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Lopes CVA, Dharmayani PNA, Ronto R, Hunter J, Mihrshahi S. Food Choices, Sustainability and Australian Native Foods: Perceptions among University Students. Foods 2024; 13:1677. [PMID: 38890905 PMCID: PMC11172005 DOI: 10.3390/foods13111677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024] Open
Abstract
(1) Background: Urgent changes in our food choices are needed for more sustainable, resilient and equitable food systems. Australian native plant-based foods have both environmental and health benefits. Including these foods in our diet may reduce both the risk of chronic diseases and the impact of climate change. This study explored the perceptions and attitudes towards food choices, sustainability and Australian native plant-based food among university students. (2) Methods: A cross-sectional online survey was completed by 212 university students in Australia from October to December 2022. Questions included information about sociodemographic characteristics, food choices, Australian native foods and the impact on sustainability. Logistic regression was used for analyses. (3) Results: Most participants recognised the impact of food choices on sustainability. There was a significant association between recognition of the impact of food choices on sustainability and the environmental and nutritional benefits of Australian native foods (OR = 2.89, 95% CI 1.29, 6.46, p = 0.010). Students who were familiar with or had tried Australian native plant-based foods were significantly more likely to recognise their environmental and nutritional benefits (p < 0.001). (4) Conclusions: Students who recognise the impact of food choices on sustainability and the benefits of Australian native foods are more likely to include native foods in their diet. More studies are needed to investigate the specific native foods consumed and the barriers and facilitators to the intake of these foods.
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Affiliation(s)
- Carla Vanessa Alves Lopes
- Department of Health Sciences, Faculty of Medicine Health and Human Sciences, Macquarie University, Macquarie Park, Sydney, NSW 2109, Australia (S.M.)
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Pfluger BA, Giunta A, Calvimontes DM, Lamb MM, Delgado-Zapata R, Ramakrishnan U, Ryan EP. Pilot Study of Heat-Stabilized Rice Bran Acceptability in Households of Rural Southwest Guatemala and Estimates of Fiber, Protein, and Micro-Nutrient Intakes among Mothers and Children. Nutrients 2024; 16:460. [PMID: 38337744 PMCID: PMC10856929 DOI: 10.3390/nu16030460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Nutrient-dense, acceptable foods are needed in low-resource settings. Rice bran, a global staple byproduct of white rice processing, is rich in amino acids, fibers, and vitamins, when compared to other cereal brans. This pilot study examines the nutritional contribution of rice bran to the daily diets of mother-child pairs in rural southwest Guatemala. Thirty households were screened. Mothers (≥18 years) and children (6 to 24 months) completed 24 h dietary recalls at baseline and after 12 weeks (endline) for diet intake and diversity analyses. During biweekly visits for 12 weeks, households with <5 members received 14 packets containing 60 g of heat-stabilized rice bran, and those with ≥5 members received 28 packets. The macro- and micro-nutrient contributions of rice bran and whole, cooked black beans were included in dietary simulation models with average intakes established between the recalls and for comparison with dietary reference intakes (DRIs). A baseline child food frequency questionnaire was administered. The 27 mothers and 23 children with complete recalls were included in analyses. Daily maternal consumption of 10 g/d of rice bran plus 100 g/d of black beans resulted in all achieving at least 50% of the fiber, protein, magnesium, niacin, potassium, and thiamin DRIs. Daily child consumption of 3 g/d of rice bran plus 10 g/d of black beans resulted in all achieving at least 50% of the magnesium, niacin, phosphorous, and thiamine DRIs. For 15/17 food categories, male children had a higher intake frequency, notably for animal-source foods and coffee. Dietary rice bran coupled with black beans could improve nutritional adequacy, especially for fiber and key micro-nutrients, with broader implications for addressing maternal and child malnutrition in low-resource settings.
