Table 2.
Population adherence to the dietary guidelines across different high- and low- to middle-income countries.
| Reference | Dietary Guidelines | Pictorial Image | Food Groups | Include Physical Activity Messages | Summary Results |
|---|---|---|---|---|---|
| High-income countries | |||||
| Ewers et al., 2020 [28] | Danish Food Based Dietary Guidelines | No image Key messages |
Fruits and vegetables Fish Whole Grains Lean meats and lean cold meats Low-fat dairy products Saturated fat sources Sodium sources Sugar Water |
Yes | Only 10% of the participants were identified as very high adherence; 17.3% high adherence; 54.4% intermediate adherence; 8.3% low adherence; and 9.9% very low-adherence. Based on table categorization of meeting the guideline proposed by the authors. |
| Schwartz and Vernarelli 2019 [35] | Dietary Guidelines for Americans | Plate and Pyramid | Fruits Vegetables Grains Dairy Protein Foods |
No | Following MyPlate and MyPyramid showed better adherence to the recommendations than those who did not follow. More whole grains (1.1 vs. 0.8 servings), and vegetables (1.5 vs. 1.4 servings) Less refined grains (6 vs. 6.6 servings) and added sugar (18.6 vs. 20.5 tbs) sources |
| Schroeter et al., 2019 [27] | Dietary Guidelines for Americans | Plate and Pyramid | Fruits Vegetables Grains Dairy Protein Foods |
No | Increased consumption of food groups after participating in education groups Fruit and vegetables and whole grains |
| Schuh et al., 2019 [29] | Swiss Dietary Guidelines | Pyramid | Beverages Vegetables and Fruits Grains, potatoes and pulses Dairy products, meat, eggs, fish and tofu Oils, fats, and nuts Sweets, salty snacks, alcohol |
Yes | Participants are not meeting the guidelines five year after issuing the guideline, regardless of socio-demographic characteristics. Meeting at least three recommendations 1993: 26.1% 2006: 24.9% |
| Irwin et al., 2019 [70] | Australian Dietary Guidelines | Plate | Grains (mostly whole grains) Vegetables and legumes/beans Lean meats, and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans Milk, yogurt, cheese and/or alternatives mostly reduced fat Fruit Use small amounts of oils and fats Only sometimes and small amounts: sugar sweetened beverages, salty snacks and sweets. |
No | Participants are not meeting the guidelines for the majority of the food groups Lean meats, and alternatives were the only group that students were meeting the recommendations Meeting the recommendations (female vs. male): Fruit: 0.7 vs. 1.3 servings/day Vegetables: 2.7 vs. 3.2 Meat and Alternatives: 3.0 vs. 2.2 Dairy and Alternatives: 1.3 Bread, cereals, grains: 4.3 vs. 3.3 Discretionary: 1.3 vs. 2.0 Fats and oils: 1.7 vs. 1.0 |
| Harrison et al., 2019 [36] | 2019 Canada Food Guide | Plate | Vegetables and Fruits Protein foods Whole grains Water |
No | Greater consumption of saturated fats from all the food groups of the Canada Food Guide Protein Foods (milk and alternatives; and meats and alternatives) contributed 47.8% in total for saturated fats. “All other foods” were main contributors: fruit juices, refined grains, and salty snacks. |
| Diaz-Mendez and García-Espejo 2019 [30] | Guide to Healthy Eating–Spanish Society for Community Nutrition | Pyramid | Whole grains Fruits Vegetables and legumes Oils (especially olive oils) Lean meats, poultry, fish, eggs Beans and nuts Milk and dairy Water |
Yes | Percent of participants meeting the guidelines: Fruits: 67.3% Vegetables: 43.7% Meat: 52.3% Breads: 86.6% Percent of participants not meeting the guidelines: Eggs: 59.3% Fish: 46.4% Pasta-rice-potatoes: 47.3% Sweets: 36.5% |
| Mestral et al., 2019 [37] | Swiss Dietary Guidelines | Pyramid | Beverages Vegetables and Fruits Grains, potatoes and pulses Dairy products, meat, eggs, fish and tofu Oils, fats, and nuts Sweets, salty snacks, alcohol |
Yes | Less than 40% of the participants adhere to all of the guidelines Percent of participants meeting the guidelines: Fruits: 38.8% Vegetables: 20.5% Dairy: 19.4% Fish: 22.5% Meat: 9.1% Liquids (beverages): 39.4% |
| Bel et al., 2019 [38] | Flemish Active Food Triangle | Triangle | Cereals and Potatoes Vegetables Fruits Meat, fish, eggs, and meat alternatives Dairy and calcium-enriched products Oils and fatty products Sugary products Unsweetened beverages (water and tea) |
