Worldwide dietary patterns and their association with socioeconomic data: an ecological exploratory study.

BACKGROUND: Dietary patterns are associated with health outcomes and environment sustainability, having socioeconomic drivers. This ecological study aims to identify dietary patterns in food availability data at the global level using multivariate statistical methodology, to associate the identified dietary patterns with socioeconomic data and to analyze the adequacy of the applied multivariate statistical methods for this purpose. METHODS: Principal Component Analysis was applied to median values of times series of food availability data of 172 UN registered countries available at FAOSTAT database in Food Balance Sheets section in a sectional manner, after calculating median values of time series for each food group and country. Principal Components were associated with socioeconomic data available from the World Bank database. Sensitivity analyses were realized to verify the stability of dietary patterns through five different times. RESULTS: Five principal components were identified in the median values of each time series, each characterizing a possible dietary pattern. The first one, a westernized dietary pattern, was composed of energy-dense and processed foods, foods of animal origin, alcoholic beverages, but also, albeit less, by vegetables, fruits and nuts, being associated with income, urbanization and trade liberalization. This westernized pattern was characterized more animal origin and processed foods, such as vegetable oils, alcoholic beverages and stimulants yet preserving unprocessed and regional foods. The other dietary patterns were three agricultural patterns characterized more by regional foods, especially starchy staples, and one coastal dietary pattern composed of fish and seafoods, being associated with GINI index, poverty, and female labor force. Sensitivity analyses demonstrated the stability of dietary patterns. CONCLUSIONS: Principal Component Analysis was adequate to identify dietary patterns in food availability data. A westernized dietary pattern was identified, being associated with income, urbanization, and trade liberalization. This association did not occur for the remain of the dietary patterns identified, these being less driven by economic development.

Are Europeans moving towards dietary habits more suitable for reducing cardiovascular disease risk?

AIMS: Cardiovascular diseases are the main cause of death in Europe. Food choices represent the most important factors undermining health and well-being; they account for as much as half of all CVD deaths in Europe. The aim of this viewpoint is to evaluate food choices of the European population and their temporal trends in relation to possible effects on the cardiovascular disease risk. DATA SYNTHESIS: The CVD death rate attributable to diet-related factors has fallen in Europe over the last 25 years; however, the pace of the reduction has slowed down in the last ten years. In parallel, in the last decade unfavorable changes in the dietary habits associated with CVD risk have occurred. CONCLUSIONS: A mismatch exists between the available evidence on the health-promoting potential of the diet and the relatively modest and inconsistent improvements of dietary habits in the European population observed in recent years. Nutritional education alone will not be enough to improve the lifestyle of people in Europe. Policy options to be considered to reach this aim should necessarily include also initiatives for facilitating production, marketing, availability and affordability of healthy foods in each and every European country.

Trends in the national food supply of absorbable zinc in Ethiopia: 1990-2017.

OBJECTIVE: This study analysed trends (1990-2017) in the availability of absorbable Zn in the national food supply of Ethiopia. DESIGN: The supply statistics of ninety-five food groups were obtained from the Ethiopian Food Balance Sheets compiled by FAO. Zn and phytate contents were determined using multiple composition databases and absorbable Zn estimated via the 'Miller' equation. Estimated average requirement cut-point method was performed to estimate proportions at risk of inadequate intake. Physiological Zn requirements set by Institute of Medicine (IOM) and International Zinc Nutrition Consultative Group (IZiNCG) were applied. Time trend was tested using Mann-Kendall statistics and Z-score and P-values are provided. SETTING: Ethiopia. PARTICIPANTS: NA. RESULTS: Between 1990 and 2017, the supply of total dietary Zn was increased by 33 % from 9·8 to 13·0 mg/person/d (Z = 6·46, P < 0·001). However, that of absorbable Zn remained constant around 2·7 mg/person/d (Z = 1·87, P > 0·05). Over the period, the phytate supply was increased by 48 % from 1415 to 2095 mg/person/d (Z = 6·50, P < 0·001) and fractional Zn absorption declined from 27·0 to 20·9 % (Z = -6·62, P < 0·001). The contribution of animal source foods for bioavailable Zn was reduced by 45 % and the share of cereals raised by 11·3 %. Over the period, prevalence of inadequate Zn intake estimated using IZiNCG and IOM requirements remained constant around 10 and 50 %, respectively. CONCLUSION: Between 1990 and 2017, Ethiopia considerably increased the total supply of Zn; however, meaningful changes in bioavailable Zn and prevalence of deficiency were not observed due to proportional rise in phytate and concomitant decline in Zn absorption.

