https://hdl.handle.net/10216/111511 2026-07-22T18:17:33Z https://hdl.handle.net/10216/173416 Title: Identifying HEXACO personality types: what do type characteristics tell us about student misconduct? Abstract: Background While previous research has largely focused on individual trait associations with academic misbehaviour, this study used a person-centred approach to explore personality type differences in student misconduct. The distribution of the personality types was also compared across sociodemographic groups and fields of study. Methods A sample of 1,398 health and non-health university students replied to a multiple-choice questionnaire covering HEXACO personality traits, eight forms of academic misconduct, and background information. Personality types were explored through cluster analysis, and differences in their behaviour and characteristics were examined using chi-square test and ANOVA. Results The five personality types identified differed in their self-reported academic misconduct. Risk-takers disclosed the highest levels of misconduct, followed by Performance-oriented students, who had competitive dispositions. Secure and Socially Considerate students exhibited more well-adjusted and prosocial traits, respectively, disclosing the lowest rates of misconduct. Insecure students scored higher than these two types on Plagiarism, combining traits associated with psychological distress that may affect their performance. The personality types also revealed gender and socioeconomic differences, and a more uniform distribution in health than in non-health fields. Conclusion This study expands on past research by analysing a distinct set of personality types in association with academic misconduct. Understanding the psychosocial characteristics and field of study distribution of these types helped to propose tailored educational strategies to foster their compliance with academic integrity. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/173776 Title: Oral healthcare in maternal health services: a cross-country comparative analysis in 10 European countries 2026-01-01T00:00:00Z https://hdl.handle.net/10216/171706 Title: Beyond Healing: The Transformative Role of Customer Experience in Healthcare and Its Contribution to Patient Well-Being Abstract: Customer Experience (CX) and transformative service research (TSR) are current academic priorities. Healthcare is a prime example of a service inherently transformative, with patient experience (PX) playing a critical role. However, the literature lacks a comprehensive understanding of PX and its effects on patients' well-being. To bridge this research gap, semi-structured interviews were conducted, involving healthcare managers, providers and patients, revealing nine key dimensions of PX, critical to patients' well-being. This study advances CX literature and TSR by proposing a conceptual framework on PX and its transformative effects, while offering managerial insights for improving well-being and experiences in healthcare. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/171979 Title: Pre-packaged food targeted to gastrointestinal pathologies: are they low in FODMAP? Abstract: A diet low in fermentable carbohydrates, oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) has been described as an effective nutritional approach in irritable bowel syndrome. There has been an increased demand for gluten- and lactose-free foodstuffs in the last few years, which are associated with gastrointestinal symptoms and are consumed by patients with gastrointestinal disease. This study aims to estimate the FODMAP content of industrial pre-packaged food products containing the 'gluten-free' and 'lactose-free' claims. The ingredient lists of the foodstuffs from a Portuguese food retail chain were verified and classified according to their estimated FODMAP content as 'low' and 'high', using as a reference the FODMAP cutoff values and the serving sizes established by the Monash University App. Descriptive statistics and the Pearson chi 2 test were applied. From the 436 eligible products identified, most were classified as 'low' (530 %, n 231), 243 % (n 106) were classified as 'high' and 227 % (n 99) were classified as having 'unknown' FODMAP content. 'High FODMAP' products accounted for 122 % of those with 'lactose-free' claims and 316 % of those with 'gluten-free' claims. The 'ready meals' and 'sauces, dressings, creams and soups' were the food categories with the highest proportion of products with high FODMAP sources. This study showed that approximately a quarter of pre-packaged industrial foods targeted to gastrointestinal pathologies are high in FODMAP. The nutritional information on the label should be more specific, enabling more accurate dosing of FODMAP contents in foodstuffs and the establishment of the recommended serving sizes. