Sugar-sweetened beverage intakes among adults between 1990 and 2018 in 185 countries

Funding Information: The investigators did not receive funding from a pharmaceutical company or other agency to write this report. L.L.C reports research funding from the Gates Foundation, the American Heart Association, and Consejo Nacional de Ciencia y Tecnología in Mexico, outside of the submitted work. R.M. reports research funding from the Gates Foundation; and (ended) the U.S. National Institutes of Health, Danone, and Nestle. She also reports consulting from Development Initiatives and as IEG chair for the Global Nutrition Report, outside of the submitted work. F.C., J.Z., and P.S. report research funding from the Gates Foundation, as well as the National Institutes of Health, outside of the submitted work. V.M. reports research funding from the Canadian Institutes of Health Research and from the American Heart Association, outside the submitted work. J.R.S. reports research funding from the Gates Foundation, as well as the National Institutes of Health, Nestlé, Rockefeller Foundation, and Kaiser Permanent Fund at East Bay Community Foundation, outside of the submitted work. S.B.C. reports research funding from the U.S. National Institutes of Health, the U.S. Department of Agriculture, the Rockefeller Foundation, the U.S. Agency for International Development, and the Kaiser Permanente Fund at East Bay Community Foundation, outside the submitted work. D.M. reports research funding from the U.S. National Institutes of Health, the Gates Foundation, the Rockefeller Foundation, Vail Innovative Global Research, and the Kaiser Permanente Fund at East Bay Community Foundation; personal fees from Acasti Pharma, Barilla, Danone and Motif FoodWorks; is on the scientific advisory board for Beren Therapeutics, Brightseed, Calibrate, Elysium Health, Filtricine, HumanCo, Instacart, January Inc., Perfect Day, Tiny Organics, and (ended) Day Two, Discern Dx, and Season Health; has stock ownership in Calibrate and HumanCo; and receives chapter royalties from UpToDate, all outside the submitted work. J.E.M. declares no competing interests. Funding Information: This research was supported by the Gates Foundation (grant OPP1176682 to D.M.), the American Heart Association (grant 903679 to L.L.C), and Consejo Nacional de Ciencia y Tecnología in Mexico (to L.L.C.). We acknowledge the Tufts University High-Performance Computing Cluster (https://it.tufts.edu/high-performance-computing), which was used for the research reported in this paper. This material is based upon work supported by the National Science Foundation under grant number 2018149. The computational resource is under active development by Research Technology, Tufts Technology Services. The funding agencies had no role in the design of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit for publication.Peer reviewe

Children’s and adolescents’ rising animal-source food intakes in 1990–2018 were impacted by age, region, parental education and urbanicity

Funding Information: We thank the Global Dietary Database Consortium for sharing and harmonizing their dietary surveys in accordance with the Global Dietary Database methods. This study was supported by grants from the Bill and Melinda Gates Foundation (OPP1176681; PI D.M.) and from the American Heart Association (20POST35200069; PI V.M.). The Bill and Melinda Gates Foundation contributed to study design during the grant application process; the funders otherwise had no role in data collection and analysis, decision to publish or preparation of the manuscript. Funding Information: V.M. reports a research grant from the Canadian Institutes of Health Research, outside the submitted work. P.W. reports research grants and contracts from the United States Agency for International Development and personal fees from the Global Panel on Agriculture and Food Systems for Nutrition, outside the submitted work. J.Z., J.R. and P.S. report research funding from Nestle, outside the submitted work. J.C. reports research funding from the Bill and Melinda Gates Foundation and the United States Agency for International Development, outside the submitted work. R.M. reports grants from National Institute of Health, Nestle, and Danone, personal fees from Bunge, Development Initiatives, outside the submitted work. D.M. reports research funding from the National Institutes of Health and the Bill and Melinda Gates Foundation; personal fees from GOED, Bunge, Indigo Agriculture, Motif FoodWorks, Amarin, Acasti Pharma, Cleveland Clinic Foundation, America’s Test Kitchen, and Danone; scientific advisory board member for Brightseed, DayTwo, Elysium Health, Filtricine, HumanCo, and Tiny Organics; and chapter royalties from UpToDate, all outside the submitted work. The other authors declare no competing interests. Publisher Copyright: © 2023, The Author(s).Animal-source foods (ASF) provide nutrition for children and adolescents’ physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the world’s child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 15–19 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes.Peer reviewe

