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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).
• 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.
• Globally, more educated individuals had higher AHEI scores for fruit (+0.8), sodium (+0.7), whole grains (+0.6), and non-starchy vegetables (+0.5).