Data_Sheet_1_A Scoping Review of Indicators for Sustainable Healthy Diets.PDF

Introduction: Diets are currently unsustainable in many countries as evidenced by the growing burden of malnutrition, degradation of natural resources, contributions to climate change, and unaffordability of healthy diets. Agreement on what constitutes a healthy and sustainable diet has been debated. In 2019, FAO and WHO published the Sustainable Healthy Diets Guiding Principles, defining what qualifies as a sustainable healthy diet. While valuable, these principles require measurable indicators to support their operationalization. Our scoping review aims to describe how sustainable healthy diets have been assessed in the literature since 2010.
Methods: A search for English-language articles published in peer-reviewed journals was conducted from January 2010 through February 2020 across three databases. Out of the 504 articles initially identified, 103 articles were included. Metadata were extracted from each article on: publication year, country of study, study aims, methods, main data sources, indicators used to assess sustainable healthy diets, reported indicator strengths or limitations, and main study findings. A qualitative content analysis identified major conceptual themes across indicators and their frequency of use.
Findings: From the 103 empirical articles included in our review, 57.3% were published after 2017. Most studies were carried out in high-income countries (74%). Approximately 42% of the articles assessed the sustainability of diets using solely health and environmental indicators; <25% assessed the sustainability of diets across health, environmental, and sociocultural aspects of sustainability. We found a substantial number of unique indicators used for assessing health (n = 82), environmental (n = 117), and sociocultural (n = 43) aspects of diets. These indicators covered concepts related to health outcomes, aspects of diet quality, natural resources, climate change, cultural acceptability, and cost of diets. The preponderance of indicators currently used in research likely poses challenges for stakeholders to identify the most appropriate measures.
Conclusion: Robust indicators for sustainable healthy diets are critical for understanding trends, setting targets, and monitoring progress across national and sub-national levels. Our review highlights the geographical imbalance, the narrow focus on health and environmental aspects, and the lack of common measures used in research. Measures registries could provide the decision-support needed by stakeholders to aid in the indicator selection process.

引言：当前许多国家的膳食模式均不可持续，具体表现为营养不良负担日益加重、自然资源退化、膳食对气候变化的推动作用，以及健康膳食可负担性不足。关于健康可持续膳食的定义，学界尚存争议。2019年，联合国粮食及农业组织（FAO）与世界卫生组织（WHO）发布《可持续健康膳食指导原则》，明确了可持续健康膳食的判定标准。尽管该原则具有重要价值，但仍需可量化的指标以支撑其落地实施。本范围综述（scoping review）旨在梳理2010年以来学术文献中可持续健康膳食的评估方式。
研究方法：本研究于2010年1月至2020年2月期间，在3个数据库中检索经同行评议的英文期刊文章。初步检索共获取504篇文献，最终纳入103篇。从每篇纳入文献中提取以下元数据：发表年份、研究开展国家、研究目的、研究方法、主要数据来源、用于评估可持续健康膳食的指标、文献报告的指标优势与局限，以及核心研究结论。本研究采用定性内容分析（qualitative content analysis），梳理各类指标的核心概念主题及其使用频次。
研究结果：本综述纳入的103篇实证研究中，57.3%发表于2017年之后。绝大多数研究（74%）在高收入国家开展。约42%的文献仅通过健康与环境维度指标评估膳食可持续性；仅不到25%的文献同时从健康、环境及社会文化三个可持续性维度评估膳食可持续性。本研究发现，用于评估膳食健康维度（n=82）、环境维度（n=117）与社会文化维度（n=43）的独特指标数量较多。这些指标涵盖健康结局、膳食质量、自然资源、气候变化、文化可接受性及膳食成本等相关概念。当前研究中大量使用的各类指标，可能会给利益相关方筛选合适的评估方法带来挑战。
结论：科学可靠的可持续健康膳食评估指标，对于掌握膳食模式变化趋势、设定相关目标以及在国家及次国家层面监测进展至关重要。本综述揭示了当前研究存在的地域分布失衡、仅侧重健康与环境维度、缺乏统一通用评估方法等问题。建立指标注册库，可为利益相关方开展指标筛选工作提供所需的决策支持。