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Affiliation(s)
- Brigitte A. Pfluger
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA 30322, USA;
| | - Alexis Giunta
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA;
| | - Diva M. Calvimontes
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, FUNSALUD, Coatepeque 09020, Quetzaltenango, Guatemala;
- Departament of Pediatrics, Center for Global Health, University of Colorado, Aurora, CO 80045, USA
- Center for Global Health, Colorado School of Public Health, Aurora, CO 80045, USA; (M.M.L.); (R.D.-Z.)
| | - Molly M. Lamb
- Center for Global Health, Colorado School of Public Health, Aurora, CO 80045, USA; (M.M.L.); (R.D.-Z.)
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA
| | - Roberto Delgado-Zapata
- Center for Global Health, Colorado School of Public Health, Aurora, CO 80045, USA; (M.M.L.); (R.D.-Z.)
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO 80045, USA
| | - Usha Ramakrishnan
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA 30322, USA;
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Elizabeth P. Ryan
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523, USA
- Colorado School of Public Health, Colorado State University, Fort Collins, CO 80523, USA
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April-Lalonde G, Deaconu A, Cole DC, Batal M. Traditional Food Consumption in Andean Ecuador and Associated Consumer Characteristics, Shopping and Eating Habits. Ecol Food Nutr 2023; 62:308-333. [PMID: 37791736 DOI: 10.1080/03670244.2023.2264197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Traditional foods (TFs) hold increasing global relevance due to their potential to address health and dietary challenges. This study explores TF consumption and patterns in a middle-income country's general population. Using 2017 Ecuadorian highlands survey data, we identified four consumption clusters with distinct TF preferences. Chi-square tests identified variations in independent variables across clusters. Poisson regression models highlighted city, age, education, and food habits as independent predictors of TF-based clusters. Our findings broaden TF importance to nutrition beyond specific populations. Understanding consumption patterns and socioeconomic links supports nuanced public health strategies to tackle contemporary health, social equity, and sustainability issues.
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Affiliation(s)
- Gabriel April-Lalonde
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre for Public Health Research, Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-Sud-de-l'Île-de-Montréal (CReSP), Montréal, Canada
| | - Ana Deaconu
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre for Public Health Research, Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-Sud-de-l'Île-de-Montréal (CReSP), Montréal, Canada
| | - Donald C Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Fair Fields, Neustadt, Canada
| | - Malek Batal
- Nutrition Department, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre for Public Health Research, Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-Sud-de-l'Île-de-Montréal (CReSP), Montréal, Canada
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Piperata BA, Scaggs SA, Dufour DL, Adams IK. Measuring food insecurity: An introduction to tools for human biologists and ecologists. Am J Hum Biol 2023; 35:e23821. [PMID: 36256611 DOI: 10.1002/ajhb.23821] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/20/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Food insecurity is a significant and growing concern undermining the wellbeing of 30% of the global population. Food in/security is a complex construct consisting of four dimensions: availability, access, utilization, and stability, making it challenging to measure. We provide a toolkit human biologists/ecologists can use to advance research on this topic. METHODS We review the strengths and limitations of common tools used to measure food access and utilization, the two dimensions most proximate to people's lived experience, and emphasize tools that provide data needed to best link food security with human biological outcomes. We also discuss methods that provide contextual data human biologists/ecologists will find useful for study design, ensuring instrument validity, and improving data quality. RESULTS Food access is principally measured using experience-based instruments that emphasize economic access. Social access, such as food sharing, is under-studied and we recommend using social network analysis to explore this dimension. In terms of utilization, emphasis has been on food choice measured as dietary diversity. Food preparation and intrahousehold distribution, also part of the utilization dimension, are less studied and standardized instruments for measuring both are lacking. The embodiment of food insecurity has focused on child growth, although a growing literature addresses adult mental wellbeing and chronic and infectious disease risk. CONCLUSIONS We see the potential to expand outcomes to include reproductive and immune function, physical activity, and the gut microbiome. Human biologists/ecologists are well-positioned to advance understanding of the human health impacts of food insecurity and provide data to support intervention efforts.
