Dietary composition in the context of development: a re-examination of the nutrition transition

Abstract

A representation of the quality of an individual’s dietary consumption in its entirety through a single measure that is succinct yet holistic has been sought by those within the nutrition research community for many years. The emergence of the Alternate Healthy Eating Index (AHEI) and its subsequent association with some of the greatest contributors to both morbidity and mortality globally has renewed interest in gathering a better understanding of what social, cultural, and economic forces might explain differences in consumption across populations and through time. To date, there has been no systematic evaluation of the variation in overall diet quality by country, year, age, and sex. Our analysis aims to fill this gap in knowledge through first gathering each of the 11 nutrient and food item components of the AHEI from the Risk Factors analysis of the Global Burden of Disease Study to construct a validated measure of aggregate diet quality. Further, we looked to use this measure to understand and explore the relationship between diet quality and a host of development indicators in order to test the underlying theory of the “Nutrition Transition”. Then, with validated indicators of development, we built a predictive model to generate estimates of expected diet quality. We then used the ratio of observed to expected diet quality to benchmark country performance. Notably, the highest observed score was 65.6 (56.4 – 76.4, 95 UI) from Cuba in 2017, while the lowest score, 38.1 (32.1 – 45.9, 95 UI), was observed in Mongolia. Generally, index scores were shown to increase with both age and passage of time. In 2017, Cuba out-performed all others with an observed to expected ratio of 1.34, while Mongolia significantly underperformed with a ratio of 0.78. Through this analysis, we were able to demonstrate the variation observed in diet quality can be partly explained by indicators of development and energy intake. Additionally, we provide a means of comparison for those countries with lower quality dietary consumption than their peers of similar circumstance so they might have a point of reference to guide future improvement.