Global dietary quality in 185 countries from 1990 to 2018 show wide differences by nation, age, education, and urbanicity

Nature Food - Tập 3 Số 9 - Trang 694-702
Victoria Miller1, Patrick Webb1, Frederick Cudhea1, Peilin Shi1, Jianyi Zhang1, Julia Reedy1, Josh Erndt‐Marino1, Jennifer Coates1, Dariush Mozaffarian1, Murat Baş2, Jemal Haidar3, Suhad Abumweis4, Anand Krishnan5, Puneet Misra5, Nahla Chawkat Hwalla6, Chandrashekar Janakiram7, Nur Indrawaty Liputo8, Abdulrahman O. Musaiger9, Farhad Pourfarzi10, Iftikhar Alam11, Karin DeRidder12, Céline Termote13, Anjum Memon14, Aida Turrini15, Elisabetta Lupotto15, Raffaela Piccinelli15, Stefania Sette15, Karim Anzid16, Marieke Vossenaar17, Paramita Mazumdar18, Ingrid Rached19, Alicia Rovirosa20, María Elisa Zapata20, Tamene Taye Asayehu21, Francis Oduor22, Julia Boedecker22, Lilian Aluso22, Johana Ortíz‐Ulloa23, J.V. Meenakshi24, Michelle Alessandra de Castro25, Giuseppe Grosso26, Anna Waśkiewicz27, Umber S. Khan28, Anastasia Thanopoulou29, Pedro Marques‐Vidal30, Neville Calleja31, Marga C. Ocké32, Zohreh Etemad32, Clive Osmond33, Lydiah M. Waswa34, Eha Nurk35, Joanne Arsenault36, Patricio López‐Jaramillo37, Abla Mehio Sibai38, Albertino Damasceno39, Carukshi Arambepola40, Carla Lopes41, Mílton Severo41, Nuno Lunet41, Duarte Torres42, Heli Tapanainen43, Jaana Lindström43, Suvi Μ. Virtanen43, Cristina Palacios44, Eva Roos45, Imelda Angeles‐Agdeppa46, Josie Desnacido46, Mario Capanzana47, Anoop Misra48, Michael G. Hennerici49, Swee Ai Ng49, Edna Gamboa Delgado50, Mauricio Caballero51, Johanna Otero52, Hae‐Jeung Lee53, Eda Köksal54, Idris Guessous55, Carl Lachat56, Stefaan De Henauw56, Ali Reza Rahbar57, Alison Tedstone57, Androniki Naska57, Angie Mathee57, Annie Ling57, Teresa Shamah Levy57, Beth Hopping57, Brahmam Ginnela57, Catherine Leclercq57, Charmaine Duante57, Christian Haerpfer57, Christine Hotz57, Christos Pitsavos57, Colin D. Rehm57, Coline van Oosterhout57, Corazon Cerdena57, Debbie Bradshaw57, Dimitrios Trichopoulos57, Dorothy Gauci57, Dulitha Fernando57, Elzbieta Sygnowska57, Erkki Vartiainen57, Farshad Farzadfar57, Gábor Zajkás57, Gillian Swan57, Yannis Μanios57, Gülden Pekcan57, Hajah Masni Ibrahim57, Harri Sinkko57, Helene Enghardt Barbieri57, Isabelle Sioen57, Jannicke Borch Myhre57, Marcela González‐Gross57, Jillian Odenkirk57, Kanitta Bundhamcharoen57, Helena Nogueira57, Khairul Zarina57, Lajos Biró57, Lars Johansson57, Laufey Steingrímsdóttir57, Leanne M Riley57, Mabel Yap57, Manami Inoue57, Maria Szabo57, Marja‐Leena Ovaskainen57, Meei-Shyuan Lee57, Mei Fen Chan57, Maroje Sorić57, Mirnalini Kandiah57, Ola Kally57, Olof Jonsdottir57, Pam Palmer57, Péter Vollenweider57, Philippos Orfanos57, Renzo Asciak57, Robert Templeton57, Rokiah Don57, Roseyati Yaakub57, Rusidah Selamat57, Helmut E. Meyer57, Sameer Al‐Zenki57, Shu-Yi Hung57, Sigrid Beer‐Borst57, Suh Wu57, Widjaja Lukito57, Wilbur Hadden57, Wulf Becker57, Xia Cao57, Yi Ma57, Yuen Lai57, Zaiton Hjdaud57, Didier Garriguet58, Jennifer Ali58, Ron Gravel58, Tina Tao58, Lennert Veerman59, Shashi Chiplonkar60, Mustafa Arıcı61, Le Tran Ngoan62, Demosthenes B. Panagiotakos63, Yanping Li64, Antonia Trichopoulou65, Noël C. Barengo66, Anuradha Khadilkar67, Veena Ekbote67, George Moschonis68, Irina Kovalskys69, Avula Laxmaiah70, Harikumar Rachakulla70, Hemalatha Rajkumar70, Erkin М Мirrakhimov70, Nimmathota Arlappa70, Licia Iacoviello71, Pascal Bovet71, Simona Costanzo71, Yves Martin‐Prével72, Katia Castetbon73, Nattinee Jitnarin74, Yao-Te Hsieh75, Sonia Olivares76, Gabriela Tejeda77, Aida Hadziomeragic78, Amanda de Moura Souza79, Wen‐Harn Pan80, Inge Huybrechts81, Alan de Brauw82, Mourad