Interpreting alignment to the EAT‐Lancet diet using dietary intakes of lactating mothers in rural Western Kenya.

The EAT‐Lancet reference diet intends to be good for planetary and human health. We compared single multiple pass method 24‐h dietary intake of mothers (n = 242) from a cross‐sectional study in Western Kenya to the recommended range of intake of 11 EAT‐Lancet food groups (e.g., 0–100 g/day legumes; maximum score 11), defining alignment two ways: daily intake among food groups where a minimum intake of 0 g was either acceptable or unacceptable. Ordinal logistic regression models assessed associations between alignment and body mass index (BMI). Cost of mothers' diets and hypothetical diets within recommended ranges (lower bounds >0 g) were estimated using food price data from markets within the mothers' locality. Mean energy intake was 1827 (95% confidence interval [CI]: 1731–1924) kcal/day. Relative to the EAT‐Lancet diet, mothers' diets were on average higher for grains; within recommendations for tubers, fish, beef and dairy; closer to lower bounds for chicken, eggs, legumes and nuts; and lower for fruits and vegetables. Mean (95% CI) alignment scores were 8.2 (8.0–8.3) when 0 g intakes were acceptable and 1.7 (1.6–1.9) otherwise. No significant associations were found between alignment and BMI. Mothers' diets and hypothetical diets within recommended ranges averaged 184.6 KES (1.6 USD) and 357.5 KES (3.0 USD)/person/day, respectively. Lactating mothers' diets were not diverse and diverged from the reference diet when an intake of 0 g was considered unacceptable. Lower bound intakes of 0 g for micronutrient‐dense food groups are inappropriate in food‐insecure populations. It would likely cost more than mothers currently spend to tailor their diets to the EAT‐Lancet reference diet. Key messages: Diets of lactating mothers in rural Western Kenya lacked diversity, were calorically‐insufficient, and diverged from the EAT‐Lancet reference diet when 0 g intake of food groups was unacceptable.The EAT‐Lancet reference diet specifies 0 g as the minimum recommended intake for many of its healthy food groups, which can make defining alignment to the diet problematic among food‐insecure populations that consume monotonous diets at risk for micronutrient deficiencies.Mothers spent an estimated average of 1.6 USD/day on their diets, while tailoring to the reference diet (less grain, more fruit and vegetable, more kilocalories) was estimated to cost nearly double. [ABSTRACT FROM AUTHOR]