Sociodemographic disparities in adherence to the Planetary Health Diet Index in Peru: Evidence from the National Food and Nutrition Survey 2017-2018.

Abstract

Background: The EAT-Lancet Healthy Reference Diet (EAT-HRD) provides global recommendations for a healthy and environmentally sustainable diet but requires country-specific analysis before promotion.

Objective: The objective was to assess Peruvian adults' adherence to the EAT-HRD and identify associated sociodemographic factors.

Design: This study is a secondary analysis of cross-sectional data from the 2017-2018 National Survey of Food and Nutrition Surveillance by Life Stages (VIANEV).

Participants: The study included 875 Peruvian adults aged 18-59 years with 24-hour dietary recall data from the Coast, Highlands, and Jungle regions.

Main outcome measures: Adherence to the EAT-HRD measured with the Planetary Health Diet Index (PHDI).

Statistical analyses: PHDI mean scores and intake relative to recommended levels for each component were calculated. Associations between PHDI and sociodemographic factors were examined using generalized linear regression.

Results: The mean PHDI score was 68.8 (95% CI, 67.8-69.9) of 140. Adherence to plant-based foods, except fruits, was below recommendations: legumes and vegetables around 55%, and lowest for nuts (4%, SE=0.4) and whole grains (18%, SE=4.3). Intakes of animal-source foods, excluding dairy, exceeded recommendations, reaching 199% (SE=2.1) for red and processed meat and 250% (SE=2.1) for poultry and eggs. Tubers, starchy vegetables, added sugar, and fruit juice also exceeded recommendations. Regional disparities were evident: lowest intakes of whole grains (3.5%, SE=2.1) and vegetables (22%, SE=9.7) in the Jungle, excessive tuber intake in the Highlands (780%, SE=30.2), and meat intake of 223% (SE=2.8) on the Coast. Female sex and poverty were associated with higher PHDI scores.

Conclusions: Peruvian adults' diets showed low adherence to the PHDI and characterized by pronounced subnational disparities, underscoring the need for food system transformation toward equitable, healthy, sustainable, and nutritionally adequate diets.