Moursi82, Mohammad Reza Maracy83, Augustin Nawidimbasba Zéba84, Nizal Sarrafzadegan85, Lital Keinan-Boker86, Rebecca Goldsmith86, Tal Shimony86, Irmgard Jordan87, Shivanand C. Mastiholi88, Moses Mwangi89, Yeri Kombe89, Zipporah Bukania89, Eman M. Alissa90, Nasser Al-Daghri91, Shaun Sabico91, Martin Gulliford92, Tshilenge S. Diba93, Kyungwon Oh94, Sanghui Kweon94, Sihyun Park94, Yoonsu Cho95, Suad Al-Hooti96, Chanthaly Luangphaxay97, Daovieng Douangvichit97, Latsamy Siengsounthone97, Constance Rybak98, Amy Luke99, Diego Salmerón100, Noppawan Piaseu101, Kalyana Sundram102, Donka Baykova103, Parvin Abedi104, Fariza Fadzil105, Noriklil Bukhary Ismail Bukhary106, Sandjaja Sandjaja107, Yu Chen108, Norie Sawada109, Susana Vale109, Lalka Rangelova110, Stefka Petrova110, Vesselka Duleva110, Anna Karin Lindroos111, Jessica Petrelius Sipinen111, Lotta Moraeus111, Per Bergman111, Ward Siamusantu112, Jochanan Stessman113, Hsing‐Yi Chang114, Makiko Sekiyama115, Nagalla Balakrishna116, Kalpagam Polasa116, Sesikeran Boindala116, Maria Fernanda Lima‐Costa117, Jalila El Ati118, Daniel Illescas-Zárate119, Luz María Sánchez‐Romero119, Ivonne Ramirez Silva120, Juan Rivera Dommarco120, Simón Barquera120, Sonia Rodríguez‐Ramírez120, Nayu Ikeda121, Sahar Zaghloul122, Anahita Houshiarrad123, Fatemeh Mohammadi‐Nasrabadi123, Morteza Abdollahi123, Khun-Aik Chuah124, Zaleha Abdullah Mahdy124, Alison L. Eldridge125, Eric L. Ding126, Tiina Laatikainen127, Sigrun Henjum128, Anne C. Fernandez129, Milton Fabián Suarez‐Ortegón130, Nawal Al‐Hamad131, Veronika Janská132, Reema Tayyem133, Parvin Mirmiran134, Roya Kelishadi135, Eva Warensjö Lemming136, Almut Richter137, Gert Mensink137, Lothar Wieler137, Daniël J. Hoffman138, Benoı̂t Salanave139, Cho‐il Kim140, Rebecca Kuriyan-Raj141, Sumathi Swaminathan141, Saeed Dastgiri142, Sirje Vaask143, Tilakavati Karupaiah144, F. V. Zohoori145, Alireza Esteghamati146, Sina Noshad146, Maryam Hashemian147, Elizabeth Mwaniki148, Elizabeth Yakes-Jimenez149, Justin Chileshe150, Sydney Mwanza150, Lydia Lera Marques151, Alan Martin Preston152, Samuél Durán Agüero153, Mariana Oleas154, Luz Posada155, Angélica Ochoa‐Avilés156, Khadijah Shamsuddin157, Zalilah Mohd Shariff158, Hamid Jan B. Jan Mohamed159, Wan Manan159, Anca Nicolau160, Cornelia Tudorie160, Bee Koon Poh161, Pamela Abbott162, Mohammadreza Pakseresht163, Sangita Sharma163, Tor A. Strand164, Ute Alexy165, Ute Nöthlings165, Jan Carmikle166, Ken Brown166, Jeremy Koster167, Indu Waidyatilaka168, Pulani Lanerolle168, Ranil Jayawardena168, Julie M. Long169, K. Michael Hambidge169, Nancy F. Krebs169, Aminul Haque170, Gudrun B. Keding171, Liisa Korkalo172, Maijaliisa Erkkola172, Riitta Freese172, Laila Eleraky173, Wolfgang Stuetz173, Inga Þórsdóttir174, Ingibjörg Gunnarsdóttir174, Lluís Serra‐Majem175, Foong Ming Moy176, Simon Anderson177, Rajesh Jeewon178, Vincent Dudler179, Linda S. Adair180, Shu Wen Ng180, Sheila Skeaff181, Dirce Maria Lobo Marchioni182, Regina Mara Fisberg182, Carol J. Henry183, Getahun Ersino183, Gordon Zello183, Alexa Meyer184, Ibrahim Elmadfa184, Claudette Mitchell185, David Balfour185, Johanna M. Geleijnse186, Mark Manary187, Laetitia Nikièma188, Tatyana El-kour189, Masoud Mirzaei190, Rubina Hakeem191
1Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
2Acıbadem University, Istanbul, Turkey
3Addis Ababa University, Addis Ababa, Ethiopia
4Al Ain University, Abu Dhabi, UAE
5All India Institute of Medical Sciences, New Delhi, India
6American University of Beirut, Beirut, Lebanon
7Amrita School of Dentistry, Ernakulam, India
8Andalas University, Padang, Indonesia
9Arab Center for Nutrition, Manama, Bahrain