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Affiliation(s)
- Barbara A Piperata
- Department of Anthropology, The Ohio State University, Columbus, Ohio, USA
| | - Shane A Scaggs
- Department of Anthropology, The Ohio State University, Columbus, Ohio, USA
| | | | - Ingrid K Adams
- Department of Extension and School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
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de Medeiros MFA, Silva SGB, Teixeira CD, Lima SCVC, Marchioni DM, Jacob MCM. Assessment of Biodiversity in Food Consumption Studies: A Systematic Review. Front Nutr 2022; 9:832288. [PMID: 35774537 PMCID: PMC9237621 DOI: 10.3389/fnut.2022.832288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/10/2022] [Indexed: 11/30/2022] Open
Abstract
The assessment of food biodiversity has gained importance in nutrition due to the positive association between the diversity of foods consumed and the quality of diets. To date, however, we do not know systematically how food consumption studies address food biodiversity. Our objective with this paper was to characterize how food consumption studies address biodiverse foods, both in terms of (i) new methods capable of overcoming the limitations of existing methods, and (ii) indicators capable of measuring the contribution of biodiversity to nutrition. We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), using four databases: Web of Science, Medline/PubMed (via National Library of Medicine), Scopus, and Google Scholar. We selected papers focused on the consumption of biodiverse foods without time constraints. In addition, we assessed the methodological quality of the studies we selected. We reviewed a total of 22 studies, and summarized the methods and indicators most used. We found that some researchers used biodiversity mapping strategies based on ethnographic approaches before the dietary assessment. Regarding dietary assessment tools, retrospective direct methods were the most used by researchers. We list 23 indicators used by the authors, among them the Dietary Species Richness (DSR), used in 18% of the studies. Studies that used biodiversity mapping strategies based on ethnographic approaches before the dietary assessment portrayed the local availability of biodiverse foods more consistently, i.e., presented lists with local edible species satisfactorily identified. We believe researchers in the future can avoid many of the limitations of current methods by ensuring that teams are interprofessional. We emphasize that most of the indicators we summarized are not sensitive enough to biodiversity since they do not measure edible resources at the species level. In this sense, the DSR is promising, because it fills information gaps, especially in the case of wild or neglected species.
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Affiliation(s)
| | | | - Carla Djaine Teixeira
- Graduate Program in Social Sciences, Center for Human Sciences, Letters and Arts, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Dirce Maria Marchioni
- Nutrition Department, School of Public Health, University of São Paulo, São Paulo, Brazil
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Hanley-Cook GT, Daly AJ, Remans R, Jones AD, Murray KA, Huybrechts I, De Baets B, Lachat C. Food biodiversity: Quantifying the unquantifiable in human diets. Crit Rev Food Sci Nutr 2022; 63:7837-7851. [PMID: 35297716 DOI: 10.1080/10408398.2022.2051163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Dietary diversity is an established public health principle, and its measurement is essential for studies of diet quality and food security. However, conventional between food group scores fail to capture the nutritional variability and ecosystem services delivered by dietary richness and dissimilarity within food groups, or the relative distribution (i.e., evenness or moderation) of e.g., species or varieties across whole diets. Summarizing food biodiversity in an all-encompassing index is problematic. Therefore, various diversity indices have been proposed in ecology, yet these require methodological adaption for integration in dietary assessments. In this narrative review, we summarize the key conceptual issues underlying the measurement of food biodiversity at an edible species level, assess the ecological diversity indices previously applied to food consumption and food supply data, discuss their relative suitability, and potential amendments for use in (quantitative) dietary intake studies. Ecological diversity indices are often used without justification through the lens of nutrition. To illustrate: (i) dietary species richness fails to account for the distribution of foods across the diet or their functional traits; (ii) evenness indices, such as the Gini-Simpson index, require widely accepted relative abundance units (e.g., kcal, g, cups) and evidence-based moderation weighting factors; and (iii) functional dissimilarity indices are constructed based on an arbitrary selection of distance measures, cutoff criteria, and number of phylogenetic, nutritional, and morphological traits. Disregard for these limitations can lead to counterintuitive results and ambiguous or incorrect conclusions about the food biodiversity within diets or food systems. To ensure comparability and robustness of future research, we advocate food biodiversity indices that: (i) satisfy key axioms; (ii) can be extended to account for disparity between edible species; and (iii) are used in combination, rather than in isolation.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2022.2051163 .
