Abstract
Purpose
To describe adherence to sustainable healthy diets among a sample of 958 Chilean pre-schoolers (3–6 years) and explore associations between adherence and child and maternal sociodemographic and anthropometric characteristics.
Methods
Children’s adherence to sustainable healthy diets was calculated from single multiple-pass 24-h dietary recalls using the Planetary Health Diet Index for children and adolescents (PHDI-C). Higher PHDI-C scores (max score = 150 points) represent greater adherence. Adjusted linear regression models were fitted to explore associations between PHDI-C scores and child and maternal characteristics.
Results
Children obtained low total PHDI-C scores (median 50.0 [IQR 39.5–59.8] points). This resulted from low consumption of nuts & peanuts, legumes, vegetables, whole cereals, and vegetable oils; a lack of balance between dark green and red & orange vegetables, inadequate consumption of tubers & potatoes and eggs & white meats, and excess consumption of dairy products, palm oil, red meats, and added sugars. Mean PHDI-C total score was significantly higher (50.6 [95%CI 49.6, 51.7] vs 47.3 [95%CI 45.0, 49.5]) among children whose mothers were ≥ 25 years compared to those with younger mothers. Positive associations were observed between scores for fruits and maternal education, vegetables and maternal age, added sugars and child weight status, while negative associations were observed between fruits and child age, and vegetable oils and maternal education. Scores for dairy products PHDI-C component were lower among girls.
Conclusion
Adherence to sustainable healthy diets was low among this sample of Chilean children and was significantly associated with maternal age, being lower among children whose mothers were younger.
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Introduction
Adopting healthy and environmentally sustainable diets (hereafter sustainable healthy diets) early in life is key to preventing multiple forms of malnutrition and mitigating climate change [1, 2]. Such diets are meant to reduce the risk of diet-related non-communicable diseases and food-borne diseases, be nutritionally adequate, have a low environmental impact, be affordable, equitable, and culturally acceptable for all [3]. Ideally, they should begin with exclusive breastfeeding for the first six months of life and continue with breastfeeding and complementary feeding until two years of age [3]. Once established in childhood, healthy dietary patterns are likely to be sustained throughout life [4] as long as people have access to diets that are rich in a wide variety of minimally-processed plant-based foods, low in ultra-processed foods that contain excess amounts of saturated fats, added sugars, and/or salt, and moderate in animal-based foods [3].
In 2019, the EAT-Lancet Commission proposed a reference diet for the population aged 2 years and older which can reduce the global greenhouse gas emissions by up to 80% [1]. If universally adopted, it has the potential to ensure sufficient food for 10 billion people in 2050, while staying within planetary boundaries for food production [1]. Chile, Brazil, and Argentina are among the countries that would benefit the most from shifting to sustainable healthy diets, where the per capita carbon footprint could be reduced by up to 75% [5]. However, the cost of the EAT-Lancet diet was estimated to be unaffordable for 1.58 billion people in the world [6], with the highest costs reported for Latin America and the Caribbean [6], suggesting that poorer nations might be less able to adhere to sustainable healthy diets due to an economic disadvantage.
Studies of diets in Latin America show poor alignment with the EAT-Lancet diet [7,8,9,10]; however, only a few included children in the analysis [7, 8]. There is only one study internationally that has provided a detailed description of children’s adherence to sustainable healthy diets [11]. This study, conducted by Bäck et al. [11], indicated that Finnish pre-schoolers’ diets were far from meeting the EAT-Lancet dietary targets due to low consumption of nuts, legumes, whole grains, vegetables, and unsaturated oils, and high consumption of red meat, dairy products, tubers and potatoes, and added sugars [11]. The absence of studies in children is a glaring gap considering they comprise almost 30% of the world’s population [12]. Further, a systematic review on predictors of children’s dietary intake found that maternal education and socio-economic position may be key determining factors [13], and a recent scoping review found that children’s diet quality was associated with their weight status [14]. This suggests that adherence to sustainable healthy diets might also be determined by child and maternal socio-demographic and anthropometric characteristics. However, no empirical evidence currently exists.
To help address the lack of studies in children and limited knowledge of determinants of sustainable healthy diets, we aimed to describe adherence to sustainable healthy diets among a sample of Chilean pre-schoolers and explore associations between adherence and child and maternal sociodemographic and anthropometric characteristics.
