Global trends in dietary quality
Authors: Patrick Mullie, Philippe Autier
Journal: The Lancet Global Health (2015)

Fumiaki Imamura and colleagues1Imamura F Micha R Khatibzadeh S et al.Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment.Lancet Glob Health. 2015; 3: e132-e142Summary Full Text Full Text PDF Scopus (484) Google Scholar assess the consumption of key dietary items internationally by comparing healthy and unhealthy dietary patterns. However, the evidence they use to inform the classification of food items is unclear and seems to lead to some arbitrary outcomes. For example, milk was classified as a healthy item, despite the fact that the health advantages associated with milk consumption remain controversial. Two large prospective studies in Sweden2Michaëlsson K Wolk A Langenskiöld S et al.Milk intake and risk of mortality and fractures in women and men: cohort studies.BMJ. 2014; 349: g6015Crossref PubMed Scopus (264) Google Scholar, 3Ludwig DS Willett WC Three daily servings of reduced-fat milk: an evidence-based recommendation?.JAMA Pediatr. 2013; 167: 788-789Crossref PubMed Scopus (35) Google Scholar have shown that high milk intake is associated with reduced life expectancy. Moreover, in populations with high prevalence of adiposity, milk consumption might simply add excess energy intake and contribute to the obesity epidemic. To assess quality independent from quantity, Imamura and colleagues assessed dietary intake adjusted for 2000 kcal per day. An unfortunate consequence of this adjustment is that the role of unrestrained energy intake in the obesity and diabetes epidemics seems to be rendered obsolete. For example, in the USA, the mean adult energy intake increased from 1955 kcal per day during 1971–75 to 2269 kcal per day during 2003–04.4Ford ES Dietz WH Trends in energy intake among adults in the United States: findings from NHANES.Am J Clin Nutr. 2013; 97: 848-853Crossref PubMed Scopus (133) Google Scholar Between 1980 and 2009, average body-mass index (BMI) worldwide increased from 25·5 to 28·5 kg per m2 for men and from 25·0 to 28·4 kg per m2 for women.5WHOGlobal health observatory data repository: mean body mass index trends (age-standardized estimate).http://apps.who.int/gho/data/node.main.A904Google Scholar In China, mean adult energy intake was 1978 kcal per day in 1970 and 2328 in 1992.6Du SF Wang HJ Zhang B Zhai FY Popkin BM China in the period of transition from scarcity and extensive undernutrition to emerging nutrition-related non-communicable diseases, 1949–1992.Obes Rev. 2014; 15: 8-15Crossref PubMed Scopus (89) Google Scholar BMI increased from 21·6 kg per m2 to 23·0 kg per m2 for men and from 21·9 to 23·0 kg per m2 for women in China between 1980 and 2009.5WHOGlobal health observatory data repository: mean body mass index trends (age-standardized estimate).http://apps.who.int/gho/data/node.main.A904Google Scholar If the public health agenda is to prevent non-communicable diseases in the world through changes in dietary habits, the emphasis should be on reducing energy intake and combating sedentary behaviour instead of assessing dietary patterns on the basis of insubstantial knowledge of the health properties of food items. We declare no competing interests. This work was funded by the International Prevention Research Institute. Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessmentConsumption 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. Full-Text PDF Open Access