Adherence to the EAT-Lancet Dietary Recommendations for a Healthy and Sustainable Diet—The Case of the Brazuca Natal Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

With great pleasure, I reviewed the manuscript by Rosa Sá de Oliveira Neta and colleagues. It is a well-written manuscript that sheds light on the sustainable aspect of food consumption in Brazil. 

Consider adding Figure 1 in color, if that is feasible. 

Consider adding a table with the ultra-processed products, according to the NOVA system. 

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Sir / Madam,

Please find below my comments and suggestions following the review of the study titled ‘Adherence to EAT-Lancet dietary recommendations for a healthy and sustainable diet - The case of the Brazuca Natal study’.

The authors have chosen an interesting topic to study and I commend the authors on the work they have undertaken.

However, the study does have several points that require revision. Importantly, the authors need to improve their presentations of ideas and impressions in each section to improve comprehension of the study. The current presentation of the manuscript lacks flow making it difficult to understand what the authors are trying to convey to the readers.

1.     Materials and Methods:

·       Please state the eligibility criteria for inclusion in the study

·       Please state the reference for excessive alcohol consumption for men and women.

·       Please provide details of sample size calculation.

·       What was the software used for statistical analysis?

2.     Results:

·       What do the authors mean by “uniformly distributed in strata”

·       Replace masculine/feminine with male/female

 

3.     Discussion:

·       Lines 329-335 – This paragraph is unclear.

Comments on the Quality of English Language

Considerable English language editing is required.

Please write succinct sentences.

Grammatical errors in the manuscript need to be rectified

Please expand all abbreviations at the first mention. There are several abbr for which the full forms have not been given

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Dear authors,

Thank you for the opportunity to review the article entitled ,,Adherence to EAT-Lancet dietary recommendations for a healthy and sustainable diet -The case of the Brazuca Natal study,,.

Although the manuscript is ell presented, it needs revision, based on the following comments.

The introduction sets the context well, but, please detail more and explain what is the purpose of the contribution and how it is leveraged.

Results section:

1. Page 6, Table 1 -Define what the ,,CI,, abbreviation refers to

2. Page 7, line 283-287 -The correlation between PHDI and age is not discussed in the text

3. Page 8, Table 3 -use decimal notation with a period and not a comma

4. Page 9, line 400 -Please delete ,,the,, before ,, Gambia,,

References are not formatted according to instructions for authors.

Best regards

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

Adherence to EAT-Lancet dietary recommendations for a healthy and sustainable diet - The case of the Brazuca Natal study

Detailed corrections to be made are listed below.

Page 1, abstract, line 26: Add space after “(PHDI).”;

Page 1, abstract, line 27: Add space after “variables.”;

Page 1, abstract, lines 29-30: Instead of “in a score that can vary from” please write “with a possible range from”;

Page 1, lines 39-40: Rephrase the sentence: “The planet is overloaded with exponential population growth at the same time that there is greater pressure to increase food production [1].”, as follows: “The world is facing a dual challenge of burgeoning population growth and mounting demands for higher food production. [1].”;

Page 1, lines 40-42: Rephrase the sentence: “…868 million going hungry and another 2 billion facing micronutrient deficiencies” as follows: “…868 million are suffering from hunger, and an additional 2 billion are contending with micronutrient deficiencies [2].”;

Page 1, lines 42-45: Rephrase the sentence: “The global syndemic conception seeks a combined solution to problems with common factors and social determinants, in this case to the "triple burden" of obesity, malnutrition and climate change pandemics”, as follows:” The concept of a global syndemic pursues an integrated approach to address issues that share common factors and are influenced by social determinants. In this instance, it aims to tackle the interconnected challenges of the "triple burden" of pandemics involving obesity, malnutrition, and climate change.”;

Page 2, lines 46-48: Please rephrase: “This global disparity highlights a major obstacle to achieving the Sustainable Development Goals (SDGs), which aim to end poverty, protect the planet and humanity by 2030”, as follows: “This worldwide inequality underscores a significant barrier to the attainment of the Sustainable Development Goals (SDGs). The SDGs strive to eradicate poverty, safeguard the planet, and ensure the well-being of humanity by the year 2030.”;

Page 2, line 65: Define what the abbreviation “POF” refers to;

Page 2, line 70: Is an initial capital letter required for this word “commission”?

Page 3, line 120: Please add “a” before “high”;

Page 3, lines 125-127: Match the categories with Figure 1, instead “Optimal” please use “Optimum”, instead “Proportion” please use “Ratio”;

Figure 1: Legend: Before “ReV” add “*”;

Figure 1, title: Please use “Source: Cacau et al.”, or “Adapted from Cacau et al”;

Page 4, lines 131-132: Please rephrase the following sentence to make it clearer: “A maximum of 5 or 10 points can be assigned, resulting in a total proportional score ranging from 0 to 150 points.”;

Page 4, line 132-133: Whether numbers “0, 10 and 5” refer to points?

