example, despite being given an adequate diet, children may still face an impaired growth or not gain weight because of underlying inflammations linked to infection. Conversely, individuals with healthy weight may have unhealthy diets and be at high risk of NCDs. Hence, estimating the hidden costs of unhealthy diets differs from estimating the cost of malnutrition in all its forms.

The new suites of healthy diet metrics have promise for policy analysis. They have potential for tracking the impact of nutrition-sensitive agrifood system policies, especially if they go beyond a focus on supply chain and also consider food environments and consumer behaviors. Using a more holistic indicator of healthy diets can avoid the double counting problems inherent in trying to add up the costs of failing to reach a dozen or more dietary guidelines. Work is underway to further validate these new measures against health outcomes.

Regressions undertaken for the current study using cross-country data suggest that increased calorie availability and greater dietary diversity, as expected, tend to be associated with less child stunting and wasting, and less underweight in women. Calorie availability and dietary diversity also are associated with increased overweight and obesity in both children and women, although these results are less significant than for undernutrition. The new GDR score’s submetrics, NCD-Protect and NCD-Risk, have the expected effects on obesity in women, although not significantly so. Finally, cross-country data on NCD risks (hypertension and diabetes) have measurement issues but have the expected negative relation (although significant only for hypertension) with the NCD-Protect score.

In this note we have suggested that a way to proceed further would be to partner with national researchers to obtain similar regression results using national (or state-level) health and nutrition survey data to elucidate the relationship between overweight and/or cardiovascular risk or diabetes, and the new diet quality variables from individual-level data. This could then inform analysis for other countries in the same region of policy interest, which have individual quantitative dietary recall data but not associated with data on NCD risk factors.

The new data quality variables could help identify how diets vary across different population subgroups, and what the key issues are, such as insufficient diet diversity, insufficient consumption of foods protective against NCDs, or excess consumption of foods with risks for NCDs.

Knowledge of the economic costs of unhealthy food choices for different population subgroups could then inform policy priorities and be compared with estimates of the costs of different agrifood policies aimed at supporting better food choices. Examples of agrifood policies which were adopted with short- and mediumterm goals of increasing farmer income and meeting nutrient needs of undernourished populations are subsidies on sugarcane and palm oil. These subsidies aimed to provide inexpensive calories and fat. However, being cognizant of the long-run costs of these policies in the context of the nutrition transition, with growing risks of diabetes and risks associated with saturated fat, can help guide the evolution of agrifood policy. There are also implications for public health nutrition policy, in that information on costs can underscore the importance of policies such as nutrition information and communication, and nutrition and exercise interventions in school-age children and adolescents.

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