In a recent study published in the journal Nutrients, researchers from Europe designed and developed VEGANScreener, a novel tool to examine the diet quality among vegans in the region. The tool comprises 29 questions focusing on foods and nutrients to promote or limit, with potential applications post-validation in self-assessment and healthcare settings.

Study: Development of the VEGANScreener, a Tool for a Quick Diet Quality Assessment among Vegans in Europe. Image Credit: j.chizhe / Shutterstock

Background

The popularity of veganism is on the rise in Europe, driven by various motivations, including animal welfare, health, and environmental sustainability. Despite the health benefits associated with vegan diets, such as reduced risks of certain diseases and improved weight management, they can also pose nutritional challenges due to potential deficiencies in crucial nutrients like vitamins B12 and D and minerals like calcium and iron.

Diet quality evaluates dietary patterns’ health impact, including adequacy, balance, moderation, and variety of healthy foods. Diet screeners are brief tools that assess overall diets or specific components and rank individuals based on intake frequency without estimating absolute nutrient levels.

In the present study, researchers designed and developed the VEGANScreener, a tool for assessing the diet quality of vegans in Europe. They described the methodology, including input from international experts and the selection of relevant dietary components. The tool aimed to assist both vegans and healthcare providers in evaluating diet quality, setting dietary goals, and monitoring dietary patterns over time, potentially addressing concerns about nutritional adequacy in the vegan population.

About the study

The VEGANScreener was developed through three stages: literature review, expert evaluation, and translation into a measurement tool for diet quality. Best practices in scale development and a modified Delphi technique were employed, involving item pooling, expert feedback, and a final consensus meeting. This iterative process efficiently integrated diet quality metrics with scale development methods, ensuring systematic capture of diet quality among European vegans.

The process involved 29 experts who assessed the proposed items based on their associations with health outcomes, consumption frequency, and between-person variation. Items with less than 60% agreement were dropped or modified. This resulted in a pool of items ranked by importance across five diet quality domains. In two rounds of feedback, experts evaluated items for inclusion, exclusion, or modifications. Those with at least 60% agreement were retained, and residual concerns were discussed in an online meeting. This quasi-anonymous process ensured impartial evaluation and consensus among experts.

The tool was translated into Czech, Dutch, German, and Spanish, adhering to ISPOR guidelines for accuracy. Pretesting involved small samples of vegans, vegetarians, and omnivores to ensure clarity and ease of completion. Iterative revisions based on qualitative feedback were made until all local versions matched the English master version. The translated versions were then deployed online.

Results and discussion

The core team selected 38 items from a pool of over 100 extracted during the literature review for expert voting. In round 1, 27 items received 60% agreement or more, while 11 were dropped. Feedback was reviewed to refine the kept items and potentially restructure the dropped ones. For round 2, 35 updated items were proposed, with 28 receiving ≥60% agreement from 19 participating experts. One item, with identical agreement for both versions, was discussed further in the online consensus meeting. The meeting, attended by 15 experts, resolved the remaining issues and finalized the screener draft, comprising 29 questions and one sub-question.

Experts provided qualitative feedback between rounds, leading to reformulation, merging, and splitting of items. For instance, the item on vegetable intake was refined based on experts’ suggestions for specificity and simplicity, resulting in separate questions on “other vegetables,” “green vegetables,” and “dark orange and red fruits and vegetables.”

The development of this tool faced challenges in categorizing novel vegan products and formulating straightforward questions due to data gaps and variability in product composition. However, respondents found the VEGANScreener easy to use, with adjustments based on food categorization and question clarity feedback. The finalized tool comprised 17 questions focusing on promoting the intake of food groups and nutrients as well as 12 (plus one subquestion) on limiting intake, including 24 food-based and five nutrient/supplement-based inquiries.

Conclusion

In conclusion, after collaborative development and expert evaluation, the VEGANScreener, tailored for European vegans, is ready for validation against reference methods and biomarkers. By offering a systematic approach to evaluate vegan diets, the VEGANScreener has the potential to enhance nutritional awareness and support among the growing population of vegans, ultimately promoting better health outcomes within this demographic. Future steps include evaluating its performance across diverse populations and settings, considering factors like gender, age, and ethnicity. Evaluation among both vegans and healthcare professionals will help gauge its validity and acceptability. If successful, the VEGANScreener could serve as a simple tool for self-assessment and improvement of dietary quality among European vegans, with potential for adaptation to other regions.