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Affiliation(s)
- Giles T Hanley-Cook
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Aisling J Daly
- Department of Data Analysis and Mathematical Modelling, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Roseline Remans
- The Alliance of Bioversity International and International Centre for Tropical Agriculture, Geneva, Switzerland
| | - Andrew D Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Kris A Murray
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
- School of Hygiene & Tropical Medicine, MRC Unit The Gambia at London, Banjul, The Gambia
| | - Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, Lyon, France
| | - Bernard De Baets
- Department of Data Analysis and Mathematical Modelling, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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Dave LA, Hodgkinson SM, Roy NC, Smith NW, McNabb WC. The role of holistic nutritional properties of diets in the assessment of food system and dietary sustainability. Crit Rev Food Sci Nutr 2021:1-21. [PMID: 34933622 DOI: 10.1080/10408398.2021.2012753] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Advancing sustainable diets for nutrition security and sustainable development necessitates clear nutrition metrics for measuring nutritional quality of diets. Food composition, nutrient requirements, and dietary intake are among the most common nutrition metrics used in the current assessment of sustainable diets. Broadly, most studies in the area classify animal-source foods (ASF) as having a substantially higher environmental footprint in comparison to plant-source foods (PSF). As a result, much of the current dietary advice promulgates diets containing higher proportions of PSF. However, this generalization is misleading since most of these studies do not distinguish between the gross and bioavailable nutrient fractions in mixed human diets. The bioavailability of essential nutrients including β-carotene, vitamin B-12, iron, zinc, calcium, and indispensable amino acids varies greatly across different diets. The failure to consider bioavailability in sustainability measurements undermines the complementary role that ASF play in achieving nutrition security in vulnerable populations. This article critically reviews the scientific evidence on the holistic nutritional quality of diets and identifies methodological problems that exist in the way the nutritional quality of diets is measured. Finally, we discuss the importance of developing nutrient bioavailability as a requisite nutrition metric to contextualize the environmental impacts of different diets.
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Affiliation(s)
- Lakshmi A Dave
- Riddet Institute, Massey University, Palmerston North, New Zealand.,Sustainable Nutrition Initiative, Riddet Institute, Massey University, Palmerston North, New Zealand
| | | | - Nicole C Roy
- Riddet Institute, Massey University, Palmerston North, New Zealand.,Department of Human Nutrition, University of Otago, Dunedin, New Zealand.,High-Value Nutrition National Science Challenge, Auckland, New Zealand
| | - Nick W Smith
- Riddet Institute, Massey University, Palmerston North, New Zealand.,Sustainable Nutrition Initiative, Riddet Institute, Massey University, Palmerston North, New Zealand
| | - Warren C McNabb
- Riddet Institute, Massey University, Palmerston North, New Zealand.,Sustainable Nutrition Initiative, Riddet Institute, Massey University, Palmerston North, New Zealand.,High-Value Nutrition National Science Challenge, Auckland, New Zealand
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Keskin B, Güneş E. Social and cultural aspects of traditional drinks: A review on traditional Turkish drinks. Int J Gastron Food Sci 2021. [DOI: 10.1016/j.ijgfs.2021.100382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cordero-Ahiman OV, Vanegas JL, Franco-Crespo C, Beltrán-Romero P, Quinde-Lituma ME. Factors That Determine the Dietary Diversity Score in Rural Households: The Case of the Paute River Basin of Azuay Province, Ecuador. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2059. [PMID: 33672453 PMCID: PMC7923421 DOI: 10.3390/ijerph18042059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 12/12/2022]
Abstract
Inadequate food and nutrition affect human well-being, particularly for many poor subpopulations living in rural areas. The purpose of this research was to analyze the factors that determine the Household Dietary Diversity Score (HDDS) in the rural area of the Paute River Basin, Azuay Province, Ecuador. The sample size of 383 surveys was determined by a stratified random sampling method with proportional affixation. Dietary diversity was measured through the HDDS, with 12 food groups (cereals; roots and tubers; fruits; sugar/honey; meat and eggs; legumes or grains; vegetables; oils/fats; milk and dairy products; meats; miscellaneous; fish and shellfish) over a recall period of 7 days. A Poisson regression model was used to determine the relationship between the HDDS and sociodemographic variables. The results show that the average HDDS of food consumption is 10.89 foods. Of the analyzed food groups, the most consumed are cereals; roots and tubers; fruits; sugar/honey. In addition, the determinants that best explain the HDDS in the predictive model were housing size, household size, per capita food expenditure, area of cultivated land, level of education, and marital status of the head of household. The tools used in this research can be used to analyze food and nutrition security interventions. Furthermore, the results allow policymakers to identify applicable public policies in the fight against hunger.
