Global dietary quality in 185 countries between 1990 and 2018 shows large differences by nation, age, education and urbanicity.

The GDD is a collaborative effort to systematically identify, collect, and standardize individual-level dietary data on 53 foods, beverages, and nutrients (Methods). The GDD uses Bayesian modeling methods to estimate dietary intake stratified jointly by age, sex, education, level and urbanicity for 185 countries between 1990 and 2018.

Global and regional diet quality in 2018

In 2018, the overall mean AHEI score was 40.3 (95% confidence interval (CI) 39.4, 41.3), with regional means ranging from 30.3 (28.7 , 32.2) in Latin America and the Caribbean to 45.7 (43.8, 49.3). South Asia (Fig. 1). Among the score components, the highest overall scores for the healthiest items were for legumes/nuts (5.0; 4.8, 5.3), followed by whole grains (4.7; 4, 5, 5.0), omega-3 fats from seafood (4.2; 3.8, 5.1) and non-starchy vegetables (3.9; 3.8, 4.0); among the most unhealthy items, the highest scores (lowest or most favorable intake) were for sugar-sweetened beverages (SSBs) (5.8; 5.7, 5.9) and red/processed meat (4 ,8; 4.5, 5.1). However, these score components varied substantially by world region. For example, the best scores in South Asia were for higher whole grains and red/processed meat and SSB, while the best scores in Latin America and the Caribbean were for higher legumes/nuts and lower sodium .

Figure 1: Global and regional mean AHEI component scores by age (all ages, children and adults only) in 2018.

AHEI score: nine components scored from 0 to 10 each and scaled to ten components (correction for trans fat shown). Healthy components: fruits, non-starchy vegetables, legumes/nuts, whole grains, PUFA and seafood omega-3 fats; unhealthy components: red/processed meat, SSB and sodium.

Quality of the national diet in 2018

Only ten countries, representing <1% of the world population, had AHEI scores ≥50. Among the world's 25 most populous countries, the average AHEI score was highest in Vietnam, Iran, Indonesia, and India (54.5 to 48.2) and lowest in Brazil, Mexico, the United States, and Egypt ( 27.1 to 33.5) (Figure 2). Most of the component scores varied substantially between these populous countries. For example, a 100-fold difference was observed in the sodium score, a 90-fold difference in the red/processed meat score, and a 23-fold difference in the SSB score. Among the components, polyunsaturated fatty acid (PUFA) and non-starchy vegetable scores varied less (twofold and threefold, respectively) between populous countries.

Figure 2: National average AHEI scores for children (left) and adults (right) in 2018.
figure 2

Children: ≤1 year to ≤19 years; adults: ≥20 years. The AHEI score ranged from 0 to 100. The national mean score was calculated as the sum of stratum-level component scores and aggregated to the national mean using weighted population proportions for 2018.

Global and regional differences between demographic subgroups

Globally, the mean AHEI score in 2018 was similar among children (39.2; 38.2; 40.3) compared to adults (40.8; 39.8; 42.0) (figure 1). However, the mean AHEI score was substantially higher among adults compared to children in Central/Eastern Europe and Central Asia, high-income countries, and the Middle East and North region of Africa By age, most regions had J- or U-shaped relationships, with the highest scores observed among the youngest (≤5 years) and/or older (≥75 years) age groups (Fig. 3) .

Fig. 3: Average global and regional AHEI score, by age (years) in 2018.
figure 3

The AHEI score ranged from 0 to 100. Circles represent the overall or regional mean for the age group, and error bars represent the corresponding 95% UI. The mean and its UI are plotted for the midpoint of each age group (<1, 1–2, 3–4, 5–9, 10–14, 15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, 80–84, 85–89, 90– 94 and ≥95 years).

Among AHEI components globally, four components were lower among children compared to adults: fruit (2.2 (2.1, 2.3) versus 2.5 (2.4, 2 ,5), respectively), non-starchy vegetables (3.1 (3.0, 4.5) versus 4.3 (4.2). , 3.2)), SSB (5.3 (5.1, 5.5) vs. 6.1 (6.0, 6.2)) and omega-3 seafood (3.3 (2.9, 4.0) vs. 4.7 (4.2, 5.7 )), while two others were greater among children versus adults: PUFA (2.1 (2.0, 2.2) versus 1.4 (1.3, 1.5)) and sodium (4, 6 (4.1, 5.1) versus 3.2 (2.9, 3.5)) (Fig. 1).

By sex, the mean AHEI score was generally higher in women compared to men globally and regionally, with the largest differences observed in high-income countries (+4.4 difference; 3.8, 5 ,0), and Central/Eastern Europe and Central Asia (+3.6; 2.1, 5.3) (Extended Data Fig. 1). Assessing different AHEI components globally, women had moderately higher scores for fruit (+0.2; 0.2, 0.3), non-starchy vegetables (+0.3; 0.1, 0 .4) and whole grains (+0.4; 0.2, 0.5).

Assessing differences by level of education, AHEI scores were higher among the more highly educated globally and in most regions except the Middle East and North Africa and Sub-Saharan Africa, where there were no obvious differences (Figure 4). Among world regions, differences by education were largest in Central/Eastern Europe and Central Asia (+3.6; 2.4, 4.9), Latin America and the Caribbean (+3.5; 0, 9, 6.0) and South Asia (+2.9; 1.1, 4.9). . Globally, more educated people had higher scores for fruit (+0.8; 0.7, 0.9), sodium (+0.7; 0.3, 1.1), whole grains (+ 0.6; 0.4, 0.8) and non-starchy vegetables (+0.5; 0.4, 0.6). However, in contrast, more educated individuals also had lower scores (less favorable consumption levels) for red/processed meat (−0.6; −0.7, −0.5), SSB (−0.6 ; −0.8, −0.4) and nuts and legumes ( −0.1; −0.2, −0.1) overall.

