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• To improve population health, policy measures should support increased intake of health-promoting foods such as fruits, vegetables, whole grains, legumes, and nuts/seeds, while reducing the intake of unhealthy foods such as red meat, processed meat, and sugary beverages.
• Globally, between 1990 and 2018, AHEI scores increased for non-starchy vegetables (+1.1), legumes/nuts (+1.1), and fruit (+0.1); decreased for red/processed meat (−1.4), sugar-sweetened beverages (−0.6), and sodium (−0.4); and remained stable for whole grains (+0.1), PUFAs (0), and seafood omega-3 (0).
• Globally, more educated individuals had lower AHEI scores (less favorable consumption levels) for red/processed meat (-0.6), sugar-sweetened beverages (-0.6), and nuts and legumes (-0.1).
• Diets globally continue to lack sufficient amounts of fruits, vegetables, legumes, nuts, and whole grains, while including excessive and sometimes rising amounts of red meat, processed meat, and sugary drinks.
• Risks related to dietary composition in the 2021 Global Nutrition Report analysis included low intake of fruits (2.8 million deaths), whole grains (2.3 million), vegetables (1.7 million), legumes (1.5 million), nuts and seeds (1.0 million), and high intake of red meat (980,000), processed meat (880,000), and sugar-sweetened beverages (290,000).
• The Healthy Diet Indicator (HDI) scores dietary intake based on eleven components: fruits and vegetables (≥ 400g), beans and other legumes (> 0g), nuts and seeds (> 0g), whole grains (> 0g), dietary fiber (> 25g), total fat (< 30% total energy), saturated fat (< 10% total energy), dietary sodium (< 2g), free sugars (< 10% total energy), processed meat (0g), and unprocessed red meat (≤ 71g).
• Suboptimal diets are characterized by low intake of fibers, fruits, vegetables, legumes, whole grains, nuts, seeds, milk, seafood, calcium, and healthy fats (omega-3 fatty acids, polyunsaturated fatty acids) and high intake of trans-fatty acids, sodium, red or processed meat, and sugar-sweetened beverages, according to Afshin et al. (2019).
• In high-income countries, Central/Eastern Europe, Central Asia, the Middle East, and Northern Africa, improvements in dietary quality driven by increased intake of fruit, non-starchy vegetables, legumes/nuts, and whole grains have been offset by stable or only minor reductions in red/processed meats, sugar-sweetened beverages (SSBs), and sodium.
• A healthy diet consists of plenty of fruits, vegetables, legumes, nuts, seeds, whole grains, and oils high in unsaturated fats, while containing little to no red and processed meat, sugar-sweetened beverages, refined grains, and oils high in saturated fats.
• Imbalanced diets low in fruits, vegetables, legumes, nuts, seeds, and whole grains, and high in red and processed meat are responsible for one of the greatest health burdens globally and in most regions.
• Globally, urban residents had higher AHEI scores for fruit (+0.2) and whole grains (+0.2), but lower scores for sugar-sweetened beverages (-0.5), red/processed meat (-0.4), and legumes/nuts (-0.1).
• The EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems established specific dietary recommendations for minimum intake of health-promoting foods (fruits, vegetables, legumes, nuts, whole grains) and maximum intake of foods with detrimental health or environmental impacts (red meat, processed meat, dairy, fish).
• The Global Nutrition Report 2021 analysis includes diet-disease associations for low intake of fruits, vegetables, legumes, nuts/seeds, and whole grains, as well as for high intake of red meat, processed meat, and sugary drinks.