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Affiliation(s)
- Otilia Vanessa Cordero-Ahiman
- Grupo de Investigación en Economía Regional (GIER), Facultad de Ciencias Económicas y Administrativas, Universidad de Cuenca, Cuenca 010107, Ecuador; (O.V.C.-A.); (P.B.-R.); (M.E.Q.-L.)
| | - Jorge Leonardo Vanegas
- Grupo de Investigación en Economía Regional (GIER), Facultad de Ciencias Económicas y Administrativas, Universidad de Cuenca, Cuenca 010107, Ecuador; (O.V.C.-A.); (P.B.-R.); (M.E.Q.-L.)
- Grupo de Producción Animal e Industrialización (PROANIN), Facultad de Ingeniería, Universidad Nacional de Chimborazo, Riobamba 060103, Ecuador
| | - Christian Franco-Crespo
- Facultad de Ciencia e Ingeniería en Alimentos y Biotecnología, Campus Huachi, Universidad Técnica de Ambato, Ambato 180104, Ecuador;
| | - Pablo Beltrán-Romero
- Grupo de Investigación en Economía Regional (GIER), Facultad de Ciencias Económicas y Administrativas, Universidad de Cuenca, Cuenca 010107, Ecuador; (O.V.C.-A.); (P.B.-R.); (M.E.Q.-L.)
| | - María Elena Quinde-Lituma
- Grupo de Investigación en Economía Regional (GIER), Facultad de Ciencias Económicas y Administrativas, Universidad de Cuenca, Cuenca 010107, Ecuador; (O.V.C.-A.); (P.B.-R.); (M.E.Q.-L.)
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EAT- Lancet diet score requires minimum intake values to predict higher micronutrient adequacy of diets in rural women of reproductive age from five low- and middle-income countries. Br J Nutr 2020; 126:92-100. [PMID: 32993824 DOI: 10.1017/s0007114520003864] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The EAT-Lancet Commission promulgated a universal reference diet. Subsequently, researchers constructed an EAT-Lancet diet score (0-14 points), with minimum intake values for various dietary components set at 0 g/d, and reported inverse associations with risks of major health outcomes in a high-income population. We assessed associations between EAT-Lancet diet scores, without or with lower bound values, and the mean probability of micronutrient adequacy (MPA) among nutrition-insecure women of reproductive age (WRA) from low- and middle-income countries (LMIC). We analysed single 24-h diet recall data (n 1950) from studies in rural DRC, Ecuador, Kenya, Sri Lanka and Vietnam. Associations between EAT-Lancet diet scores and MPA were assessed by fitting linear mixed-effects models. Mean EAT-Lancet diet scores were 8·8 (SD 1·3) and 1·9 (SD 1·1) without or with minimum intake values, respectively. Pooled MPA was 0·58 (SD 0·22) and energy intake was 10·5 (SD 4·6) MJ/d. A one-point increase in the EAT-Lancet diet score, without minimum intake values, was associated with a 2·6 (SD 0·7) percentage points decrease in MPA (P < 0·001). In contrast, the EAT-Lancet diet score, with minimum intake values, was associated with a 2·4 (SD 1·3) percentage points increase in MPA (P = 0·07). Further analysis indicated positive associations between EAT-Lancet diet scores and MPA adjusted for energy intake (P < 0·05). Our findings indicate that the EAT-Lancet diet score requires minimum intake values for nutrient-dense dietary components to avoid positively scoring non-consumption of food groups and subsequently predicting lower MPA of diets, when applied to rural WRA in LMIC.
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