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/171897 Title: Interventions to Reduce Sodium Consumption Through a Reduction in Salt Usage in Cooking-A Systematic Review and Meta-analysis Abstract: Context: Public health experts have identified salt as a primary dietary risk factor, leading many countries worldwide, recognizing its cost-effectiveness, to implement salt-reduction programs to combat cardiovascular disease and other chronic illnesses. Some nations found that a substantial portion of dietary salt comes from cooking practices. Objectives: This systematic review aims to describe and assess the effectiveness of interventions aimed at decreasing salt usage in cooking. Data Sources: A search across Scopus, PubMed, and Web of Science was conducted to identify interventions from the past decade that target reduced salt usage during cooking, with effectiveness measured through 24-hour urinary sodium excretion. Data Extraction: Thirteen studies were ultimately included (comprising 5 intervention study protocols and 8 randomized controlled trials). Data Analysis: The interventions primarily focused on adult participants (n = 11). The interventions ranged from educational initiatives, education combined with salt-restricted utensils, warning labels on salt containers, substitution of salt with potassium-enriched low-sodium alternatives to the use of dosing devices for cooking at home. While 3 studies reported a significant reduction in urinary sodium excretion (mainly through educational efforts), others showed decreases without statistically significant differences between groups. The performed meta-analysis with data from 3185 participants indicated that interventions to reduce salt usage during cooking showed a significant trend towards reducing sodium intake (Hedges' g, -1.06; 95% CI, -1.68 to -0.44; P < .001). Conclusion: The findings suggest that interventions targeting reduced salt usage are effective on sodium intake reduction, assessed by 24-hour urinary sodium excretion, particularly among hypertensive individuals. This approach could aid in achieving the World Health Organization's goal of a 30% reduction in salt intake by 2030. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/151865 Title: Diet quality, asthma and airway inflammation in school-aged children 2025-01-01T00:00:00Z https://hdl.handle.net/10216/172159 Title: Nutritional quality of voluntarily fortified foods with micronutrients versus non-fortified foods consumed by the Portuguese population Abstract: Voluntary food fortification is a common strategy to improve micronutrient intake, yet concerns remain regarding its application to foods with poor overall nutritional quality. This study evaluated the nutritional quality of micronutrient-fortified foods (Mn-FF) versus non-fortified foods consumed by the Portuguese population, using data from the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016) and the updated Nutri-Score algorithm. A total of 2074 food items were analysed across six categories: cereal bars (n = 103), breakfast cereals (n = 394), cookies and biscuits (n = 485), dairy substitutes (n = 97), plain and flavoured milks (n = 101), and yoghurts (n = 894). Of these, 30.3 % (n = 629) were Mn-FF. Nutri-Score ratings (A to E) were grouped into three classes: [A, B], [C], and [D, E]. Significant associations were found between fortification status and Nutri-Score classification for breakfast cereals (chi(2)=30.02; p < 0.001), cookies and biscuits (chi(2)=99.5; p < 0.001), and yoghurts (chi(2)=17.27; p < 0.001). Fortified breakfast cereals and yoghurts were more frequently classified in less favourable Nutri-Score classes, while fortified cookies and biscuits showed slightly better profiles. No significant differences were observed in other categories. This is the first study in Portugal to evaluate Mn-FF using the updated Nutri-Score. Findings support the need to align fortification practices with public health goals through nutrient profiling regulation. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/172149 Title: Fumonisins' risk assessment in broa, a maize-based bread-An example from the Portuguese market Abstract: Broa, a traditional maize-based bread, is culturally significant in Portugal but may be contaminated with mycotoxins, particularly fumonisins. This study assessed the occurrence of fumonisin in Portuguese broa and evaluated the associated health risks from dietary exposure. Thirty-nine broa samples were analyzed for fumonisin B1 and B2 content. Exposure assessment was conducted using consumption data from the National Food, Nutrition and Physical Activity Survey (IAN-AF) 2015-2016 by calculating Estimated Daily Intake (EDI) for different population groups. Fumonisin B1 was found in 94,9 % of samples and fumonisin B2 in 61,5 %, with maximum concentrations of 292 mu g/kg and 87 mu g/kg, respectively. The highest sum of both fumonisins reached 379 mu g/kg. All samples complied with European Union (EU) maximum limits (1000 mu g/kg). Under normal consumption scenarios, EDI remained below the Tolerable Daily Intake (TDI) (1,0 mu g/kg bw/day) for all population groups. However, worst-case scenarios indicated that children (0-9 years) could exceed safe limits consuming highly contaminated broa. Our findings reveal a significant regulatory gap, as EU legislation lacks specific maximum levels for traditional maize-based breads, such as broa. We recommend establishing productspecific regulatory limits and implementing targeted monitoring programs, particularly focusing on vulnerable populations such as children, to ensure food safety while preserving this culturally important traditional food. 2026-01-01T00:00:00Z https://hdl.handle.net/10216/171891 Title: Assessment of potentially motivating factors to follow time-restricted eating protocols in a population of adults living in Portugal Abstract: Chrononutrition is a growing field that has been attracting significant attention for its potential benefits in metabolic health and body weight regulation. Among chrononutrition strategies, time-restricted eating (TRE) is the most extensively investigated approach in clinical studies. TRE intends to synchronise eating and fasting cycles with the human circadian rhythms. However, larger and longer randomised clinical trials are still needed to establish the effectiveness and long-term health outcomes of TRE interventions. Furthermore, it is crucial to explore whether individuals in free-living conditions, outside controlled clinical settings, can successfully adopt TRE principles into their daily routines to achieve potential health benefits. This study aimed to investigate the association between daily routines and potential adherence to TRE protocols, as well as to identify factors that can potentially predict adherence to these protocols in a sample of adults living in Portugal. A cross-sectional study was conducted using an online questionnaire to assess dietary and sleeping habits, daily routines and the likelihood of adherence to various restrictions in daily eating windows. Associations between variables were analysed using the Spearman correlation coefficient and the Chi-Square test, while an ordinal logistic regression was performed to identify predictive factors. Statistical analyses were conducted on IBM SPSS Statistics version 29.0. The questionnaire was filled out by 130 participants (80 % women) with a mean age of 37.9 +/- 13.59 years. On workdays, 71.6 % of participants reported a daily eating window of 12 to 14 h, while on free days, the highest percentage (46.6 %) reported between 10 and 12 h. A significant inverse correlation was observed between willingness to adhere to a TRE protocol based on perceived health benefits and both age (rho = -0.356, p < 0.001) and sex (rho = -0.321, p < 0.001). Moderate correlations were also found between the willingness to follow a TRE protocol on workdays (rho = 0.538) and free days (rho = 0.598) and the potential health benefits of this type of intervention (p < 0.001). Additionally, sex was associated with potential adherence to the TRE protocol (chi(2)(2) = 10.644, p = 0.005), with a tendency for men to show lower willingness for adherence. Associations were also identified between body weight management and reducing the eating window by 1 to 2 h (chi(2)(12) = 24.883, df = 12, p = 0.015) and 2 to 3 h (chi(2)(12) = 22.367, p = 0.034). Moreover, the perceived importance of income, body weight management and cooking knowledge were significant predictors of the likelihood of adherence to a TRE protocol with a 3 to 4 h restriction in the eating window on workdays (p < 0.005). These results provide valuable insights that should be considered when translating research into clinical practice, specifically in an adult population, as individuals' willingness and motivation to adopt TRE protocols in free-living conditions are influenced by multiple factors. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/163796 Title: Identifying sustainable foods from among those culturally acceptable by Portuguese children and adolescents (3-17 years old) 2025-01-01T00:00:00Z https://hdl.handle.net/10216/171968 Title: Development and validation of a multicriteria measure to assess the sustainability characteristics of diets: the Diet Sustainability Score Abstract: Purpose This cross-sectional study aims to develop and validate the Diet Sustainability Score (DSS), a multicriteria measure designed to evaluate the sustainability of diets by integrating nutritional, environmental, economic, and sociocultural dimensions. Methods Dietary data from 2287 adults (18 + years) who completed two non-consecutive 24-h dietary recalls during the National Food, Nutrition, and Physical Activity Survey (IAN-AF 2015/2016) were used to assess the psychometric properties of the DSS. Content validity was assessed through expert evaluation. Reproducibility was tested using the intraclass correlation coefficient (ICC), and construct validity was examined by testing conceptually derived hypotheses. Results The DSS demonstrated robust content validity through expert assessment and alignment with established frameworks. Reproducibility was supported by an ICC of 0.407 and construct validity by confirming 78% of conceptually derived hypotheses. The DSS showed positive associations with females, older ages, higher education, and higher income, as well as healthier lifestyle behaviours, including non-smoking, non-alcohol consumption, greater organic food intake, and less frequent eating out-of-home habits. Participants with higher DSS consumed more vegetables, fruits, fish, white meat, and olive oil and less red and processed meat, sweets, and salty snacks, aligning with Portuguese Mediterranean dietary guidelines. Conclusion The DSS effectively captures the multidimensional nature of sustainable diets, offering a reliable tool for research and policy to promote more sustainable eating practices. