Study: Global dietary quality in 185 countries from 1990 to 2018 show wide differences by nation, age, education, and urbanicity. Image Credit: Akhenaton Images /

Over the past 30 years, our diet has not improved

Everyone eats. However, the way people eat varies according to their culture, geography, level of knowledge, and economic status. Furthermore, diet is associated with many diseases, with poor diet quality causing more than 25% of global preventable deaths.

new Nature Food The study describes diet quality on a global basis in a stratified manner. Here, researchers report modest diet quality in all regions, with small gains in most regions, with the exception of southern Asia and sub-Saharan Africa.

Stady: The quality of the global diet in 185 countries from 1990 to 2018 shows significant differences by country, age, education, and urban. Image Credit: Akhenaton Images /

an introduction

The greatest nutritional benefit is observed when food and nutrients are taken together in a complementary manner. Although the components of an optimal diet have been well defined, global eating patterns remain obscure. A poor diet can cause delayed growth, increased risks of heart metabolism, and poor health in children.

Previous research on diet quality has been limited, as these studies largely excluded children and adolescents. Furthermore, many of these studies used limited data on food consumption and sociodemographic characteristics such as age, gender, education, and residential area.

The current large multinational study uses three different diet quality scores to assess global eating patterns at the individual level.

about studying

The data used in this study were obtained from the recent Global Dietary Database (GDD) compiled in 2018. This collaborative database consists of the systematic and standardized compilation of data for 53 foods, nutrients and beverages.

Data were obtained from surveys conducted in 185 countries between 1990 and 2018. All data were analyzed by age, gender, education and urban housing status.

Assessment of diet quality was performed primarily using the Alternative Healthy Eating Index (AHEI), with secondary comparative analyzes using the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean Diet Score (MED).

AHEI scores are associated with a reduced risk of cardiovascular disease (CVD), diabetes and cancer of approximately 25%, 30%, and 5%, respectively. Conversely, an increase in AHEI recorded by only 20% improved the risk of death from CVD or cancer. This underscores the importance of the current study, with actionable results that should prompt corrective steps to improve diet quality and thus reduce diet-related morbidity and mortality over the next few years.


With a maximum potential of 100, the average global AHEI score was 40 in 2018. Only 10 countries with less than 1% of the world’s population exceeded the score of 50.

When countries with high population density were assessed, Vietnam, Iran, Indonesia and India scored the highest, all of which were around 50. In contrast, the United States, Brazil, Mexico, and Egypt scored less than 30.

The range stretched from 30 in Latin America and the Caribbean to nearly 49 in South Asia. Legumes and nuts got the highest global score, followed by whole grains.

Vegetables and non-starchy seafood rich in omega-3 fats also got relatively good AHEI scores. Overall, the highest scores were for sugar-sweetened beverages and for red and processed meats.

Individual diet components such as sodium and meat differed 100-fold between the densely populated countries, while SSBs showed a 23-fold difference. On the other hand, intake of polyunsaturated fatty acids (PUFAs) and non-starchy vegetables was associated with the least variation in such countries, varying by threefold at most.

While South Asia scored higher for whole grains, intake of meat and SSBs was lower. In Latin American and Caribbean countries, the intake of legumes and nuts was higher, while the sodium intake was lower.

Children and adults had similar AHEI scores. However, in Central and Eastern Europe, Central Asia, North Africa, and the Middle East, as well as all high-income countries (HICs), adults had a significantly better diet than children. More specifically, the U- or J-shaped curves indicated that the best diets were reported for children aged five years or younger and individuals aged 75 or older.

It was found that children consumed less fruits, vegetables, and omega-3 seafood and SSBs than adults. However, adults have a higher percentage of PUFA and sodium. Interestingly, higher parental education was associated with poorer diet quality in South Asia, North Africa, and the Middle East, as opposed to the rest of the world. Urban children have a higher nutritional quality in most parts of the world, with the exception of those in the Middle East and North Africa.

Women, particularly in high-income and Central Asian countries, as well as Central and Eastern European countries, had a better diet, with a difference of up to four compared to men. The best results were for fruits, vegetables, and whole grains.

Education favored better diet quality, with more fruit and whole grains but less consumption of SSB, meat, legumes, and nuts in urban areas. In general, better education has been linked to higher consumption of fruits, sodium, vegetables, and whole grains.

City dwellers usually had a better diet, with the exception of North Africa and the Middle East. This is likely due to differences in the choice of healthy foods compared to unhealthy foods by urban versus rural communities.

Over the 18 years in which the study was conducted, the average score increased by 1.5 due to improvement in five regions, except for Southern Asia and Sub-Saharan Africa, which reported lower scores. Vegetables, legumes, and nuts were responsible for this increase, with meat and sodium associated with lower points.

Iran, the United States, Vietnam and China recorded the largest increase in AHEI scores among the most populous countries. Conversely, Tanzania, Nigeria, Japan, and the Philippines were among the countries in this low-scoring category.

When comparing DASH and MED scores, the researchers found the same trends, with highest scores in South Asia and lower scores in Latin America and the Caribbean. Adults got better grades, especially those with better education. Urban residence was linked to better outcomes only with DASH.

These results also showed a slight improvement over the 18 years of data collection.

What are the effects?

The study notes that diet quality still shows significant differences and inconsistencies around the world.

South Asia and Sub-Saharan Africa topped the world with the highest scores, despite being home to many low-income countries. Close examination showed that this was due to lower consumption of sugary drinks and meat, while healthy foods such as fruits, vegetables, legumes, nuts and healthy fats were associated with unexplainedly low consumption patterns.

Asia is slowly increasing consumption of meat and sodium, as is the case in countries in Latin America and the Caribbean. Meanwhile, wealthy countries in Europe, the Middle East, North Africa, and Central Asia have a higher intake of healthy foods but score lower for their excessive consumption of meat, sodium, and sugary drinks.

This refers to “a A dual focus on increasing healthy foods and minimizing harmful factors is essential in these areas. ‚ÄúThese changes must be promoted through national and grass-roots policies to enhance food security and ensure that every citizen has access to nutritious food at a reasonable price.

Journal reference:

  • Miller, F, Webb, B, Codia, F. et al. (2022). The quality of the global diet in 185 countries from 1990 to 2018 shows significant differences by country, age, education and urbanization. Nature Food. doi: 10.1038/s43016-022-00594-9.

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