10Ardabil University of Medical Sciences, Ardabil, Islamic Republic of Iran
11Bacha Khan University, Charsadda, Pakistan
12Belgian Public Health Institute, Brussels, Belgium
13Biodiversity International, Maccarese, Italy
14Brighton and Sussex Medical School. Brighton, UK
15CREA-Alimenti e Nutrizione, Rome, Italy
16Cadi Ayyad University, Ben Guerir, Morocco
17Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala
18Centre For Media Studies, New Delhi, India
19Centro de Atencion Nutricional Antimano (CANIA), Miami, FL, USA
20Centro de Estudios sobre Nutrición Infantil (CESNI), Buenos Aires, Argentina
21College of Applied Sciences, Department of Food Science and Applied Nutrition, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
22Consultative Group on International Agricultural Research (CGIAR), Montpellier, France
23Cuenca University, Cuenca, Ecuador
24Delhi School of Economics, University of Delhi, Delhi, India
25Departamento de Alimentacao Escolar, Sao Paulo, Brazil
26Department of Biomedical and Biotechnological Sciences, University of Catnia, Catania, Italy
27Department of CVD Epidemiology, Prevention and Health Promotion, Institute of Cardiology, Warsaw, Poland
28Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
29Diabetes Center, 2nd Department of Internal Medicine, Athens University, Athens, Greece
30Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
31Directorate for Health Information & Research, Tarxien, Malta
32Dutch National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
33Eastern Mediterranean Public Health Network (EMPHNET), Amman, Jordan
34Egerton University, Njoro, Kenya
35Estonian National Institute for Health Development, Tallinn, Estonia
36FHI Solutions, Washington, DC, USA
37FOSCAL and UDES, Bucaramanga, Colombia
38Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
39Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
40Faculty of Medicine, University of Colombo, Colombo 5, Sri Lanka
41Faculty of Medicine – Institute of Public Health, University of Porto, Porto, Portugal
42Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
43Finnish Institute for Health and Welfare, Helsinki, Finland
44Florida International University, Miami, FL USA
45Folkhälsan Research Center, Helsinki, Finland
46Food and Nutrition Research Institue (DOST-FNRI), Manila, Philippines
47Food and Nutrition Research Institue (DOST-FNRI), Taguig City, Philippines
48Fortis CDOC Center for Excellence for Diabetes, New Delhi, India
49FrieslandCampina, Amersfoort, the Netherlands
50Fundacion Cardiovascular de Colombia, Bucaramanga, Colombia
51Fundacion INFANT and Consejo Nacional De Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
52Fundacion Oftalmologica de Santander (FOSCAL), Floridablanca, Colombia
53Gachon University, Seongnam-Si, South Korea
54Gazi University, Ankara, Turkey
55Geneva University Hospitals, Geneva, Switzerland
56Ghent University, Ghent, Belgium
57Global Dietary Database Consortium, Boston, MA, USA
58Government of Canada, Statistics Canada, Ottawa, Ontario, Canada
59Griffith University – Gold Coast, Queensland, Australia
60HC Jehangir Medical Research Institute, Pune, India
61Hacettepe University Faculty of Medicine, Ankara, Turkey
63Harokopio University, Athens, Greece
64Harvard School of Public Health, Cambridge, MA, USA
65Hellenic Health Foundation and University of Athens, Athens, Greece
66Herbert Wetheim College of Medicine, Miami, FL, USA
67Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
68Hypertension Research Center, Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
69ICCAS (Instituto para la Cooperacion Científica en Ambiente y Salud), Buenos Aires, Argentina