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/172024 Title: Association between dietary intake and the expression of clock genes in adults: a brief report Abstract: Background The circadian system regulates several physiological processes, including energy metabolism, through the expression of core clock genes. Animal studies suggest that dietary composition can influence circadian gene expression; however, evidence in humans remains limited.Objective This study aimed to explore the association between dietary macronutrient intake and the expression of circadian clock genes in the whole blood of adults with distinct metabolic profiles.Methods Nineteen adults (94.7% female; 43.4 +/- 16.05 years) were categorized into healthy-weight and overweight/obesity groups based on BMI. Dietary intake was assessed using a 3-day food diary, and clock gene expression (CLOCK, BMAL1, PER2, CRY) was evaluated in whole blood samples collected between 08:00 a.m. and 04:00 p.m. Statistical analyses included group comparisons and correlation analyses between macronutrient intake and gene expression.Results No statistically significant differences were observed in the clock gene expression between BMI groups, although group-level trends were noted, particularly in PER2 and CRY expression. The overweight/obesity group exhibited a significantly higher percentage of energy intake from protein. Correlation analyses revealed several time-dependent associations between macronutrient intake and clock gene expression. Notably, in the healthy BMI group, BMAL1 and CRY expression correlated with lipid and protein intake, while in the overweight/obesity group, CLOCK expression was strongly associated with both lipid and carbohydrate intake.Conclusion These findings suggest that macronutrient composition may influence peripheral circadian gene expression in a time- and BMI-dependent manner. Further research is necessary to confirm these associations in larger and more diverse populations and to investigate the potential for chrononutrition strategies to support metabolic health. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/172005 Title: Challenging the Wine Component in Mediterranean Diet Scores: Cognitive Outcomes in Portuguese Adults at High Risk of Dementia Abstract: Introduction: The Mediterranean diet (MD) has been linked to better cognition, but evidence in older adults at high dementia risk is limited. Moreover, the traditional Mediterranean Diet Adherence Screener (MEDAS) counts daily wine consumption as a beneficial component, which may distort genuine diet-cognition relationships. Objective: Evaluate whether MD adherence, as measured with the original MEDAS (MEDAS-O) versus a version that reverses the wine item (MEDAS-R), is associated with cognitive function in Portuguese adults aged 55-85 years at increased dementia risk. Methodology: The sample comprised 75 participants from the NUTRIMIND randomised controlled trial (mean age 70.5 +/- 7.0 years). MD adherence was evaluated using the original version of MEDAS (MEDAS-O) and an adapted version with a reverse score in the wine question (MEDAS-R). Cognitive function was assessed via the Montreal Cognitive Assessment (MoCA), Addenbrooke's Cognitive Examination Revised (ACE-R) and Mini-Mental State Examination (MMSE). Statistical analysis was performed using Analysis of Covariance (ANCOVA) models adjusted for age, sex, BMI, education, and physical activity. Results: MEDAS-R was positively associated with better MMSE performance (p = 0.043) and showed a borderline association with the MoCA (p = 0.051), but not with the ACE-R score (p = 0.356). No association was found between MEDAS-O and cognitive function. Better cognitive scores were more frequently observed among participants with higher education (p < 0.001). Conclusions: Reversing the wine item changes how MEDAS relates to cognitive function. These findings support re-evaluating how wine is scored in MD adherence measures. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/171260 Title: A case/non-case study of a national pharmacovigilance database to explore drug-induced acute kidney injury Abstract: BackgroundMonitoring safety throughout a medicine's lifecycle is essential. Pharmacovigilance systems are rich sources contributing to this aim in a real world context.AimTo identify and estimate disproportionality rates associated with the drugs that are most frequently reported to induce acute kidney injury (AKI).MethodA case/non-case study was conducted, using data extracted in 2022 from the Portuguese National Pharmacovigilance Database for the period between 01/01/2009 and 12/31/2020. Cases were identified using the 'Acute Renal Failure' standardized MedDRA query, all remaining reports were considered non-cases, and a random sample without replacement of 4 non-cases per case was extracted. Data were expressed as the reporting odds ratio (ROR) and the 95% confidence interval.ResultsDuring this 11-year period, 352 AKI cases were identified, representing 0.7% of the 53,505 reports received. A total of 559 different drugs were considered 'suspect' in these AKI cases. Three therapeutic subgroups (ATC2) showed a significant ROR: antithrombotic agents (ROR 6.72; 95% CI 2.23-20.22), antivirals for systemic use (ROR 4.02; 95% CI 2.76-5.87), and antineoplastic drugs (ROR 2.14; 95% CI 1.48-3.11). Additionally, we identified individual drugs with significant RORs where no class effect was observed, namely mycophenolic acid, ciclosporin, tacrolimus, simvastatin, prednisolone, vancomycin, and deferasirox. In total, eleven drugs were identified as potentially associated with the occurrence of AKI.ConclusionThis study highlights the importance of clinical pharmacy activities in closely monitoring renal function of people with known risk factors or those prescribed medications known to increase the risk of AKI. Some of the medications identified require further investigation to validate their association with AKI. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/170120 Title: Pressing Issues for Oral Health Care Access and Quality Improvement During Pregnancyin Portugal - A Qualitative Study 2025-01-01T00:00:00Z https://hdl.handle.net/10216/169830 Title: Oral health practices and determinants among university students - A cross-sectional study = Práticas e determinantes de saúde oral entre estudantes universitários - um estudo transversal 2025-01-01T00:00:00Z https://hdl.handle.net/10216/168479 Title: Dietary intake according to different patterns of food preparation in children and adults: results from the Portuguese National Food, Nutrition and Physical Activity Survey (IAN-AF 2015/2016) Abstract: Objective: To investigate associations between dietary intake and patterns of food preparation, by age group. Design: This cross-sectional study analysed dietary intake data from the most recent Portuguese National Food, Nutrition and Physical Activity Survey. Cluster analysis categorized dietary intake based on the source of food preparation. Regression models were used to study the association between dietary daily intake, Healthy Eating Score (HES), and patterns of food preparation. Setting: Portugal, using data representative of the Portuguese population. Participants: A total of 5005 Portuguese residents aged 3 to 84 years were included in the analysis. Dietary intake and food preparation patterns were examined by age group. Results: The predominant pattern of food preparation was food prepared by restaurants, canteens, and other away-from-home establishments (45.9%, 95%CI = 43.8, 48.1%). Children and adolescents in this pattern had significantly higher intakes of energy and carbohydrates but lower protein intake compared to those consuming predominantly home-prepared foods. Among adults and the elderly, this pattern was associated with higher intakes of energy, saturated fats, trans fats, and free sugars, and lower fibre intake. Additionally, children and adolescents whose diets predominantly included food prepared away-from-home showed a decrease in HES (ß = -0.7, 95% CI = -1.3, -0.2), and adults experienced a greater reduction (ß = -1.2, 95% CI = -1.5, -0.9). Conclusions: In Portugal, consuming food prepared away-from-home is associated with poorer dietary quality, with higher energy and unhealthy nutrient intake and lower HES, suggesting a need for interventions focused on promoting healthier food preparation practices. (c) 2025 Cambridge University Press. All rights reserved. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/168475 Title: Dietary exposure to heterocyclic amines by the Portuguese population: comparison of different exposure assessment methods Abstract: To estimate dietary exposure to heterocyclic amines (HAs) in the Portuguese population, three methods of attributing HAs occurrence data to consumed food items were compared. Participants are part of the National Food, Nutrition and Physical Activity Survey (n = 5005, 3-84y). Food consumption was collected through two non-consecutive 24 h dietary recalls or food diaries. HAs occurrence was extracted from the literature. Margins of exposure (MOE) were estimated for different cancer types. Three methods were considered: 1.FoodEx2 Hierarchy model (FH) - random HAs values were attributed to missing data, considering the closest item in the occurrence dataset according to the FoodEx2 hierarchy; 2.FoodEx2 Hierarchy Median model (FHM) - median HAs values of the closest items in the dataset were attributed to missing data; 3.Regression Tree model (RTM) - an RTM was used to predict mean occurrence values of homogeneous food groups based on the FoodEx2 hierarchy. The FH method presents higher dietary exposure for the 95th percentile and lower MOE values, appearing to estimate better. Red and white meat were the main contributors to HAs intake. The Portuguese population's dietary exposure to HAs seems to be safe. However, MOE values for prostate cancer in children may raise concern about potential future adult risk from early-life exposures. