The intersection between sex and skin color in adherence to the Planetary Health Diet in Brazil

Background The Planetary Health Diet (PHD), developed by the EAT-Lancet Commission, aims to promote human health while safeguarding the planet's ecosystems. Objective: This study examines the intersection of sex and skin color in adherence to the PHD in Brazil. Design: Data are from the 2017–2018 National Dietary Survey. Participants: 46,164 Brazilians aged 10 and older. Skin color was self-reported and categorized as white, brown, black, and other. A 24-hour recall was used to calculate the validated Planetary Health Dietary Index (PHDI). Statistical analyses performed: Generalized linear models were used to estimate the association of interest, with white men as the reference group, and adjusting for potential confounders. Results: In unadjusted analysis, white women had the highest mean PHDI score (46.5 [95% CI 46.1, 46.9]), while brown men had the lowest (45.1 [95% CI 44.7, 45.5]). After adjustment for age, income, region, and area of residency, mean PHDI scores were significantly higher across all groups compared to white men: brown women scored 1.3 points higher (95% CI 0.7, 1.8), black women 1.2 points higher (95% CI 0.3, 2.1), white women 0.65 points higher (95% CI 0.14, 1.2), and black men 0.9 points higher (95% CI 0.04, 1.8). Conclusions: After accounting for socioeconomic factors, Black and brown women showed the highest adherence to the PHDI. These findings highlight the role of structural inequalities in shaping dietary patterns and reinforce the need for policies that promote equitable access to healthy and sustainable diets.