Subjects and methods
Study design and participants
This study is a secondary analysis of cross-sectional data collected in 2016 from the Food Environment Chilean Cohort (FECHiC). The original study design and recruitment process have been described in detail elsewhere [15]. Briefly, 961 children aged 3–6-years-old were recruited from public schools located in low-medium income neighbourhoods of south-eastern Santiago, Chile. Participants are a convenience sample, but they have similar socioeconomic and anthropometric characteristics to children living in low-medium income neighbourhoods of urban areas across the country [16, 17].
Data collection
Baseline data collection for FECHiC was conducted between April to August of 2016. Trained dietitians obtained sociodemographic data (i.e., children’s age, gender, maternal age, and level of maternal education) from children’s primary caretakers (usually mothers) and measured child and maternal anthropometric characteristics (weight, height, waist circumference) following standardized procedures [18]. Children’s dietary intake data was obtained from their primary caretakers using single 24-h recalls following the US Department of Agriculture (USDA) automated multiple pass method [19], which helps reduce the risk of recall bias [20]. A photographic atlas of Chilean foods and culinary preparations [21] was used to aid estimation of portion sizes. Dietary recall characteristics such as day of the recall (weekday vs weekend/holiday), type of eating pattern on the day of recall (typical vs atypical (because of celebration, or sickness, or vacation)), type of diet on the day of recall (normal (i.e., omnivorous with no dietary restriction of any kind) vs special (i.e., lactose free, gluten free, vegetarian, or vegan)), and reliability of the recall (reliable (i.e., recalls with no missing information) vs unreliable (i.e., recalls with missing information on the amount consumed of some food items) were also collected. Three participants with unavailable dietary data were excluded from this study. The final sample included 958 participants (Supplemental Fig. 1).
Linkage of dietary data with nutrient composition and ingredients list data
Dietary intake data was linked to a bespoke food composition database developed for Chile by the University of North Carolina and the Institute of Nutrition and Food Technology (INTA) that included data from the USDA National Nutrient Database [22] and from nutrition information panels and ingredients list of packaged products available in Chile during the first quarter of 2016 [23]. Once the linkage process was completed, children’s energy and nutritional intake were determined.
Outcomes of interest
Children’s adherence to sustainable healthy diets was quantified using the Planetary Health Diet Index for children and adolescents (PHDI-C) [24]; an adaptation of the Planetary Health Diet Index (PHDI) developed and validated by Cacau et al. [25]. The PHDI-C follows the EAT-Lancet Commission’s dietary recommendations [1] with five modifications to better reflect children’s and adolescents’ micronutrient requirements [24]. It comprises 16 components: four adequacy components for food groups that children are encouraged to eat more of (i.e., nuts & peanuts, legumes, fruits, and vegetables); three ratio components to promote consumption of a variety of vegetables and cereals (i.e., dark green vegetables ratio, red and orange vegetables ratio, and whole cereals ratio); five optimum components for foods whose consumption should be balanced to achieve diet quality and environmental sustainability (i.e., cereals, tubers & potatoes, dairy products, eggs & white meats, and vegetable oils); and four moderation components for foods that children should eat less of (i.e., palm oil, red meats, animal fats, and added sugars) [24]. Each component is associated with a range of recommended percentages of total energy intake and a continuous scoring scale. Components can score between 0 to 10 points, except for the dark green vegetables and red and orange vegetables ratio components where the maximum score is 5 points. The formulae to calculate each PHDI-C component score are provided in detail elsewhere [24]. For adequacy components, consumption equal to or above the recommended percentage of total energy intake is given the highest score while consumption below the recommended percentage of total energy intake is given proportionally lower scores; for ratio and optimum components, consumption equal to or close to the recommended percentage of total energy intake is given higher scores while consumption either above or below the recommended percentage of total energy intake is given proportionally lower scores; lastly, for moderation components, consumption equal to or close to zero is given higher scores while consumption above zero is given proportionally lower scores. Of note is that consumptions outside the recommended range of percentage of total energy intake for each component are given zero points. PHDI-C component scores are then added, resulting in a total score ranging from 0 to 150 points (see Table 2, columns 1–3) [24]. Higher total scores indicate higher adherence to sustainable healthy diets.
Independent variables
We explored associations between children’s PHDI-C total and individual component scores and child and maternal characteristics, including child gender (female or male), child age (3–4 years or 5–6 years), maternal age (categorized as < 25 years or ≥ 25 years to distinguish between young mothers and older mothers, respectively), and maternal education (incomplete secondary education, complete secondary education, or complete tertiary education), which was used as a proxy of socioeconomic position [26]. Weight and height were used to calculate child and maternal body mass index (BMI) and determine weight status according to appropriate WHO Child Growth Standards [27, 28] and adults cut-points [29]. A small proportion of children (2.4%) and mothers (0.5%) were at risk of undernutrition, and they were classified as non-overweight along with those in the healthy weight range. Maternal waist circumference was used to determine the presence of abdominal obesity on children’s mothers (waist circumference > 88 cm) [30].
