Development of a sustainable diet index in US adults

Sukyoung Jung; Heather A Young; Barbara H Braffett; Samuel J Simmens; Cynthia L Ogden

doi:10.1186/s12937-024-00943-3

Development of a sustainable diet index in US adults

Nutr J. 2024 Apr 10;23(1):46. doi: 10.1186/s12937-024-00943-3.

Authors

Sukyoung Jung^{1

2}, Heather A Young³, Barbara H Braffett³, Samuel J Simmens⁴, Cynthia L Ogden³

Affiliations

¹ Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA. sukyoung_jung@gwu.edu.
² The Korean Institute of Nutrition, Hallym University, 1 Hallymdaehak-gil, Chuncheon, 24252, South Korea. sukyoung_jung@gwu.edu.
³ Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
⁴ Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.

Abstract

Background: A transformation towards healthy diets through a sustainable food system is essential to enhance both human and planet health. Development of a valid, multidimensional, quantitative index of a sustainable diet would allow monitoring progress in the US population. We evaluated the content and construct validity of a sustainable diet index for US adults (SDI-US) based on data collected at the individual level.

Methods: The SDI-US, adapted from the SDI validated in the French population, was developed using data on US adults aged 20 years and older from the National Health and Nutrition Examination Survey, 2007-2018 (n = 25,543). The index consisted of 4 sub-indices, made up of 12 indicators, corresponding to 4 dimensions of sustainable diets (nutritional quality, environmental impacts, affordability (economic), and ready-made product use behaviors (sociocultural)). A higher SDI-US score indicates greater alignment with sustainable diets (range: 4-20). Validation analyses were performed, including the assessment of the relevance of each indicator, correlations between individual indicators, sub-indices, and total SDI-US, differences in scores between sociodemographic subgroups, and associations with selected food groups in dietary guidelines, the alternative Mediterranean diet (aMed) score, and the EAT-Lancet diet score.

Results: Total SDI-US mean was 13.1 (standard error 0.04). The correlation between SDI-US and sub-indices ranged from 0.39 for the environmental sub-index to 0.61 for the economic sub-index (Pearson Correlation coefficient). The correlation between a modified SDI-US after removing each sub-index and the SDI-US ranged from 0.83 to 0.93. aMed scores and EAT-Lancet diet scores were significantly higher among adults in the highest SDI-US quintile compared to the lowest quintile (aMed: 4.6 vs. 3.2; EAT-Lancet diet score: 9.9 vs. 8.7 p < .0001 for both).

Conclusions: Overall, content and construct validity of the SDI-US were acceptable. The SDI-US reflected the key features of sustainable diets by integrating four sub-indices, comparable to the SDI-France. The SDI-US can be used to assess alignment with sustainable diets in the US. Continued monitoring of US adults' diets using the SDI-US could help improve dietary sustainability.

Keywords: Diet index; Dietary patterns; Environmental impact; Multidimensional assessment; Sustainable diets.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Diet / methods
Diet / statistics & numerical data
Diet, Healthy* / methods
Diet, Healthy* / statistics & numerical data
Female
Humans
Male
Middle Aged
Nutrition Policy
Nutrition Surveys* / methods
Nutrition Surveys* / statistics & numerical data
Nutritive Value
United States
Young Adult

Grants and funding

RS-2023-00274240/National Research Foundation of Korea