Food Sustainability Knowledge and EAT-Lancet Adherence in Turkish Adults

This study aimed to evaluate the knowledge and attitudes of Turkish adults toward food sustainability and assess their adherence to the EAT-Lancet dietary pattern. A cross-sectional study was conducted among 3,446 adults aged 19-65 in Türkiye. Data were collected using a demographic questionnaire, the Food Sustainability Knowledge and Attitudes Questionnaire (FSKAQ), and a food frequency questionnaire to calculate EAT-Lancet index scores. Statistical analyses included Kruskal-Wallis tests, chi-square tests, and multinomial logistic regression.

Objective:

This study aimed to evaluate the knowledge and attitudes of Turkish adults regarding food sustainability and to assess their level of adherence to the EAT-Lancet dietary pattern, a model developed to promote both human health and environmental sustainability.

Methods:

A descriptive, cross-sectional study was conducted across Türkiye with a sample of 3,446 individuals aged between 19 and 65 years. Participants were recruited through voluntary participation, and individuals with chronic illnesses, alcohol or substance dependency, or illiteracy were excluded. Data were collected using a structured questionnaire that included demographic variables (e.g., age, gender, marital status, income, physical activity), anthropometric measurements (height and weight), and dietary intake.

Participants' knowledge and attitudes toward food sustainability were assessed using the Food Sustainability Knowledge and Attitudes Questionnaire (FSKAQ), which has been validated in Turkish. This instrument consists of four sub-dimensions addressing different aspects of sustainability knowledge and attitudes but does not yield a total score. Each sub-dimension is evaluated individually.

Dietary intake was assessed using a food frequency questionnaire (FFQ), and adherence to the EAT-Lancet dietary pattern was calculated using the EAT-Lancet index. This index includes 14 food components categorized as "emphasized" or "restricted" foods and assigns scores from 0 to 3 for each, with higher total scores indicating greater adherence. Final scores were divided into quartiles (Q1-Q4) to classify adherence levels.

All statistical analyses were conducted using SPSS 26.0. Descriptive statistics were used to summarize participant characteristics. The Kruskal-Wallis H test and chi-square tests were used for group comparisons, and multinomial logistic regression was applied to identify factors associated with higher EAT-Lancet index adherence. A significance level of p \< 0.05 was considered statistically significant.

Eligibility Criteria:
Inclusion Criteria:

* Individuals residing in Türkiye,
* Aged between 19 and 64 years,
* Voluntarily agreed to participate in the study,
* Completed the questionnaire in full,
* Provided complete anthropometric, demographic, and dietary data.

Exclusion Criteria:

* Individuals with alcohol or substance dependence,
* Those diagnosed with chronic diseases (e.g., diabetes, hypertension, cardiovascular disease),
* Illiterate individuals,
* Participants with incomplete questionnaire responses or missing anthropometric or dietary data.