Statistical analysis
Total PHDI-C scores and individual component scores were reported using descriptive statistics. Additionally, we reported the proportion of participants whose scores were (1) < 25% of the maximum score; (2) ≥ 25% and < 50%; (3) ≥ 50% and < 75%; and ≥ 75% of the maximum score.
Linear regression models were fitted to explore whether children’s PHDI-C total and individual component scores (dependent variables) were associated with child and maternal sociodemographic and anthropometric characteristics. All models included all maternal and child characteristics plus three dietary recall characteristics that were significantly associated with PHDI-C total scores: day of dietary recall (weekday vs weekend/holiday); type of eating pattern on the day of the recall (typical vs atypical); and type of diet on the day of the recall (normal vs special) [24]. We reported adjusted estimates alongside 95% confidence intervals (CI). Only participants with complete dietary, sociodemographic, and anthropometric data were included in this analysis (n = 917) (Supplementary Fig. 1). Forty-one children were excluded due to missing anthropometric data (one child and two mothers refused to be measured, and 38 mothers were not measured due to pregnancy). Statistical analysis was conducted in Stata v17. Statistical significance was defined as p-value < 0.05.
Results
Participants socio-demographic, anthropometric and dietary recall characteristics (Table 1)
In 2016, most children (72.6%) were 3–4 years and 51.8% were female. Their mothers were mostly ≥ 25 years (82.6%), with 55.2% having completed secondary and 26.7% having completed tertiary education. Half of children had normal weight status, 28.7% were living with overweight, and 18.4% were living with obesity. Most mothers (70.2%) were living with either overweight or obesity, and 53.2% presented abdominal obesity. Dietary recalls were mostly from weekdays (85.7%) and were reported by primary caretakers as children’s typical eating pattern (83.6%). Most participants (94.5%) reported having a normal diet on the day of the dietary recall. Six percent of recalls were classified as unreliable by INTA’s dietetic team because of missing information on some food items.
Children’s PHDI-C scores (Table 2)
Adherence to sustainable healthy diets was low (median PHDI-C total score = 50.0 points), with the majority (95.4%, n = 914) of children obtaining < 75 points.
For adequacy components, median percentage of total energy intake from nuts & peanuts, legumes, and vegetables were below recommended intakes. Consequently, 97.4%, 83.2% and 36.1% of children obtained < 2.5 points for each component, respectively. In contrast, median percentage of total energy intake from fruits was closer to the recommended intake, with 49.2% (n = 471) obtaining ≥ 7.5 points.
For ratio components, median percentage of total energy intake from dark green vegetables and whole cereals were negligible, with ~ 90% of participants (n = 855 and n = 876, respectively) obtaining < 1.25 points. Median percentage of total energy intake from red & orange vegetables was slightly higher than recommended, with 28.5% of children (n = 273) obtaining ≥ 3.75 points.
For optimum components, median percentage of total energy intake from cereals was close to the recommended intake, resulting in 50% (n = 476) of children obtaining ≥ 7.5 points. Consumption of tuber & potatoes was either negligible for at least 50% of participants or excessive for at least 25% of participants, meaning the majority (93%, n = 886) obtained < 2.5 points. Consumption of dairy products was higher than recommended for at least 75% of participants, resulting in 44.1% of participants (n = 423) obtaining < 2.5 points. Consumption of eggs & white meats was lower than recommended for at least 50% of participants and higher than recommended for at least 25% of participants, meaning that almost 60% of participants (n = 552) obtained < 2.5 points. Consumption of vegetable oils was lower than recommended for most children, with only 30.0% (n = 288) obtaining ≥ 7.5 points.
Finally, median percentage of total energy intake from moderation components palm oil, red meat, and added sugars were higher than recommended, with 46.2%, 49.5%, and 96.7% of participants obtaining < 2.5 points, respectively. Consumption of animal fats was close to the recommended intake for at least 50% of participants, meaning 51.5% of participants obtained ≥ 7.5 points.
Associations between PHDI-C total score and sociodemographic and anthropometric characteristics (Table 3)
Mean total PHDI-C score was significantly higher for participants whose mothers were ≥ 25 years old compared to those whose mothers were younger (50.6 vs 47.3 points, p-value 0.009). No other statistically significant associations were observed.