70ICMR-National Institute of Nutrition, Hyderabad, India
71IRCCS Neuromed, Pozzilli, Italy
72Institut de Recherche pour le Developpement, Montpellier, France
73Institut de Veille Sanitaire, Bobigny, France
74Institute for International Investigation, NDRI-USA, New York, NY, USA
75Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, ROC
76Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
77Institute of Nutrition in Central America and Panama (INCAP), Guatemala City, Guatemala
78Institute of Public Health of Federation of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
79Institute of Studies in Public Health, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
80Institutes of Biomedical Sciences, Academia Sinica, Taipei, Taiwan ROC
81International Agency for Research on Cancer, Lyon, France
82International Food Policy Research Institute (IFPRI), Washington, DC, USA
83Interventional Cardiology Research Center, Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
84Intitut de Recherche en Sciences de la Sante, Bobo-Dioulasso, Burkina Faso
85Isfahan Cardiovascular Research Center, Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
86Israel Center for Disease Control, Ramat Gan, Israel
87Justus Liebig University Giessen, Giessen, Germany
88KLE Academy of Higher Education and Research (Deemed-to-be-University) Jawaharlal Nehru Medical College, Belagavi, India
89Kenya Medical Research Institute, Nairobi, Kenya
90King Abdulaziz University, Jeddah, Saudi Arabia
91King Saud University, Riyadh, Saudi Arabia
92King's College London, London, UK
93Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
94Korea Disease Control and Prevention Agency (KDCA), Cheongju, South Korea
95Korea University, Seoul, South Korea
96Kuwait Institute for Scientific Research, Kuwait City, Kuwait
97Lao Tropical and Public Health Institute, Vientiane, Lao PDR
98Leibniz Centre for Agricultural Landscape Research, Muncheberg, Germany
99Loyola University Chicago, Chicago, IL, USA
100Mahidol University, Nakhon Pathom, Thailand
101Mahidol University, Bangkok, Thailand
102Malaysian Palm Oil Council (MPOC), Petaling Jaya, Malaysia
103Medical Center Markovs, Sofia, Bulgaria
104Menopause Andropause Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Islamic Republic of Iran
105Ministry of Health, Kuala Lumpur, Malaysia
106Ministry of Health, Sabak Bernam, Malaysia
107Ministry of Health, Jakarta, Indonesia
108NYU School of Medicine, New York, NY USA
109National Cancer Center Institute for Cancer Control, Tokyo, Japan
110National Centre of Public Health and Analyses (NCPHA), Sofia, Bulgaria
111National Food Agency, Uppsala, Sweden
112National Food and Nutrition Commission, Lusaka, Zambia
113National Food and Nutrition Institute, Warsaw, Poland
114National Health Research Institutes, Zhunan township, Taiwan ROC
115National Institute for Environmental Studies, Health and Environmental Risk Division, Tsukuba, Japan
116National Institute of Nutrition, Hyderabad, India
117National Institute of Nutrition, Hanoi, Vietnam
118National Institute of Nutrition and Food Technology & SURVEN RL, Tunis, Tunisia
119National Institute of Public Health (INSP), Mexico City, Mexico
120National Institute of Public Health (INSP), Cuernavaca, Mexico
121National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
122National Nutrition Institute, Cairo, Egypt
123National Nutrition and Food Technology Research Institute (NNFTRI): SBMU, Tehran, Islamic Republic of Iran
124National University of Malaysia (UKM), Kuala Lumpur, Malaysia
125Nestlé Research, Lausanne, Switzerland
126New England Complex Systems Institute, Cambridge, MA, USA
