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Validation of REFRESH, a brief 10-item screener for assessing environmentally sustainable and healthy diets
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Edité par CCSD -
The growing concern over public health and environmental sustainability calls for dietary assessment tools that address both aspects. This study introduces REFRESH, a concise dietary screener designed to evaluate diet healthiness and environmental impact. We aimed to assess the internal consistency, relative validity, diagnostic capacity and construct validity of REFRESH compared to food diaries.Internal consistency was assessed by Kuder Richardson-20 (KR-20) coefficient. Relative validity was compared against food diaries, assessing absolute agreement for each item and using BlandAltman analysis for the overall scale. Cross-classification was evaluated in three categories of low, medium, and high adherence to environmentally sustainable healthy diets. Diagnostic capacity was determined using Negative Predictive Value (NPV) and Positive Predictive Value (PPV). Construct validity was assessed via linear regression between REFRESH scores and health promoting/detrimental nutrients, health outcomes relative risks, and environmental impact indicators. Based on data from 93 adult Spaniards, REFRESH showed a KR-20=0·70. Agreements with food diaries for individual items ranged from 60% to 88%, with overall REFRESH scores averaging 1·1 point (95% CI 0·7-1·4) higher. NPV values ranged from 53% to 88%, and PPV values from 67% to 100%. Using both methods, 59% of individuals were classified into the identical category in the three-level categorization, with only 1% misclassified into the opposite category. REFRESH scores exhibit a positive correlation with health-promoting nutrients, and a negative correlation with nutrients that are detrimental. Higher REFRESH scores were associated with reduced relative risks of adverse health outcomes and lower environmental impact. Overall, REFRESH is a valid, reliable tool for assessing diet healthiness and environmental sustainability. Besides being designed for Spain, REFRESH could be easily adapted to the realities of others countries. Thus, contributing to large-scale promotion of sustainable healthy diets.This study has not received any specific funding.
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