Associations between individual component scores and sociodemographic and anthropometric characteristics (Table 4)
Among adequacy components, mean score for fruits was significantly lower for children aged 5–6 years compared to children aged 3–4 years (5.3 vs 6.2 points, p-value 0.004), and significantly higher for children’s whose mothers had completed tertiary education compared to those whose mothers had not completed secondary education (6.4 vs 5.5 points, p-value 0.038). Mean score for vegetables was significantly higher for children whose mothers were ≥ 25 years compared to those with younger mothers (4.2 vs 3.6 points, p-value 0.025). We did not observe significant associations between ratio component scores and sociodemographic or anthropometric characteristics. Among optimum components, mean score for dairy products was significantly lower for females compared to males (3.5 vs 4.0 points, p-value 0.023). Mean score for vegetable oils was significantly lower for children whose mothers had completed secondary or tertiary education, compared to those whose mothers had not completed secondary education (5.5 and 5.4 vs 6.0 points, respectively; p-value 0.032 and 0.023, respectively). Finally, among moderation components, mean score for added sugars was significantly higher for children living with obesity compared to children not living with overweight/obesity (0.3 vs 0.1 points, p-value 0.037).
Discussion
This sample of Chilean children had low PHDI-C total scores, suggesting low adherence to sustainable healthy diets. This was due to low consumption of nuts & peanuts, legumes, vegetables, whole cereals and vegetable oils; a lack of balance between dark green and red & orange vegetables, inadequate (either low or excess) consumption of tubers & potatoes and eggs & white meats, and excess consumption of dairy products, palm oil, red meats, and added sugars.
Our findings are consistent with those of Bäck et al. in their study of Finnish pre-schoolers (3–6 years, n = 862) [11]. They found that mean consumption of nuts, legumes, vegetables, whole cereals, and vegetable oils was lower than recommended, and consumption of tubers & potatoes, dairy products, red meat, and added sugars was higher than recommended by the EAT-Lancet Commission. Similarly, Gormaz et al. [7] reported that a representative sample of the Chilean population (≥ 2 years, n = 4920 of which 5% were children aged 2–5-year-old [31]) had low consumption of nuts, legumes, whole cereals, and vegetable oils, and high consumption of dairy products, red meat, and added sugars. Our findings also align with the results observed among European adolescents from the HELENA cohort study [32, 33] showing low adherence to the planetary health diet as measured by the PHDI (mean total score = 44.3 (95% CI 43.7, 44.9) points). Collectively, these studies reflect the nutrition transition away from minimally processed foods towards animal-sourced foods and ultra-processed products [34]. They suggest that to achieve sustainable healthy diets, strategies should target children’s low consumption of nuts & peanuts, legumes, vegetables (particularly dark green vegetables), and whole cereals, and high consumption of dairy products, palm oil, red meats, and added sugars. Implementation of triple-duty actions, such as school feeding programs based on sustainable healthy dietary guidelines [35] along with policies limiting access and exposure to unhealthy food and beverages [2], can help achieve this goal. In Chile, the introduction of the Food Labelling and Advertising Law at the end of June 2016 [36] may have reduced children’s intake of added sugars and saturated fats from ultra-processed products consumed at schools [37]; however, it is still unknown whether this policy has improved their adherence to sustainable healthy diets. Barriers to achieving this likely include the relatively low cost and increased availability of ultra-processed products [34] and significantly higher cost of healthy diets [38], particularly for low-medium income households [13] such as those in this study.
We found that children whose mothers were ≥ 25 years had significantly higher mean PHDI-C total score and higher mean vegetables component score compared to children with younger mothers. While the difference is small (3.4 points), it might be explained by a potentially lower socioeconomic status among mothers who bear children at a younger age [39] or by a potentially higher nutrition knowledge among older women compared to younger women [40]. Both variables have been associated with increased accessibility of fruits and vegetables and low home availability of unhealthy discretionary foods in a systematic review [13].
Additionally, we observed a negative association between the score for fruits and child age, which is consistent with a systematic review of determinants of children’s fruit and vegetable intake [41]. On the other hand, a significantly higher score for fruits was observed among children whose mothers had completed tertiary education compared to those whose mothers has not completed secondary education. This is in line with existing literature on predictors of children’s dietary intake that establish maternal education as a key determinant for home fruit accessibility and children’s nutrition knowledge [13]. Additionally, higher levels of education have been significantly associated with pro-environmental behaviours [42, 43]. We observed that the score for vegetable oils was significantly lower among children whose mothers had completed tertiary education. This may be explained by the negative association observed between maternal education and home availability of unhealthy snacks, which are usually high in vegetable oils [13]. We observed a significantly lower score for dairy products among females compared to males. This was explained by a slightly higher number of girls with dairy products consumption above the recommended intake (161 girls vs 131 boys). This is contrary to what has been observed in several developed countries where boys consume higher quantities of dairy products than girls [44]. Finally, a significantly higher score for added sugars was observed among children living with obesity. A possible explanation is lower consumption of added sugars among children living with obesity due to parents' efforts to restrict children’s dietary intake [45].
