TABLE 1 Characteristics of the included studies, assessment of head health and/or sustainable dietary patterns and related outcomes in children and adolescents 1 Instrument Authors (reference) Country Study design Quantity, age, and gender, compliance with social and etal level. 85) Italy Cross-sectional study=314 614 years 47.8%male Score range:−4 to 12. TABLE1(Continued) InstrumentAuthors(reference)CountryStudydesignSamplesize, age and genderAdherence level Health outcome correlates with adherence level Quality assessment Arriscadoetal.(97) Spain − Cross-sectional study S. 12% up to 5 years old TABLE 1 (Continued) Instrument Authors (reference) CountryStudyDesignSample size, age and gender Adherence level Health score correlates with quality assessments of adherence levelc KorkmazandKabaran (86) Turkey S. − Cross-sectional study 6.9% up to 90 years.
TABLE 1 (Continued) Instrument Authors (references) Country Study Design Samples Nutrition, age and gender Level of adherence Health goals related to level of adherence Quality assessments. TABLE1(Continued) Instrument Authors(reference) CountryStudyDesignSample, age and genderAdherence levelHealth score correlates with quality assessments of adherence level here: 24.8%. 72 Egmond-Fröhlichet al.(62) Germany Cross-sectional study=11,676 617 years No information on sex%. Mean±SD:55.0±11.0HuSKY resulted in a negative negative association with ADHD symptoms.72 Food Quality Index for ChildrenHuybrechtsetal. 141) Belgium Cross-sectional study=169 25–6.5 years No information on sex%.
Mean±SD DQI-AVynckeetal.(41)European countries (Austria, Belgium, France, Germany, Greece, Italy, Spain and Sweden). TABLE 1 (Continued) Instrument Authors (reference) Country Study design Sample size Age and gender Level of adherence Health outcomes associated with level of adherence Quality assessment DASHRobsonetal. (80)SanDiegoStudent average=698 612 old 49.3% male Score range: 0–80. TABLE 1 (Continued) Instrument Authors (reference) Country Study design Sample size, age and gender Level of adherence Health outcomes associated with level of adherence Quality scoresc Maniosetal. (90) Greece Cross-sectional study = 2660 9-13 years 50.6% male Score range: 0-48.
Mean±SD:0.78±0.11 The result was inversely related to BMI.86 School Child Diet Index(ALES)Molinaetal.(157)Brazil Cross-sectional study=1282 7–10 years 42% male Range of scores: -10 to 10. Low compliance: 77.2% (< 80th percentile) Thescore was unrelated to BMI.72 Healthy Eating Index(Brazil)Lealetal.(39)Brazil Cross-sectional study=556 2–5 years old 53.6% males. TABLE1(Continued) Instrument Authors(reference)CountryStudyDesignSamplesMammation,Age and GenderLevel of AdherenceHealth related quality assessments of adherence level Zhaoetal.(107)China Cross-sectional study.S.1.
However, some instruments, such as the KIDMED, already had a predefined list of 'yes or no'. More than half of 64 instruments) did not take into account quantitative data (e.g. portions, quantities) of the included components and 73.4% (47 of 64 instruments) took into account recommended frequencies of food consumption. Figure 3 shows that the components present in at least half of the reviewed instruments were, in descending order, the following: vegetables, fruit, dairy.
The revised instruments were based on national recommendations or principles of dietary patterns known in advance (eg, MD, national and international recommendations). In addition, some instruments used percentiles (medians, quintiles, quartiles, or tertiles) or other specific cutoffs to determine the level of adherence (eg, low, moderate, high) (Table 2). Adherence to a priori dietary patterns found In this systematic review, it was found that adherence.
Adherence to the a priori dietary patterns identified In this systematic review it was found that the adherence
Associations between the dietary patterns identified and the health-related outcomes
Anthropometric/clinical factors
Discussion
Some of the described instruments were developed specifically for children and adolescents, such as the KIDMED index (119), while others were modified from those used in adults. All identified dietary patterns are based on a priori criteria supported by scientific knowledge and differ from each other in terms of the number of elements, ingredients included, limitations for scoring and inclusion of quantitative food portions or frequency of food consumption, which hinders direct comparisons between them. Most of them share the characteristics of a healthy and sustainable diet, as stated by the EAT-Lancet Commission (5).
However, none of these instruments have been shown to have sustainable properties, so instruments are only considered sustainable due to their a priori ranking in the literature or based on the inclusion of specific food groups known to have a lower ecological footprint, such as fruits and vegetables. According to the EAT-Lancet Commission, these diets should contain adequate caloric intake and consist of eating a variety of plant foods, small amounts of animal-based foods, unsaturated fats instead of saturated fats, and small amounts of refined, highly processed grains. foods and added sugars (5). It is crucial to develop strategies to increase adherence to healthy and sustainable dietary patterns worldwide.
Indeed, for 2050, this transformation will require a >50% reduction in global consumption of unhealthy foods, such as red meat and sugar, and a >100%. As such, it becomes relevant and essential to produce evidence that instruments that measure adherence to dietary patterns for children and young people are also sustainable, for example through associations of the dietary pattern represented with greenhouse gas emissions, land use or a water footprint. Future research can produce a new instrument that at the same time sets a healthy and sustainable dietary pattern for children and young people.
Adherence to the dietary patterns identified
Health-related outcomes associated with the dietary patterns identified
It is also worth noting that because many of the studies focused on MD adherence (50 of 128), it is important to consider a possible data bias regarding the described associations with health outcomes.
Final remarks
Conclusions
Acknowledgments
CA, SR, and AO: reviewed and edited the article; and all authors: read and approved the final manuscript.
Data Availability
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