Is vitamin D deficiency a public health concern for low middle income countries? A systematic literature review.

PURPOSE: Vitamin D deficiency has been receiving increasing attention as a potential public health concern in low and lower-middle income countries (LMICs), of which there are currently 83. We aimed to conduct a comprehensive systematic literature review (SLR) of available data on vitamin D status and prevalence of vitamin D deficiency in all 83 LMICs. METHODS: We followed the general methodology for SLRs in the area of serum 25-hydroxyvitamin D. Highest priority was placed on identifying relevant population-based studies, followed by cross-sectional studies, and to a lesser extent case-control studies. We adopted the public health convention that a prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D < 25/30 nmol/L) at > 20% in the entire population and/or at-risk population subgroups (infants, children, women of child-bearing age, pregnancy) constitutes a public health issue that may warrant intervention. RESULTS: Our SLR revealed that of the 83 LMICs, 65% (n = 54 countries) had no published studies with vitamin D data suitable for inclusion. Using data from the remaining third, a number of LMICs had evidence of excess burden of vitamin D deficiency in one or more population subgroup(s) using the above convention (Afghanistan, Pakistan, India, Tunisia and Mongolia) as well as possibly other LMICs, albeit with much more limited data. Several LMICs had no evidence of excess burden. CONCLUSION: Vitamin D deficiency is a public health issue in some, but certainly not all, LMICs. There is a clear need for targeting public health strategies for prevention of vitamin D deficiency in those LMICs with excess burden.

Trends in energy and nutrient supply in Ethiopia: a perspective from FAO food balance sheets.

BACKGROUND: Ethiopia is the second-most populous country in Africa. Although most people still live in rural areas, the urban population is increasing. Generally, urbanisation is associated with a nutrition transition and an increase in risk factors for non-communicable diseases (NCDs). The objective of this study was to determine how the nutritional composition of the Ethiopian food supply has changed over the last 50 years and whether there is evidence of a nutrition transition. METHODS: Food balance sheets for Ethiopia from 1961 to 2011 were downloaded from the FAOSTAT database and daily per capita supply for 17 commodity groupings was calculated. After appropriate coding, per capita energy and nutrient supplies were determined. RESULTS: Per capita energy supply was 1710 kcal/d in 1961, fell to 1403 kcal/d by 1973, and increased to 2111 kcal/d in 2011. Carbohydrate was by far the greatest energy source throughout the period, ranging from 72% of energy in 1968 to 79% in 1998; however, this was mostly provided by complex carbohydrates as the contribution of sugars to energy only varied between 4.7% in 1994 and 6.7% in 2011. Energy from fat was low, ranging from 14% of energy in 1970 to 10% in 1998. Energy from protein ranged from 14% in 1962 to 11% in 1994. Per capita supplies of calcium, vitamin A, C, D, folate and other B-vitamins were insufficient and there was a low supply of animal foods. CONCLUSIONS: The Ethiopian food supply is still remarkably high in complex carbohydrates and low in sugars, fat, protein, and micronutrients. There is little evidence yet of changes that are usually associated with a nutrition transition.

Comparison of food consumption in Indian adults between national and sub-national dietary data sources.