Previous studies have shown that maternal education is positively associated with home accessibility of vegetables and negatively associated with home availability of sugar-sweetened beverages [13]; however, probably due to a lack of socioeconomic heterogeneity in our sample, we did not observe a significant association between the score for vegetables or added sugars and maternal education.
Strengths
A strength of this study is the use of the PHDI-C as it allowed us to describe children’s adherence to sustainable healthy diets in line with the EAT Lancet Commission recommendations [24], while taking into consideration their specific nutritional requirements [24]. The dietary data used in this study was collected by trained dietitians following the USDA five-step multi-pass method, which has been shown to reduce the risk of recall bias [20]. Additionally, the use of a photographic atlas of Chilean foods and culinary preparations [21] allowed the accurate estimation of portion sizes and the following estimation of children’s dietary intake. The level of detail obtained during data collection enabled researchers to link dietary data with all the information required to apply the PHDI-C as accurately as possible [24]. Finally, the large sample size and availability of child and maternal data enabled us to explore associations between PHDI-C scores and participants’ sociodemographic and anthropometric characteristics.
Limitations
Our results come from a convenience sample of Chilean pre-schoolers living in low-medium income neighbourhoods of Santiago, Chile, and therefore, are not generalizable to children in other countries or from other parts of Chile. Another limitation is the use of single 24-h recalls for collecting dietary data, which are less likely to provide a measure of usual intake compared to multiple 24-h recalls [46], particularly for foods that are not consumed every day. Dietary recalls are also prone to recall bias [47]. We tried to reduce this risk by conducting the data collection process with trained dietitians and following the USDA multi-pass method [20], which led to 94.4% dietary recalls being classified as reliable. Finally, the absence of income data for participants in this study prevented us from exploring a direct association between PHDI-C scores and socioeconomic position and we used maternal education as a proxy [26].
Conclusions
Adherence to sustainable healthy diets was low among this sample of Chilean pre-schoolers, particularly among those whose mothers were younger. These findings serve as a baseline for tracking changes in adherence to sustainable healthy diets over time and contribute to a growing body of literature calling for strategies to address children’s low consumption of plant-based minimally processed foods, and high consumption of animal-source foods and ultra-processed products. Further research is needed to assess whether Chile’s Food Labelling and Advertising Law has helped Chilean children transition towards healthier and environmentally sustainable dietary patterns.
Availability of data and material
The de-identified data described in the manuscript, code book, and analytic code will not be made available publicly but can be made available on reasonable request. Proposals should be directed to the corresponding author, who will then pass the proposal on to members of the Center for Research in Food Environments and Prevention of Nutrition-related Chronic Diseases (CIAPEC)—INTA for deliberation and approval. To gain access, data requestors will need to sign a data access and collaboration agreement.
