Global dietary quality in 185 countries from 1990 to 2018 show wide differences by nation, age, education, and urbanicity
Victoria Miller(Tufts University), Patrick Webb(Tufts University), Frederick Cudhea(Tufts University), Peilin Shi(Tufts University), Jianyi Zhang(Tufts University), Julia Reedy(Tufts University), Josh Erndt‐Marino(Tufts University), Jennifer Coates(Tufts University), Dariush Mozaffarian(Tufts University), Global Dietary Database(Acıbadem University), Murat Baş(Acıbadem University), Jemal Haidar(Statistics Canada), Suhad Abumweis(Al Ain University), Anand Krishnan(All India Institute of Medical Sciences), Puneet Misra(All India Institute of Medical Sciences), Nahla Chawkat Hwalla(Amrita Vishwa Vidyapeetham), Chandrashekar Janakiram(Andalas University), Nur Indrawaty Liputo(Bahrain Center for Strategic International and Energy Studies), Abdulrahman O. Musaiger(Ardabil University of Medical Sciences), Farhad Pourfarzi(Bacha Khan University), Iftikhar Alam(Bacha Khan University), Karin DeRidder(Alliance Bioversity International - CIAT), Céline Termote(Brighton and Sussex Medical School), Anjum Memon(Brighton and Sussex Medical School), Aida Turrini(Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione), Elisabetta Lupotto(Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione), Raffaela Piccinelli(Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione), Stefania Sette(Cadi Ayyad University), Karim Anzid(Cadi Ayyad University), Marieke Vossenaar, Paramita Mazumdar, Ingrid Rached(Fundación Centro de Estudios Infectológicos), Alicia Rovirosa(Fundación Centro de Estudios Infectológicos), María Elisa Zapata(Addis Ababa Science and Technology University), Tamene Taye Asayehu(CGIAR), Francis Oduor(CGIAR), Julia Boedecker(CGIAR), Lilian Aluso(CGIAR), Johana Ortíz‐Ulloa(University of Delhi), J.V. Meenakshi(University of Delhi), Michelle Alessandra de Castro(University of Catania), Giuseppe Grosso(University of Catania), Anna Waśkiewicz(Aga Khan University), Umber S. Khan(Aga Khan University), Anastasia Thanopoulou(Tehran University of Medical Sciences), Reza Malekzadeh(Ministry for Health), Neville Calleja(National Institute for Public Health and the Environment), Marga C. Ocké(National Institute for Public Health and the Environment), Zohreh Etemad(Eastern Mediterranean Public Health Network), Mohannad Al Nsour(Egerton University), Lydiah M. Waswa(Egerton University), Eha Nurk(Family Health International 360), Joanne E Arsenault(Family Health International 360), Patricio López‐Jaramillo(Universidad De Santander), Abla Mehio Sibai(Eduardo Mondlane University), Albertino Damasceno(Eduardo Mondlane University), Carukshi Arambepola(Universidade do Porto), Carla Lopes(Universidade do Porto), Mílton Severo(Universidade do Porto), Nuno Lunet(Universidade do Porto), Duarte Torres(Universidade do Porto), Heli Tapanainen(Finnish Institute for Health and Welfare), Jaana Lindström(Finnish Institute for Health and Welfare), Suvi Μ. Virtanen(Florida International University), Cristina Palacios(Florida International University), Eva Roos(Nutrition Center of the Philippines), Imelda Angeles‐Agdeppa(Nutrition Center of the Philippines), Josie Desnacido(Nutrition Center of the Philippines), Mario V. Capanzana(Diabetes Foundation), Anoop Misra(FrieslandCampina (Netherlands)), Ilse Khouw(FrieslandCampina (Netherlands)), Swee Ai Ng(University of North Carolina at Chapel Hill), Edna Gamboa Delgado(Consejo Nacional de Investigaciones Científicas y Técnicas), Mauricio Caballero(Consejo Nacional de Investigaciones Científicas y Técnicas), Johanna Otero(Gachon University), Hae‐Jeung Lee(Gachon University), Eda Köksal(University Hospital of Geneva), Idris Guessous(Ghent University Hospital), Carl Lachat(Ghent University Hospital), Stefaan De Henauw(Ghent University Hospital), Ali Reza Rahbar, Alison Tedstone, Androniki Naska, Angie Mathee, Annie Ling, Bemnet Tedla, Beth Hopping, Brahmam Ginnela, Catherine Leclercq, Charmaine Duante, Christian Haerpfer, Christine Hotz, Christos Pitsavos, Colin D. Rehm, Coline van Oosterhout, Corazon