Global dietary quality in 185 countries from 1990 to 2018 show wide differences by nation, age, education, and urbanicity
Authors: Miller Victoria , Webb Patrick , Cudhea Frederick , Shi Peilin , Zhang Jianyi , Reedy Julia , Erndt-Marino Josh , Coates Jennifer , Mozaffarian Dariush ,   Global Dietary Database, Bas Murat , Ali Jemal Haidar , Abumweis Suhad , Krishnan Anand , Misra Puneet , Hwalla Nahla Chawkat , Janakiram Chandrashekar , Liputo Nur Indrawaty , Musaiger Abdulrahman , Pourfarzi Farhad , Alam Iftikhar , DeRidder Karin , Termote Celine , Memon Anjum , Turrini Aida , Lupotto Elisabetta , Piccinelli Raffaela , Sette Stefania , Anzid Karim , Vossenaar Marieke , Mazumdar Paramita , Rached Ingrid , Rovirosa Alicia , Zapata María Elisa , Asayehu Tamene Taye , Oduor Francis , Boedecker Julia , Aluso Lilian , Ortiz-Ulloa Johana , Meenakshi J. V. , Castro Michelle , Grosso Giuseppe , Waskiewicz Anna , Khan Umber S. , Thanopoulou Anastasia , Malekzadeh Reza , Calleja Neville , Ocke Marga , Etemad Zohreh , Nsour Mohannad Al , Waswa Lydiah M. , Nurk Eha , Arsenault Joanne , Lopez-Jaramillo Patricio , Sibai Abla Mehio , Damasceno Albertino , Arambepola Carukshi , Lopes Carla , Severo Milton , Lunet Nuno , Torres Duarte , Tapanainen Heli , Lindstrom Jaana , Virtanen Suvi , Palacios Cristina , Roos Eva , Agdeppa Imelda Angeles , Desnacido Josie , Capanzana Mario , Misra Anoop , Khouw Ilse , Ng Swee Ai , Delgado Edna Gamboa , Caballero Mauricio , Otero Johanna , Lee Hae-Jeung , Koksal Eda , Guessous Idris , Lachat Carl , De Henauw Stefaan , Rahbar Ali Reza , Tedstone Alison , Naska Androniki , Mathee Angie , Ling Annie , Tedla Bemnet , Hopping Beth , Ginnela Brahmam , Leclercq Catherine , Duante Charmaine , Haerpfer Christian , Hotz Christine , Pitsavos Christos , Rehm Colin , van Oosterhout Coline , Cerdena Corazon , Bradshaw Debbie , Trichopoulos Dimitrios , Gauci Dorothy , Fernando Dulitha , Sygnowska Elzbieta , Vartiainen Erkki , Farzadfar Farshad , Zajkas Gabor , Swan Gillian , Ma Guansheng , Pekcan Gulden , Ibrahim Hajah Masni , Sinkko Harri , Barbieri Helene Enghardt , Sioen Isabelle , Myhre Jannicke , Gaspoz Jean-Michel , Odenkirk Jillian , Bundhamcharoen Kanitta , Nelis Keiu , Zarina Khairul , Biro Lajos , Johansson Lars , Steingrimsdottir Laufey , Riley Leanne , Yap Mabel , Inoue Manami , Szabo Maria , Ovaskainen Marja-Leena , Lee Meei-Shyuan , Chan Mei Fen , Cowan Melanie , Kandiah Mirnalini , Kally Ola , Jonsdottir Olof , Palmer Pam , Vollenweider Peter , Orfanos Philippos , Asciak Renzo , Templeton Robert , Don Rokiah , Yaakub Roseyati , Selamat Rusidah , Yusof Safiah , Al-Zenki Sameer , Hung Shu-Yi , Beer-Borst Sigrid , Wu Suh , Lukito Widjaja , Hadden Wilbur , Becker Wulf , Cao Xia , Ma Yi , Lai Yuen , Hjdaud Zaiton , Garriguet Didier , Ali Jennifer , Gravel Ron , Tao Tina , Veerman Jacob Lennert , Chiplonkar Shashi , Arici Mustafa , Ngoan Le Tran , Panagiotakos Demosthenes , Li Yanping , Trichopoulou Antonia , Barengo Noel , Khadilkar Anuradha , Ekbote Veena , Mohammadifard Noushin , Kovalskys Irina , Laxmaiah Avula , Rachakulla Harikumar , Rajkumar Hemalatha , Meshram Indrapal , Avula Laxmaiah , Arlappa Nimmathota , Hemalatha Rajkumar , lacoviello Licia , Bonaccio Marialaura , Costanzo