References
Willett W, Rockström J, Loken B, Springmann M, Lang T, Vermeulen S, Garnett T, Tilman D, DeClerck F, Wood A, Jonell M, Clark M, Gordon LJ, Fanzo J, Hawkes C, Zurayk R, Rivera JA, De Vries W, Majele Sibanda L, Afshin A, Chaudhary A, Herrero M, Agustina R, Branca F, Lartey A, Fan S, Crona B, Fox E, Bignet V, Troell M, Lindahl T, Singh S, Cornell SE, Srinath Reddy K, Narain S, Nishtar S, Murray CJL (2019) Food in the anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. The Lancet 393(10170):447–492. https://doi.org/10.1016/s0140-6736(18)31788-4
Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, Brinsden H, Calvillo A, De Schutter O, Devarajan R, Ezzati M, Friel S, Goenka S, Hammond RA, Hastings G, Hawkes C, Herrero M, Hovmand PS, Howden M, Jaacks LM, Kapetanaki AB, Kasman M, Kuhnlein HV, Kumanyika SK, Larijani B, Lobstein T, Long MW, Matsudo VKR, Mills SDH, Morgan G, Morshed A, Nece PM, Pan A, Patterson DW, Sacks G, Shekar M, Simmons GL, Smit W, Tootee A, Vandevijvere S, Waterlander WE, Wolfenden L, Dietz WH (2019) The global syndemic of obesity, undernutrition, and climate change: the Lancet Commission report. The Lancet 393(10173):791–846. https://doi.org/10.1016/s0140-6736(18)32822-8
Food and Agriculture Organisation WHO (2019) Sustainable healthy diets – guiding principles. FAO and WHO, Rome
Forestell CA (2017) Flavor perception and preference development in human infants. Ann Nutr Metab 70(Suppl 3):17–25. https://doi.org/10.1159/000478759
Semba RD, de Pee S, Kim B, McKenzie S, Nachman K, Bloem MW (2020) Adoption of the ‘planetary health diet’ has different impacts on countries’ greenhouse gas emissions. Nat Food 1(8):481–484. https://doi.org/10.1038/s43016-020-0128-4
Hirvonen K, Bai Y, Headey D, Masters WA (2020) Affordability of the EAT–Lancet reference diet: a global analysis. Lancet Glob Health 8(1):e59–e66. https://doi.org/10.1016/s2214-109x(19)30447-4
Gormaz T, Cortés S, Tiboni-Oschilewski O, Weisstaub G (2022) The Chilean diet: is it sustainable? Nutrients 14(15):3103. https://doi.org/10.3390/nu14153103
Marchioni D, Cacau L, De Carli E, Carvalho A, Rulli M (2022) Low adherence to the EAT-Lancet sustainable reference diet in the Brazilian population: findings from the National Dietary Survey 2017–2018. Nutrients 14(6):1187. https://doi.org/10.3390/nu14061187
López G, Batis C, González C, Chávez M, Cortés-Valencia A, López-Ridaura R, Lajous M, Stern D (2022) EAT-Lancet Healthy Reference Diet score and diabetes incidence in a cohort of Mexican women. Eur J Clin Nutr. https://doi.org/10.1038/s41430-022-01246-8
Shamah-Levy T, Gaona-Pineda E, Mundo-Rosas V, Méndez Gómez-Humarán I, Rodríguez-Ramírez S (2020) Association of a healthy and sustainable dietary index and overweight and obesity in Mexican adults. Salud Publica Mex 62(6):745–753. https://doi.org/10.21149/11829
Bäck S, Skaffari E, Vepsäläinen H, Lehto R, Lehto E, Nissinen K, Ray C, Nevalainen J, Roos E, Erkkola M, Korkalo L (2022) Sustainability analysis of Finnish pre-schoolers’ diet based on targets of the EAT-Lancet reference diet. Eur J Nutr 61(2):717–728. https://doi.org/10.1007/s00394-021-02672-3
The World Bank (2022) Population ages 0–14 (% of total population) | Data. https://data.worldbank.org/indicator/SP.POP.0014.TO.ZS. Accessed 12 Sep 2022
Zarnowiecki D, Dollman J, Parletta N (2014) Associations between predictors of children’s dietary intake and socioeconomic position: a systematic review of the literature. Obes Rev 15(5):375–391. https://doi.org/10.1111/obr.12139
Jarman M, Edwards K, Blissett J (2022) Influences on the dietary intakes of preschool children: a systematic scoping review. Int J Behav Nutr Phys Act 19(1):1–15. https://doi.org/10.1186/s12966-022-01254-8
Venegas Hargous C, Reyes M, Smith Taillie L, Gonzalez CG, Corvalan C (2020) Consumption of non-nutritive sweeteners by pre-schoolers of the food and environment Chilean cohort (FECHIC) before the implementation of the Chilean food labelling and advertising law. Nutr J 19(1):69. https://doi.org/10.1186/s12937-020-00583-3
SEREMI de Desarrollo Social Metropolitana (2016) Pobreza y Distribución del Ingreso en la Región Metropolitana de Santiago: Resultados Encuesta CASEN 2015 [Poverty and Income Distribution in the Metropolitan Region of Santiago: Results from the 2015 CASEN Survey]. Ministerio de Desarrollo Social. https://www.gobiernosantiago.cl/wp-content/uploads/2014/12/DOCUMENTO-POBREZA-Y-DISTR-ING-RMS-CASEN-2015.pdf