Cerdeña, Debbie Bradshaw, Dimitrios Trichopoulos, Dorothy Gauci, Dulitha Fernando, Elzbieta Sygnowska, Erkki Vartiainen, Farshad Farzadfar, Gábor Zajkás, Gillian Swan, Guansheng Ma, Ayla Gülden Pekcan, Hajah Masni Ibrahim, Harri Sinkko, Heléne Enghardt Barbieri, Isabelle Sioen, Jannicke Borch Myhre, Jean‐Michel Gaspoz, Jillian Odenkirk, Kanitta Bundhamcharoen, Keiu Nelis, Khairul Zarina, Lajos Biró, Lars Johansson, Laufey Steingrímsdóttir, Leanne M Riley, Mabel Yap, Manami Inoue, Maria Szabo, Marja‐Leena Ovaskainen, Meei‐Shyuan Lee, Mei Fen Chan, Melanie Cowan, Mirnalini Kandiah, Ola Kally, Olof Jonsdottir, Pam Palmer, Péter Vollenweider, Philippos Orfanos, Renzo Asciak, Robert Templeton, Rokiah Don, Roseyati Yaakub, Rusidah Selamat, Safiah Md Yusof, Sameer Al‐Zenki, Shu-Yi Hung, Sigrid Beer‐Borst, Suh Wu, Widjaja Lukito, Wilbur C. Hadden, Wulf Becker, Xia Cao, Yi Ma, Yuen Lai, Zaiton Hjdaud(Statistics Canada), Didier Garriguet(Statistics Canada), Jennifer Ali(Statistics Canada), Ron Gravel(Statistics Canada), Tina Tao(Griffith University), Lennert Veerman(Griffith University), Shashi Chiplonkar(Jehangir Hospital), Mustafa Arıcı(Hanoi Medical University), Ngoan Tran Le(Hanoi Medical University), Demosthenes B. Panagiotakos(Harvard University), Yanping Li(Harvard University), Antonia Trichopoulou(Hellenic Health Foundation), Noël C. Barengo(Jehangir Hospital), Anuradha Khadilkar(Jehangir Hospital), Veena Ekbote(Isfahan University of Medical Sciences), Noushin Mohammadifard(Isfahan University of Medical Sciences), Irina Kovalskys(Fundación Pro Salud y Medio Ambiente), Avula Laxmaiah(National Institute of Nutrition), Harikumar Rachakulla(National Institute of Nutrition), Hemalatha Rajkumar(National Institute of Nutrition), Indrapal I Meshram(National Institute of Nutrition), Avula Laxmaiah(National Institute of Nutrition), Nimmathota Arlappa(National Institute of Nutrition), Hemalatha Rajkumar(Istituto Neurologico Mediterraneo), Licia lacoviello(University of Insubria), Marialaura Bonaccio(Istituto Neurologico Mediterraneo), Simona Costanzo(Istituto Neurologico Mediterraneo), Yves Martin‐Prével(Institut de Veille Sanitaire), Katia Castetbon(Institut de Veille Sanitaire), Nattinee Jitnarin(Institute of Biomedical Sciences, Academia Sinica), Yao-Te Hsieh(Institute of Biomedical Sciences, Academia Sinica), Sonia Olivares(Institute of Nutrition of Central America and Panama), Gabriela Tejeda(Institute of Nutrition of Central America and Panama), Aida Hadziomeragic(Universidade Federal do Rio de Janeiro), Amanda de Moura Souza(Universidade Federal do Rio de Janeiro), Wen‐Harn Pan(Institute of Biomedical Sciences, Academia Sinica), Inge Huybrechts(International Food Policy Research Institute), Alan de Brauw(International Food Policy Research Institute), Mourad Moursi(Isfahan University of Medical Sciences), Maryam Maghroun(Isfahan University of Medical Sciences), Augustin Nawidimbasba Zeba(Isfahan University of Medical Sciences), Nizal Sarrafzadegan(Isfahan University of Medical Sciences), Lital Keinan-Boker, Rebecca Goldsmith, Tal Shimony(Justus-Liebig-Universität Gießen), Irmgard Jordan(Justus-Liebig-Universität Gießen), Shivanand C. Mastiholi(Kenya Medical Research Institute), Moses Mwangi(Kenya Medical Research Institute), Yeri Kombe(Kenya Medical Research Institute), Zipporah Bukania(King Abdulaziz University), Eman M. Alissa(King Abdulaziz University), Nasser Al-Daghri(King Saud University), Shaun Sabico(King's College London), Martin Gulliford(Ministry of Public Health), Tshilenge S. Diba(Ministry of Public Health), Kyungwon Oh(Korea Disease Control and Prevention Agency), Sanghui Kweon(Korea Disease Control and Prevention Agency), Sihyun Park(Korea University), Yoonsu Cho(Korea University), Suad Al-Hooti(Kuwait Institute for Scientific Research), Chanthaly Luangphaxay(Public Health Institute), Daovieng Douangvichit(Public Health Institute), Latsamy Siengsounthone(Public Health Institute), Pedro Marques‐Vidal(Leibniz Centre for Agricultural Landscape Research), Constance Rybak(Loyola University Chicago), Amy