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Diets are only slightly healthier than they were 30 years, according to a global study.

Researchers from the Friedman School of Nutrition Science and Policy at Tufts University investigated the eating habits of adults and children in 185 countries over three decades. They used the Alternative Healthy Eating Index, which ranks different diets on a scale of 0 to 100, with 0 representing heavy consumption of sugar and processed meats and 100 representing the recommended balance of fruits, vegetables, legumes/nuts and whole grains. They also used data from over 1,100 surveys from the Global Dietary Database, a large, collaborative compilation of data on food and nutrient consumption levels worldwide.

They concluded the average global in 2018 was 40.3, 1.5 points higher than in 1990. European countries were included in the region defined as “high-income countries” which also includes North America and Australia. In 2018, the mean score for high-income countries was 37.8, 3.2 points higher than in 1990. 

There were some notable variations by country, with nutritious options becoming more popular in the United States, Vietnam, China, and Iran, and less so in Tanzania, Nigeria, and Japan.

Regionally, averages ranged from as low as 30.3 in Latin America and the Caribbean to as high as 45.7 in South Asia. Only 10 countries, representing less than 1% of the world’s population, had scores over 50. The world’s highest scoring countries were Vietnam, Iran, Indonesia and India, and the lowest scoring were Brazil, Mexico, the United States and Egypt.