Junta Nacional de Auxilio Escolar y Becas (JUNAEB), Departamento de Planificación y Estudios, Ministerio de Educación (2016) Informe Mapa Nutricional 2016 [Nutritional Map Report 2016]. https://www.junaeb.cl/wp-content/uploads/2013/03/Informe-Mapa-Nutricional-2016.pdf
World Health Organization (WHO) (2006) WHO STEPS surveillance manual: the WHO STEPwise approach to chronic disease risk factor surveillance. World Health Organization, Ginebra
Raper N, Perloff B, Ingwersen L, Steinfeldt L, Anand J (2004) An overview of USDA’s dietary intake data system. J Food Compos Anal 17(3–4):545–555. https://doi.org/10.1016/j.jfca.2004.02.013
Moshfegh AJ, Rhodes DG, Baer DJ, Murayi T, Clemens JC, Rumpler WV, Paul DR, Sebastian RS, Kuczynski KJ, Ingwersen LA, Staples RC, Cleveland LE (2008) The US Department of Agriculture automated multiple-pass method reduces bias in the collection of energy intakes. Am J Clin Nutr 88(2):324–332. https://doi.org/10.1093/ajcn/88.2.324
Universidad de Chile, Ministerio de Salud de Chile (2010) Atlas fotográfico de alimentos y preparaciones típicas chilenas: encuesta nacional de consumo alimentario 2010. Ministerio de Salud, Santiago, Chile
United States Department of Agriculture (USDA), Agricultural Research Service (2019) FoodData central. https://ndb.nal.usda.gov/ndb/. Accessed 12 Nov 2020
Rebolledo N, Reyes M, Popkin B, Adair L, Avery C, Corvalán C, Ng S, Smith Taillie L (2022) Changes in nonnutritive sweetener intake in a cohort of preschoolers after the implementation of Chile’s Law of Food Labelling and Advertising. Pediatr Obes 17(7):e12895. https://doi.org/10.1111/ijpo.12895
Venegas Hargous C, Orellana L, Strugnell C, Corvalan C, Allender S, Bell C (2023) Adapting the Planetary Health Diet Index for children and adolescents. Int J Behav Nutr Phys Act 20:146. https://doi.org/10.1186/s12966-023-01516-z
Cacau LT, De Carli E, de Carvalho AM, Lotufo PA, Moreno LA, Bensenor IM, Marchioni DM (2021) Development and validation of an index based on EAT-Lancet recommendations: the Planetary Health Diet Index. Nutrients 13(5):1698. https://doi.org/10.3390/nu13051698
Sirin S (2005) Socioeconomic status and academic achievement: a meta-analytic review of research. Rev Educ Res 75(3):417–453. https://doi.org/10.3102/00346543075003417
World Health Organization (2006) WHO child growth standards. Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-forage. Methods and development. World Health Organization, Geneva
de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85(9):660–667
World Health Organization (WHO) (2019) Body mass index – BMI. http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi
Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285(19):2486–2497
Departamento de Nutrición, Escuela de Nutrición, Escuela de Salud Pública, Centro de Microdatos (2010) Informe Final Encuesta Nacional de Consumo Alimentario. Universidad de Chile, Santiago de Chile
Cacau LT, Hanley-Cook GT, Huybrechts I, De Henauw S, Kersting M, Gonzalez-Gross M, Gottrand F, Ferrari M, Nova E, Castillo MJ, Molnár D, Widhalm K, Androutsos O, Manios Y, Stehle P, Lachat C, Marchioni DM, Moreno LA (2023) Relative validity of the Planetary Health Diet Index by comparison with usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet among European adolescents: the HELENA study. Eur J Nutr 62(6):2527–2539. https://doi.org/10.1007/s00394-023-03171-3
Cacau LT, Hanley-Cook GT, Vandevijvere S, Leclercq C, De Henauw S, Santaliestra-Pasias A, Manios Y, Mourouti N, Esperanza Díaz L, Gonzalez-Gross M, Widhalm K, Molnar D, Stehle P, Kafatos A, Gottrand F, Kersting M, Castillo M, Lachat C, Marchioni DM, Huybrechts I, Moreno LA (2024) Association between adherence to the EAT-Lancet sustainable reference diet and cardiovascular health among European adolescents: the HELENA study. Eur J Clin Nutr 78(3):202–208. https://doi.org/10.1038/s41430-023-01379-4
Popkin BM, Adair LS, Ng SW (2012) Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 70(1):3–21. https://doi.org/10.1111/j.1753-4887.2011.00456.x
Venegas Hargous C, Strugnell C, Allender S, Orellana L, Corvalan C, Bell C (2023) Double- and triple-duty actions in childhood for addressing the global syndemic of obesity, undernutrition, and climate change: a scoping review. Obes Rev 24(4):e13555. https://doi.org/10.1111/obr.13555
Corvalan C, Reyes M, Garmendia ML, Uauy R (2019) Structural responses to the obesity and non-communicable diseases epidemic: update on the Chilean law of food labelling and advertising. Obes Rev 20(3):367–374. https://doi.org/10.1111/obr.12802
