BACKGROUND: Plant-based diets are not inherently healthy. Similar to omnivorous diets, they may contain excessive amounts of sugar, sodium, and saturated fats, or lack diversity. Moreover, vegans might be at risk of inadequate intake of certain vitamins and minerals commonly found in foods that they avoid. We developed the VEGANScreener, a tool designed to assess the diet quality of vegans in Europe. METHODS: Our approach combined best practices in developing diet quality metrics with scale development approaches and involved the following: (a) narrative literature synthesis, (b) evidence evaluation by an international panel of experts, and (c) translation of evidence into a diet screener. We employed a modified Delphi technique to gather opinions from an international expert panel. RESULTS: Twenty-five experts in the fields of nutrition, epidemiology, preventive medicine, and diet assessment participated in the first round, and nineteen participated in the subsequent round. Initially, these experts provided feedback on a pool of 38 proposed items from the literature review. Consequently, 35 revised items, with 17 having multiple versions, were suggested for further consideration. In the second round, 29 items were retained, and any residual issues were addressed in the final consensus meeting. The ultimate screener draft encompassed 29 questions, with 17 focusing on foods and nutrients to promote, and 12 addressing foods and nutrients to limit. The screener contained 24 food-based and 5 nutrient-based questions. CONCLUSIONS: We elucidated the development process of the VEGANScreener, a novel diet quality screener for vegans. Future endeavors involve contrasting the VEGANScreener against benchmark diet assessment methodologies and nutritional biomarkers and testing its acceptance. Once validated, this instrument holds potential for deployment as a self-assessment application for vegans and as a preliminary dietary screening and counseling tool in healthcare settings.

Biomedical Research Networking Center for Physiopathology of Obesity and Nutrition 28029 Madrid Spain

Center for Public Health Promotion National Institute of Public Health 100 00 Prague Czech Republic

Department Nutrition and Dietetics Faculty of Health Professions Bern University of Applied Sciences 3008 Bern Switzerland

Department of Analytical Chemistry Faculty of Science Palacky University 779 00 Olomouc Czech Republic

Department of Epidemiology and Biostatistics 3rd Faculty of Medicine Charles University 100 00 Prague Czech Republic

Department of Epidemiology Center for Public Health Medical University of Vienna 1090 Vienna Austria

Department of Epidemiology Harvard TH Chan School of Public Health Boston MA 02115 USA

Department of Internal Medicine University Hospital Kralovske Vinohrady 3rd Faculty of Medicine Charles University 100 00 Prague Czech Republic

Department of Nutrition Harvard TH Chan School of Public Health Boston MA 02115 USA

Department of Nutritional Sciences Faculty of Life Sciences University of Vienna 1090 Vienna Austria

Department of Preventive Medicine and Public Health University of Navarra IdiSNA 31008 Pamplona Spain

Department of Public Health and Primary Care Faculty of Medicine and Health Sciences Ghent University 9000 Ghent Belgium

Department of Social and Preventive Medicine Center for Public Health Medical University of Vienna 1090 Vienna Austria

Faculty of Economics and Business Department of Marketing Innovation and Organisation Unit Consumer Behaviour Ghent University 9000 Ghent Belgium

Institute for Biometrics and Epidemiology German Diabetes Center Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf 40225 Düsseldorf Germany

Institute for Clinical and Experimental Medicine 140 21 Prague Czech Republic

Institute of Applied Health Sciences University of Aberdeen Aberdeen AB24 3FX UK

Institute of Microbiology of the CAS 142 20 Prague Czech Republic

Research Institute for Plant Based Nutrition 35444 Biebertal Germany

School of Bioscience and Industrial Technology HOGENT University of Applied Sciences and Arts 9000 Ghent Belgium

See more in PubMed

The Vegan Society Definition of Veganism. 2023. [(accessed on 9 September 2023)]. Available online: https://www.vegansociety.com/go-vegan/definition-veganism.

Greenebaum J. Veganism, Identity and the Quest for Authenticity. Food Cult. Soc. 2012;15:129–144. doi: 10.2752/175174412x13190510222101. DOI

Gheihman N. Veganism as a lifestyle movement. Sociol. Compass. 2021;15:e12877. doi: 10.1111/soc4.12877. DOI

IPSOS . An Exploration into Diets around the World. IPSOS; Paris, France: 2018.

