Agroecological Integration in National Dietary Guidelines Is Not Explained by National Income: A Comparative Analysis of 15 Countries

<title>Abstract</title> <p>Background National dietary guidelines are meant to translate nutrition science into public health practice, but they rarely address how food is produced. Whether this gap is driven by a country's economic resources or by how guideline development is institutionally organised remains unclear. Methods Fifteen countries spanning three World Bank income tiers (five low-and-middle-income, three middle-income, seven high-income) were sampled. Official dietary guideline documents and their technical annexes were scored across seven domains, ranging from sustainability and soil health to public procurement and intersectoral collaboration, using a three-point ordinal scale (0 = no mention, 1 = conceptual, 2 = actionable). Two coders scored all documents independently; a third coder adjudicated disagreements. Reliability was assessed with Cohen's kappa. Group differences by income tier were tested using an exact permutation Kruskal-Wallis test with post-hoc pairwise comparisons. Hierarchical clustering identified structural typologies. Reporting followed the Standards for Reporting Qualitative Research (SRQR). Results Coders agreed on 102 of 105 scoring decisions (kappa = 0.953). Cumulative scores ranged from 1 (Guatemala) to 12 (Chile) out of a possible 14. Income tier showed no association with cumulative score (chi-square = 0.457, p = 0.811, epsilon-squared = 0.033); all pairwise comparisons were non-significant. Clustering identified three groups: a Multi-Sectoral Pragmatist cluster (n = 7) spanning all income tiers, an Institutional/Procurement-Isolated cluster (n = 6) composed mainly of high-income countries with narrow, consumer-facing mandates, and a two-country Planetary Health cluster (Chile, Brazil) with the highest and most consistently actionable scores. Three coded entries, in Chile and Brazil, referenced regenerative-specific agricultural mechanisms rather than general sustainability language. Conclusions In this sample, upstream agricultural and ecological content in dietary guidelines was unrelated to national income. Several lower-income countries scored as high as, or higher than, wealthier nations, and the strongest performers combined explicit institutional mandates with production-linked content. This suggests that governance design, rather than fiscal capacity, is the more relevant lever for future guideline reform, though the small sample means these findings should be confirmed in larger studies before broad policy application.</p>