Healthy and sustainable dietary patterns in children and adolescents: a systematic review.

The need to adherence to healthy and sustainable dietary pattern in pediatric age is discussed worldwide, being linked to a progressively incidence of non-communicable diseases in adulthood. The aims of this systematic review were to summarize the healthy and/or sustainable dietary patterns, defined a priori, described in the literature for use among the pediatric age; to evaluate the adherence to these dietary patterns and identify the health-related benefits associated with the adherence to these patterns. A literature search was carried out on MEDLINE, SCOPUS and WEB of SCIENCE from 2010 up to 2021, according to the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number: CRD42020221788). A hundred and twenty-eight papers were included according to the following criteria: 2-17 years old participants, healthy and /or sustainable dietary patterns defined by an a priori methodology; papers written in English or Portuguese and published since 2010. Fifty instruments with 14 adaptations that measure adherence to healthy and/or sustainable dietary patterns in children and adolescents were found. The Mediterranean Diet was the most studied dietary pattern. Adherence to healthy and/or sustainable dietary patterns has wide variations worldwide. Most of the instruments described have been little studied in pediatric age, reducing the ability to extrapolate results. A higher adherence to these dietary patterns was associated to lower body fat, waist circumference, blood pressure and metabolic risk. There is no consensus regarding the association with body mass index. No studies have proofs of the sustainability characteristics of these instruments, being necessary to produce a new sustainable instrument or test the association of the previous ones with, for example, the ecological footprint. Further validations of these instruments in each country and more prospective are needed studies to establish temporal relationships with health-related outcomes.