Yes | Between years the participants adherence to guidelines deteriorated over the time for most groups Change in percent of participants meeting the guidelines: Water and sugar-free drinks: △+7% Bread and cereals: △−15% Potato, rice, and pasta: △+2% Vegetable: △−1% Fruit (including juices): △−3% Fruit (excluding juices): △−1% Dairy products and calcium-enriched products: △−1% Cheese: △+4% Meat, eggs, fish, and substitutes: △−2% Spreadable and cooking fat: △−4% |
| Schwartz and Vernarelli, 2018 [35] | Dietary Guidelines for Americans | MyPlate | Fruits Vegetables Grains Dairy Protein Foods |
No | Participants who follow a MyPlate plan were able to meet the food groups requirements for the following groups: Dark green and orange vegetables Refined grains Whole grains Total meat Milk and dairy Sodium sources |
| Jun et al., 2018 [59] | Dietary Guidelines for Americans | MyPlate | Fruits Vegetables Grains Dairy Protein Foods |
No | A small percentage of participants met the dietary guidelines: Fruits: 21.3% Vegetables: 11.4% Whole grains: 4.3% |
| Brassard et al., 2018 [67] | 2007 Canada’s Food Guide | Rainbow | Vegetables and fruits Grain products Milk and alternatives Meat and alternatives |
No | Participants were consuming less than the recommendations for fruits and vegetables, and grain-products. Milk and alternatives; and Meat and alternatives are in line with the recommendations. |
| Stroebele-Benschop et al., 2018 [74] | German Dietary Guidelines | Circle | Cereals and potatoes Vegetables Fruits Milk and dairy products Meat, sausages, fish, and eggs Fats and oils |
No | Participants were not meeting the recommendations for most of the food groups. Percentage of participants that met the recommendations: Vegetables: 12.9% Fruit: 37.6% Whole grain: 50.5% Milk and milk products: 45.5% Meat and meat products: 95.0% Fish: 15.8% Eggs: 80.2% Oil: 90.1% Fat: 89.1% Water and unsweetened beverages: 76.2% |
| Chatelan et al., 2017 [40] | Swiss Dietary Guidelines | Pyramid | Beverages Vegetables and Fruits Grains, potatoes and pulses Dairy products, meat, eggs, fish and tofu Oils, fats, and nuts Sweets, salty snacks, alcohol |
Yes | Less than 1% follow all the food groups. Percentage of participants that met the recommendations: Fruit and vegetables: 18.0% Non-caloric beverages: 75.0% |
| Mishra et al., 2015 [71] | Australian Dietary Guidelines | Plate | Grains (mostly whole grains) Vegetables and legumes/beans Lean meats, and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans Milk, yogurt, cheese and/or alternatives mostly reduced fat Fruit Use small amounts of oils and fats Only sometimes and small amounts: sugar sweetened beverages, salty snacks and sweets. |
No | Younger age participants were not meeting the recommendations for all the food groups. Middle-age participants were not meeting the recommendations for cereals, vegetables, and meat and alternatives. |
| Schumacher et al., 2014 [72] | Australian Dietary Guidelines | Plate | Grains (mostly whole grains) Vegetables and legumes/beans Lean meats, and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans Milk, yogurt, cheese and/or alternatives mostly reduced fat Fruit Use small amounts of oils and fats Only sometimes and small amounts: sugar sweetened beverages, salty snacks and sweets. |
No | Participants were meeting the recommendations for the guideline for the majority of the groups. Fruit: 23.8% Vegetables: 28.6% Dairy: 15.7% Breads and Cereals: 5.7% The only exception was for the meat and substitutes group, where 69.3% were meeting them. |
| Yen and Lewis 2013 [32] | Dietary Guidelines for Americans | MyPlate | Fruits Vegetables Grains Dairy Protein Foods |
No | After participating in an educational program, participants did not improve their intake for the groups: grains, vegetables, and meat and alternatives. They improved their intake for fruit, dairy, and oil. |
| De Abreu et al. 2013 [43] | Swiss Dietary Guidelines | Pyramid | Beverages Vegetables and Fruits Grains, potatoes and pulses Dairy products, meat, eggs, fish and tofu Oils, fats, and nuts Sweets, salty snacks, alcohol |
