estimate). Since the purpose of this scoping review was to provide an overview of the existing evidence regardless of methodological quality or risk of bias, the articles included were not critically appraised (Tricco et al. 2018).

# Results

## Search 1: Evidence on the link between diet quality, health/nutrition outcomes and economic costs (all three components)

### **Search results and characteristics of selected studies**

The study selection process for the first literature search objective is shown in **Figure 2** . The total number of records screened, after removing duplicates was 704; 142 full texts were screened. We identified a total of 20 studies that included data from LMICs and estimated the burden of unhealthy food choice by quantifying the impact of individual dietary factors (dairy products, salt, sugar, sugar-sweetened beverages, ultra-processed foods) or poor-quality diets (measured by healthy eating indices) on diet-related NCD outcomes (cardio-vascular diseases, diabetes, chronic disease) (see **Table 2** ). A comparison of key findings in terms of mortality, DALYs and health care costs are summarized in **Table 3** .

Most of the studies were based on the GBD data and methodology. Several studies estimated the cost (mortality and DALYs) of cardiovascular disease or the NCD burden attributable to the dietary risk factors, using the GBD dataset for 204 countries (B. Zhang et al. 2023; Dong et al. 2022; Qiao et al. 2022) or in specific country contexts (Brazil, Mexico) (Dávila-Cervantes 2020; Machado et al. 2022). Globally, in 2019, 6.9 million CVD deaths and 153.2 million CVD DALYs were attributable to dietary risk factors, with high sodium, low whole grains, low legumes, low fruits and high red meat being the top risks (B. Zhang et al. 2023; Dong et al. 2022). This increased to 7.9 million deaths and 187.7 million DALYs globally when including other NCDs such as cancers and T2DM (Qiao et al. 2022). Using the same dataset at country level for Brazil, Machado and colleagues (2022) show a lower age-standardized death rate (65.3 per 100,000 in Brazil vs. 101 globally in 2019) for NCDs attributable to dietary risks.

Four studies (three in Brazil, one in Costa Rica) estimated the costs associated with excess salt/sodium consumption, one using the GBD dataset (Guedes et al. 2022) and the others assessed health care costs associated with hypertension (Nilson, da Silva, and Jaime 2020; Nilson et al. 2020; Vega-Solano et al. 2023). In 2017, the burden of hypertension and CVDs associated with excessive salt intake in Brazil accounted for USD 192.1 million in health care costs (hospitalization, outpatient care and medication for hypertension) and USD 752.7 million in productivity losses due to premature deaths (Nilson et al. 2020). In Costa Rica, excessive salt intake was estimated to cost USD 15.1 million in health care costs and USD 6.8 million in annual productivity costs (GDP losses) (VegaSolano et al. 2023).

An additional eight studies were found that estimated costs (usually mortality and DALYs) associated with specific dietary risk factors such as diets high in red meat (Liu et al. 2022) or processed meat (Rocha et al. 2023), high in sugar-sweetened beverage intake (Bardach et al. 2023; Li et al. 2021), or low in fiber (Zhuo et al. 2022).

Two studies modeled the savings in health care costs associated with improvements in population dietary intake. Basto-Abreu and colleagues (2020) estimated that a 36.8 kcal/day reduction in energy intake from beverages and snacks would result in a 5 percentage point decrease over five years in adult obesity prevalence and save USD 1.84 billion in direct and indirect health care costs in Mexico. In the Islamic Republic of Iran, the estimated reduction in CVD and T2DM incidence due to optimal dairy food consumption would result in $0.43 per capita savings in health care costs over one year and $190.25 in 20 years (Javanbakht et al. 2018).

Three studies included children in their study population. In a study of SSB consumption in four countries (Argentina, Brazil, Trinidad & Tobago, El Salvador), Alcaraz et al. estimated that SSB consumption in one year was associated with 12% of overweight and obesity cases in children and adolescents, as well as 2.8% of those in adults. The total cost associated with SSB consumption was 18,000 deaths, 0.5 million DALYs and USD 2 billion in 7