Hargreaves S.M., Rosenfeld D.L., Moreira A.V.B., Zandonadi R.P. Plant-based and vegetarian diets: An overview and definition of these dietary patterns. Eur. J. Nutr. 2023;62:1109–1121. doi: 10.1007/s00394-023-03086-z. PubMed DOI

Ghaffari M., Rodrigo P.G.K., Ekinci Y., Pino G. Consumers’ motivations for adopting a vegan diet: A mixed-methods approach. Int. J. Consum Stud. 2022;46:1193–1208. doi: 10.1111/ijcs.12752. DOI

Janssen M., Busch C., Rodiger M., Hamm U. Motives of consumers following a vegan diet and their attitudes towards animal agriculture. Appetite. 2016;105:643–651. doi: 10.1016/j.appet.2016.06.039. PubMed DOI

Smart Protein Plant-Based Foods in Europe: How Big is the Market? [(accessed on 15 April 2024)]. Available online: https://smartproteinproject.eu/plant-based-food-sector-report/

Euromonitor . International’s Product Claims and Positioning System. Euromonitor; London, UK: 2021.

Cantero P.A., Santos C.P.O., Lopez-Ejeda N. Vegetarian diets in Spain: Temporal evolution through national health surveys and their association with healthy lifestyles. Endocrinol. Diab. Nutr. 2023;70:1–8. PubMed

IPSOS Bezmasou Stravu Preferuje Desetina Mladých. 2019. [(accessed on 5 October 2023)]. Available online: https://www.ipsos.com/cs-cz/bezmasou-stravu-preferuje-desetina-mladych.

iVOX Vleesconsumptie in België Blijft verder Dalen. 2023. [(accessed on 5 October 2023)]. Available online: https://proveg.com/be/vleesconsumptie-in-belgie-blijft-verder-dalen/

Paslakis G., Richardson C., Nohre M., Brahler E., Holzapfel C., Hilbert A., de Zwaan M. Prevalence and psychopathology of vegetarians and vegans—Results from a representative survey in Germany. Sci. Rep. 2020;10:6840. doi: 10.1038/s41598-020-63910-y. PubMed DOI PMC

Euromonitor . Voice of the Consumer: Lifestyles Survey 2021. Euromonitor; London, UK: 2021.

Willett W., Rockstrom J., Loken B., Springmann M., Lang T., Vermeulen S., Garnett T., Tilman D., DeClerck F., Wood A., et al. Food in the Anthropocene: The EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393:447–492. doi: 10.1016/S0140-6736(18)31788-4. PubMed DOI

Al-Ibrahim A.A., Jackson R.T. Healthy eating index versus alternate healthy index in relation to diabetes status and health markers in U.S. adults: NHANES 2007–2010. Nutr. J. 2019;18:26. doi: 10.1186/s12937-019-0450-6. PubMed DOI PMC

Klapp A.L., Feil N., Risius A. A Global Analysis of National Dietary Guidelines on Plant-Based Diets and Substitutions for Animal-Based Foods. Curr. Dev. Nutr. 2022;6:nzac144. doi: 10.1093/cdn/nzac144. PubMed DOI PMC

Bakaloudi D.R., Halloran A., Rippin H.L., Oikonomidou A.C., Dardavesis T.I., Williams J., Wickramasinghe K., Breda J., Chourdakis M. Intake and adequacy of the vegan diet. A systematic review of the evidence. Clin. Nutr. 2021;40:3503–3521. doi: 10.1016/j.clnu.2020.11.035. PubMed DOI

Parker H.W., Vadiveloo M.K. Diet quality of vegetarian diets compared with nonvegetarian diets: A systematic review. Nutr. Rev. 2019;77:144–160. doi: 10.1093/nutrit/nuy067. PubMed DOI

Selinger E., Neuenschwander M., Koller A., Gojda J., Kuhn T., Schwingshackl L., Barbaresko J., Schlesinger S. Evidence of a vegan diet for health benefits and risks—An umbrella review of meta-analyses of observational and clinical studies. Crit. Rev. Food Sci. 2022;63:9926–9936. doi: 10.1080/10408398.2022.2075311. PubMed DOI

Orlich M.J., Singh P.N., Sabate J., Jaceldo-Siegl K., Fan J., Knutsen S., Beeson W.L., Fraser G.E. Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2. JAMA Intern. Med. 2013;173:1230–1238. doi: 10.1001/jamainternmed.2013.6473. PubMed DOI PMC

Pollakova D., Andreadi A., Pacifici F., Della-Morte D., Lauro D., Tubili C. The Impact of Vegan Diet in the Prevention and Treatment of Type 2 Diabetes: A Systematic Review. Nutrients. 2021;13:2123. doi: 10.3390/nu13062123. PubMed DOI PMC

