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A modified Delphi to inform development of a multidimensional diet quality score for a sustainable healthy diet
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DOI：10.1017/S0007114526106345.png)
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Abstract
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No existing dietary metric simultaneously captures key dimensions of sustainable healthy diets (SHD): dietary variety; intake of animal products and extent of food processing. This methods and construct development study aimed to identify indicators of an SHD that can be used to inform a multidimensional diet quality score. A modified Delphi was used to gain expert consensus regarding the development of an SHD score. Three iterative surveys were conducted between November 2022 and May 2023. Surveys asked participants’ opinions regarding the measurement of the three dimensions of SHD (Dimension 1: variety of unprocessed and minimally processed foods; Dimension 2: intake of animal products; and Dimension 3: intake of ultra-processed foods (UPF)) and weighting and aggregation of a score that assesses these three dimensions. Thirteen international experts completed all three surveys. Consensus from experts led to the identification of food-based indicators of SHD. Experts agreed that Dimension 1 should be comprised of twelve food groups; with food groups and scoring ranges informed by the Global Diet Quality Score; Dimension 2 comprised of five food groups with scoring ranges informed by the EAT-Lancet planetary health diet; and Dimension 3 as one food group measured as a cut-off value of ≤10 % energy from UPF. There was consensus that each dimension should be equally weighted. Outcomes from this work have been used to inform the development and validation of a multidimensional diet quality score to assess the healthfulness and environmental sustainability of diets among healthy adult populations.
Keywords:
Diet quality metrics
sustainable healthy diets
sustainability
dietary variety
animal products
ultra-processed foods
Global Diet Quality Score healthy food groups
Minimum Dietary Diversity
sustainable healthy diets
ultra-processed foods
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