International Journal of Environmental Research and Public Health · 4 authors, 5 centres
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This critical review proposes a holistic framework for dietary quality assessment that incorporates social and environmental factors to improve the translation of dietary scores into practical recommendations. The main limitation is that it is a conceptual review without empirical evidence, and it does not provide specific clinical guidelines.
The paper addresses the global burden of noncommunicable diseases linked to poor dietary quality, emphasizing the need for holistic assessment beyond reductionist approaches. Methods: It is a critical review that contrasts reductionism and holism in nutrition science, using the Diet Quality Index-International (DQI-I) as an example index. The review proposes a conceptual framework integrating biomedical, social, and environmental factors to contextualize dietary quality assessment. Key Results: The framework suggests that dietary quality indices should consider contextual factors such as socioeconomics, food accessibility, pollution, and cultural influences. For instance, food deserts and economic disparities can limit access to nutritious foods, affecting index components like variety, adequacy, moderation, and balance. The review illustrates how these factors can be incorporated into assessment processes at individual and community levels, potentially improving evidence-based practices. Limitations: As a narrative review, it lacks empirical data and does not provide definitive solutions or clinical recommendations. The framework is conceptual and requires further validation. Implications: The holistic approach could enhance evidence-based practices, guide public health policies, and help tailor dietary recommendations by identifying barriers and facilitators to dietary quality in diverse populations.