Luke(Loyola University Chicago), Nipa Rojroongwasinkul(Mahidol University), Noppawan Piaseu(Malaysian Palm Oil Board), Kalyana Sundram(Malaysian Palm Oil Board), Donka Baykova(Ahvaz Jundishapur University of Medical Sciences), Parvin Abedi(Ministry of Health), Fariza Fadzil(Ministry of Health), Noriklil Bukhary Ismail Bukhary(Ministry of Health), Pascal Bovet(Ministry of Health), Sandjaja Sandjaja(Ministry of Health), Yu Chen(New York University), Norie Sawada, Shoichiro Tsugane(National Center of Public Health and Analyses), Lalka Rangelova(National Center of Public Health and Analyses), Stefka Petrova(National Center of Public Health and Analyses), Vesselka Duleva(National Food Administration), Anna Karin Lindroos(National Food Administration), Jessica Petrelius Sipinen(National Food Administration), Lotta Moraeus(National Food Administration), Per Bergman(National Food Administration), Ward Siamusantu(Instytut Zywnosci Zywienia), L Szponar(National Health Research Institutes), Hsing‐Yi Chang(National Health Research Institutes), Makiko Sekiyama(National Institute for Environmental Studies), Nagalla Balakrishna(National Institute of Nutrition), Kalpagam Polasa(National Institute of Nutrition), Sesikeran Boindala(National Institute of Nutrition), Khanh Le Nguyen Bao(Institut National de Nutrition et de Technologie Alimentaire), Jalila El Ati(Institut National de Nutrition et de Technologie Alimentaire), Daniel Illescas-Zárate(Instituto Nacional de Salud Pública), Luz María Sánchez‐Romero(Instituto Nacional de Salud Pública), Ivonne Ramirez Silva(Instituto Nacional de Salud Pública), Juan Rivera Dommarco(Instituto Nacional de Salud Pública), Sı́món Barquera(Instituto Nacional de Salud Pública), Sonia Rodríguez‐Ramírez(National Institute of Biomedical Innovation, Health and Nutrition), Nayu Ikeda(National Institute of Biomedical Innovation, Health and Nutrition), Sahar Zaghloul(National Nutrition and Food Technology Research Institute), Anahita Houshiarrad(National Nutrition and Food Technology Research Institute), Fatemeh Mohammadi‐Nasrabadi(National Nutrition and Food Technology Research Institute), Morteza Abdollahi(National Nutrition and Food Technology Research Institute), Khun-Aik Chuah(National University of Malaysia), Zaleha Abdullah Mahdy(Nestlé (Switzerland)), Alison L. Eldridge(Nestlé (Switzerland)), Eric L. Ding(North-West University), Herculina Kruger(OsloMet – Oslo Metropolitan University), Sigrun Henjum(OsloMet – Oslo Metropolitan University), Anne C. Fernandez(Royal College of Surgeons in Ireland), Milton Fabian Suárez‐Ortegón(Pontificia Universidad Javeriana), Nawal Al‐Hamad(Public Health Authority of the Slovak Republic), Veronika Janská(University of Jordan), Reema Tayyem(University of Jordan), Parvin Mirmiran(Isfahan University of Medical Sciences), Roya Kelishadi(Isfahan University of Medical Sciences), Eva Warensjö Lemming(National Food Administration), Almut Richter(Robert Koch Institute), Gert Mensink(Robert Koch Institute), Lothar Wieler(Rutgers, The State University of New Jersey), Daniël J. Hoffman(Rutgers, The State University of New Jersey), Benoı̂t Salanave(Seoul National University), Cho‐il Kim(Seoul National University), Rebecca Kuriyan-Raj, Sumathi Swaminathan(Tabriz University of Medical Sciences), Saeed Dastgiri(Tabriz University of Medical Sciences), Sirje Vaask(Tallinn University), Tilakavati Karupaiah(Taylor's University), Fatemeh Vida Zohoori(Tehran University of Medical Sciences), Alireza Esteghamati(Tehran University of Medical Sciences), Sina Noshad(Tehran University of Medical Sciences), Maryam Hashemian(Technical University of Kenya), Elizabeth Mwaniki(Technical University of Kenya), Elizabeth Yakes-Jimenez(University of New Mexico), Justin Chileshe(Tropical Diseases Research Centre), Sydney Mwanza(Fundación Chile), Lydia Lera Marques(University of Puerto Rico, Medical Sciences Campus), Alan Martin Preston(University of Puerto Rico, Medical Sciences Campus), Samuel Durán‐Agüero(San Sebastián University), Mariana Oleas(Universidad de Antioquia), Luz Posada(University of