Page 4, lines 135-137: Please rephrase the following sentence: “The lower the consumption of foods in the “Moderation” component, the higher the score and the opposite occurs with the foods in the “Adequacy” group, indicating which foods should have their consumption stimulated in order to have a healthy and sustainable diet..”, use the next text: “A higher score is associated with reduced consumption of foods categorized under "Moderation," while the inverse holds true for foods falling under "Adequacy." This underscores the importance of promoting the consumption of specific foods to foster a healthy and sustainable diet.”, or something similar;

Page 4, line 150: Please delete “de Dados”, it is stated twice in the sentence;

Page 4, line 179: “m2” “2” should be written as a superscript;

Rage 4, line 181: Add “an” before “accuracy” in the sentence;

Page 5, lines 186-188: Please rephrase the sentence: “To measure the presence of FNI in the households of the interviewees, a version of the Brazilian Scale for Food Insecurity (BSFI) was applied, with 14 central closed questions, with dichotomous answers, about the experience in the last three months of insufficiency.” as follows: After “was applied.“ (a full stop). Then, a new sentence: “It comprised 14 central closed questions, …”;

Page 5, line 192: Define which word the abbreviation “FNS” refers to;

Page 5, lines 214-215: Please rephrase the sentence: “… aged 45.06±0.80 years uniformly distributed in strata.” as follows: “… with an average age of 45.06±0.80 years, and they were uniformly distributed among strata.”;

Page 6, line 238 Table 1: Please correct “19 years old” as follows “1-9 years”;

Page 6, Table 1: Define what the “CI” abbreviation refers to;

Page 6, Table 1: Mark what “*” refers to in the table 1;

Page 6, line 261: Add space after “1951”;

Page 6, line 267: After “PHDI components” add “Figure 2”, and delete at the end of the same sentence (page 7, line 274);

Page 6, line 272: In the text for vegetable oils “3.43”, in Figure 2 “3.23”, please check;

Page 7, title of the Figure 2: What does this sign “≠” refer to?

Page 7, lines 283-287: The correlation between PHDI and age is not discussed in the text;

Page 7, Table 2: Indicate in the table what “*” refers to;

Page 7, line 295: After “the Sustainable Diet index” add “(Table 3)”;

Page 8, Table 3: Use decimal notation with a period and not a comma;

Page 8, line 332: Delete “The” before “Gambia”;

Page 8, line 340: Add “a” before “less” and before “lower”;

Page 9, lines 362-365: Please correct the next sentence “The implementation of government policies for food and social protection are fundamental for achieving sovereignty and FNS, since the problem in the northeast region was not lack of incentives for agricultural production, marked by sugar production in the colonial period, but rather unequal access the land”, as follows: “The implementation of government policies for food and social protection is fundamental for achieving food sovereignty (FNS). In the case of the northeast region, the problem is not a lack of incentives for agricultural production, as evidenced by the historical significance of sugar production during the colonial period. Instead, the issue lies in the unequal access to land."

Page 9, lines 371-373: Correct the sentence: “It cuts across sustainability by encouraging the population to prioritize in natura food and predominantly plant-based foods to the detriment of ultra-processed foods” as follows: “It promotes sustainability by encouraging the population to prioritize whole, natural foods and predominantly plant-based options while discouraging the consumption of ultra-processed foods.”;

Page 9, line 380: Does this number in parentheses “(2)” refer to reference number 2 “[2]”?

Page 9, lines 385-387: Correct the next sentence “Despite the Brazuca-Natal participants not reaching even half of the possible points in the PHDI, individuals who had greater adherence showed less possibility of developing overweight or obesity as follows: “Although the Brazuca-Natal participants didn't achieve even half of the possible points on the PHDI, individuals with higher adherence had a reduced likelihood of developing overweight or obesity”;

Page 9, lines 387-390: Please correct the next sentence “We found an inverse correlation between BMI and PHDI, which has already been well validated by other studies, such as the one by Cacau et al. (2021) [21] revealed that Brazilians with higher PHDI scores (greater adherence to the EAT-Lancet diet) were 24% less likely to be overweight/obese.” as follows “We observed an inverse correlation between BMI and PHDI, a relationship that has been well-established in other studies. For instance, Cacau et al. (2021) [21] found that Brazilians with higher PHDI scores (indicating greater adherence to the EAT-Lancet diet) were 24% less likely to be overweight or obese.”;

