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The four countries where they eat the healthiest diet: Spain 'falls' off the podium
Wednesday, September 28, 2022 @ 8:53 AM


Most nations have not improved food quality in recent years, and Spain is no exception. Are we really improving our way of eating? If we were to rate our dietary adherence to healthy diets on a scale of 1 to 10, where 'zero' would be a poor diet, rich in sugars and processed fats, and 'ten' would be a balance between fruits, vegetables, legumes, nuts and whole grains, most countries would get a four. That, being generous.

Adherence to a healthy diet around the world has improved by about 1.5 points between 1990 and 2018. In other words, we are not eating much better than we were 30 years ago, according to a new study carried out by the researchers at Tufts University's Friedman School of Nutrition Science and Policy. Their results have been published in the journal Nature Food.

This study represents one of the most comprehensive estimates to date of the true quality of our diet and is presented as the first to include data from both children and adults. And while it is true that, globally, adherence to a healthy diet has not substantially improved, the variations in some countries were notable.

This is the case of the United States, Vietnam, China and Iran in particular, and Tanzania, Nigeria and Japan to a lesser extent, which have improved in the last three decades compared to their previous values. That does not imply, however, that their diet has reached optimal values: some are still at the bottom of the table.

Victoria Miller, visiting scientist at McMaster University (Canada) and lead author of the study, explains that the intake of legumes, nuts and non-starchy vegetables has improved, but at the same time the consumption of red and processed meat, sugar-sweetened beverages has increased and sodium compared to 30 years ago. These new ingredients would counteract the potential health benefits of other more recommended foods.

It is estimated that today, poor diet is responsible for 26% of preventable deaths worldwide. In addition, although it is known that following a healthy diet is beneficial for health, the differences in diet quality according to demographics, age, gender, education or proximity to urban areas that can determine the quality of our diet are still unknown. 

For this reason, Miller and her colleagues reviewed data from 185 countries and more than 1,100 surveys from the Global Dietetic Database, measuring global, regional and national dietary patterns in both children and adults. The researchers' primary outcome was the 0-100 scale known as the Alternative Healthy Eating Index, a validated measure of diet quality.

At the regional level, mean adherence to a healthy diet ranged from a low of 30.3 in Latin America and the Caribbean to a high of 45.7 in South Asia. The average score was 40.3, which is precisely the score for Spain. And although it exceeds the European average, it is behind the rest of the Mediterranean countries. Only 10 countries, representing less than 1% of the world's population, scored above 50.

Vietnam, Iran, Indonesia and India lead the ranking, while Brazil, Mexico, the United States and Egypt close it. Globally, women were more likely to follow recommended dietary guidelines than men, and older adults ate healthier than younger adults.

Likewise, Miller points out, the socioeconomic and educational level is important: adults with a higher level of education and children with parents with a higher educational level were those who had a better dietary quality in general. As a detail, he points out that the quality of the diet was better in the younger children, but worsened as the children grew older.

Finally, as for limitations of the study, the authors recall that there may be possible measurement errors in the dietary data, incomplete surveys in the case of some countries, and a lack of information on the consumption of some types of nutrients such as trans fats.

Still, the study offers key benchmarks to keep in mind for long-term goals. In the future, the researchers plan to estimate how different aspects of poor diets may contribute to the risk of certain diseases around the world.

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