Global, regional and national intake of plant-based foods among youth in 185 countries (1990–2018): findings from the Global Dietary Database

Introduction: Healthful plant-based foods can improve youth nutrition and contribute to global targets such as Sustainable Development Goal (SDG) 2 on ending malnutrition, SDG3 improving health and SDG12 promoting sustainable diets, yet global intakes remain unquantified. Methods: We analysed the Global Dietary Database, aggregating 1248 dietary surveys from 185 countries in a Bayesian hierarchical model adjusted for survey heterogeneity, temporal trends and data uncertainty. We assessed energy-adjusted consumption of fruits, non-starchy vegetables, starchy vegetables (excluding potatoes), beans/legumes and nuts/seeds among youth by age (0-19) globally in 2018; evaluated heterogeneity regionally, nationally and by sex, education and urbanicity; and assessed trends from 1990. Results: Globally, plant-based food intake was low, from 1.19 servings/day (95% uncertainty interval (UI) 1.16 to 1.35) in <1-year-olds to 3.55 servings/day (3.35 to 3.79) in 15-19-year-olds. South Asia had the lowest intakes across all ages; East/Southeast Asia had the highest intakes for several ages, driven by non-starchy vegetables. Intake increased with age in all regions except high-income countries, where <1-year-olds consumed the most (3.77 servings/day (95% UI 3.30 to 4.35)), mainly from fruit (2.43 (2.14 to 2.77)). Across most regions, females consumed more fruit and non-starchy vegetables; urban youth consumed more fruit and nuts/seeds and those from higher educated households had higher intakes of all plant-based foods except beans/legumes. Among the 25 most populous countries, lowest intakes of total plant-based foods were in Spain (1.35 (1.10 to 1.75)), Pakistan (1.43 (1.21 to 1.76)), and the UK (1.71 (1.50 to 2.01)); and highest in Vietnam (4.28 (3.29 to 5.78)), Congo (4.38 (3.49 to 5.95)) and Mexico (5.18 (4.75 to 5.65)). Compared to 1990, youth globally in 2018 consumed more non-starchy vegetables and nuts/seeds, less starchy vegetables, and higher total plant-based foods. Conclusion: Youth globally consume inadequate healthful plant-based foods, varying substantially by age, region and sociodemographic factors. These findings highlight gaps towards SDGs, underscoring the needs for targeted surveillance, policy interventions, and equity-focused strategies to improve youth dietary quality.