Wang T., Masedunskas A., Willett W.C., Fontana L. Vegetarian and vegan diets: Benefits and drawbacks. Eur. Heart J. 2023;44:3423–3439. doi: 10.1093/eurheartj/ehad436. PubMed DOI PMC

Zimmer J., Lange B., Frick J.S., Sauer H., Zimmermann K., Schwiertz A., Rusch K., Klosterhalfen S., Enck P. A vegan or vegetarian diet substantially alters the human colonic faecal microbiota. Eur. J. Clin. Nutr. 2012;66:53–60. doi: 10.1038/ejcn.2011.141. PubMed DOI

Yin P., Zhang C., Du T., Yi S., Yu L., Tian F., Chen W., Zhai Q. Meta-analysis reveals different functional characteristics of human gut Bifidobacteria associated with habitual diet. Food Res. Int. 2023;170:112981. doi: 10.1016/j.foodres.2023.112981. PubMed DOI

Boutros G.H., Landry-Duval M.A., Garzon M., Karelis A.D. Is a vegan diet detrimental to endurance and muscle strength? Eur. J. Clin. Nutr. 2020;74:1550–1555. doi: 10.1038/s41430-020-0639-y. PubMed DOI

Schmidt J.A., Rinaldi S., Ferrari P., Carayol M., Achaintre D., Scalbert A., Cross A.J., Gunter M.J., Fensom G.K., Appleby P.N., et al. Metabolic profiles of male meat eaters, fish eaters, vegetarians, and vegans from the EPIC-Oxford cohort. Am. J. Clin. Nutr. 2015;102:1518–1526. doi: 10.3945/ajcn.115.111989. PubMed DOI PMC

Wang F.L., Wan Y., Yin K.H., Wei Y.G., Wang B.B., Yu X.M., Ni Y., Zheng J.S., Huang T., Song M.Y., et al. Lower Circulating Branched-Chain Amino Acid Concentrations Among Vegetarians are Associated with Changes in Gut Microbial Composition and Function. Mol. Nutr. Food Res. 2019;63:e1900612. doi: 10.1002/mnfr.201900612. PubMed DOI

Richter M., Boeing H., Grunewald-Funk D., Heseker H., Krokes A., Leschik-Bonnet E., Oberritter H., Strohm D., Watzl B. Vegan Diet Position of German Nutrition Society e. V. (GNS) Ernahr. Umsch. 2016;63:M220–M230.

Leung A.M., Avram A.M., Brenner A.V., Duntas L.H., Ehrenkranz J., Hennessey J.V., Lee S.L., Pearce E.N., Roman S.A., Stagnaro-Green A., et al. Potential risks of excess iodine ingestion and exposure: Statement by the american thyroid association public health committee. Thyroid. 2015;25:145–146. doi: 10.1089/thy.2014.0331. PubMed DOI PMC

Key T.J., Papier K., Tong T.Y.N. Plant-based diets and long-term health: Findings from the EPIC-Oxford study. Proc. Nutr. Soc. 2022;81:190–198. doi: 10.1017/S0029665121003748. PubMed DOI PMC

Gallagher C.T., Hanley P., Lane K.E. Pattern analysis of vegan eating reveals healthy and unhealthy patterns within the vegan diet. Public Health Nutr. 2022;25:1310–1320. doi: 10.1017/S136898002100197x. PubMed DOI PMC

Haider S., Sima A., Kuhn T., Wakolbinger M. The Association between Vegan Dietary Patterns and Physical Activity—A Cross-Sectional Online Survey. Nutrients. 2023;15:1847. doi: 10.3390/nu15081847. PubMed DOI PMC

Gehring J., Touvier M., Baudry J., Julia C., Buscail C., Srour B., Hercberg S., Peneau S., Kesse-Guyot E., Alles B. Consumption of Ultra-Processed Foods by Pesco-Vegetarians, Vegetarians, and Vegans: Associations with Duration and Age at Diet Initiation. J. Nutr. 2021;151:120–131. doi: 10.1093/jn/nxaa196. PubMed DOI

Satija A., Bhupathiraju S.N., Rimm E.B., Spiegelman D., Chiuve S.E., Borgi L., Willett W.C., Manson J.E., Sun Q., Hu F.B. Plant-Based Dietary Patterns and Incidence of Type 2 Diabetes in US Men and Women: Results from Three Prospective Cohort Studies. PLoS Med. 2016;13:e1002039. doi: 10.1371/journal.pmed.1002039. PubMed DOI PMC

