Children’s adherence to a healthy and environmentally sustainable dietary pattern based on the EAT-Lancet recommendations: the role of the family environment

This study aimed to investigate the association between family characteristics and adherence to the EAT-Lancet dietary recommendations in 7-year-old children. This is a prospective birth cohort study with 2125 children from Generation XXI (Porto, Portugal), who provided 3-day food diaries at age 7, used to assess habitual food consumption. At the age of 4, maternal diet was assessed using a Food Frequency Questionnaire, and a diet quality score was calculated (higher scores indicating a better maternal diet), and parental-child feeding practices were assessed with the Child Feeding Questionnaire. Adherence to the EAT-Lancet dietary recommendations was evaluated using the World Index for Sustainability and Health (WISH) at the age of 7 years, previously adapted to paediatric age. Hierarchical linear regression models (consecutive addition of blocks of variables based on a theoretical framework) were employed to evaluate the associations between family characteristics and adherence to the WISH at age 7 (<i>β</i> regression coefficients and the respective 95 % confidence intervals (95 % CI)). Higher maternal age and education at child's birth were associated with increased adherence to the WISH at age 7 (<i>β</i> = 0·018, 95 % CI 0·005, 0·031; <i>β</i> = 0·038, 95 % CI 0·024, 0·053, respectively). A better maternal diet quality and using more restrictive practices on child's diet, at 4 years old, were both associated with higher scoring in the WISH at 7 years old (<i>β</i> = 0·033, 95 % CI 0·018, 0·049; <i>β</i> = 0·067, 95 % CI 0·009, 0·125, respectively). Early maternal sociodemographic and diet quality play a significant role in influencing the adherence to a healthy and environmentally sustainable dietary pattern at school-age.