Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Food and health

Dietary diversity and healthy life expectancy—an international comparative study



The prolongation of healthy life expectancy (HALE) is a core issue of health policy in many countries. The purpose of this study is to clarify the relationship between dietary diversity and HALE using international databases.


HALE data by country were derived from the Global Burden of Disease (GBD) 2015 database. Average food supply (g/day/capita) and energy supply (kcal/day/capita) by country, excluding loss between production and household, were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. Each food was sorted across 12 food groups, and dietary diversity was obtained from food groups using the Quantitative Index for Dietary Diversity (QUANTIDD). The cross-sectional and longitudinal associations between QUANTIDD and HALE were examined in the countries with populations of one million or greater.


Cross-sectional analysis showed that HALE was significantly associated with QUANTIDD (β = 99.9 ± 11.4, p < 0.001) in the single regression model and in the multiple regression model controlled for covariates (β = 36.4 ± 11.3, p = 0.002). Longitudinal analysis showed that HALE increased with QUANTIDD during the 15-year study period (β = 46.4 ± 5.1, p < 0.001), and this association was also significant when controlled for covariates (β = 39.7 ± 5.1, p < 0.001). Longitudinal association of QUANTIDD with the percentage difference between life expectancy and HALE controlled for covariates was significantly negative (β = − 1.3 ± 0.5, p = 0.011).


After controlling for socioeconomic indicators, longer healthy life is enjoyed by populations of countries with greater dietary diversity.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type



Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2


  1. WHO. WHO methods for life expectancy and healthy life expectancy. 2014. Available at: Accessed on 29 March 2018.

  2. Global Burden of Disease Study 2015 (GBD 2015) Data Resources. Available at: Accessed on 29 March 2018.

  3. DALYs GBD, Collaborators H. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1603–58.

    Article  Google Scholar 

  4. Kant AK, Block G, Schatzkin A, Ziegler RG, Nestle M. Dietary diversity in the US population, NHANES II, 1976-1980. J Am Diet Assoc. 1991;91:1526–31.

    CAS  PubMed  Google Scholar 

  5. Kant AK, Schatzkin A, Harris TB, Ziegler RG, Block G. Dietary diversity and subsequent mortality in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Am J Clin Nutr. 1993;57:434–40.

    Article  CAS  Google Scholar 

  6. Iwasaki M, Kimura Y, Yoshihara A, Ogawa H, Yamaga T, Takiguchi T, et al. Association between dental status and food diversity among older Japanese. Community Dent Health. 2015;32:104–10.

    CAS  PubMed  Google Scholar 

  7. Conklin AI, Monsivais P, Khaw KT, Wareham NJ, Forouhi NG. Dietary diversity, diet cost, and incidence of type 2 diabetes in the united kingdom: a prospective cohort study. PLoS Med. 2016;13:e1002085.

    Article  Google Scholar 

  8. Fernandez E, D’Avanzo B, Negri E, Franceschi S, La Vecchia C. Diet diversity and the risk of colorectal cancer in northern Italy. Cancer Epidemiol Biomark Prev. 1996;5:433–6.

    CAS  Google Scholar 

  9. La Vecchia C, Munoz SE, Braga C, Fernandez E, Decarli A. Diet diversity and gastric cancer. Int J Cancer. 1997;72:255–7.

    Article  Google Scholar 

  10. Kimura Y, Wada T, Ishine M, Ishimoto Y, Kasahara Y, Konno A, et al. Food diversity is closely associated with activities of daily living, depression, and quality of life in community-dwelling elderly people. J Am Geriatr Soc. 2009;57:922–4.

    Article  Google Scholar 

  11. Xiu LL, Wahlqvist ML, Lee MS, Chen RC. Cognitive impairment and limited dietary diversity or physical inactivity are conjoint precursors of incident diabetes more so in elderly women than men. Asia Pac J Clin Nutr. 2013;22:635–45.