Satija A., Bhupathiraju S.N., Spiegelman D., Chiuve S.E., Manson J.E., Willett W., Rexrode K.M., Rimm E.B., Hu F.B. Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults. J. Am. Coll. Cardiol. 2017;70:411–422. doi: 10.1016/j.jacc.2017.05.047. PubMed DOI PMC

Thompson A.S., Tresserra-Rimbau A., Karavasiloglou N., Jennings A., Cantwell M., Hill C., Perez-Cornago A., Bondonno N.P., Murphy N., Rohrmann S., et al. Association of Healthful Plant-based Diet Adherence With Risk of Mortality and Major Chronic Diseases Among Adults in the UK. JAMA Netw. Open. 2023;6:e234714. doi: 10.1001/jamanetworkopen.2023.4714. PubMed DOI PMC

Thiele S., Mensink G.B.M., Beitz R. Determinants of diet quality. Public Health Nutr. 2004;7:29–37. doi: 10.1079/Phn2003516. PubMed DOI

Imamura F., Micha R., Khatibzadeh S., Fahimi S., Shi P.L., Powles J., Mozaffarian D., Dis G.B.D.N.C. Dietary quality among men and women in 187 countries in 1990 and 2010: A systematic assessment. Lancet Glob. Health. 2015;3:E132–E142. doi: 10.1016/S2214-109x(14)70381-X. PubMed DOI PMC

Williams E., Vardavoulia A., Lally P., Gardner B. Experiences of initiating and maintaining a vegan diet among young adults: A qualitative study. Appetite. 2023;180:106357. doi: 10.1016/j.appet.2022.106357. PubMed DOI

Pointke M., Pawelzik E. Plant-Based Alternative Products: Are They Healthy Alternatives? Micro- and Macronutrients and Nutritional Scoring. Nutrients. 2022;14:601. doi: 10.3390/nu14030601. PubMed DOI PMC

Curtain F., Grafenauer S. Plant-Based Meat Substitutes in the Flexitarian Age: An Audit of Products on Supermarket Shelves. Nutrients. 2019;11:2603. doi: 10.3390/nu11112603. PubMed DOI PMC

Christopher A., Bartkowski J.P., Haverda T. Portraits of Veganism: A Comparative Discourse Analysis of a Second-Order Subculture. Societies. 2018;8:55. doi: 10.3390/soc8030055. DOI

Alkerwi A. Diet quality concept. Nutrition. 2014;30:613–618. doi: 10.1016/j.nut.2013.10.001. PubMed DOI

Gil A., Martinez de Victoria E., Olza J. Indicators for the evaluation of diet quality. Nutr. Hosp. 2015;31((Suppl. S3)):128–144. doi: 10.3305/nh.2015.31.sup3.8761. PubMed DOI

Kim S., Haines P.S., Siega-Riz A.M., Popkin B.M. The Diet Quality Index-International (DQI-I) provides an effective tool for cross-national comparison of diet quality as illustrated by China and the United States. J. Nutr. 2003;133:3476–3484. doi: 10.1093/jn/133.11.3476. PubMed DOI

FAO/WHO . Sustainable Healthy Diets—Guiding Principles. FAO; Rome, Italy: 2019.

NCI Dietary Assessment Primer: Screeners at a Glance. [(accessed on 9 September 2023)]; Available online: https://dietassessmentprimer.cancer.gov/profiles/screeners/index.html.

Kronsteiner-Gicevic S., Tello M., Lincoln L.E., Kondo J.K., Naidoo U., Fung T.T., Willett W.C., Thorndike A.N. Validation of the Rapid Prime Diet Quality Score Screener (rPDQS), A Brief Dietary Assessment Tool with Simple Traffic Light Scoring. J. Acad. Nutr. Diet. 2023;123:1541–1554.e7. doi: 10.1016/j.jand.2023.05.023. PubMed DOI

Thompson F.E., Kipnis V., Subar A.F., Krebs-Smith S.M., Kahle L.L., Midthune D., Potischman N., Schatzkin A. Evaluation of 2 brief instruments and a food-frequency questionnaire to estimate daily number of servings of fruit and vegetables. Am. J. Clin. Nutr. 2000;71:1503–1510. doi: 10.1093/ajcn/71.6.1503. PubMed DOI

Willett W. Nutritional Epidemiology. 3rd ed. Volume 40. Oxford University Press; Oxford, UK: New York, NY, USA: 2013. 529p Monographs in epidemiology and biostatistics.

