A review of the uses and reliability of food balance sheets in health research

Nutr Rev. 2020 Dec 1;78(12):989-1000. doi: 10.1093/nutrit/nuaa023.


Context: Food Balance Sheets (FBSs) are constructed by the Food and Agricultural Organization (FAO) and portray the food supply and utilization pattern of a country over time.

Objective: To examine and analyse the uses of FAO-FBS data in international studies of health and nutrition, and to identify the reported strengths, limitations and reliability of FBS.

Data sources: PubMed, SCOPUS, EMBASE, Food Science and Technology Abstracts (FSTA) and Google Scholar.

Data extraction: Data extracted were author, year of publication, country/countries of the study, aim, study design, analysis, data collected, data sources and outcomes. Additional relevant information (e.g. strengths and limitations of the FBS), were also included. The bibliographies of all included studies were further searched, and any potentially relevant studies retrieved and assessed.

Data analysis: 119 eligible studies (all study designs) published from the earliest available to the end of April, 2016 were collated into five categories of use: within-country analysis of food availability, nutrient availability and/or dietary trends (n = 17); inter-country, regional or global comparison of food groups, nutrient availability and/or dietary trends (n = 45); comparison of FBS with other national sources of dietary data (n = 7); association between FBS dietary factors and mortality or health outcomes (n = 45); and modelling studies (n = 5).

Conclusion: Studies indicate that FBS are useful for international comparison and analysis of trends over time, as they are standardized and updated regularly. FBS data are more reliable when averaged over several years; when results are reported as nutrient densities, trends, and percentage of energy or ratios, rather than absolute values. Also, users should be aware that the quality of FBS data depends on the reliability of national input data. The FBS is a vital source of global food composition data and is valuable for epidemiological studies when reported and analysed appropriately.

Keywords: Food Balance Sheet (FBS); Food and Agricultural Organization (FAO); Food disappearance data.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Databases, Factual*
  • Diet* / trends
  • Financial Statements
  • Food / statistics & numerical data*
  • Food Supply / statistics & numerical data*
  • Global Health*
  • Humans
  • Nutrients
  • Nutritional Status
  • Population Health
  • Reproducibility of Results
  • Research*