Accurate data on dietary intake are important for public health, nutrition and agricultural policy. The National Sample Survey is widely used by policymakers in India to estimate nutritional outcomes in the country, but has not been compared with other dietary data sources. To assess relative differences across available Indian dietary data sources, we compare intake of food groups across six national and sub-national surveys between 2004 and 2012, representing various dietary intake estimation methodologies, including Household Consumption Expenditure Surveys (HCES), FFQ, food balance sheets (FBS), and 24-h recall (24HR) surveys. We matched data for relevant years, regions and economic groups, for ages 16-59. One set of national HCES and the 24HR showed a decline in food intake in India between 2004-2005 and 2011-2012, whereas another HCES and FBS showed an increase. Differences in intake were smallest between the two HCES (1 % relative difference). Relative to these, FFQ and FBS had higher intake (13 and 35 %), and the 24HR lower intake (-9 %). Cereal consumption had high agreement across comparisons (average 5 % difference), whereas fruit and nuts, eggs, meat and fish and sugar had the least (120, 119, 56 and 50 % average differences, respectively). Spearman's coefficients showed high correlation of ranked food group intake across surveys. The underlying methods of the compared data highlight possible sources of under- or over-estimation, and influence their relevance for addressing various research questions and programmatic needs.

Dietary gap assessment: an approach for evaluating whether a country's food supply can support healthy diets at the population level.

OBJECTIVE: Dietary diversity, and in particular consumption of nutrient-rich foods including fruits, vegetables, nuts, beans and animal-source foods, is linked to greater nutrient adequacy. We developed a 'dietary gap assessment' to evaluate the degree to which a nation's food supply could support healthy diets at the population level. Design/Setting In the absence of global food-based dietary guidelines, we selected the Dietary Approaches to Stop Hypertension (DASH) diet as an example because there is evidence it prevents diet-related chronic disease and supports adequate micronutrient intakes. We used the DASH guidelines to shape a hypothetical 'healthy' diet for the test country of Cameroon. Food availability was estimated using FAO Food Balance Sheet data on country-level food supply. For each of the seven food groups in the 'healthy' diet, we calculated the difference between the estimated national supply (in kcal, edible portion only) and the target amounts. RESULTS: In Cameroon, dairy and other animal-source foods were not adequately available to meet healthy diet recommendations: the deficit was -365 kcal (-1527 kJ)/capita per d for dairy products and -185 kcal (-774 kJ)/capita per d for meat, poultry, fish and eggs. Adequacy of fruits and vegetables depended on food group categorization. When tubers and plantains were categorized as vegetables and fruits, respectively, supply nearly met recommendations. Categorizing tubers and plantains as starchy staples resulted in pronounced supply shortfalls: -109 kcal (-457 kJ)/capita per d for fruits and -94 kcal (-393 kJ)/capita per d for vegetables. CONCLUSIONS: The dietary gap assessment illustrates an approach for better understanding how food supply patterns need to change to achieve healthier dietary patterns.

Shifts in population dietary patterns and physical inactivity as determinants of global trends in the prevalence of diabetes: an ecological analysis.

BACKGROUND AND AIMS: The worldwide epidemiology of diabetes is rapidly changing as a result of the spreading of westernised nutritional and lifestyle habits. We conducted an ecological analysis to identify dietary, lifestyle and socio-economic factors associated with global diabetes prevalence. METHODS AND RESULTS: Country-specific estimates of diabetes prevalence were obtained. Data were then matched to year- and country-specific food and energy availability for consumption, and to year-specific information on obesity, physical inactivity, urbanisation, gross domestic product (GDP), and smoking. Data were obtained from publicly available databases compiled by the Food Agricultural Organisation (FAO), World Health Organisation (WHO) and World Bank. Cluster analysis was used to derive dietary patterns of global food consumption. The association with diabetes prevalence was evaluated. Stepwise multiple regression analysis was conducted to identify predictors associated with worldwide diabetes prevalence. 96 countries were eligible for inclusion in the analysis. The average diabetes prevalence was 7.0% and the highest rate was observed in the Middle-Eastern region (13.1%). The worldwide prevalence of obesity and physical inactivity was 15.1% and 36.1%, respectively. Diabetes prevalence was associated with age and physical inactivity prevalence in a fully adjusted multiple regression model. Three dietary patterns (agricultural, transitional and westernised) were identified by the cluster analysis. Diabetes prevalence showed a direct dose-response association with the degree of exposure to a westernised dietary pattern. CONCLUSIONS: The adoption of sedentary lifestyle and westernised dietary patterns appears to be closely linked to the global rise in diabetes prevalence.