Page 9, line 391: After “studies” add space;

Page 9, lines 393-395: Rephrase the sentence “Corroborating our findings, Marchioni et al. (2022) [22] when considering adherence to the PHDI by food components in the Northeast region, they highlighted the highest scores for fruits, vegetables, legumes, dairy products, and vegetable oils” as follows “Consistent with our findings, Marchioni et al. (2022) [22], in their study of adherence to the PHDI based on food components in the Northeast region, pointed out the highest scores for fruits, vegetables, legumes, dairy products, and vegetable oils.";

Page 9, line 400: Delete “the” before “Gambia”;

Page 10, lines 405-407: Rephrase the sentence: “The source of legumes that scored the most in the PHDI was beans, which despite having had a reduction in consumption by Brazilians [56], is a regional food and continues to be the staple food of Northeasterners” as follows “Beans, a regional food and the staple diet of Northeasterners, scored the highest among legumes in the PHDI, despite a reduction in consumption by Brazilians [56]”;

Page 10, lines 410-414: Rephrase the next sentence: “This decrease in bean consumption may reflect the contemporary Brazilian agricultural model, based on monoculture, focused on the great demand for commodities such as soy, corn, wheat and sugar [25]or it may indicate a higher consumption of ultra-processed foods or even that Brazilians are cooking less when compared to what was analyzed by the POF (2008-2009) “, as follows: “The decrease in bean consumption may be indicative of the contemporary Brazilian agricultural model, which is primarily focused on monoculture and the high demand for commodities such as soy, corn, wheat, and sugar [25]. It could also suggest an increase in the consumption of ultra-processed foods or a decrease in cooking practices, as compared to the period analyzed by the POF (2008-2009).";

Page 10, lines 415-417: Please rephrase the sentence:” Among the optimal components, vegetable oils had their intake highlighted in our study, a similar finding was visualized by Campirano et al. (2023) [58] and Marchioni et al. (2022) [22] for the northeast region of Brazil.” as follows: “Within the ideal components, our study identified a notable emphasis on vegetable oil intake, a trend that aligns with the observations made by Campirano et al. (2023) [58] and Marchioni et al. (2022) 22] for the northeast region of Brazil.”;

Page 10, lines 417-420: Please rephrase the next sentence: “Then, dairy products stood out as an optimal component, being congruent with a national study that analyzed the northeast region [22] and different from the findings by Trijsburg et al. (2021), in which individuals consumed less than recommended [14].” as follows: “Next, dairy products emerged as a key component, which corresponds to the results of a national study that focused on the northeast region [22]. This contrasts with the findings of Trijsburg et al. (2021), where individuals consumed less than the recommended amount [14].";

Page 10, lines 421-422: Please rephrase: “The worst scores in the moderation component of the PHDI in our study were for foods that should have their consumption restricted, in this case, animal fat and red meat.” as follows: “In our study, the lowest scores in the moderation component of the PHDI were observed for foods that should be consumed in moderation, notably animal fat and red meat.”;

Page 10, lines 423-428: “This means that, due to the inversion of scores in this component, these people consume a greater amount of these foods. Although the high consumption of meat seems to be contradictory in relation to the FNI situation [24], it is important to remember that the PHDI establishes a limit of 2.4 points for the consumption of red meat, which is equivalent to a maximum of 2.4% of the total calorie density of the diet, and this limit can be easily reached by rich foods in proteins and fats.”, as follows: “This implies that, given the reversal of scores in this component, these individuals have a higher consumption of these foods. Although the elevated meat consumption may appear contradictory in relation to the FNI situation [24], it's crucial to bear in mind that the PHDI sets a threshold of 2.4 points for red meat consumption, equivalent to a maximum of 2.4% of the total calorie density in the diet. This limit can be easily met by foods rich in proteins and fats.";

Page 10, line 434: Correct “eg.” as follows “e.g.”;

References are not formatted according to instructions for authors.

Comments on the Quality of English Language

The manuscript is well-written, some minor corrections are inserted in comments. 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have done a good job in addressing all my suggestions and they have improved the quality of the manuscript tremendously.

Figure 1 - There seem to be 2 figures pasted on top of each other.

Line 257-258 Data were collected from 411 individuals of both sexes, with an average age of 45.06±0.80 years  and they were evenly distributed among strata. The authors have done a good job clarifying this sentence. I would suggest adding the following - among the 4 age and sex strata.

 

Comments on the Quality of English Language

Minor grammatical errors still exist. For eg Line 210-211 Race was categorized in (into and not in) “white” and “non-white”.

Author Response

Please see the attachment

Author Response File: Author Response.pdf