Global, regional, and national consumption of animal-source foods between 1990 and 2018 : findings from the Global Dietary Database

Funding Information: The investigators did not receive funding from a pharmaceutical company or other agency to write this report. JR, JZ, and PS report research funding from Nestlé, outside the submitted work. JC reports research funding from the Bill & Melinda Gates Foundation, outside the submitted work. RM reports grants from US National Institutes of Health, Nestlé, and Danone, and personal fees from Bunge, Development Initiatives, outside the submitted work. PW reports research grants and contracts from the US Agency for International Development and personal fees from the Global Panel on Agriculture and Food Systems for Nutrition, outside the submitted work. DM reports research funding from the US National Institutes of Health and the Gates Foundation; personal fees from GOED, Bunge, Indigo Agriculture, Motif FoodWorks, Amarin, Acasti Pharma, Cleveland Clinic Foundation, America's Test Kitchen, and Danone; scientific advisory board member for Brightseed, DayTwo, Elysium Health, Filtricine, HumanCo, and Tiny Organics; and chapter royalties from UpToDate, all outside the submitted work. All other authors declare no competing interests. Publisher Copyright: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Diet is a major modifiable risk factor for human health and overall consumption patterns affect planetary health. We aimed to quantify global, regional, and national consumption levels of animal-source foods (ASF) to inform intervention, surveillance, and policy priorities. Methods: Individual-level dietary surveys across 185 countries conducted between 1990 and 2018 were identified, obtained, standardised, and assessed among children and adults, jointly stratified by age, sex, education level, and rural versus urban residence. We included 499 discrete surveys (91·2% nationally or subnationally representative) with data for ASF (unprocessed red meat, processed meat, eggs, seafood, milk, cheese, and yoghurt), comprising 3·8 million individuals from 134 countries representing 95·2% of the world population in 2018. We used Bayesian hierarchical models to account for differences in survey methods and representativeness, time trends, and input data and modelling uncertainty, with five-fold cross-validation. Findings: In 2018, mean global intake per person of unprocessed red meat was 51 g/day (95% uncertainty interval [UI] 48–54; region-specific range 7–114 g/day); 17 countries (23·9% of the world's population) had mean intakes of at least one serving (100 g) per day. Global mean intake of processed meat was 17 g/day (95% UI 15–21 g/day; region-specific range 3–54 g/day); seafood, 28 g/day (27–30 g/day; 12–44 g/day); eggs, 21 g/day (18–24 g/day; 6–35 g/day); milk 88 g/day (84–93 g/day; 45–185 g/day); cheese, 8 g/day (8–10 g/day; 1–34 g/day); and yoghurt, 20 g/day (17–23 g/day; 7–84 g/day). Mean national intakes were at least one serving per day for processed meat (≥50 g/day) in countries representing 6·9% of the global population; for cheese (≥42 g/day) in 2·3%; for eggs (≥55 g/day) in 0·7%; for milk (≥245 g/day) in 0·3%; for seafood (≥100 g/day) in 0·8%; and for yoghurt (≥245 g/day) in less than 0·1%. Among the 25 most populous countries in 2018, total ASF intake was highest in Russia (5·8 servings per day), Germany (3·8 servings per day), and the UK (3·7 servings per day), and lowest in Tanzania (0·9 servings per day) and India (0·7 servings per day). Global and regional intakes of ASF were generally similar by sex. Compared with children, adults generally consumed more unprocessed red meat, seafood and cheese, and less milk; energy-adjusted intakes of other ASF were more similar. Globally, ASF intakes (servings per week) were higher among more-educated versus less-educated adults, with greatest global differences for milk (0·79), eggs (0·47), unprocessed red meat (0·42), cheese (0·28), seafood (0·28), yoghurt (0·22), and processed meat (0·21). This was also true for urban compared to rural areas, with largest global differences (servings per week) for unprocessed red meat (0·47), milk (0·38), and eggs (0·20). Between 1990 and 2018, global intakes (servings per week) increased for unprocessed red meat (1·20), eggs (1·18), milk (0·63), processed meat (0·50), seafood (0·44), and cheese (0·14). Interpretation: Our estimates of ASF consumption identify populations with both lower and higher than optimal intakes. These estimates can inform the targeting of intervention, surveillance, and policy priorities relevant to both human and planetary health. Funding: Bill & Melinda Gates Foundation and American Heart Association.Peer reviewe

