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

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.