The Tufts University Friedman School of Nutrition Science and Policy recently released a report detailing dietary trends across 185 countries. Using individual data from the Global Dietary Database, the study reveals limited improvement in global diet quality over the past three decades but highlights important regional differences in nutritional needs.
According to the report, the world’s average Alternative Healthy Eating Index (AHEI) score is about 40 out of 100 as of 2018, with 0 being the least healthy and 100 being the most healthy. “That would be a failing grade,” Dariush Mozaffarian, co-author and Dean for Policy and Jean Mayer Professor of Nutrition at the Friedman School, tells Food Tank. Just ten countries had scores over 50, with average scores greatest in South Asia. “Dietary quality overall is not high,” he says.
A high AHEI score represents greater consumption of non-starchy vegetables, fruits, legumes/nuts, whole grains, good fats, and seafood and plant proteins. A low score represents a poor intake of these food groups and a higher consumption of unhealthy options, such as foods high in sodium, sugar-sweetened beverages (SSBs), and red and processed meat.
From 1990 to 2018, the mean global AHEI score increased by 1.5, a “modest” improvement, according to the report. Most regions experienced an increasing trend, with Sub-Saharan Africa seeing a decline in dietary quality during this time period.
Notably, “there is not one nutrition or food problem in the world,” Mozaffarian tells Food Tank. Diets overall are poor for many “different reasons in different places.”
High income countries, including the United States, have increased their consumption of healthy food groups. But the U.S. has not drastically reduced consumption of SSBs and other unhealthy foods. In contrast, the starchy staples and more uniform diets of low income countries means there is generally a lower consumption of unhealthy foods, but there is also an “insufficient intake of healthy foods,” Mozaffarian points out. Latin America and many East Asian countries are also seeing a substantial increase in red and processed meat over time.
Controlling for demographic factors, the study finds that in 2018, the mean AHEI score was generally highest for infants and very young children compared to adolescents. Higher income countries had a dramatic decrease in diet quality from infancy to childhood and through early adulthood. In contrast, Sub-Saharan Africa had a relatively stable score among different age groups.
Education can also affect diet quality, the report shows, but the links between education and diet are not uniform. “In many places more educated adults have substantially healthier diets, but in some places there’s not a big difference by education,” Mozaffarian tells Food Tank. Areas where education had a significant impact on the consumption of healthier foods include Central and Eastern Europe, Central Asia, South Asia, and Latin America.
Likewise, living in cities matters in some regions more than others. Urban dwellers in the Middle East tend to have poorer diets than rural people, whereas urban people in East Asia typically have a higher diet quality.
“I think these details are really important,” Mozaffarian tells Food Tank. Understanding region-specific concerns helps to guide better, less generalized policies. Public health campaigns can be more “thoughtful” and “imaginative,” considering the diverse needs of different nations, he says.
“In five or six Latin American countries black box warning label systems have been created on added sugar and salt,” Mozaffarian explains. But these warnings do not tackle the high red meat consumption in this area or address the need for more vegetables, fruits, and other healthy foods in people’s diet.
There is an urgent need for more effective nutritional policies. “Poor diet is the top cause of poor health in the world,” Mozaffarian tells Food Tank, with the report revealing that 26 percent of preventable death is caused by inadequate diets. “All policies have to take food and nutrition seriously.”
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