Low adherence to food-based dietary guidelines among adults in Belgium

Abstract Background Poor diets are a major contributor to disease and premature death. Food-based dietary guidelines provide evidence-based, context-specific recommendations to promote health and prevent chronic disease. In light of recent evidence, Belgium updated its guidelines in 2025. The extent to which adults meet these recommendations is currently unknown. Methods We used cross-sectional data from the Belgian National Food Consumption Survey 2022-2023. A total of 1,499 adults (≥18 years) completed two non-consecutive 24-hour dietary recalls administered by trained interviewers and a self-administered Food Frequency Questionnaire. Foods were categorised according to the 2025 guidelines. Habitual intakes were modelled and adherence to guidelines estimated using the Statistical Program to Assess habitual Dietary Exposure (SPADE). Results Adherence to dietary guidelines was low for all health-promoting food groups, with 90% (95% CI: 89-92) not meeting recommendations for fruit, 93% (95% CI: 92-95) for vegetables, 97% (95% CI: 96-98%) for nuts, 88% (95% CI: 87-90) for legumes, 99% (95% CI: 98-99) for wholegrain cereals, 88% (95% CI: 87-91) for milk and milk products, 77% (95% CI: 73-81) for fish and shellfish, and 63% (95% CI: 60-66) for water. Conversely, excessive intake was observed for foods associated with adverse health outcomes, with 46% (95% CI: 40-52) exceeding recommendations for unprocessed red meat, 91% (95% CI: 89-94) for processed red meat, and 82% (95%CI: 79-84) for alcoholic drinks. Average intake of sugar-sweetened beverages was 147 ml/day (95%CI: 134-161) in adults aged 18-64. Conclusions Poor diets remain a major concern that needs to be addressed in Belgium. Evidence-based strategies-such as enhancing affordability of healthy foods, regulating food marketing, improving nutritional labelling, and fostering supportive food environments-should be considered by policymakers. Continuous monitoring of diets and their determinants is needed to support improvement. Key messages • Most adults fail to meet the new national food-based dietary guidelines in Belgium. • Improving diets and addressing their determinants should be a policy priority.