Poor diet quality is one of the most important risk factors for several chronic diseases such as cardiovascular diseases, diabetes and certain types of cancer and the promotion of healthy dietary patterns is a global priority for several public health agencies such as the World Health Organization. To be effective, global nutritional, food and agricultural policies should be based on the highest level of scientific evidence. However, there is little information about worldwide nutritional and dietary quality trends and although several surveillance systems exist, most of these are limited to pre-determined geographical regions.

A research group called the Global Burden of Diseases Nutrition and Chronic Disease Expert Group (NutriCoDE) was put together to better characterize global patterns of diets and their trends over time. This group has recently published a systematic assessment of dietary quality among men and women of 187 countries between 1990 and 2010 in the scientific journal the Lancet Global Health. The objective of their report was to characterize global changes in dietary patterns and to determine the impact of age, sex and national income on these trends. For this purpose, they have obtained all possible national surveys on dietary trends and narrowed them down to 325 surveys that were deemed to be of sufficient quality to establish these trends.  Their report focused on 17 dietary factors that were classified in two categories, the healthy ones and the unhealthy ones. Items included in the healthy eating patterns included fruits, vegetables, beans and legumes, nuts and seeds, whole grains, milk, polyunsaturated fatty acids, fish, plant omega-3s and dietary fibre while items included in the unhealthy eating patterns included unprocessed red meats, processed meats, sugar-sweetened beverages, saturated fat, trans fat, dietary cholesterol and sodium. Based on this classification, a healthy eating score and an unhealthy eating score were computed for each country. Not surprisingly, healthy eating habits were observed in older adults compared to younger ones, in women compared to men and in higher incomes countries compared to lower incomes countries. However, the unhealthy dietary patterns were also much higher in high-income countries compared to low-income countries.

Globally, the authors found that between 1990 and 2010, global dietary patterns based on healthy items improved modestly while during the same period, global dietary patterns based on unhealthy items worsened to a greater extent than the rise in healthy eating patterns. Interestingly, the largest improvement in healthy eating patterns was observed in middle-income countries. However, the largest deterioration in unhealthy eating patterns was also observed in middle-income countries.

Although the changes in healthy and unhealthy eating patterns may be attributable to a large extent to socio-economic parameters, this report has highlighted a more complex association between dietary patterns and socio-economic status that what could have been anticipated. Indeed, in high-income countries such as Northern Europe, USA and Canada, lower socio-economic status is typically associated with unhealthy food patterns while in Southern Europe; lower socio-economic status is associated with higher consumption of fruits and vegetables. The authors have suggested that this most likely reflected a greater domestic production in rural areas.


Altogether, this report by the NutriCoDE group is really an eye-opener with regards to nutritional transitions that are currently being operated around the globe as although more people adopt healthy eating habits, this increment is counterbalanced by an even higher proportion of people with poor dietary habits.  Let’s hope that this report will be used by international, national and local stakeholders to establish food policies that promote healthy eating habits while trying to de-normalize unhealthy eating behaviours based on country-specific realities and preoccupations.