Yes | Only 23% of the sample were meeting at least 3 recommendations. Fruits: 39.4% Vegetables: 7.1% Dairy: 8.4% Majority were meeting the recommendations for meat and fish. Meat: 61.3% Fish: 66.4% |
| Black and Billette, 2013 [44] | 2007 Canada’s Food Guide | Rainbow | Vegetables and fruits Grain products Milk and alternatives Meat and alternatives |
No | Only 26.3% of participants met all of the recommendations. Dark green: 12% Orange fruit: 8% Potatoes: 10% Other: 43% |
| Rossiter et al., 2012 [31] | 2007 Canada’s Food Guide | Rainbow | Vegetables and fruits Grain products Milk and alternatives Meat and alternatives |
No | Participants were consuming below the recommendations for fruits and vegetables, and grains. Milk and dairy were consumed in the recommendation range. Meat and alternatives were consumed above the recommendations. |
| Park et al., 2012 [45] | Korean National Dietary Guidelines | Wheels | Fruits Vegetables Meat, fish, eggs, and beans Milk Grains |
Yes | Overall adherence was 3.23 (1–5 Likert scale) for meeting the recommendations. |
| Kirpatrick et al., 2012 [46] | Dietary Guidelines for Americans | MyPlate | Fruits Vegetables Grains Dairy Protein Foods |
No | Over 50% of adults met the recommendations for total grains, meats, and beans; less then 20% of adults met the recommendations for other groups |
| Mc Daniel and Belury 2012 [60] | Dietary Guidelines for Americans | MyPlate | Fruits Vegetables Grains Dairy Protein Foods |
No | Participants’ intakes of fruit and vegetables were below the recommendations. Meat and beans; and Milk and dairy were within the recommendations. Grains were above the recommendations Oils were below the recommendations. |
| Allen et al., 2011 [68] | 2007 Canada’s Food Guide | Rainbow | Vegetables and fruits Grain products Milk and alternatives Meat and alternatives |
No | Less than 48% of the sample were meeting the recommendations for all groups (with females having a better adherence then males) Male vs. Female Vegetables and fruits: 9.5% vs. 17.9% Milk and alternatives: 16.2% vs. 22.2% Grain products: 16.2% vs. 38.2% |
| Winham and Florian, 2011 [61] | Dietary Guidelines for Americans | Pyramid | Fruits Vegetables Grains Milk Meat |
Yes | Less than 30% of Hispanics adhere to the guidelines 7% of bi-racial group adhere to the guidelines. |
| Niclasen and Schnor, 2011 [75] | Greenlandic (similar to the Danish guidelines) | No image | Fruits Vegetables Traditional foods Whole grains Fat Sugar Water |
Yes | Students meeting the guidelines varied from 14% to 87% depending on the groups. Diet variety: 87.0% Marine animals: 31.6% Local terrestrial animals and birds: 37.1% Fish: 31.8% Fruit: 14.8% Vegetables: 38.9% Potatoes: 79.7% Candies: 14.7% Soft-drinks: 18.6% Pre-cooked dinner: 83.4% |
| Kristjansdottir et al., 2010 [33] | Food-based dietary Guidelines set for Icelandic Population | Circle/Plate | Fruits and vegetables Cereals and cereal products Dairy products Animal source foods and nuts Oils and visible fats Water |
Yes | After the intervention there was an improvement on the food groups intake, however, the participants from both intervention and control groups were still not meeting the recommendations. |
| Krebs-Smith et al., 2010 [62] | Dietary Guidelines for Americans | Pyramid | Fruits Vegetables Grains Milk Meat |
Yes | Majority of the population did not meet the recommendations for all the food groups, with exception for total grains, and meat and beans. |
| Vandevijvere et al., 2009 [73] | Flemish Active Food Triangle | Triangle | Cereals and Potatoes Vegetables Fruits Meat, fish, eggs, and meat alternatives Dairy and calcium-enriched products Oils and fatty products Sugary products Unsweetened beverages (water and tea) |
Yes | Population was consuming below the recommendations for liquids, grains, vegetables, fruits, and milk and soya products. Population was consuming above the recommendations for meats/fish/eggs/legumes/nuts/substitutes |
| Kranz et al., 2009 [63] | Dietary Guidelines for Americans | Pyramid | Fruits Vegetables Grains Milk Meat |
Yes | Younger children presented a higher adherence to the guidelines than older children. Older children have less than 40% adherence for fruit and vegetables. |
