Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment
Open accessAbstract
BACKGROUND: Healthy dietary patterns are a global priority to reduce non-communicable diseases. Yet neither worldwide patterns of diets nor their trends with time are well established. We aimed to characterise global changes (or trends) in dietary patterns nationally and regionally and to assess heterogeneity by age, sex, national income, and type of dietary pattern. METHODS: In this systematic assessment, we evaluated global consumption of key dietary items (foods and nutrients) by region, nation, age, and sex in 1990 and 2010. Consumption data were evaluated from 325 surveys (71·7% nationally representative) covering 88·7% of the global adult population. Two types of dietary pattern were assessed: one reflecting greater consumption of ten healthy dietary items and the other based on lesser consumption of seven unhealthy dietary items. The mean intakes of each dietary factor were divided into quintiles, and each quintile was assigned an ordinal score, with higher scores being equivalent to healthier diets (range 0-100). The dietary patterns were assessed by hierarchical linear regression including country, age, sex, national income, and time as exploratory variables. FINDINGS: From 1990 to 2010, diets based on healthy items improved globally (by 2·2 points, 95% uncertainty interval (UI) 0·9 to 3·5), whereas diets based on unhealthy items worsened (-2·5, -3·3 to -1·7). In 2010, the global mean scores were 44·0 (SD 10·5) for the healthy pattern and 52·1 (18·6) for the unhealthy pattern, with weak intercorrelation (r=-0·08) between countries. On average, better diets were seen in older adults compared with younger adults, and in women compared with men (p<0·0001 each). Compared with low-income nations, high-income nations had better diets based on healthy items (+2·5 points, 95% UI 0·3 to 4·1), but substantially poorer diets based on unhealthy items (-33·0, -37·8 to -28·3). Diets and their trends were very heterogeneous across the world regions. For example, both types of dietary patterns improved in high-income countries, but worsened in some low-income countries in Africa and Asia. Middle-income countries showed the largest improvement in dietary patterns based on healthy items, but the largest deterioration in dietary patterns based on unhealthy items. INTERPRETATION: Consumption of healthy items improved, while consumption of unhealthy items worsened across the world, with heterogeneity across regions and countries. These global data provide the best estimates to date of nutrition transitions across the world and inform policies and priorities for reducing the health and economic burdens of poor diet quality. FUNDING: The Bill & Melinda Gates Foundation and Medical Research Council.
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These dietary patterns have healthful aspects and are characterized by fiber-rich plant-based foods, lean meat and fish, and herbs, some of which are derived from ancient medicinal practices.
“These dietary patterns have healthful aspects and are characterized by fiber-rich plant-based foods, lean meat and fish, and herbs, some of which are derived from ancient medicinal practices.[114][115][116]”
From Popular dietary patterns: alignment with American Heart Association 2021 dietary guidance: a scientific statement from the American Heart Association. (2023) · cites this paper as [114]
Global dietary patterns have shifted in nearly every nation in the world.
“In recent years, global dietary patterns have shifted in nearly every nation in the world.4”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [4]
The observed diversity of diets within and across individuals, generations, cultures, and populations further belies a particular biologic preference for food.
“The observed diversity of diets within and across individuals, generations, cultures, and populations further belies a particular biologic preference for food.4, 346, 392-394”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [4]
Relatively sparse data on diet and CVD exist from LMIC, though new data sources are rapidly emerging.
“Relatively sparse data on diet and CVD exist from these countries though new data sources are rapidly emerging (1,2).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [1]
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- Authors
- Imamura, F., Micha, R., Khatibzadeh, S., Fahimi, S., Shi, P., Powles, J., & Mozaffarian, D.
- Affiliations
- University of Cambridge (GB)
- Agricultural University of Athens (GR)
- Harvard University (US)
- Tufts University (US)
- Corresponding author
- Imamura, Fumiaki
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2015-03
- Volume
- 3
- Issue
- 3
- Pages
- e132-e142
- ISSN
- 2214-109X (ISSN-L)
- PMC
- PMC4342410
- OpenAlex
- W2003157775
- Cited by
- 834
- References
- 36
- Citations by year
- 2026: 39 · 2025: 83 · 2024: 64 · 2023: 71 · 2022: 76 · 2021: 131 · 2020: 96 · 2019: 85 · 2018: 72 · 2017: 49 · 2016: 41 · 2015: 27
- FWCI
- 67.77
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- The Lancet Global Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Bushehr University of Medical Sciences Repository (Bushehr University of Medical Sciences) (acceptedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Funders
- The Bill & Melinda Gates Foundation
- Medical Research Council Unit Programme (MC_UU_125015/5)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Life Sciences › Agricultural and Biological Sciences › Food Science › Nutrition, Health, and Society Studies
- Physical Sciences › Environmental Science › Ecology › Agriculture Sustainability and Environmental Impact
- Keywords
- diet quality, healthy eating patterns, unhealthy dietary patterns, sex differences in diet, age differences in diet, regional differences in diet, non-communicable disease prevention, dietary intake, low-income countries, middle-income countries, high-income countries, Africa, Asia, Europe
- MeSH terms
- Adult, Africa, Age Factors, Aged, Aged, 80 and over, Asia, Diet, Diet Surveys, Female, Humans, Income, Male, Middle Aged, Poverty, Sex Factors, Global Health, Nutrition Assessment, Young Adult
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