Seasonal Maize yield forecasting in South and East African Countries using hybrid Earth observation models.

Climate change still adversely affects agriculture in the sub-Saharan Africa. There is need to strengthen early action to bolster livelihoods and food security. Most governments use pre- and post-harvest field surveys to capture statistics for National Food Balance Sheets (NFBS) key in food policy and economic planning. These surveys, though accurate, are costly, time consuming, and may not offer rapid yield estimates to support governments, emergency organizations, and related stakeholders to take advanced strategic decisions in the face of climate change. To help governments in Kenya (KEN), Zambia (ZMB), and Malawi (MWI) adopt digitally advanced maize yield forecasts, we developed a hybrid model based on the Regional Hydrologic Extremes Assessment System (RHEAS) and machine learning. The framework is set-up to use weather data (precipitation, temperature, and wind), simulations from RHEAS model (soil total moisture, soil temperature, solar radiation, surface temperature, net transpiration from vegetation, net evapotranspiration, and root zone soil moisture), simulations from DSSAT (leaf area index and water stress), and MODIS vegetation indices. Random Forest (RF) machine learning model emerged as the best hybrid setup for unit maize yield forecasts per administrative boundary scoring the lowest unbiased Root Mean Square Error (RMSE) of 0.16 MT/ha, 0.18 MT/ha, and 0.20 MT/ha in Malawi's Karonga district, Kenya's Homa Bay county, and Zambia's Senanga district respectively. According to relative RMSE, RF outperformed other hybrid models attaining the lowest score in all countries (ZMB: 25.96%, MWI: 28.97%, and KEN: 27.54%) followed by support vector machines (ZMB: 26.92%, MWI: 31.14%, and KEN: 29.50%), and linear regression (ZMB: 29.44%, MWI: 31.76%, and KEN: 47.00%). Lastly, the integration of VI and RHEAS information using hybrid models improved yield prediction. This information is useful for NFBS bulletins forecasts, design and certification of maize insurance contracts, and estimation of loss and damage in the advent of climate justice.

Evolution of energy and nutrient supply in Zambia (1961-2013) in the context of policy, political, social, economic, and climatic changes.

An adequate supply of energy, micronutrients and macronutrients is essential to achieve food and nutrition security to prevent malnutrition. Socio-economic, political, and climatic events, however, can affect the supply of food and nutrients. We assessed country-level supply trends of food and nutrients and their sources within the context of policy changes and political, socio-economic and climatic events from 1961 to 2013 in Zambia. Due to the lack of national food consumption data, food supply data from the FAO food balance sheets, matched to food composition tables, were used to estimate the energy, macronutrient and micronutrient content of 264 food items available to Zambia. We calculated historical nutrient supplies based on demographic characteristics and population-level dietary requirements. Results showed that Zambia was nutrition insecure from 1961 to 2013 for key micronutrients vitamin A, folate, riboflavin, vitamin B12, calcium, zinc, iron, and energy-deficient from the late-1980s. The diet has not substantially changed over time, with maize being the dominant food source. However, refined energy-dense food has steadily increased in the diet coupled with a reduction in fibre. These nutrient supply and dietary pattern trends coincide with specific socio-economic, policy, political, and climatic events from the 1970s to the early-mid 2000s, such as population growth, maize subsidy and crop diversification policies, regime change and drought. This study shows how policy, political and climatic events have been central features shaping nutrient supplies and the consequences for nutrition security. The study provides a context to inform future food policies to improve food and nutrition security. Supplementary Information: The online version contains supplementary material available at 10.1007/s12571-022-01329-1.

Individual- and supply-level macronutrient intakes are well correlated over a 50-year period (1961-2011) in 18 countries in Asia, North America, and Europe.

