What People Are Eating Around the World
Understanding what foods people consume at all stages of life is important to demonstrate how food security and nutrition is linked to development, health, and well-being. This knowledge is also critical for shaping food system and nutrition policies to ensure they are health promoting and consumer-oriented in positive ways[
12••]. Insight into dietary intake remains a challenge for researchers because of the nature of dietary surveys and data gathering methods, recall memory of those being surveyed, and geographical and representative coverage of survey data. The increasing availability of data on diets, sourcing, and costs, and the development of better metrics, survey tools, and open-access databases will allow researchers to develop a clearer picture of dietary trends and patterns[
13••,
14]. As yet, important questions remain unanswered: What are people actually eating across the world? Where do people get their food from and how much do they pay, or are willing to pay, for food? What influences their dietary choices? Do health, environmental, or ethical issues factor into their decision making?
One of the key drivers of optimal nutritional status of populations is diets. The International Conference on Nutrition Rome Declaration states that “optimal diets, including traditional diets, meet nutrient requirements across all age groups and special nutrition needs. These diets avoid excessive intake of saturated fat, sugars, and sodium, essentially eliminating trans fats, among others” [
15].
The WHO provides more detailed recommendations in that diets should be composed of a variety of foods that are of sufficient quantity, of high quality, and free from pathogens [
16]. Sufficient quantity means that food eaten should meet energy needs in the form of calories based on the age, weight and size, sex, activity level, and overall stage of life for an individual. Quality refers to the types and varieties of foods and ingredients consumed by that individual. Foods can be grouped as healthy or unhealthy, though food classification is more complex than the simplified categories presented here. Healthy foods include whole grains, fruits, vegetables, nuts and seeds, beans and legumes, fish and seafood, and foods rich in total polyunsaturated fatty acids, omega-three fatty acids, and dietary fiber. Unhealthy foods include excessive amounts of unprocessed red meats, processed meats (cured and salted), overly processed starches, simple sugars and sugar-sweetened beverages, and foods containing high levels of saturated fat, trans fat, dietary cholesterol, and sodium [
17].
The diversity of foods within food groups and across the range of food groups plays an important role in meeting optimal diets [
18‐
20]. However, diversity does not always mean that the overall diet is healthy: a diversity of foods can be a combination of mixed foods that include foods high in trans fats, refined or simple sugars, and sodium, or overly refined, highly processed food items [
21], which have a propensity to lead to obesity and diet-related non-communicable diseases (DR-NCDs) [
22]. Food must also be safe to ensure that acute and chronic food-borne diseases are minimized during the production, processing, storage, transport, and distribution stages of food supply chains, as well as during storage, preparation, and cooking within households [
23,
24].
Evidence has demonstrated that optimal nutrition early in life is essential to adult well-being, productivity, and human capital. However, few infants and young children consume nutritionally optimal diets, which has significant ramifications for early growth and development [
25‐
27]. Data collected by UNICEF on infant and young child feeding practices show that 16% of children aged 6 to 24 months eat what is defined as a “minimally acceptable diet,” which is an indicator of both dietary diversity and meal frequency, along with continued breastfeeding [
28]. Of children under the age of 6 months, only 41% are exclusively breastfed globally [
1]. While there are differences in feeding practices between rural and urban areas and across all wealth groups for a variety of reasons, the diets of infants and young children remain inadequate in all countries [
13••].
Dietary constraints, pressures, and influences continue into childhood and adolescence. The Global School-based Student Health Survey, a self-reported survey representing 83 economies, shows that among children and teens aged 13 to 17 years globally, approximately 30% do not eat fruit and 14% do not get access to and do not eat vegetables on a daily basis. However, 44% consume soda every day [
13••]. Vitamin and mineral deficiencies are high in this age group in low-and middle-income countries (LMICs). Regional analysis indicates inadequate intake of iron, iodine, vitamin A, zinc, and calcium, with adolescent girls and populations in South Asia experiencing a greater risk of deficiency [
29,
30].
Dietary data on adults also indicate sub-optimal patterns. Across regions, most diets are low in fruits, vegetables, whole grains, nuts and seeds, fiber, and legumes, and high in overly processed, packaged foods that can contain higher amounts of refined sugars, sodium, and unhealthy fats. In wealthy countries and among wealthy consumers, consumption of red and processed meats tends to be higher. These foods are often out of reach for poor consumers living in low-income countries for various reasons, including inadequate infrastructure of supply chains and cost [
2,
20‐
22]. There are sub-regional exceptions to these trends: in much of Africa, legumes are highly consumed, and in some parts of Asia, vegetable consumption is still considered the mainstay of the diet. In low-income countries and places that restrict meat consumption for religious or cultural reasons, the consumption frequency of red meat (and perhaps other animal source foods) is low [
8••,
13]. Likewise, dietary trends differ based on age, gender, and the overall stage of the lifecycle: healthier diets are more evident in older adults than younger adults, and in women than men [
17].