    PubMed  Google Scholar 

  12. Otsuka R, Nishita Y, Tange C, Tomida M, Kato Y, Nakamoto M, et al. Dietary diversity decreases the risk of cognitive decline among Japanese older adults. Geriatr Gerontol Int. 2017;17:937–44.

    Article  Google Scholar 

  13. Otsuka R, Kato Y, Nishita Y, Tange C, Nakamoto M, Tomida M, et al. Dietary diversity and 14-year decline in higher-level functional capacity among middle-aged and elderly Japanese. Nutrition. 2016;32:784–9.

    Article  Google Scholar 

  14. Drewnowski A, Henderson SA, Shore AB, Fischler C, Preziosi P, Hercberg S. Diet quality and dietary diversity in France: implications for the French paradox. J Am Diet Assoc. 1996;96:663–9.

    Article  CAS  Google Scholar 

  15. Jayawardena R, Byrne NM, Soares MJ, Katulanda P, Yadav B, Hills AP. High dietary diversity is associated with obesity in Sri Lankan adults: an evaluation of three dietary scores. BMC Public Health. 2013;13:14.

    Article  Google Scholar 

  16. Grasgruber P, Sebera M, Hrazdira E, Cacek J, Kalina T. Major correlates of male height: a study of 105 countries. Econ Hum Biol. 2016;21:172–95.

    Article  CAS  Google Scholar 

  17. Grasgruber P, Sebera M, Hrazdira E, Hrebickova S, Cacek J. Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries. Food Nutr Res. 2016;60:31694.

    Article  Google Scholar 

  18. Katanoda K, Kim HS, Matsumura Y. New Quantitative Index for Dietary Diversity (QUANTIDD) and its annual changes in the Japanese. Nutrition. 2006;22:283–7.

    Article  Google Scholar 

  19. Laird NM, Ware JH. Random-effects models for longitudinal data. Biometrics. 1982;38:963–74.

    Article  CAS  Google Scholar 

  20. Morrell CH, Brant LJ, Ferrucci L. Model choice can obscure results in longitudinal studies. J Gerontol A Biol Sci Med Sci. 2009;64:215–22.

    Article  Google Scholar 

  21. R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2017. Accessed on 29 March 2018.

    Google Scholar 

  22. The R Stats Package. Available at: Accessed on 29 March 2018.

  23. Package ‘nlme’. Available at: Accessed on 29 March 2018.

  24. Ruel MT. Operationalizing dietary diversity: a review of measurement issues and research priorities. J Nutr. 2003;133 :3911S–26S.

    Article  CAS  Google Scholar 

  25. Bernstein MA, Tucker KL, Ryan ND, O’Neill EF, Clements KM, Nelson ME, et al. Higher dietary variety is associated with better nutritional status in frail elderly people. J Am Diet Assoc. 2002;102:1096–104.

    Article  Google Scholar 

  26. Kimura Y, Okumiya K, Sakamoto R, Ishine M, Wada T, Kosaka Y, et al. Comprehensive geriatric assessment of elderly highlanders in Qinghai, China IV: comparison of food diversity and its relation to health of Han and Tibetan elderly. Geriatr Gerontol Int. 2009;9:359–65.

    Article  Google Scholar 

  27. Salehi-Abargouei A, Akbari F, Bellissimo N, Azadbakht L. Dietary diversity score and obesity: a systematic review and meta-analysis of observational studies. Eur J Clin Nutr. 2016;70:1–9.

    Article  CAS  Google Scholar 

  28. Guidelines for the compilation of Food Balance Sheets, 2017. Available at: Accessed on 29 March 2018.

  29. Food balance sheets. A handbook. Food and Agriculture Organization of the United Nations, Rome, 6–7, 2001. Available at: Accessed on 29 March 2018.

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Keiko Miyamoto.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miyamoto, K., Kawase, F., Imai, T. et al. Dietary diversity and healthy life expectancy—an international comparative study. Eur J Clin Nutr 73, 395–400 (2019).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links