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

Funding Information: This research was supported by the Bill and Melina Gates Foundation (grant OPP1176682 to D. Mozaffarian). We acknowledge the Tufts University High Performance Computing Cluster ( https://it.tufts.edu/high-performance-computing ), which was used for the research reported in this paper. This material is based upon work supported by the National Science Foundation under grant number 2018149. The computational resource is under active development by Research Technology, Tufts Technology Services. The funding agency did not contribute to the design or conduct of the study; collection, management, analysis or interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. Funding Information: This research was supported by the Bill and Melina Gates Foundation (grant OPP1176682 to D. Mozaffarian). We acknowledge the Tufts University High Performance Computing Cluster (https://it.tufts.edu/high-performance-computing), which was used for the research reported in this paper. This material is based upon work supported by the National Science Foundation under grant number 2018149. The computational resource is under active development by Research Technology, Tufts Technology Services. The funding agency did not contribute to the design or conduct of the study; collection, management, analysis or interpretation of the data; preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. Funding Information: M. OHearn reports research funding from the Gates Foundation, as well as the National Institutes of Health and Vail Innovative Global Research and employment with Food Systems for the Future, outside of the submitted work. L. Lara-Castor reports research funding from the Gate Foundation, as well as the Consejo Nacional de Ciencia y Tecnologia (CONACyT), Friedman School of Nutrition Science and Policy and the American Heart Association, outside of the submitted work. V. Miller reports research funding from the Canadian Institutes of Health Research and the American Heart Association, outside of the submitted work. F. Cudhea, J. Zhang, and P. Shi report research funding form the Gates Foundation, as well as the National Institutes of Health, outside of the submitted work. J. Reedy reports research funding from the Gates Foundation, as well as the National Institutes of Health, Nestlé, Rockefeller Foundation, and Kaiser Permanent Fund at East Bay Community Foundation, outside of the submitted work. J. Wong reports research funding from the National Institutes of Health and membership in the US Preventative Services Task Force (unpaid) and the National Academies of Sciences, Engineering and Medicine Committee on Evaluating the Process to Develop the Dietary Guidelines for Americans, 2020–2025 (unpaid), outside the submitted work. C. Economos reports research funding from the United States Department of Agriculture, the National Institutes of Health, the JPB Foundation and Newman’s Own Foundation. She also reports her position as vice chair to the National Academies of Science Roundtable on Obesity Solutions (unpaid) and her prior advisory board position at Care/Of Scientific. None of the above relate to this paper. R. Micha reports research funding from the Gates Foundation, as well as the National Institutes of Health, Nestlé and Danone, outside the submitted work. She also reports consulting fees as IEG chair of the Global Nutrition Report, outside the submitted work. D. Mozaffarian reports funding from the National Institutes of Health, the Gates Foundation, the Rockefeller Foundation, Vail Innovative Global Research and the Kaiser Permanente Fund at East Bay Community Foundation; personal fees from Acasti Pharma, Barilla, Danone and Motif FoodWorks; is on the scientific advisory board for Beren Therapeutics, Brightseed, Calibrate, DiscernDx, Elysium Health, Filtricine, HumanCo, January, Perfect Day, Tiny Organics and (ended) Day Two and Season Health; has stock ownership in Calibrate and HumanCo; and receives chapter royalties from UpToDate. Funding Information: Custom code was developed using R (version 4.0.0) with two-tailed α = 0.05, for cleaning, merging and formatting of all data inputs; calculation of age-adjusted relative risks; comparative risk assessment modeling, including PAF calculations for each dietary factor separately and joint PAF calculations for all dietary factors; summary aggregation of stratum-level PAF estimates at the global, regional and national levels; and data visualization. Given their computational size and complexity, all comparative risk assessment modeling codes were run on the Tufts University High Performance Computing Cluster ( https://it.tufts.edu/high-performance-computing ), supported by the National Science Foundation (grant 2018149, https://www.nsf.gov/awardsearch/showAward?AWD_ID=2018149&HistoricalAwards=false ) under active development by Research Technology ( https://it.tufts.edu/researchtechnology.tufts.edu ), Tufts Technology Services. The statistical code used for this analysis is not publicly available. The GDD can make the statistical code available to researchers upon request. Eligibility criteria for such requests include: utilization for nonprofit purposes only, for appropriate scientific use based on a robust research plan and by investigators from an academic institution. GDD will nominate co-authors to be included on any papers generated using GDD-generated statistical code. If you are interested in requesting access to the statistical code, please submit the following documents: (1) proposed research plan (please download and complete the proposed research plan form https://www.globaldietarydatabase.org/sites/default/files/manual_upload/research-proposal-template.pdf ), (2) data-sharing agreement (please download this form https://www.globaldietarydatabase.org/sites/default/files/manual_upload/tufts-gdd-data-sharing-agreement.docx , complete the highlighted fields and have someone who is authorized to enter your institution into a binding legal agreement with outside institutions sign the document. Note that this agreement does not apply when protected health information or personally identifiable information are shared), (3) email items (1) and (2) to [email protected]. Please use the subject line ‘GDD Code Access Request’. Once all documents have been received, the GDD team will be in contact with you regarding subsequent steps. Publisher Copyright: © 2023, The Author(s).The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8–14.4 million) incident T2D cases, representing 70.3% (68.8–71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0–27.1%)), excess refined rice and wheat intake (24.6% (22.3–27.2%)) and excess processed meat intake (20.3% (18.3–23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4–87.7%)) and Latin America and the Caribbean (81.8% (80.1–83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1–60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.Peer reviewe

