Diet quality of a population from a high-income gulf country in the era of transition: Kuwait as a model example

Highlights
•Suboptimal dietary intake was identified among Kuwaiti adults.
•A high proportion consumed insufficient fruits/vegetables, whole grains, and fish.
•Most adults exceeded recommended limits for sodium and saturated fat intake.
•Younger adults had poorer dietary intake compared to older adults.
•Overall diet quality did not differ by sex.
•Establishes a baseline for future dietary assessments and public health strategies.

Abstract
Diet is a modifiable risk factor for cardiovascular diseases (CVD). While the rate of CVD is escalating in Kuwait, studies examining dietary intake in the Kuwaiti population are scarce. This study aimed to evaluate the diet quality of a nationally representative sample of Kuwaiti adults using the first and only National Nutrition Survey. Dietary intake was assessed using a 24-hour dietary recall among 980 adults aged 20 years or older. Diet quality was evaluated using the American Heart Association (AHA) diet score. Intake and scores of the AHA components were analyzed for the total sample and stratified by age and sex using complex survey regression models adjusted for sampling weights. The mean AHA diet score (maximum 80) was 42.5 ± 0.46. Over 70% of adults consumed insufficient amounts of fruits/vegetables, whole grains, fish/shellfish, and nuts/seeds/legumes, while nearly 80% exceeded saturated fat limits and over 95% exceeded sodium recommendations. Diet quality scores increased significantly with age (P < .0001), with older adults (≥60 years, score = 49.4) scoring notably higher than younger adults (<30 years, score = 37.4). Younger adults had particularly low intake of fruits, vegetables, whole grains, and fish, while no differences were observed for sodium or nuts/seeds/legumes. Overall diet quality did not differ significantly by sex. Suboptimal diet quality was prevalent, particularly among younger adults in Kuwait. This study underscores the urgent need for targeted dietary improvements and establishes a crucial reference point for future public health initiatives.