Life · 7 authors, 2 centres
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This study analyzed per capita protein, fat, and calorie supply trends across 38 OECD countries from 2000 to 2019 using joinpoint regression. All three indicators increased significantly, with fat showing the steepest rise (0.6%/year on average), and a marked acceleration after 2012–2014. By 2019, 71% of countries had fat availability above the recommended upper limit, highlighting a critical target for obesity and diet-related disease prevention policies.
**Background:** Diet-related non-communicable diseases account for approximately 11 million deaths worldwide (22% of all deaths in 2017), a burden exceeding that of smoking. The global nutrition transition—a shift toward Western-style, energy-dense diets—is a key driver of obesity, type 2 diabetes, cardiovascular disease, and certain cancers. While food supply data from Food Balance Sheets overestimate actual intake, they provide consistent, long-term, cross-nationally comparable proxies for consumption patterns. This study aimed to quantify trends in per capita protein, fat, and calorie availability across all 38 OECD member countries between 2000 and 2019, and to compare macronutrient distributions against international recommendations.
**Methods:** Data were extracted from the OECD Health Statistics database, originally sourced from FAO Food Balance Sheets. Daily per capita protein (g/capita/day), fat (g/capita/day), and calorie (kcal/capita/day) supplies were analyzed for 38 countries from 2000 to 2019. Joinpoint regression (Joinpoint 4.9.0.0) was used to identify breakpoints in time series and calculate annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals. The software tested models with 0–3 breakpoints using a weighted Bayesian information criterion, requiring a minimum of three time points per trend segment. Macronutrient energy contributions were calculated using Atwater coefficients (4 kcal/g protein, 9 kcal/g fat), with carbohydrate (including fiber) estimated by subtraction. Distributions were compared to acceptable macronutrient distribution ranges (AMDR).
**Key Results:** All three indicators increased significantly across the OECD average from 2000 to 2019. The average daily fat supply rose from 122.8 g/capita in 2000 to 136.9 g/capita in 2019 (+11.5%), with an AAPC of 0.6% (95%CI: 0.5–0.7). Two breakpoints were identified: an initial increase (APC: 0.7; 95%CI: 0.5–0.9) until 2006, stagnation until 2013, then a sharp acceleration from 2013 onward (APC: 1.0; 95%CI: 0.8–1.1). In 2000, France had the highest fat supply (169.9 g) and Colombia the lowest (73.2 g); by 2019, the United States led (180.1 g) and Chile was lowest (87.8 g). Korea showed the steepest positive trend (AAPC: 2.6; 95%CI: 2.4–2.7), while France was the only country with a significant decline (AAPC: −0.8; 95%CI: −0.9–−0.6). The average protein supply increased from 99.2 g/capita/day in 2000 to 103.8 g in 2019 (AAPC: 0.3; 95%CI: 0.2–0.4), with breakpoints in 2008 and 2012. The post-2012 trend showed the highest rate (APC: 0.5; 95%CI: 0.3–0.6). Protein increased in 14 countries and decreased in 7 (France, Greece, Italy, Japan, Slovakia, Slovenia, Spain). Iceland had the highest protein supply in both 2000 (123.7 g) and 2019 (143.9 g), while Colombia had the lowest in 2000 (63.4 g) and Slovakia in 2019 (71.1 g). Average daily calorie supply increased from approximately 3,200 kcal/capita in 2000 to 3,382 kcal/capita in 2019 (AAPC: 0.2; 95%CI: 0.1–0.2), with breakpoints in 2006 and 2014. The post-2014 trend accelerated (APC: 0.4; 95%CI: 0.3–0.5). In 2019, Japan had the lowest calorie supply (2,691 kcal) and the United States the highest (3,862 kcal). Macronutrient distribution shifted markedly: fat's share of total energy rose from 32.7% (95%CI: 30.7–34.7%) in 2000 to 37.6% (95%CI: 36.0–39.3%) in 2019, protein's share increased from approximately 12.4% to 13.4%, and carbohydrate's share correspondingly declined. In 2000, 16 countries (42.1%) had fat intake above the recommended upper limit of 35% of total energy; by 2019, this had risen to 27 countries (71%). All countries fell within the recommended protein range (10–35%) in 2019. Six countries fell below the lower limit of 45% for carbohydrate intake in 2019, while none exceeded the upper limit.
**Clinical Implications:** The consistent upward trend in fat and calorie availability across OECD countries, particularly the acceleration after 2012–2014, signals an increasingly obesogenic food environment. By 2019, over two-thirds of OECD countries had fat supplies exceeding recommended levels, a pattern strongly linked to obesity, cardiovascular disease, and type 2 diabetes. The positive finding that all countries maintained optimal protein proportions suggests protein adequacy is not a concern, but the rising fat share warrants urgent policy attention. The authors recommend taxation of unhealthy foods, VAT reductions on healthy options (e.g., fruits, vegetables, fish), regulation of advertising and packaging, and agricultural policy reforms. These findings support WHO's GPW13 targets and the NCD action plan goal of halting diabetes prevalence increases by 2025. Limitations include the use of supply (not consumption) data, which overestimates intake; inability to differentiate carbohydrate from fiber or saturated from unsaturated fats; and lack of adjustment for physical activity, cultural factors, or within-country socioeconomic disparities.