Validity of REFRESH, a New Screener for Assessing Environmentally Sustainable and Healthy Diets ^†

Abstract

Background and objectives: Current dietary patterns are the leading cause of morbidity and mortality worldwide, in addition to significantly contributing to natural resource scarcity, environmental degradation, and biodiversity loss. The general adoption of healthy diets with a low environmental impact is timely. While dietary screeners have been used widely to assess the nutritional adequacy of diets, no simple tool that considers both human and environmental dimensions has been developed. Methods: We developed REFRESH (Rapid Evaluation FoR an Environmentally Sustainable and Healthy diet), a 10-item screener that briefly assesses the dietary environmental sustainability and healthiness at once by evaluating habitual consumption of key food groups for a healthy and environmentally sustainable diet. The scoring criteria are based on the EAT-Lancet Commission, FAO, and WHO recommendations. Overall, REFRESH score ranges from 0 to 10 points, with 0 being the lowest and 10 being the highest for adopting an environmentally sustainable healthy diet. Subsequently, we conducted a validation study to evaluate the reliability and validity of REFRESH. In this study, 100 participants were asked to complete the screener’s questionnaire. The results were then compared with a 7-day food record completed in the following week. The questionnaire’s reliability was evaluated by comparing reported servings in both dietary assessments. Additionally, we evaluated the capacity of REFRESH´s scoring system to capture dietary quality and environmental impact. Results: Preliminary validation study results indicated a mean REFRESH score of 5.73 points (range: 1–8) among the participants. Comparing the REFRESH data to the food records, we found a good correlation among both dietary tools. However, we identified that participants tended to slightly overestimate their consumption of legumes, fruits, and vegetables while underestimating their consumption of highly processed foods. The diet of participants who scored higher included a larger proportion of whole plant-based foods. This pattern led to a higher intake of fiber, a lower intake of saturated fats, and a 20% lower environmental impact. Discussion: REFRESH is a valid instrument for rapid estimation of healthy and environmentally sustainable diets and, thus, can be useful for research and clinical practice. The availability of such a validated screener is crucial for promoting environmentally sustainable healthy dietary changes in the general population.