Estimates of energy intake, requirements and imbalances based on anthropometric measurements at global, regional and national levels and for sociodemographic groups: a modelling study.

Introduction: An accurate understanding of total energy intake, energy requirements for healthy body weights and the resultant imbalance is important for many aspects of dietary analysis. Despite its importance, existing estimates are highly uncertain and not well aligned with trends in body weight and malnutrition, especially at regionally comparable and global levels. We estimated energy intake, energy requirements and energy imbalances at global, regional, national and sociodemographic levels based on anthropometric measures.

Methods: We used predictive equations for estimating energy requirements derived from a comprehensive database of doubly labelled water studies, and paired them with global datasets on body weight, height and physical activity to estimate a new proxy of energy intake. We calculated energy requirements to attain healthy body weights by applying the predictive equations to a body mass index that minimises risks for weight-related diseases and is classified as normal. We calculated energy imbalances as the difference between the estimated intake and energy requirements to attain healthy body weights.

Results: On average, 2160 kilocalories per person per day (kcal/day) were required in 2020 to sustain measured levels of body weight, height and physical activity (95% CI, 2100 to 2210 kcal/day), ranging from 1980 (95% CI, 1900 to 2060) kcal/day in low-income countries to 2360 (95% CI, 2310 to 2410) kcal/day in high-income countries. The estimated intake exceeded energy requirements to attain healthy body weights by 80 (95% CI, 70 to 100) kcal/day on average, with 192 countries (97%) having average intakes above recommendations, and 6 countries (3%) with intake below, and increasing to 14 (7%) when considering rural residences. Between 1990 and 2020, 50 countries (25%) changed from average intakes below recommendations to intakes above.

Conclusions: Estimating total energy intake based on anthropometric measures captures the regional and temporal trends in body weight, height and physical activity. The estimates can be used as a complementary measure to existing proxies of energy intake. Among other things, they can inform misreporting of intake in dietary surveys, uncertainty in the amount of food wasted and the lack of data on at-home production in food availability statistics. Aligning existing measures of food intake with consistent estimates of overall energy intake could improve dietary analyses and policy planning.