Figure 4: Global and regional mean absolute differences in AHEI component scores in children (top) and adults (bottom) in 2018, by high and low level of education.
figure 4

AHEI score: nine components each scored from 0 to 10 and scaled to ten components (correction not shown). The absolute difference by education was calculated as the stratum-level difference and aggregated to the overall and regional mean differences using weighted population proportions for low (<6 years) and high (≥12 years) education levels only years) (excludes education level ≥6). and <12 years).

Globally, AHEI scores did not differ significantly by urban and rural residence (Figure 5). However, higher scores were evident among urban versus rural individuals in Central/Eastern Europe and Central Asia (difference +2.2; 0.9, 3.5) and Southeast and East Asian (+1.4; 0.6, 2.4) and lower scores between urban and rural areas. individuals in the Middle East and North Africa (−3.8; −5.5, −2.2). Globally, people living in urban areas had higher scores for fruit (+0.2; 0.2, 0.3) and whole grains (+0.2; 0.1, 0.4) , but lower scores for SSBs (−0.5; −0.7, −0.4), red/processed meat (−0.4, −0.5, −0.1) and legumes/nuts ( −0.1; −0.2, −0.1).

Fig. 5: Global and regional mean absolute differences in AHEI component scores in children (top) and adults (bottom) in 2018, by urban versus rural residence.
figure 5

AHEI score: nine components each scored from 0 to 10 and scaled to ten components (correction not shown). The absolute difference by urbanicity was calculated as the stratum-level difference and aggregated to global and regional mean differences using weighted population proportions.

Changes in dietary pattern scores between 1990 and 2018

Between 1990 and 2018, the average global AHEI score (standardized to 2018 population distributions) increased by +1.5 (1.0, 2.0). Increasing trends occurred in five of the seven regions: Central/Eastern Europe and Central Asia (+4.6; 4.0, 5.3); high income countries (+3.2; 2.9, 3.5); Southeast and East Asia (+2.7; 1.7, 3.8); the Middle East and North Africa (+2.2; 1.4, 3.0); and Latin America and the Caribbean (+1.3; 0.6, 2.0). No significant change was observed in South Asia (0; −0.9, 1.1) and a downward trend was observed in sub-Saharan Africa (−1.1; −1.8, − 0.4) (Fig. 6).

Figure 6: Global and regional mean absolute differences in AHEI component scores in children (top) and adults (bottom), between 2018 and 1990.
figure 6

AHEI score: nine components each scored from 0 to 10 and scaled to ten components (correction not shown). The absolute difference by time was calculated as the stratum-level difference and aggregated to global and regional mean differences using population-weighted proportions for 2018.

Among AHEI components globally, scores increased over time for non-starchy vegetables (+1.1; 1.0, 1.2), legumes/nuts (+1.1; 1.0 , 1.3) and fruit (+0.1; 0.1, 0.2); decreased for red/processed meat (−1.4; −1.5, −1.2), SSB (−0.6; −0.7, −0.6) and sodium (−0.4; − 0.6, −0.2); and remained stable for whole grains (+0.1; 0, 0.2), PUFAs (0; 0, 0.1) and seafood omega-3 (0; 0, 0.1).

Among the most populous countries, the largest absolute improvement in the AHEI score between 1990 and 2018 occurred in Iran (+12.0; 9.9, 13.9), the United States (+4.6; 4.1, 5.1), Vietnam (+4.5; 2.4, 7.2). ) and China (+4.3; 2.8, 5.9), while the largest declines were found in Tanzania (−3.7; −5.8, −1.5), Nigeria (− 3.0; −5.3, −0.7), Japan (−2.7; −3.1). , −2.3) and the Philippines (−1.8; −2.7, −0.9) (Fig. 7).

Figure 7: Absolute national mean change in AHEI scores among children (left) and adults (right) between 1990 and 2018.
figure 7

The AHEI score ranged from 0 to 100. The absolute difference between 2018 and 1990 was calculated as the stratum-level difference and aggregated to national average differences using population-weighted proportions for in 2018.

Results for DASH and MED

Detailed results of the DASH and MED scores are presented in the Supplementary Information. Briefly, the overall mean DASH and MED scores in 2018 were 22.9 (22.6, 23.2) and 4.1 (3.9, 4.2), respectively (Figs 2 and 3 of extended data). Regionally, the averages of these scores were consistently highest in South Asia, and lowest in Latin America and the Caribbean (Extended Data Figs. 4 and 5). Among population subgroups, overall DASH and MED scores were higher among adults compared to children (DASH: 23.2 (22.9, 23.4) versus 22.3 (21.9, 22 .7); MED: 4.3 (4.1, 4.4) versus 3.7 (3.5, 3.8)), but did not differ appreciably by sex (Data Figs. 2 and 3 expanded). Overall mean scores were higher among the more educated than the less educated (difference +2.6 (2.3, 2.8) and +0.3 (0.2, 0.4), respectively) ) (Extended Data Fig. 7) and, for DASH only, between urban and rural individuals. (+0.4; 0.2, 0.7) (Extended Data Fig. 8). Worldwide, mean DASH and MED scores increased moderately between 1990 and 2018, +1.0 (0.8, 1.1) for DASH and +0.3 (0.2, 0.4) for MED (Extended Data Figs. 6 and 9). Across strata in 2018, intercorrelations for dietary pattern scores were 0.8 for AHEI and DASH, 0.5 for AHEI and MED, and 0.6 for DASH and MED.

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