Sociodemographic Disparities in Adherence to the Planetary Health Diet Index in Peru: Evidence from the National Food and Nutrition Survey, 2017-2018

Background: The EAT-Lancet Healthy Reference Diet (EAT-HRD) provides global recommendations for a healthy and environmentally sustainable diet but requires country-specific analysis before promotion. Objective: The objective was to assess Peruvian adults' adherence to the EAT-HRD and identify associated sociodemographic factors. Design: This study is a secondary analysis of cross-sectional data from the 2017-2018 National Survey of Food and Nutrition Surveillance by Life Stages. Participants: The study included 875 Peruvian adults aged 18 to 59 years with 24-hour dietary recall data from the Coast, Highlands, and Jungle regions. Main outcome measures: Adherence to the EAT-HRD measured with the Planetary Health Diet Index (PHDI). Statistical analyses: PHDI mean scores and intake relative to recommended levels for each component were calculated. Associations between PHDI and sociodemographic factors were examined using generalized linear regression. Results: The mean PHDI score was 68.8 (95% CI, 67.8 to 69.9) of 140. Adherence to plant-based foods, except fruits, was below recommendations: legumes and vegetables around 55%, and lowest for nuts (4% ± 0.4%) and whole grains (18% ± 4.3%). Intakes of animal-source foods, excluding dairy, exceeded recommendations, reaching 199% ± 2.1% for red and processed meat and 250% ± 2.1% for poultry and eggs. Tubers, starchy vegetables, added sugar, and fruit juice also exceeded recommendations. Regional disparities were evident: lowest intakes of whole grains (3.5% ± 2.1%) and vegetables (22% ± 9.7%) in the Jungle, excessive tuber intake in the Highlands (780% ± 30.2), and meat intake of 223% ± 2.8 on the Coast. Female sex and poverty were associated with higher PHDI scores. Conclusions: Peruvian adults’ diets showed low PHDI adherence with marked subnational disparities, highligting the need transform food systems. toward equitable, healthy, and sustainable diets. Further research on nutrient adequacy is needed to guide local PHDI adaptation.