Simona , Martin-Prevel Yves , Castetbon Katia , Jitnarin Nattinee , Hsieh Yao-Te , Olivares Sonia , Tejeda Gabriela , Hadziomeragic Aida , de Moura Souza Amanda , Pan Wen-Harn , Huybrechts Inge , de Brauw Alan , Moursi Mourad , Maghroun Maryam , Zeba Augustin Nawidimbasba , Sarrafzadegan Nizal , Keinan-Boker Lital , Goldsmith Rebecca , Shimony Tal , Jordan Irmgard , Mastiholi Shivanand C. , Mwangi Moses , Kombe Yeri , Bukania Zipporah , Alissa Eman , Al-Daghri Nasser , Sabico Shaun , Gulliford Martin , Diba Tshilenge S. , Oh Kyungwon , Kweon Sanghui , Park Sihyun , Cho Yoonsu , Al-Hooti Suad , Luangphaxay Chanthaly , Douangvichit Daovieng , Siengsounthone Latsamy , Marques-Vidal Pedro , Rybak Constance , Luke Amy , Rojroongwasinkul Nipa , Piaseu Noppawan , Sundram Kalyana , Baykova Donka , Abedi Parvin , Fadzil Fariza , Bukhary Noriklil Bukhary Ismail , Bovet Pascal , Sandjaja Sandjaja , Chen Yu , Sawada Norie , Tsugane Shoichiro , Rangelova Lalka , Petrova Stefka , Duleva Vesselka , Lindroos Anna Karin , Sipinen Jessica Petrelius , Moraeus Lotta , Bergman Per , Siamusantu Ward , Szponar Lucjan , Chang Hsing-Yi , Sekiyama Makiko , Nagalla Balakrishna , Polasa Kalpagam , Boindala Sesikeran , Le Nguyen Bao Khanh , El Ati Jalila , Illescas-Zarate Daniel , Sanchez-Romero Luz Maria , Silva Ivonne Ramirez , Dommarco Juan Rivera , Barquera Simon , Rodríguez-Ramírez Sonia , Ikeda Nayu , Zaghloul Sahar , Houshiar-rad Anahita , Mohammadi-Nasrabadi Fatemeh , Abdollahi Morteza , Chuah Khun-Aik , Mahdy Zaleha Abdullah , Eldridge Alison , Ding Eric L. , Kruger Herculina , Henjum Sigrun , Fernandez Anne , Suarez-Ortegon Milton Fabian , Al-Hamad Nawal , Janská Veronika , Tayyem Reema , Mirmiran Parvin , Kelishadi Roya , Lemming Eva Warensjo , Richter Almut , Mensink Gert , Wieler Lothar , Hoffman Daniel , Salanave Benoit , Kim Cho-il , Kuriyan-Raj Rebecca , Swaminathan Sumathi , Dastgiri Saeed , Vaask Sirje , Karupaiah Tilakavati , Zohoori Fatemeh Vida , Esteghamati Alireza , Noshad Sina , Hashemian Maryam , Mwaniki Elizabeth , Yakes-Jimenez Elizabeth , Chileshe Justin , Mwanza Sydney , Marques Lydia Lera , Preston Alan Martin , Aguero Samuel Duran , Oleas Mariana , Posada Luz , Ochoa Angelica , Shamsuddin Khadijah , Shariff Zalilah Mohd , Jan Bin Jan Mohamed Hamid , Manan Wan , Nicolau Anca , Tudorie Cornelia , Poh Bee Koon , Abbott Pamela , Pakseresht Mohammadreza , Sharma Sangita , Strand Tor , Alexy Ute , Nöthlings Ute , Jan Carmikle  , Brown Ken , Koster Jeremy , Waidyatilaka Indu , Lanerolle Pulani , Jayawardena Ranil , Long Julie M. , Hambidge K. Michael , Krebs Nancy F. , Haque Aminul , Keding Gudrun B. , Korkalo Liisa , Erkkola Maijaliisa , Freese Riitta , Eleraky Laila , Stuetz Wolfgang , Thorsdottir Inga , Gunnarsdottir Ingibjorg , Serra-Majem Lluis , Moy Foong Ming , Anderson Simon , Jeewon Rajesh , Zugravu Corina Aurelia , Adair Linda , Ng Shu Wen , Skeaff Sheila , Marchioni Dirce , Fisberg Regina , Henry Carol , Ersino Getahun , Zello Gordon , Meyer Alexa , Elmadfa Ibrahim , Mitchell Claudette , Balfour David , Geleijnse Johanna M. , Manary Mark , Nikiema Laetitia , El-kour Tatyana , Mirzaei Masoud , Hakeem Rubina 
Published: September 2022

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.