Reliable information on dietary trends is essential. We compared individual-level dietary estimates for total energy, carbohydrate, fat, and protein intake over time with national supply data from the Global Expanded Nutrient Supply Model (186 paired estimates from 1961 to 2011, 18 countries). We hypothesized that supply data would overestimate individual measures and that the two measures would be weakly correlated. Individual- and supply-level estimates were compared using Spearman correlation coefficients and linear mixed-effect models were used to estimate the differences between measures. Overall, the correlations between individual- and supply-level measures were moderate for energy (rs = 0.34) and carbohydrate (rs = 0.39), strong for fat (rs = 0.85), and protein (rs = 0.69). Trends in total energy measured by individual-level surveys and total energy supply were positively correlated in 38.9% of countries, whereas trends in macronutrients aligned between estimates in most countries. Supply-level dietary data overestimated individual-level intakes, especially in higher income countries in Europe and in the United States. In the United States, supply-level data exceeded individual-level estimates by 26.3% to 29.9% for energy, carbohydrate, and fat, whereas protein estimates were similar between measures. In Europe, supply-level estimates overestimated individual-level intake by 19.9% for energy, 17.0% for carbohydrate, 13.7% for fat, and 7.7% for protein, whereas estimates for energy and macronutrients were similar in Asia. In Asia and lower income countries, our findings generally support the use of supply-level data in the absence of individual-level data, though this finding may be related to smaller sample size and differences in underlying national statistics that inform supply data.

Discrepancies between two long-term dietary datasets in the United Kingdom (UK).

Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by the Department for Environment, Food and Rural Affairs (Defra) (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: Estimates made by FAO-FBS were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses. Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+23.4% and +1.4%, respectively) and a decrease in fish (-7.1% and -3.2%, respectively). Temporal trends did not agree between the two datasets for dairy, calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.

Trends in Vitamin B12 Supply and Prevalence of Inadequate Intake in Africa: Regional and Country-Specific Estimates.

BACKGROUND: In Africa, little is known about the epidemiological significance of vitamin B12 deficiency. OBJECTIVE: To analyze regional and country-specific trends (1990-2017) in vitamin B12 supply in Africa and estimate the prevalence of inadequate intake. METHODS: National food balance data compiled by Food and Agriculture Organization for 45 African countries were used. Per capita food supplies for 95 commodities were transformed into B12 contents (µg/capita/day) assuming no fortification and B12 density was determined per 1000 kcal. Estimated Average Requirement cut point method was used for estimating the prevalence of inadequate intake. RESULTS: Over the period, the mean per capita B12 supply in Africa significantly increased by 12.7% from 2.02 to 2.27 µg/capita/day (z = 5.27, P < .001). However, the B12 density remained below the reference goal of 0.8 µg/1000 kcal. In 2017, the B12 supplies (µg/capita/day) in Northern (3.52), Central (3.15), and Southern Africa (2.99) were considerably higher than Western (2.10) and Eastern Africa (1.36) regions. The supply in upper-middle- or high-income countries (3.21) was also substantially higher than low- (1.58) and low-middle-income (2.58) countries. In 2017, the B12 supplies ranged from 5.95 in Mauritius to 0.66 in Ethiopia. Similarly, the nutrient density extended from 1.88 in Gambia to 0.28 in Ethiopia. In Africa, the estimated prevalence of inadequate intake declined from 48.1% in 1990 to 29.9% in 2007 and resurged to 40.6% in 2017. In 2017, the prevalence of inadequate intake was nearly universal (> 90%) in 4 countries and exceeded 50% in 8 more countries. CONCLUSION: Many African countries have major deficits in vitamin B12 supply.

Recent Trends in Dietary Habits of the Italian Population: Potential Impact on Health and the Environment.

