From varied plate to dietary biodiversity

Abstract

The healthfulness of a dietary pattern is not merely measured in its content of nutrients, but also
of the diversity of the ingredients present. The methods of analyzing dietary diversity, such as
Minimum Dietary Diversity for Women (MDD-W) index and Dietary Species Richness (DSR),
have been developed in the last decades, used to capture different forms of dietary diversity.
Increased dietary diversity has been shown to generate positive health outcomes, even when
adjusting for dietary quality. Increased dietary diversity can have further implications on the
environment and food system at large, as it can correspond to increased agrobiodiversity, or
number of species present and used in the agricultural landscape.

In this thesis I apply the contemporary knowledge of dietary diversity to analyze the dietary
records data from the HELPFUL-trial conducted by Avesani et al. (2024) – an intervention study
in which chronic kidney disease (CKD) patients were put on a more flexible plant predominant
diet while retaining safe potassium levels. Since CKD can lead to substantial dietary restriction,
it was particularly relevant to know the result on dietary diversity for that patient group, since
CKD patients are commonly put on highly restrictive diets to avoid hyperkalemia.

For assessing total dietary biodiversity on a species level, no increase in dietary diversity, neither
in MDD-W nor DSR, was observed for the trial. However, when applying a threshold value of
15 g, to adjust for species in small amounts, there was an increase in the species count.

Suggestions for future intervention studies of similar type could be to more actively stimulate a
higher count of species intake, such as by connecting the intervention diet to recipes and meal
plans.

Popular Abstract

We have all learned the importance of safeguarding biodiversity in the natural world. But
what if I told you that researchers in dietary science are becoming increasingly interested in
reviewing the biodiversity of your plate, as a way of better understanding how healthy your
diet is... The recommendation to “eat varied” is transitioning from a common sense catch
phrase into a separate scientific discipline with refined techniques to link the variation of the
plate to various health outcomes. Research of data from large cohort studies such as the EPIC
trial shows that high dietary biodiversity, that is a high count of species in the food repertoire,
is linked to positive health outcomes, even when adjusting for dietary quality. Meaning that
many species on the plate is associated with positive health effects, beyond its impact on the
nutrient intake – a topic that is currently drawing much new research efforts to better
understand the intricacies.

A high rate of dietary diversity can also enhance biodiversity in the farming landscape – after
all, many species on the plate will correspond to many species used in agriculture. This
connection sparked the modern scientific discipline of dietary biodiversity.

Beyond the general population, if there is one group who could benefit from adding more
diversity to the diet – it would be participants of chronic kidney disease (CKD). Because they
are commonly advised to adhere to low-potassium foods – they are often missing out on a
wide array of healthy foods, making their diet highly restricted.

However, much research is conducted to find a more flexible approach for CKD patients, by
allowing more plant rich and potassium rich diet with the help through medication. One such
trial, called the HELPFUL-trial, was conducted by Carla Avesani and her team at the
Karolinska Institute in Stockholm. In that study, the researchers were able to provide a more
plant-predominant and potassium rich diet for CKD patients in a safe way. While the trial was
a success in many ways, the researchers did not measure the dietary diversity of the patients’
diet – despite that being such central parameter for the diets of CKD patients.

The HELPFUL-trial serves a good example to analyze dietary records from the viewpoint of
dietary biodiversity. In this thesis, I have applied the contemporary knowledge of dietary
diversity and applied it to analyze the dietary records data from the HELPFUL trial. And for
results? Well, let’s just say that the researchers behind the study were excited to know that the
patients actually did consume more species during the intervention – at least when cutting
away the dietary noise, i.e. ingredients with less than 15 grams. Suggestions for future
intervention studies of similar sort, to improve DSR even further, is to more actively find
ways to stimulate a higher species intake, such as by implementing cooking education and
spreading recipes and menu ideas for the participants as part of the intervention.

Dietary diversity is a relatively new subject within food science and nutrition, with much of
the traditional tools used to gather food records poorly adapted for the topic. In this thesis I
discuss and explore suitable ways to calculate dietary diversity from food records data and
what to consider for future calculations.

• author: Lilliestråle, Axel Carl Åke Rickard
• supervisor: Anne Nilsson; Carla Maria Avesani
• organization: Food Technology and Nutrition (M.Sc.)
• course: KLTM02 20261
• year: 2026
• type: H2 - Master's Degree (Two Years)
• subject: Agriculture and Food Sciences; Technology and Engineering
• keywords: Dietary Diversity, Dietary Biodiversity, Dietary Species Richness, DSR, Minimum Dietary Diversity for Women, MDD-W, Chronic Kidney Disease, CKD, Agrobiodiversity, Dietary records data, Artificial Intelligence, AI, Food Engineering Nutrition and Food Chemistry
• language: English
• id: 9237596
• date added to LUP: 2026-06-16 14:15:22
• date last changed: 2026-06-16 14:15:22