Associating Dietary Sustainability with Health: A Focus on General and Central Adiposity

Abstract

This study aims to explore the relationship between the Diet Sustainability Score (DSS) and health outcomes, specifically body mass index (BMI) and waist-to-height ratio (WHtR). Using data from 2287 Portuguese adults in the National Food, Nutrition, and Physical Activity Survey (IAN-AF 20152016), DSS was calculated based on four dimensions: health-related nutritional attributes, environmental impact, economic affordability, and sociocultural acceptability. Logistic regression models were used to analyse associations between DSS and general adiposity (BMI classes: under/normal weight vs. overweight/obesity) and central adiposity (WHtR classes: healthy vs. unhealthy central adiposity). Models were adjusted for sex, age, education and physical activity level to control for potential confounders. Higher DSS is associated with reduced odds of overweight/obesity (OR = 0.91, 95%CI: 0.88, 0.94), and unhealthy central adiposity (OR = 0.91, 95%CI: 0.87, 0.95), suggesting that more sustainable dietary patterns are associated with more favourable adiposity profiles. This study highlights the importance of promoting sustainable diets as part of public health strategies aimed at addressing obesity and integrating health, environmental, economic, and sociocultural dimensions for more comprehensive, long-term population health improvements. (c) 2026 by the authors.