(LB02-18-25) Universal Sub-constructs of a Healthy Diet for Children and Adolescents: A Ten-Year Retrospective Systematic Literature Review

Objectives: To identify universal subconstructs of a healthy diet for children and adolescents aged 2-19 years to inform recommendations for metrics that monitor healthiness of diets at global and national levels.

Methods: We carried out a critical narrative review in three phases. Phase 1: a systematic review of literature published between 2014 and 2024 was conducted. A subset of articles (n=100) was purposefully sampled based on predefined characteristics (child age, country, geographic region, study objective). Content analysis was used to identify subconstructs of healthy diets. Phase 2: subconstructs identified in phase 1 were compared to six subconstructs for adult populations, previously identified by the Healthy Diets Monitoring Initiative (HDMI). Phase 3: subconstructs identified in phase 1 were compared to existing healthy diet metrics concurrently identified by HDMI as suitable for global monitoring of child and adolescent diets.

Results: Eight subconstructs specific to children and adolescents were identified, namely nutrient, energy, and food group requirements; foods and nutrients to moderate or avoid; food group diversity and variety; macronutrient and energy balance; nutrient rich foods or food groups; food safety; meal frequency; and eating regularity. Compared to the six subconstructs of adult healthy diets identified by HDMI, two subconstructs differed in their operationalization (nutrient, energy, and food group requirements and food safety) and two child- and adolescent-specific subconstructs were identified (meal frequency and eating regularity) that appeared to reflect themes distinct from the other adult and child subconstructs. Diet metrics identified elsewhere as suitable for global monitoring of child and adolescent diets integrate nutrient, energy, and food group requirements; foods and nutrients to moderate or avoid; and food group diversity and variety but no other diet subconstructs. Minimum Dietary Diversity, based on 10 nutritious food groups, and the Adapted NOVA food score were the metrics that most closely reflected the content of the subconstructs identified in our review.

Conclusions: Findings from this review could be used to develop and validate metrics of a healthy diet, specifically for children and adolescents.

Funding Sources: Bill and Melinda Gates Foundation (grant: INV-063321)