How prices and income influence global patterns in saturated fat intake by age, sex and world region : a cross-sectional analysis of 160 countries

Peer reviewe

Defining diet quality: a synthesis of dietary quality metrics and their validity for the double burden of malnutrition

Achieving most of the UN Sustainable Development Goals requires a strong focus on addressing the double burden of malnutrition, which includes both diet-related maternal and child health (MCH) and non-communicable diseases (NCDs). Although, the most optimal dietary metric for assessing malnutrition remains unclear. Our aim was to review available global dietary quality metrics (hereafter referred to as dietary metrics) and evidence for their validity to assess MCH and NCD outcomes, both separately and together. A systematic search of PubMed was done to identify meta-analyses or narrative reviews evaluating validity of diet metrics in relation to nutrient adequacy or health outcomes. We identified seven dietary metrics aiming to address MCH and 12 for NCDs, no dietary metrics addressed both together. Four NCD dietary metrics (Mediterranean Diet Score, Alternative Healthy Eating Index, Healthy Eating Index, and Dietary Approaches to Stop Hypertension) had convincing evidence of protective associations with specific NCD outcomes, mainly mortality, cardiovascular disease, type 2 diabetes, and total cancer. The remaining NCD dietary metrics and all MCH dietary metrics were not convincingly validated against MCH or NCD health outcomes. None of the dietary metrics had been validated against both MCH and NCD outcomes. These findings highlight major gaps in assessing and addressing diet to achieve global targets and effective policy action

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

Evidence 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

Children's and adolescents' rising animal-source food intakes in 1990-2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the worlds child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 1519 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes. (c) 2023, The Author(s)

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.814.4 million) incident T2D cases, representing 70.3% (68.871.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.027.1%)), excess refined rice and wheat intake (24.6% (22.327.2%)) and excess processed meat intake (20.3% (18.323.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.487.7%)) and Latin America and the Caribbean (81.8% (80.183.4%)); and lowest proportional burdens were in South Asia (55.4% (52.160.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally. (c) 2023, The Author(s)