Population growth, globalization, urbanization, and economic pressures are causing changes in food consumption all over the world. The study's aims are (1) to evaluate trends in food habits in Italy to highlight deviations from the traditional Mediterranean diet, (2) to analyze the features of the present Italian diet that should be modified to meet evidence-based global scientific targets for a healthy and sustainable diet proposed by the EAT-Lancet Commission. Trends in food availability for human consumption during the period 2000-2017 were assessed using the food balance sheets (FBSs). Greenhouse gas (GHG) emission was estimated according to life cycle assessment (LCA) analyses. During the study period, the availability of animal fat and beef meat greatly declined (-58% and -32%, respectively), followed by fruit, potatoes, vegetables, milk, and non-tropical oils (-20%, -15%, -13%, -14%, and -11%, respectively). A substantial increase has occurred for tropical oils, fish, and nuts (+156, +26%, and +21%, respectively). In order to meet the targets of consumption proposed by the EAT-Lancet Commission, the consumption of legumes and nuts should be almost doubled, whereas the consumption of meat, eggs, dairy products, animal fat, tropical oils, and sugars should be reduced by proportions ranging from 60% to 90%. If implemented, these changes would reduce the diet-related greenhouse gas emission by nearly 50%. In conclusion, these data call for nutritional education programs and interventions on the food system aimed at promoting a healthier and more environmentally sustainable diet. To this end, the availability and affordability of products with a better impact on human health and the environment should be promoted.

Use of food consumption data of food balance sheets and national food consumption surveys in deterministic long-term dietary exposure assessments of pesticides.

Deterministic long-term dietary exposure estimates of pesticide residues across different countries are called International Estimated Daily Intakes (IEDIs). Effect of using Food Balance Sheets (FBS) or National Food Consumption Surveys (NFCS) to calculate the IEDI was investigated. Presence of aggregated foods tended to increase the IEDI, and clustering of data from countries with comparable dietary patterns tended to decrease the IEDI. Furthermore, IEDIs for global use were not always at least as conservative as those for regional or national use. Risk assessors using these data should be aware of these limitations. As FBS data are only available for the general population and IEDIs are highest for children, a method was developed to convert FBS based IEDIs to indicative IEDIs for children. This may be appropriate if no NFCS data are available for this age group and the critical health-based guidance value is relevant for this age group.

Metabolic Food Waste and Ecological Impact of Obesity in FAO World's Region.

Obesity represents a titanic cost for the world's health systems but also a substantial ecological cost to the environment. High energy foods have been shown to be the major contributor to Greenhouse Gas (GHG) emissions, challenging the diet-environment-health triangle. The waste of resources and the unnecessary ecological cost due to an excessive consumption of foods leading to obesity have been ignored so far. Metabolic Food Waste [MFW(kg of food)] corresponds to the amount of food leading to Excess Body Fat (EBF) and its impact on the environment, expressed as carbon [MFW(kgCO2eq)], water [MFW(×10 L)] and land footprint [MFW(×10 m2)]. We aim to estimate the MFW(kg of food) in the seven FAO regions, Europe (EU), North America and Oceania (NAO), Latin America (LA), Sub-Saharan Africa (SSA), Industrialized Asia (IA), North Africa, West and Central Asia (NAWCA) and South and Southeast Asia (SSEA), and evaluate its impact on ecological footprints. The overall impact of MFW(tons of food) in the world corresponds to 140.7 gigatons associated to overweight and obesity. Between the different regions, EU is responsible of the greatest amount of MFW(tons of food) volume (39.2 gigatons), followed by NAO (32.5 gigatons). In terms of ecological impact, EU and NAO displayed the highest values for all three MFW footprints, about 14 times more than SSA. We provide evidence of the enormous amount of food lost through obesity and its ecological impact. Reducing metabolic food waste associated with obesity will contribute in reducing the ecological impact of unbalanced dietary patterns through an improvement of human health.

Corrigendum: Metabolic Food Waste and Ecological Impact of Obesity in FAO World's Region.

[This corrects the article DOI: 10.3389/fnut.2019.00126.].

Global comparison of national individual food consumption surveys as a basis for health research and integration in national health surveillance programmes.