127North-West University, Potchefstroom, South Africa
128Oslo Metropolitan University (OsloMet), Oslo, Norway
129Perdana University, Puchong, Malaysia
130Pontificia Universidad Javeriana Seccional, Cali, Colombia
131Public Authority for Food and Nutrition, Sabah Al Salem, Kuwait
132Public Health Authority of the Slovak Republic, Bratislava, Slovak Republic
133Qatar University and University of Jordan, Doha, Qatar
134Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
135Research Institute for Primordial Prevention of NCD, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran
136Risk and Benefit Assessment Department, Swedish Food Agency, Uppsala, Sweden
137Robert Koch Institute, Berlin, Germany
138Rutgers University, New Brunswick, NJ, USA
139Santé publique France, the French Public Health Agency, Saint Maurice, France
140Seoul National University, Seoul, South Korea
141St. John's Research Institute, Bangalore, India
142Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
143Tallinn University, Tallinn, Estonia
144Taylor’s University, Subang Jaya, Malaysia
145Teesside University, Middlesbrough, UK
146Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
147Tehran University of Medical Sciences and Utica University, Tehran, Islamic Republic of Iran
148The Technical University of Kenya, Nairobi, Kenya
149The University of New Mexico, Albuquerque, NM, USA
150Tropical Diseases Research Centre, Ndola, Zambia
151Unidad de Nutricion Publica, Macul, Chile
152Department of Biochemistry, University of Puerto Rico – Medical Science Campus, San Juan, Puerto Rico
153Universidad San Sebastian, Santiago, Chile
154Universidad Tecnica del Norte, Ibarra, Ecuador
155Universidad de Antioquia, Medellin, Colombia
156Universidad de Cuenca, Cuenca, Ecuador
157Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
158Universiti Putra Malaysia, Serdang, Malaysia
159Universiti Sains Malaysia, Kubang Kerian, Malaysia
160University Dunarea de Jos, Galati, Romania
161University Kebangsaan Malaysia, Bangi, Malaysia
162University of Aberdeen, Aberdeen, UK
163University of Alberta, Edmonton, Alberta, Canada
164University of Bergen, Bergen, Norway
165University of Bonn, Department of Nutrition and Food Sciences, Bonn, Germany
166University of California, Davis, Davis, CA, USA
167University of Cincinnati, Cincinnati, OH, USA
168University of Colombo, Colombo, Sri Lanka
169University of Colorado School of Medicine, Aurora, CO, USA.
170University of Dhaka, Dhaka, Bangladesh
171University Of Goettingen, Goettingen, Germany
172University of Helsinki, Department of Food and Nutrition, Helsinki, Finland
173University of Hohenheim, Stuttgart, Germany
174University of Iceland, Reykjavík, Iceland
175University of Las Palmas de Gran Canaria (ULPGC), Las Palmas, Spain
176University of Malaya, Kuala Lumpur, Malaysia
177University of Manchester, Manchester, UK
178University of Mauritius, Moka, Mauritius
179University of Medicine and Pharmacy Carol Davila Bucharest, Romania
180University of North Carolina at Chapel Hill, Chapel Hill, NC USA
181University of Otago, Dunedin, New Zealand
182University of Sao Paulo, Sao Paulo, Brazil
183University of Saskatchewan, Saskatoon, Saskatchewan, Canada
184University of Vienna, Vienna, Austria
185University of the Southern Caribbean, Port-of-Spain, Trinidad and Tobago
186Wageningen University, Wageningen, Netherlands
187Washington University in St Louis, St Louis, MO, USA
188World Health Organization (WHO), Geneva, Switzerland
189World Health Organization (WHO), Amman, Jordan
190Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Islamic Republic of Iran
191Ziauddin University Karachi, Karachi, Pakistan

