Martin White and coauthors consider that the commercial food system has the potential to show leadership and support for dietary public health, but systemic change is needed first and this is likely to require governmental action

Emilie Aguirre and colleagues discuss what changes to Europe’s agricultural policy might mean for our health

Background FAO/WHO have encouraged national governments to create food-based dietary guidelines (FBDGs) to support healthy diets. However, little is known about the extent to which food supply composition aligns with FBDGs, thereby structurally supporting or undermining population-level adherence. It is also unclear how this alignment has evolved over time. The aim of this study was to determine to what extent the global food supply aligns with FBDGs, and to examine historical trends. Methods Descriptive time series analysis of food supply alignment (FSA), 1961–2013. FSA was characterised as a ratio dividing country-level food supply data by FBDG across four food groups: fruit and vegetables (FV); sugar (SU); fish and seafood (FS); and red and processed meat (RP). FBDG data was collected from guidance produced by international bodies, and from countries with published FBDGs. The food supply was estimated using yearly FAOSTAT data. A population-weighted average of this ratio was created for all countries included in the analysis, and stratified by region and country income. Findings FBDGs from 89 countries were included. Of those, 80% had country guidelines for FV, 34% for SU, 44% for FS, and 21% for RP. FSA (1.0 = perfect alignment) based on global guidelines showed a higher supply than recommended for FV (1.2), SU (1.2) and RP (1.1). FSA based on country guidelines showed a lower supply than recommended for FV (0.9) and a higher supply than recommended for SU (2.3), RP (2.3) and FS (1.4). FSA also showed substantial differences in levels and trends across region and country income. Interpretation As of 2013, food supplies were not aligned with national and international FBDGs and misalignment persisted across five decades with subtantial variation in trends based on geography and country income. The long running nature of these trends suggest that the transition toward sustainable and healthful food systems represent a signifiant global challange. Additionally, acknowledging the degree of misalignment between macro-level structural factors, such as the composition of the food supply, in relation to national or global food policy aims may further aid efforts for population level adherence.