**Table 3: Summary of potential global healthy diet metrics for adults and their strengths and limitations for country study purposes**

|**Metric**|**Description**|**Strengths**|**Limitations**|
|---|---|---|---|
|**Minimum Diet Diversity –**<br>**Women**|<br>• Gender-sensitive dichotomous indicator of<br>whether women 15-49 years have consumed<br>at least 5 out of 10 defined food groups the<br>previous day or night.<br>• Food group indicator|<br>• Valid indicator of better<br>micronutrient adequacy<br>• Available from Gallup World Poll<br>surveys for 55 LMIC plus<br>Palestine & DHS for 3 countries<br>(as of 20-Jun-2023)|• Does not include food groups<br>associated with greater NCD risk<br>• Not validated for men|
|**Food Group Diversity**<br>**Score**|• Measure of the number of food groups<br>consumed the previous day or night, of the<br>ten food groups used to construct the MDD-<br>W indicator<br>• Food group indicator|• Valid measure of greater nutrient<br>intakesfor men and women<br>• Available from Gallup World Poll<br>surveys for 55 LMIC plus<br>Palestine (as of 20-Jun-2023)|•<br>Does not include food<br>groups associated with<br>greater NCD risk|
|**Global Diet**<br>**Recommendation (GDR)**<br>**Score)**(Two sub-scores)|• Measure based on food consumption from<br>nine health-protective food groups and eight<br>food groups to avoid/limit the previous day<br>or night<br>• Validated against quantitative intakes<br>aligned with each of 11 WHO<br>recommendations on healthy diets<br>• DQ-Q asks yes/no questions about<br>consumption of a sentinel set of individual<br>foods<sup>5</sup>; no data on quantity of consumption|• Indicator (GDR Score >=10) is a<br>valid indicator of adhering to >=6<br>of current 11 global dietary<br>recommendations (and by proxy,<br>NCD risk) for men and women<br>• Food group questions adapted for<br>each country<br>• Available from Gallup World Poll<br>surveys for 55 LMIC plus<br>Palestine (as of 20-Jun-2023)|• Does not indicate nutrient<br>adequacy (unless paired with Food<br>Group Diversity Score or MDD-<br>W)<br>• Not validated against health<br>outcomes<br>• Using both sub-scores is more<br>informative than using combined<br>score|
|**Global Diet Quality Score**<br>**(GDQS)**(Two sub-scores)|• Food-based metric consisting of 25 food<br>groups classified as healthy, unhealthy, or<br>unhealthy when consumed in excessive<br>amounts<br>• Uses open recall of foods and beverages<br>consumed, requires some data on quantity<br>of consumption|• Valid quantitative measure of<br>nutrient adequacy and NCD risk<br>for men and women 15+ years<br>• Validated against health outcomes|• Limited availability of nationally<br>representative datasets (~7 LMIC,<br>as of 23-Jun-2023)<br>• Using both sub-scores is more<br>informative than using combined<br>score|
|**Global Dietary Database**<br>**(GDD) – 54 dietary risk**<br>**factors**|• Derived from modeling approach using<br>nationally or subnationally representative<br>surveys<br>• Model generates means for 54 dietary<br>factors for 185 countries|• Dietary intakes estimated for most<br>food groups, stratified by<br>demographic characteristics<br>(education, urban/rural residence)<br>• Validated with health outcomes|• For countries without 24-hour<br>dietary recall data, GDD estimates<br>are modeled based on existing data<br>sources<br>• Modeled data may be unclear to<br>non-experts|

> 5 DQ-Q also allows for monitoring intake of ultra-processed foods and is tracked in a way that has some relevance for sustainable diets.

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