Individual food consumption surveys (IFCS) are performed to evaluate compliance with food/nutrient intake requirements or exposure to potential harmful dietary contaminants/components. In this review, we inventoried methods and designs used in national IFCS and discussed the methodologies applied across countries. Literature searches were performed using fixed sets of search terms in different online databases. We identified IFCS in thirty-nine countries from six world continents. National IFCS systems are available in most of the high-income countries, while such surveys are scarce in low- and middle-income countries (e.g. Africa, Eastern Europe and several Asian countries). Few countries (n 9) have their national IFCS incorporated into national health and nutrition surveys, allowing the investigation of dietary-related disease outcomes. Of the integrated surveys, most have the advantage of being continuous/regular, contrary to other IFCS that are mostly erratic. This review serves as the basis to define gaps and needs in IFCS worldwide and assists in defining priorities for resource allocation. In addition, it can serve as a source of inspiration for countries that do not have an IFCS system in place yet and advocate for national IFCS to be incorporated into national health and nutrition surveys in order to create: (1) research opportunities for investigating diet-disease relationships and (2) a frame to plan and evaluate the effect of diet-related policies (e.g. promotion of local nutrient-rich foods) and of nutrition recommendations, such as food-based dietary guidelines. Countries that integrate their IFCS within their national health and nutrition survey can serve as proof-of-principle for other countries.

Association between worldwide dietary and lifestyle patterns with total cholesterol concentrations and DALYs for infectious and cardiovascular diseases: an ecological analysis.

Global dietary and lifestyle trends are primary risk factors for communicable and non-communicable diseases. An ecological analysis was conducted to examine the association of global dietary and lifestyle patterns with total cholesterol concentrations. This study also investigated whether total cholesterol modified the association between dietary and lifestyle habits with disability-adjusted-life-years-lost (DALYs) for infectious and cardiovascular diseases (CVDs). Country-specific mean total cholesterol concentrations and DALYs for infectious and CVDs were obtained. Data were then matched to country-specific food and energy availability for consumption and information on obesity, physical inactivity, urbanization, gross domestic product (GDP), life expectancy and smoking. Stepwise multiple regression models were developed to identify significant predictors of total cholesterol concentrations and DALYs for infectious and CVDs. Life expectancy and egg and meat consumption were significantly associated with cholesterol concentrations. DALYs for infectious diseases were associated with smoking, life expectancy and per capita GDP. Smoking was the only predictor of DALYs for CVDs. The improvement of socio-demographic conditions and economic growth is likely to reduce the burden of communicable diseases in developing countries. A concurring increase in non-communicable diseases is expected, and these results have, yet again, identified smoking as a primary risk factor for CVDs.

Assessing global dietary habits: a comparison of national estimates from the FAO and the Global Dietary Database.

BACKGROUND: Accurate data on dietary habits are crucial for understanding impacts on disease and informing policy priorities. Nation-specific food balance sheets from the United Nations FAO provided the only available global dietary estimates but with uncertain validity. OBJECTIVES: We investigated how FAO estimates compared with nationally representative, individual-based dietary surveys from the Global Dietary Database (GDD) and developed calibration equations to improve the validity of FAO data to estimate dietary intakes. DESIGN: FAO estimates were matched to GDD data for 113 countries across the following 9 major dietary metrics for 30 y of data (1980-2009): fruit, vegetables, beans and legumes, nuts and seeds, whole grains, red and processed meats, fish and seafood, milk, and total energy. Both absolute and percentage differences in FAO and GDD mean estimates were evaluated. Linear regression was used to evaluate whether FAO estimates predicted GDD dietary intakes and whether this prediction varied according to age, sex, region, and time. Calibration equations were developed to adjust FAO estimates to approximate national dietary surveys validated by using randomly split data sets. RESULTS: For most food groups, FAO estimates substantially overestimated individual-based dietary intakes by 74.5% (vegetables) and 270% (whole grains) while underestimating beans and legumes (-50%) and nuts and seeds (-29%) (P < 0.05 for each). In multivariate regressions, these overestimations and underestimations for each dietary factor further varied by age, sex, region, and time (P < 0.001 for each). Split-data set calibration models, which accounted for country-level covariates and other sources of heterogeneity, effectively adjusted FAO estimates to approximate estimates from national survey data (r = 0.47-0.80) with small SEs of prediction (generally 1-5 g/d). CONCLUSIONS: For all food groups and total energy, FAO estimates substantially exceeded or underestimated individual-based national surveys of individual intakes with significant variation depending on age, sex, region, and time. Calibration models effectively adjusted the comprehensive, widely accessible FAO data to facilitate a more-accurate estimation of individual-level dietary intakes nationally and by age and sex.