| St. John et al., 2009 [69] | 2007 Canada’s Food Guide | Rainbow | Vegetables and fruits Grain products Milk and alternatives Meat and alternatives |
No | Fruit and vegetables are the groups for which the children have the lowest adherence. Milk and dairy; and meat and alternatives have been less adherent to some specific subgroups: normal weight and overweight. |
| Serra-Majem et al., 2008 [47] | Guide to Healthy Eating–Spanish Society for Community Nutrition | Pyramid | Whole grains Fruits Vegetables and legumes Oils (especially olive oils) Lean meats, poultry, fish, eggs Beans and nuts Milk and dairy Water |
Yes | Majority of the population were not meeting the recommendations for fruits (72.7%), vegetables (57.6%), and beans (58.1%). Majority of the population exceeded recommendation for intake of fatty meats and sausages (56.1%). Intake for bake goods was 20.2%, soft-drinks 21.8%, and fats 23.6%, and sugars 33.5%. |
| Tande et al., 2004 [48] | 1992 Dietary Guidelines for Americans | Pyramid | Bread, Cereal, Rice, Pasta Fruit Vegetable Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Milk, Yogurt, Cheese Fats and oils Sweets |
No | Participants were not meeting the recommendations for all the groups, consuming fewer than the recommended. Serving/1000 kcal Dairy: 0.95 Fruit: 0.70 Vegetables: 1.55 Grain: 3.19 Meat: 1.06 |
| Pullen and Walker, 2002 [64] | 1992 Dietary Guidelines for Americans | Pyramid | Bread, Cereal, Rice, Pasta Fruit Vegetable Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Milk, Yogurt, Cheese Fats and oils Sweets |
No | Women are not adhering the recommendations for the pyramid groups, with exception for fruits that have adherence of 65.4%. Meat: 38.6% Dairy: 48.1% Vegetables: 22.3% Grain products: 3.8% |
| Anding et al., 2001 [65] | 1992 Dietary Guidelines for Americans | Pyramid | Bread, Cereal, Rice, Pasta Fruit Vegetable Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Milk, Yogurt, Cheese Fats and oils Sweets |
No | Less than 43% of the participants followed at least one recommendation from the guideline. Fruits, vegetables, and milk were consumed less than the recommendations. More than 60% of the participants exceeded the recommendations for fats, sugar and sodium. |
| Brady et al., 2000 [66] | 1992 Dietary Guidelines for Americans | Pyramid | Bread, Cereal, Rice, Pasta Fruit Vegetable Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Milk, Yogurt, Cheese Fats and oils Sweets |
No | Participants from both sexes and ethnicities were consuming less than the recommendations for fruits and dairy. Participants also exceeded the recommendations for sugar and discretionary foods. |
| Muñoz et al., 1997 [49] | 1992 Dietary Guidelines for Americans | Pyramid | Bread, Cereal, Rice, Pasta Fruit Vegetable Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Milk, Yogurt, Cheese Fats and oils Sweets |
No | Participants were not meeting (consuming less) the recommendations for fruit, vegetables, and grains. Dairy and meat intake met the recommendations. |
| Cleveland et al., 1997 [50] | 1992 Dietary Guidelines for Americans | Pyramid | Bread, Cereal, Rice, Pasta Fruit Vegetable Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Milk, Yogurt, Cheese Fats and oils Sweets |
No | Participants were not meeting the recommendations (consuming less) for grains, dairy and fruits. Vegetables and meats were within the recommendations. |
| Gambera et al., 1995 [34] | 1992 Dietary Guidelines for Americans | Pyramid | Bread, Cereal, Rice, Pasta Fruit Vegetable Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts Milk, Yogurt, Cheese Fats and oils Sweets |
No | After intervention participants increased their intake for milk, vegetables, fruits, and grains, and decrease intake of meats. |
| Low- and middle-income countries | |||||
| Steele et al., 2020 [54] | Dietary Guidelines for the Brazilian population 2014 | No | Unprocessed or minimally processed foods Processed culinary ingredients Processed foods Ultra-processed foods |
No | Slight increase in consumption of unprocessed/minimally processed foods after coronavirus disease 2019 (COVID-19) pandemic. Consumption of ultra-processed foods remains the same after COVID-19. |
