Sustainable-psycho-nutritional intervention program for a sustainable diet (the 'NutriSOS' study) and its effects on eating behavior, diet quality, nutritional status, physical activity, metabolic biomarkers, gut microbiota, and water and carbon footprints in Mexican population: study protocol of an mHealth randomized controlled trial.

Mexico is going through an environmental and nutritional crisis related to unsustainable dietary behaviors. Sustainable diets could solve both problems together. This study protocol aims to develop a 3-stages, 15 weeks mHealth randomized controlled trial (RCT) of a sustainable-psycho-nutritional intervention program to promote Mexican population adherence to a sustainable diet and to evaluate its effects on health and environmental outcomes. In stage 1, the program will be designed using the sustainable diets, behavior change wheel, and COM-B models. A sustainable food guide, recipes, meal plans, and a mobile application will be developed. In stage 2, the intervention will be implemented for seven weeks, and a 7-weeks follow-up period in a young Mexican adults (18 to 35 years) sample, randomly divided (1:1 ratio) into a control group (n=50) and an experimental group (n=50), that will be divided in two arms at week 8. Outcomes will include health, nutrition, environment, behavior, and nutritional-sustainable knowledge. Additionally, socioeconomics and culture will be considered. Thirteen behavioral objectives will be included using successive approaches in online workshops twice a week. The population will be monitored using the mobile application consisting of behavioral change techniques. In stage 3, the effects of the intervention will be assessed using mixed-effect models on dietary intake and quality, nutritional status, physical activity, metabolic biomarkers (serum glucose and lipid profile), gut microbiota composition, and dietary water and carbon footprints of the evaluated population. Improvements in health outcomes and a decrease in dietary water and carbon footprints are expected.