Tóm tắt

AbstractEvidence on what people eat globally is limited in scope and rigour, especially as it relates to children and adolescents. This impairs target setting and investment in evidence-based actions to support healthy sustainable diets. Here we quantified global, regional and national dietary patterns among children and adults, by age group, sex, education and urbanicity, across 185 countries between 1990 and 2018, on the basis of data from the Global Dietary Database project. Our primary measure was the Alternative Healthy Eating Index, a validated score of diet quality; Dietary Approaches to Stop Hypertension and Mediterranean Diet Score patterns were secondarily assessed. Dietary quality is generally modest worldwide. In 2018, the mean global Alternative Healthy Eating Index score was 40.3, ranging from 0 (least healthy) to 100 (most healthy), with regional means ranging from 30.3 in Latin America and the Caribbean to 45.7 in South Asia. Scores among children versus adults were generally similar across regions, except in Central/Eastern Europe and Central Asia, high-income countries, and the Middle East and Northern Africa, where children had lower diet quality. Globally, diet quality scores were higher among women versus men, and more versus less educated individuals. Diet quality increased modestly between 1990 and 2018 globally and in all world regions except in South Asia and Sub-Saharan Africa, where it did not improve.

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Tài liệu tham khảo

2021 Global Nutrition Report: The State of Global Nutrition (Development Initiatives, 2021).

GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet https://doi.org/10.1016/s0140-6736(18)32203-7 (2018).

GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet https://doi.org/10.1016/s0140-6736(18)32225-6 (2018).

GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet https://doi.org/10.1016/s0140-6736(19)30041-8 (2019).

Sacks, F. M. et al. Rationale and design of the Dietary Approaches to Stop Hypertension trial (DASH). A multicenter controlled-feeding study of dietary patterns to lower blood pressure. Ann. Epidemiol. 5, 108–118 (1995).

Hu, F. B. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr. Opin. Lipidol. 13, 3–9 (2002).

Micha, R. et al. Etiologic effects and optimal intakes of foods and nutrients for risk of cardiovascular diseases and diabetes: systematic reviews and meta-analyses from the Nutrition and Chronic Diseases Expert Group (NutriCoDE). PLoS ONE 12, e0175149 (2017).

Teo, K. et al. Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle- and low-income countries: the Prospective Urban Rural Epidemiology (PURE) study. JAMA 309, 1613–1621 (2013).

Yusuf, S. et al. Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet 395, 795–808 (2020).

Ezzati, M. & Riboli, E. Behavioral and dietary risk factors for noncommunicable diseases. N. Engl. J. Med. 369, 954–964 (2013).

Kennedy, G., Nantel, G. & Shetty, P. Globalization of food systems in developing countries: impact on food security and nutrition. FAO Food Nutr. Pap. 83, 1–300 (2004).

Wang, D. D. et al. Global improvement in dietary quality could lead to substantial reduction in premature death. J. Nutr. 149, 1065–1074 (2019).

Vandevijvere, S. et al. Monitoring and benchmarking population diet quality globally: a step-wise approach. Obes. Rev. 14, 135–149 (2013).

Green, R., Sutherland, J., Dangour, A. D., Shankar, B. & Webb, P. Global dietary quality, undernutrition and non-communicable disease: a longitudinal modelling study. BMJ Open 6, e009331 (2016).

Del Gobbo, L. C. et al. Assessing global dietary habits: a comparison of national estimates from the FAO and the Global Dietary Database. Am. J. Clin. Nutr. 101, 1038–1046 (2015).