VEGANScreener VEGANScreener Project Description. 2022. [(accessed on 22 October 2023)]. Available online: https://www.veganscreener.eu/

Kant A.K. Dietary patterns and health outcomes. J. Am. Diet Assoc. 2004;104:615–635. doi: 10.1016/j.jada.2004.01.010. PubMed DOI

Boateng G.O., Neilands T.B., Frongillo E.A., Melgar-Quinonez H.R., Young S.L. Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer. Front. Public Health. 2018;6:149. doi: 10.3389/fpubh.2018.00149. PubMed DOI PMC

DeVellis R.F. Scale Development: Theory and Applications. 3rd ed. Volume i. SAGE; Thousand Oaks, CA, USA: 2012. 205p (Applied social research methods series).

Woodcock T., Adeleke Y., Goeschel C., Pronovost P., Dixon-Woods M. A modified Delphi study to identify the features of high quality measurement plans for healthcare improvement projects. BMC Med. Res Methodol. 2020;20:8. doi: 10.1186/s12874-019-0886-6. PubMed DOI PMC

Taylor E. We Agree, Don’t We? The Delphi Method for Health Environments Research. Herd-Health Environ. Res. 2020;13:11–23. doi: 10.1177/1937586719887709. PubMed DOI

Hsu C.C., Sandford B.A. The Delphi Technique: Making Sense of Consensus. Pract. Assess. Res. Eval. 2007;12:10. doi: 10.7275/pdz9-th90. DOI

Qualtrics 2023. [(accessed on 9 September 2023)]. Available online: https://www.qualtrics.com.

Wild D., Grove A., Martin M., Eremenco S., McElroy S., Verjee-Lorenz A., Erikson P. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005;8:94–104. doi: 10.1111/j.1524-4733.2005.04054.x. PubMed DOI

Project REDCap. [(accessed on 15 April 2024)]. Available online: https://www.project-redcap.org/

Alessandrini R., Brown M.K., Pombo-Rodrigues S., Bhageerutty S., He F.J., MacGregor G.A. Nutritional Quality of Plant-Based Meat Products Available in the UK: A Cross-Sectional Survey. Nutrients. 2021;13:4225. doi: 10.3390/nu13124225. PubMed DOI PMC

Rizzolo-Brime L., Orta-Ramirez A., Martin Y.P., Jakszyn P. Nutritional Assessment of Plant-Based Meat Alternatives: A Comparison of Nutritional Information of Plant-Based Meat Alternatives in Spanish Supermarkets. Nutrients. 2023;15:1325. doi: 10.3390/nu15061325. PubMed DOI PMC

Flint M., Bowles S., Lynn A., Paxman J.R. Novel plant-based meat alternatives: Future opportunities and health considerations. Proc. Nutr. Soc. 2023;82:370–385. doi: 10.1017/S0029665123000034. PubMed DOI

Lima R.D., Block J.M. Coconut oil: What do we really know about it so far? Food Qual. Saf. 2019;3:61–72. doi: 10.1093/fqsafe/fyz004. DOI

da Silveira J.A.C., Meneses S.S., Quintana P.T., Santos V.D. Association between overweight and consumption of ultra-processed food and sugar-sweetened beverages among vegetarians. Rev. De Nutr.-Braz. J. Nutr. 2017;30:431–441. doi: 10.1590/1678-98652017000400003. DOI

Pagliai G., Dinu M., Madarena M.P., Bonaccio M., Iacoviello L., Sofi F. Consumption of ultra-processed foods and health status: A systematic review and meta-analysis. Br. J. Nutr. 2021;125:308–318. doi: 10.1017/S0007114520002688. PubMed DOI PMC

Juul F., Vaidean G., Parekh N. Ultra-processed Foods and Cardiovascular Diseases: Potential Mechanisms of Action. Adv. Nutr. 2021;12:1673–1680. doi: 10.1093/advances/nmab049. PubMed DOI PMC

Chen Z., Khandpur N., Desjardins C., Wang L., Monteiro C.A., Rossato S.L., Fung T.T., Manson J.E., Willett W.C., Rimm E.B., et al. Ultra-Processed Food Consumption and Risk of Type 2 Diabetes: Three Large Prospective U.S. Cohort Studies. Diabetes Care. 2023;46:1335–1344. doi: 10.2337/dc22-1993. PubMed DOI PMC

Development and evaluation of a web-based diet quality screener for vegans (VEGANScreener): a cross-sectional, observational, multicenter, clinical study