| Sousa and Costa, 2018 [53] | Dietary Guidelines for the Brazilian population 2006 | Pyramid | Rice, bread, pasta, potato, cassava Fruits Vegetables Beans and nuts Milk, cheese, and yogurt Sugar and sweets Oils and fats |
No | Participants were not meeting the guidelines for most of the food groups: Grains: 95.8% Vegetables: 74.1% Fruits: 49.4% Meat: 97.2% Beans: 93.5% Dairy products: 87.5% Fats and oils: 99.6% Sugars: 58.3% |
| Ansari and Samara 2018 [52] | WHO Dietary Guidelines for the Eastern Mediterranean region | Plate | Bread, cereals, potatoes, and rice Milk and dairy products Foods containing fat Foods/drinks containing sugar Meat, poultry, fish, dried beans, and eggs Fruit and vegetables |
Yes | Participants had an adherence for most of the food groups below 45%, exception for cereal/cereal products that had an adherence of 71.8%. Sweets: 43.5% Cakes/Cookies: 44.2% Snacks: 33.0% Fast food/canned foods: 41.1% Lemonade/soft-drinks: 43.7% Fruits and vegetables: 33.4% Dairy products: 19.1% Meat/sausage products: 16.5% Fish/seafood: 32.1% |
| Louzada et al., 2018 [51] | Dietary Guidelines for the Brazilian population 2014 | No | Unprocessed or minimally processed foods Processed culinary ingredients Processed foods Ultra-processed foods |
No | Consumption of unprocessed/minimally processed foods was higher than the other groups: Prevalence of intake: Minimally or unprocessed foods: 58.1% Processed culinary ingredients: 10.9% Processed foods: 10.6% Ultra-processed foods: 20.4% |
| Tian et al., 2017 [55] | Chinese Food Pagoda | Pagoda | Water Cereals and tubers Vegetables and fruits Meat and Poultry; Aquatic products; Eggs Milk and dairy products; soybeans and nuts; Salt and Oils |
Yes | Participants were consuming oils and fats above the recommendations, while fruits, eggs, aquatic products, and milk were below recommendations. Vegetables were the only group that meet the recommendations. |
| Batis et al., 2016 [41] | Mexican Dietary Guidelines | Plate | Fruit and vegetables Cereals Beans and animal protein sources |
No | Low proportion adheres to the recommendations. Legumes: 1–4% Seafood: 4–8% Fruit and vegetables: 7–16% Dairy: 9–23% Sugar-sweetened beverages: 10–22% High saturated fat and added sugar products: 14–42% Processed meat: 7–23% |
| Chin Koo et al., 2016 [56] | Malaysian Dietary Guidelines | Pyramid | Rice, cereals, noodles, and tubers Vegetables and fruits Animal source of foods and legumes Fats, sugar and salt |
No | Average consumption of the guidelines was below 40% for most of the food groups, with exception for “meat/poultry” with 84.8% Cereals/grains: 40.1% Fruits: 13.4% Vegetables: 9.5% Fish: 24.7% Legumes: 8.9% Milk/Dairy products: 5.5% |
| Verly Jr. et al., 2013 [42] | Dietary Guidelines for the Brazilian population 2006 | Pyramid | Rice, bread, pasta, potato, cassava Fruits Vegetables Beans and nuts Milk, cheese, and yogurt Sugar and sweets Oils and fats |
No | Participants were not meeting the recommendations for grains, fruits, vegetables, meat, oils, and sugars food groups. Participants were meeting the recommendations for milk and dairy, and beans/nuts groups. |
| Jayawardena et al., 2013 [57] | Food-Based Dietary Guidelines for Sri Lanka | Pyramid | Rice, bread, other cereals, and yams Fruits Vegetables Milk and/or Milk products Fish, pulses, meat, and eggs Nuts, oils, and seeds |
No | Participants were exceeding the recommendations for grains, meats and pulses, and added sugars sources. Below recommendations for fruits, vegetables, and dairy. |
| Zang et al., 2012 [58] | Chinese Food Pagoda | Pagoda | Water Cereals and tubers Vegetables and fruits Meat and Poultry; Aquatic products; Eggs Milk and dairy products; soybeans and nuts; Salt and Oils |
Yes | Majority of the participants were not meeting the recommendations for the following groups: Only 6.1%, 1.6% and 3.6% consumed the minimum recommendations for cereals, fruits, and vegetables. Participants consuming more than maximum recommendations for meats (65.4%). Dairy (67.4%), eggs (63.9%), and fish and shrimps (81.8%) were consumed less than the minimum recommendations. |