Fretes G, Corvalán C, Reyes M, Taillie LS, Economos CD, Wilson NLW, Cash SB (2023) Changes in children’s and adolescents’ dietary intake after the implementation of Chile’s law of food labeling, advertising and sales in schools: a longitudinal study. Int J Behav Nutr Phys Act 20(1):1–10. https://doi.org/10.1186/s12966-023-01445-x
Rao M, Afshin A, Singh G, Mozaffarian D (2013) Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open 3(12):e004277. https://doi.org/10.1136/bmjopen-2013-004277
van Roode T, Sharples K, Dickson N, Paul C (2017) Life-course relationship between socioeconomic circumstances and timing of first birth in a birth cohort. PLoS ONE 12:e0170170
De Vriendt T, Matthys C, Verbeke W, Pynaert I, De Henauw S (2009) Determinants of nutrition knowledge in young and middle-aged Belgian women and the association with their dietary behaviour. Appetite 52(3):788–792. https://doi.org/10.1016/j.appet.2009.02.014
Krølner R, Rasmussen M, Brug J, Klepp K-I, Wind M, Due P (2011) Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature. Part II: qualitative studies. Int J Behav Nutr Phys Act 8(1):1–38. https://doi.org/10.1186/1479-5868-8-112
Meyer A (2015) Does education increase pro-environmental behavior? Evidence from Europe. Ecol Econ 116:108–121. https://doi.org/10.1016/j.ecolecon.2015.04.018
Krizanova J, Rosenfeld D, Tomiyama A, Guardiola J (2021) Pro-environmental behavior predicts adherence to plant-based diets. Appetite 163:105243. https://doi.org/10.1016/j.appet.2021.105243
Dror DK, Allen LH (2023) Dairy product intake in children and adolescents in developed countries: trends, nutritional contribution, and a review of association with health outcomes. Nutr Rev 72(2):68–81. https://doi.org/10.1111/nure.12078
Pesch MH, Miller AL, Appugliese DP, Rosenblum KL, Lumeng JC (2018) Mothers of obese children use more direct imperatives to restrict eating. J Nutr Educ Behav 50(4):403-407.e401. https://doi.org/10.1016/j.jneb.2017.10.010
Burrows TL, Martin RJ, Collins CE (2010) A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labeled water. J Am Diet Assoc 110(10):1501–1510. https://doi.org/10.1016/j.jada.2010.07.008
Naska A, Lagiou A, Lagiou P (2017) Dietary assessment methods in epidemiological research: current state of the art and future prospects. F1000Research 6:926. https://doi.org/10.12688/f1000research.10703.1
World Medical Association (WMA) (2008) Declaration of Helsinki. Ethical principles for medical research involving human subjects. WMA, Seoul, Korea
WHO Expert Committee on Physical Status: the Use and Interpretation of Anthropometry (1995) Physical status: the use of and interpretation of anthropometry, report of a WHO expert committee. World Health Organization, Geneva, Switzerland
Acknowledgements
We thank all the staff involved in the data collection for the FECHiC study and all participants for their valuable contribution.
Funding
Open Access funding enabled and organized by CAUL and its Member Institutions. This work received financial support from Bloomberg Philanthropies, IDRC grants #108180-001 (INTA-UNC) & #107731-002 (INFORMAS), CONICYT FONDECYT #1161436. CVH was supported by a Deakin University Postgraduate Research Scholarship. Funders had no influence in the study design, data collection, analysis, or interpretation of the data, writing of the manuscript, or in the decision to submit this paper for publication.
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All authors contributed to the study conceptualization and design; CC provided the databases necessary for the research; CVH & LO performed the statistical analysis; CVH wrote the first draft; all authors reviewed and edited the manuscript; all authors read and approved the final manuscript.
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The original study was approved by INTA’s institutional review board and was performed in accordance with the Declaration of Helsinki of 1975 as revised in 1983 [48]. The present study met the criteria for exemption from ethical review and was authorized to be conducted by Deakin University Human Research Ethics Committee (reference number 2021-065) and INTA’s institutional review board.
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Venegas Hargous, C., Orellana, L., Corvalan, C. et al. Chilean children’s adherence to sustainable healthy diets and its associations with sociodemographic and anthropometric factors: a cross-sectional study. Eur J Nutr (2024). https://doi.org/10.1007/s00394-024-03435-6
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DOI: https://doi.org/10.1007/s00394-024-03435-6