HealthyandSustainableDietaryPatternsin ChildrenandAdolescents:ASystematicReview

Abstract

The need for adherence to a healthy and sustainable dietary pattern in the pediatric stage is discussed worldwide, being linked to a progressive incidenceofnoncommunicablediseasesinadulthood.Theaimsofthissystematicreviewweretosummarizethehealthyand/orsustainabledietary patterns, defined a priori, described in the literature for use during the pediatric stage; to evaluate the adherence to these dietary patterns; and identify the health-related benefits associated with adherence to these patterns. A literature search was carried out on Medline, Scopus, and Web ofSciencefrom2010upto2021,accordingtothePreferredReportingItemsforSystematicReviewsandMeta-Analyses(PRISMA)guidelines.Atotal of 128 articles were included according to the following criteria: participants 2–17 y old, healthy and/or sustainable dietary patterns defined by an a priori methodology; articles written in English or Portuguese; and published since 2010. Fifty instruments with 14 adaptations that measure adherence to healthy and/or sustainable dietary patterns in children and adolescents were found. The Mediterranean Diet was the most studied dietary pattern. Adherence to healthy and/or sustainable dietary patterns has wide variations worldwide. Most of the instruments described have beenlittlestudiedatpediatricages,reducingtheabilitytoextrapolateresults.Higheradherencetothesedietarypatternswasassociatedwithlower bodyfat,waistcircumference,bloodpressure,andmetabolicrisk.ThereisnoconsensusregardingtheassociationwithBMI.Nostudieshaveproofs of the sustainabilitycharacteristicsof these instruments,itbeing necessary to produceanew sustainable instrumentortest the associationof the previous ones with, for example, the ecological footprint. Further validations of these instruments in each country and more prospective studies areneededtoestablishtemporalrelationswithhealth-relatedoutcomes.Thissystematicreviewwasregisteredatwww.crd.york.ac.uk/prospero/as CRD42020221788