EAT-Lancet Reference Diet and Nutritional Adequacy in Children: Examining the Planetary Health Diet Index for Children (PHDI-C)

Purpose: The EAT-Lancet Commission introduced a global reference diet in 2019 for individuals aged two years and older. Concerns exist regarding its ability to fulfill children’s specific micronutrient requirements. The PHDI-C, an adapted version of the Planetary Health Diet Index (PHDI), was developed to better reflect the nutritional needs of growing children. However, its association with micronutrient adequacy in pediatric populations has not been fully examined. Our study investigates whether the PHDI-C is associated with micronutrient adequacy in children and compares its performance to the original PHDI. Methods: This cross-sectional study compared the association of the PHDI and PHDI-C with nutritional adequacy in children aged 4–5 years from the SENDO cohort. Dietary, lifestyle, and socio-demographic data were collected via parent-administered questionnaires. Scores for both indices were calculated, and participants were categorized into tertiles. Micronutrient adequacy was assessed using the Estimated Average Requirement (EAR) cut-off points, and multivariate analyses examined the relationship between both indices and the risk of inadequate micronutrient intake. Results: After adjusting for potential confounders, higher PHDI-C scores were associated with fewer unmet EARs (p < 0.001). Children in the highest tertile had significantly lower odds (0.37-fold; 95% CI: 0.20–0.69; p  = 0.002) of having ≥ 3 inadequate micronutrient intakes compared to the lowest tertile. For the original PHDI, the odds reduction was 0.58-fold (95% CI: 0.31–1.07; p  = 0.071). Conclusion: The PHDI-C is linked to better nutritional adequacy than the original PHDI. Further research is needed to validate the PHDI-C in terms of environmental sustainability.