Cuenca), Angélica Ochoa‐Avilés(University of Cuenca), Khadijah Shamsuddin(Universiti Putra Malaysia), Zalilah Mohd Shariff(Universiti Putra Malaysia), Hamid Jan Bin Jan Mohamed(Hospital Universiti Sains Malaysia), Wan Manan("Dunarea de Jos" University of Galati), Anca Nicolau("Dunarea de Jos" University of Galati), Cornelia Tudorie("Dunarea de Jos" University of Galati), Bee Koon Poh(University of Aberdeen), Pamela Abbott(University of Alberta), Mohammadreza Pakseresht(University of Alberta), Sangita Sharma(University of Alberta), Tor A. Strand(University of Bonn), Ute Alexy(University of Bonn), Ute Nöthlings(University of Bonn), Jan Carmikle(University of California, Davis), Ken Brown(University of Cincinnati), Jeremy Koster(University of Cincinnati), Indu Waidyatilaka(University of Colombo), Pulani Lanerolle(University of Colombo), Ranil Jayawardena(University of Colombo), Julie M. Long(University of Colorado Denver), K. Michael Hambidge(University of Colorado Denver), Nancy F. Krebs(University of Dhaka), Aminul Haque(University of Dhaka), Gudrun B. Keding(University of Helsinki), Liisa Korkalo(University of Helsinki), Maijaliisa Erkkola(University of Helsinki), Riitta Freese(University of Hohenheim), Laila Eleraky(University of Hohenheim), Wolfgang Stuetz(University of Hohenheim), Inga Þórsdóttir(University of Iceland), Ingibjörg Gunnarsdóttir(Universidad de Las Palmas de Gran Canaria), Lluís Serra‐Majem(Universidad de Las Palmas de Gran Canaria), Foong Ming Moy(University of Manchester), Simon Anderson(University of Manchester), Rajesh Jeewon(Carol Davila University of Medicine and Pharmacy), Corina‐Aurelia Zugravu(University of North Carolina at Chapel Hill), Linda S. Adair(University of North Carolina at Chapel Hill), Shu Wen Ng(University of North Carolina at Chapel Hill), Sheila Skeaff(Universidade de São Paulo), Dirce Maria Lobo Marchioni(Universidade de São Paulo), Regina Mara Fisberg(Universidade de São Paulo), Carol J. Henry(University of Saskatchewan), Getahun Ersino(University of Saskatchewan), Gordon Zello(University of Vienna), Alexa Meyer(University of Vienna), Ibrahim Elmadfa(University of Vienna), Claudette Mitchell(University of the Southern Caribbean), David Balfour(University of the Southern Caribbean), Johanna M. Geleijnse(Washington University in St. Louis), Mark Manary(Washington University in St. Louis), Laetitia Nikièma(World Health Organization), Tatyana El-kour(Shahid Sadoughi University of Medical Sciences and Health Services), Masoud Mirzaei(Shahid Sadoughi University of Medical Sciences and Health Services), Rubina Hakeem(Ziauddin University)
Cited by 233Open Access
Abstract
Evidence on what people eat globally is limited in scope and rigour, especially as it relates to children and adolescents. This impairs target setting and investment in evidence-based actions to support healthy sustainable diets. Here we quantified global, regional and national dietary patterns among children and adults, by age group, sex, education and urbanicity, across 185 countries between 1990 and 2018, on the basis of data from the Global Dietary Database project. Our primary measure was the Alternative Healthy Eating Index, a validated score of diet quality; Dietary Approaches to Stop Hypertension and Mediterranean Diet Score patterns were secondarily assessed. Dietary quality is generally modest worldwide. In 2018, the mean global Alternative Healthy Eating Index score was 40.3, ranging from 0 (least healthy) to 100 (most healthy), with regional means ranging from 30.3 in Latin America and the Caribbean to 45.7 in South Asia. Scores among children versus adults were generally similar across regions, except in Central/Eastern Europe and Central Asia, high-income countries, and the Middle East and Northern Africa, where children had lower diet quality. Globally, diet quality scores were higher among women versus men, and more versus less educated individuals. Diet quality increased modestly between 1990 and 2018 globally and in all world regions except in South Asia and Sub-Saharan Africa, where it did not improve.