFI），该问卷涵盖了代表全球健康饮食的14个食物组，来自支持向健康与可持续饮食转变的食物系统调查，涉及27个欧洲国家（n = 27417）。随后，使用第三次法国个人和国家食物消费调查中的24小时饮食回顾（n = 1645）对ELFI进行进一步验证，将其与评估绝对依从性的有效《柳叶刀》指数（ELI）以及食物组消费、营养健康指标（营养素充足性和饮食质量）和环境影响相关联。分析包括可靠性评估、结构效度、同时效度和法则效度。
ELFI显示出很强的可靠性（α > 0.80），因子分析揭示了一个双因子解决方案：“鼓励食用的食物”和“需平衡及限制食用的食物”。验证性因子分析表明ELFI在结构上是有效的。同时效度得到确认，因为它与性别、年龄、教育程度、收入、家庭规模、身体活动和吸烟习惯相关（P < 0.05）。ELFI与ELI相关（0.44，P < 0.0001）以及与食物组消费相关。关于法则效度，“鼓励食用的食物”和“需平衡及限制食用的食物”的ELFI子分数与更好的营养健康相关（分别为β = 0.62和0.23；P < 0.0001）以及与更低的环境影响相关（分别为β = -0.16和-0.36；P < 0.0001）。
ELFI方法是一种有价值且易于实施的指标，用于在大规模多国研究中评估对可持续和健康饮食的相对依从性。
