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• Higher-income countries exhibit better scores for healthy dietary components, such as fruit and whole grains, but worse scores for unhealthy components, such as red/processed meats and sodium, compared to lower-income countries.
• 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).
• Across the world's 25 most populous countries in 2018, there was a 100-fold difference in sodium scores, a 90-fold difference in red/processed meat scores, and a 23-fold difference in sugar-sweetened beverage scores.
• 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.
• Red/processed meat and sodium consumption have significantly increased over time in Asia and Latin America and the Caribbean.