Imamura, F. et al. Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment. Lancet Glob. Health 3, e132–e142 (2015).

Miller, V., Webb, P., Micha, R. & Mozaffarian, D. Defining diet quality: a synthesis of dietary quality metrics and their validity for the double burden of malnutrition. Lancet Planet Health 4, e352–e370 (2020).

Miller, V. et al. Global Dietary Database 2017: data availability and gaps on 54 major foods, beverages and nutrients among 5.6 million children and adults from 1220 surveys worldwide. BMJ Global Health 6, e003585 (2021).

Vandevijvere, S. et al. Global trends in ultraprocessed food and drink product sales and their association with adult body mass index trajectories. Obes. Rev. 20, 10–19 (2019).

Li, Y. et al. Time trends of dietary and lifestyle factors and their potential impact on diabetes burden in China. Diabetes Care 40, 1685–1694 (2017).

Murakami, K., Livingstone, M. B. E. & Sasaki, S. Thirteen-year trends in dietary patterns among Japanese adults in the National Health and Nutrition Survey 2003–2015: continuous Westernization of the Japanese diet. Nutrients 10, 994 (2018).

Marrón-Ponce, J. A., Tolentino-Mayo, L., Hernández-F, M. & Batis, C. Trends in ultra-processed food purchases from 1984 to 2016 in Mexican Households. Nutrients 11, 45 (2018).

Schwingshackl, L., Bogensberger, B. & Hoffmann, G. Diet quality as assessed by the healthy eating index, alternate healthy eating index, dietary approaches to stop hypertension score, and health outcomes: an updated systematic review and meta-analysis of cohort studies. J. Acad. Nutr. Diet 118, 74–100.e111 (2018).

Chiuve, S. E. et al. Alternative dietary indices both strongly predict risk of chronic disease. J. Nutr. 142, 1009–1018 (2012).

Sotos-Prieto, M. et al. Association of changes in diet quality with total and cause-specific mortality. N. Engl. J. Med. 377, 143–153 (2017).

Trébuchet, A. et al. Prospective association between several dietary scores and risk of cardiovascular diseases: is the Mediterranean diet equally associated to cardiovascular diseases compared to National Nutritional Scores? Am. Heart J. 217, 1–12 (2019).

Shivappa, N., Hebert, J. R., Kivimaki, M. & Akbaraly, T. Alternative Healthy Eating Index 2010, Dietary Inflammatory Index and risk of mortality: results from the Whitehall II cohort study and meta-analysis of previous Dietary Inflammatory Index and mortality studies. Br. J. Nutr. 118, 210–221 (2017).

Neelakantan, N., Koh, W.-P., Yuan, J.-M. & van Dam, R. M. Diet-quality indexes are associated with a lower risk of cardiovascular, respiratory, and all-cause mortality among Chinese adults. J. Nutr. 148, 1323–1332 (2018).

Chen, G.-C. et al. Diet quality indices and risk of type 2 diabetes mellitus: The Singapore Chinese Health Study. Am. J. Epidemiol. 187, 2651–2661 (2018).

Wu, X. Y. et al. The influence of diet quality and dietary behavior on health-related quality of life in the general population of children and adolescents: a systematic review and meta-analysis. Qual. Life Res. 28, 1989–2015 (2019).

Dalwood, P., Marshall, S., Burrows, T. L., McIntosh, A. & Collins, C. E. Diet quality indices and their associations with health-related outcomes in children and adolescents: an updated systematic review. Nutr. J. 19, 118 (2020).

Jennings, A., Welch, A., van Sluijs, E. M., Griffin, S. J. & Cassidy, A. Diet quality is independently associated with weight status in children aged 9-10 years. J. Nutr. 141, 453–459 (2011).

Marshall, S., Burrows, T. & Collins, C. E. Systematic review of diet quality indices and their associations with health-related outcomes in children and adolescents. J. Hum. Nutr. Diet 27, 577–598 (2014).

Krasevec, J., An, X., Kumapley, R., Bégin, F. & Frongillo, E. A. Diet quality and risk of stunting among infants and young children in low- and middle-income countries. Matern. Child Nutr. https://doi.org/10.1111/mcn.12430 (2017).