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/168474 Title: Health and environmental impacts of shifting to plant-based analogues: a risk-benefit assessment Abstract: PurposePlant-based analogues (PBAs) simulate animal-based foods' attributes and can facilitate adherence to flexitarian and vegetarian dietary patterns, which have been associated with health benefits. However, possibly classifying PBAs as ultra-processed (UPF) and excluding healthy animal-based foods (e.g., fish) can result in unintended health risks. This study aims to quantify the health and environmental impact of replacing animal-based foods with PBAs.MethodsUsing data from the Portuguese National Dietary Survey (n = 3852 adults; 2015-2016), three substitution scenarios of animal-based foods with PBAs were modelled: vegan (replacing all animal-based foods with PBAs), ovolactovegetarian (replacing meat and fish with PBA), and pescatarian (replacing meat with PBA). Varying degrees of substitution (33%, 50%, 67%, 100%) and two classification approaches for PBAs were explored: UPF or non-UPF. The overall health impact was estimated considering several health outcomes (cancer, cardiovascular diseases and metabolic outcomes) combined through Disability-Adjusted Life Years (DALYs). The environmental impact was measured through greenhouse gas emissions and land use.ResultsEnvironmental benefits were evident, especially for the vegan scenario. Regarding health impact, the 100% substitution of all animal-based foods (vegan scenario) might represent a risk if PBAs are classified as UPF (triangle DALY average = 72,109 years). The highest overall benefit was found for 100% substitution of meat only (pescatarian scenario) independently of considering PBAs as UPF or not (UPF: triangle DALY average = - 40,202 years; non-UPF: triangle DALY average = - 88,827 years).ConclusionPBAs can be considered feasible alternatives to animal-based foods, and the results emphasise meat substitution as a crucial factor for health and environmental benefits. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/168469 Title: Adherence to the EAT-Lancet Planetary Health Diet in Portugal and its associations with socioeconomic and lifestyle factors Abstract: PurposeThe Planetary Health Diet (PHDiet) proposed by the EAT-Lancet Commission is expected to bear health and environmental benefits. This study assesses adherence to the PHDiet in Portuguese adults and its associations with socioeconomic and lifestyle factors. For that, an adapted PHDiet score was computed, and its construct validated.MethodsData from the National Food and Physical Activity Survey 2015-2016 were used for this analysis, covering a representative sample of 3852 adults with two non-consecutive dietary interviews (8-15 days apart). Adherence to the PHDiet was measured through a score (ranging from 0 to 140), afterwards divided into terciles (T1-T3). Multinomial regression models were used (i) to assess the construct validity through associations with diet quality based on WHO recommendations and diet environmental impact using greenhouse gas emissions (GHGE) and land use (LU); (ii) to investigate associations between adherence to the PHDiet and socioeconomic and lifestyle characteristics. The prevalence of consumption of PHDiet components above/below the recommendations was estimated.ResultsAdherence to the PHDiet was generally low (36.0, 95% CI 35.4-36.6), with high consumption of meat and added sugars and low consumption of pulses, nuts, and whole grains. Higher PHDiet scores were found for diets with lower environmental impact (GHGE: ORT1vsT3:1.31; 95% CI 1.26; 1.37; LU: ORT1vsT3:1.25; 95% CI 1.21; 1.29), lower animal protein intake levels (ORT1vsT3:1.11; 95% CI 1.06; 1.16) and higher diet quality (ORT1vsT3:0.70; 95% CI 0.68; 0.72), verifying the construct validity. Men (ORT1vsT3:1.32; 95% CI 1.12; 1.55), intermediate-educated individuals (ORT1vsT3:1.43; 95% CI 1.16; 1.75), and those facing food insecurity (ORT1vsT3:1.79; 95% CI 1.36; 2.38) had higher odds of having lower scores.ConclusionLow adherence to the PHDiet is associated with several socioeconomic and lifestyle factors. This highlights the need to implement targeted public health policies that encourage shifts towards a healthier and more sustainable dietary pattern. 2025-01-01T00:00:00Z