2.3.2. Adherence to a Healthy Lifestyle

Assessments of participant lifestyle information were conducted using the Diet and Healthy Lifestyle Scale (DEVS) [31], which was developed following the recommendations of the guidelines for healthy vegetarian diets and lifestyles proposed by the Department of Nutrition, School of Public Health, Loma Linda University [32,33]. The instrument consists of 14 items that generate information related to the following five domains: (1) plant-based diets, (2) consumption of animal foods, (3) regular physical exercise, (4) adequate water intake, and (5) moderate exposure to sunlight. Each question presents three potential responses. The total score of the instrument, which ranges from 0 to 14 points, is calculated by summing the scores assigned to each item, with each category of the item receiving a score of 0, 0.5, or 1 point. Participants receive a score of 1 point when they report consuming ≥6 daily servings of whole grains, ≥3 daily servings of legumes, ≥8 daily servings of vegetables, ≥4 daily servings of fruits, ≥1.5 daily servings of nuts and seeds, ≤2 daily servings of vegetable oils, and 0 daily servings of dairy products and eggs [34]. Higher scores reflect greater adherence to healthy lifestyle habits. The reliability of the instrument was assessed using several internal consistency coefficients. The results showed high reliability with an ordinal alpha (α) of 0.80, an omega coefficient (ω) of 0.83, and an H coefficient of 0.84 [31].