Martin-Calvo, N., Chavarro, J. E., Falbe, J., Hu, F. B. & Field, A. E. Adherence to the Mediterranean dietary pattern and BMI change among US adolescents. Int. J. Obes. 40, 1103–1108 (2016).

Switkowski, K. M., Gingras, V., Rifas-Shiman, S. L. & Oken, E. Patterns of complementary feeding behaviors predict diet quality in early childhood. Nutrients 12, 810 (2020).

Mikkilä, V., Räsänen, L., Raitakari, O. T., Pietinen, P. & Viikari, J. Longitudinal changes in diet from childhood into adulthood with respect to risk of cardiovascular diseases: The Cardiovascular Risk in Young Finns Study. Eur. J. Clin. Nutr. 58, 1038–1045 (2004).

Lake, A. A., Mathers, J. C., Rugg-Gunn, A. J. & Adamson, A. J. Longitudinal change in food habits between adolescence (11–12 years) and adulthood (32–33 years): the ASH30 Study. J. Public Health 28, 10–16 (2006).

Wang, D. D. et al. Trends in dietary quality among adults in the United States, 1999 through 2010. JAMA Intern. Med. 174, 1587–1595 (2014).

Fang Zhang, F. et al. Trends and disparities in diet quality among US adults by supplemental nutrition assistance program participation status. JAMA Netw. Open 1, e180237 (2018).

Dehghan, M. et al. Relationship between healthy diet and risk of cardiovascular disease among patients on drug therapies for secondary prevention. Circulation 126, 2705–2712 (2012).

Miller, V. et al. Global, regional, and national consumption of animal-source foods between 1990 and 2018: findings from the Global Dietary Database. Lancet Planet. Health 6, e243–e256 (2022).

Chen, X., Maguire, B., Brodaty, H. & O’Leary, F. Dietary patterns and cognitive health in older adults: a systematic review. J. Alzheimers Dis. 67, 583–619 (2019).

Roman, B., Carta, L., Martínez-González, M. A. & Serra-Majem, L. Effectiveness of the Mediterranean diet in the elderly. Clin. Interv. Aging 3, 97–109 (2008).

Bromage, S. et al. Development and validation of a novel food-based global diet quality score (GDQS). J. Nutr. 151, 75s–92s (2021).

Herforth, A. W., Wiesmann, D., Martínez-Steele, E., Andrade, G. & Monteiro, C. A. Introducing a suite of low-burden diet quality indicators that reflect healthy diet patterns at population level. Curr. Dev. Nutr. 4, nzaa168–nzaa168 (2020).

Micha, R. et al. Estimating the global and regional burden of suboptimal nutrition on chronic disease: methods and inputs to the analysis. Eur. J. Clin. Nutr. 66, 119–129 (2012).

Khatibzadeh, S. et al. A global database of food and nutrient consumption. Bull. World Health Organ. 94, 931–934 (2016).

Food and Agriculture Organization of the United Nations. Food balances. 2021. https://www.fao.org/faostat/en/#data2021 (accessed March 3, 2021).

Smith, M. R., Micha, R., Golden, C. D., Mozaffarian, D. & Myers, S. S. Global Expanded Nutrient Supply (GENuS) Model: a new method for estimating the global dietary supply of nutrients. PLoS ONE 11, e0146976 (2016).

Gelman, A. & Pardoe, I. Bayesian measures of explained variance and pooling in multilevel (hierarchical) models. Technometrics 48, 241–251 (2006).

Wagner, T., Diefenbach, D. R., Christensen, S. & Norton, A. S. Using multilevel models to quantify heterogeneity in resource selection. J. Wildl. Manag. 75, 1788–1796 (2011).

United Nations Population Division. Total population by sex (thousands). 2019. https://population.un.org/wpp/DataQuery/2019 (accessed June 12, 2020).

Barro, R. & Lee, J. A new data set of educational attainment in the world, 1950–2010. J. Dev. Econ 104, 184–198 (2013).

United Nations Population Division. Urban population (% of total population). 2018. https://data.worldbank.org/indicator/SP.URB. TOTL.IN.ZS2018 (accessed June 12, 2020).