Dietary Patterns Are Changing
Profound dietary changes are occurring in concert with increased movement of people to urbanizing centers and cities; demographic changes among populations, with increased numbers of older populations in some parts of the world (Europe, Canada, the USA, Australia) and younger in others (Africa); and globalization and trade factors that influence goods and services, particularly in the food sector [
31,
32]. The food systems and food environments that engender diets have become more interconnected from global to local levels, with longer, more complex food supply chains and different types of actors beyond just producers and consumers moving food in those chains [
33‐
35]. With the enhanced interconnectedness of places and people, and the transitions witnessed with globalization and urbanization, there have been shifts in consumer purchases and preferences towards more so-called unhealthy, cheap, and convenient diets [
36,
37]. This dietary shift has been associated with increasing prevalence of overweight and obesity and non-communicable disease (NCD) worldwide [
38]. These dietary trends and their health outcomes are not just an issue for high-income countries (HICs): more LMICs are experiencing this shift in conjunction with a transition from undernutrition to overweight and obesity, and NCD risk [
39‐
42].
When looking at trends from 1990 to 2013, consumption of most food groups and critical dietary components has increased across all regions of the world [
2,
43]. While this rise in consumption is nuanced and regionally complex, the consumption of “unhealthy” food items has outpaced the consumption of “healthy” foods in most regions of the world [
17]. The intake of whole grains, which is associated with a reduction in risk for diabetes, colorectal cancer, coronary heart disease, and stroke [
44], rose substantially in Southeast Asia only. Consumption of processed meat, a risk factor for colorectal cancer, increased in all regions of the world, but so did fruit consumption. Vegetable consumption increased only in some parts of the world [
45]. Sugar-sweetened beverage consumption grew in most regions, with the largest increase in North America. Reductions in sodium intake have been minimal in all regions of the world, but are consistently surpassing the global recommended intake of 2500 mg per day and currently stand at 4000 mg per day [
2,
13,
43]. However, there are exceptions: some places experienced a decline in the intake of industrially produced trans fats, which occurred as a result of political commitment made to reduce trans fatty acids in the food supply. This decision reflected the very clear evidence on the adverse health effects of trans fats [
6].
Many diets now contain a significant share of packaged, processed foods, such as sugar-sweetened beverages, baked goods, dairy products, processed meats, chips and crackers, cake mixes, pies, pastries, and sweets. Generally, packaged foods are industrially processed and high in salt, sugar, and saturated and trans fats [
13••]. The 2018 Global Nutrition Report estimated 86% of diets do not align with the WHO healthy diet recommendations, which is largely due to the heavily processed foods in diets [
13••,
46,
47]. Globally, sales of total per capita volumes of packaged food rose over 13% from 2005 to 2017 [
13••]. Patterns and trends in per capita sale volumes show that Europe, North America, and Oceania purchased the highest volumes of these packaged foods between 2005 and 2017, with some stagnation or declining sales growth over that time period. Latin America and Africa are undergoing significant growth in sales of packaged foods, albeit from a lower baseline compared with North America. The number of kilocalories purchased from sugar-sweetened beverages is highest in HICs. Sales trends indicate that in many LMICs there have been modest increases in these types of beverage sales from 2009 to 2017 [
13••,
48,
49].
People are increasingly eating away from home. Since 1995, the amount of overall income spent on foods eaten away from home has risen significantly in Latin America, particularly in Brazil, Chile, and Colombia [
42]. Over the last 40 years, snacks eaten “on the go” have replaced main lunches and dinners in the USA [
50]. This change is also apparent in Asia: in China, people who live in neighborhoods with a higher density of restaurants tend to eat breakfast and dinner away from home, a trend that is positively associated with increased overweight [
51]. Portion sizes, particularly in the USA, UK, and Latin America, have significantly increased over the last few decades. These trends illustrate that the global population is cooking less and eating out more, largely due to lifestyle changes [
31]. The shift to food eaten outside the home along with portion size has likely contributed to the rising obesity pandemic [
52,
53].