The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis

Ashkan Afshin, Renata Micha, Shahab Khatibzadeh, Saman Fahimi, Peilin Shi, John Powles, Gitanjali Singh, Mohammad Yawar Yakoob, Morteza Abdollahi, Suad Al-Hooti, Farshad Farzadfar, Anahita Houshiar-Rad, Nahla Hwalla, Eda Koksal, Abdulrahman Musaiger, Gulden Pekcan, Abla Mehio Sibai, Sahar Zaghloul, Goodarz Danaei, Majid Ezzati, Dariush Mozaffarian, 2010 Global Burden of Diseases, Injuries, and Risk Factors Study: NUTRItrition and ChrOnic Diseases Expert Group (NUTRICODE), and Metabolic Risk Factors of ChrOnic Diseases Collaborating Group, Ashkan Afshin, Renata Micha, Shahab Khatibzadeh, Saman Fahimi, Peilin Shi, John Powles, Gitanjali Singh, Mohammad Yawar Yakoob, Morteza Abdollahi, Suad Al-Hooti, Farshad Farzadfar, Anahita Houshiar-Rad, Nahla Hwalla, Eda Koksal, Abdulrahman Musaiger, Gulden Pekcan, Abla Mehio Sibai, Sahar Zaghloul, Goodarz Danaei, Majid Ezzati, Dariush Mozaffarian, 2010 Global Burden of Diseases, Injuries, and Risk Factors Study: NUTRItrition and ChrOnic Diseases Expert Group (NUTRICODE), and Metabolic Risk Factors of ChrOnic Diseases Collaborating Group

Abstract

Objective/design: We conducted a comparative risk assessment analysis to estimate the cardiometabolic disease (CMD) mortality attributable to 11 dietary and 4 metabolic risk factors in 20 countries of the Middle East by age, sex and time. The national exposure distributions were obtained from a systematic search of multiple databases. Missing exposure data were estimated using a multilevel Bayesian hierarchical model. The aetiological effect of each risk factor on disease-specific mortality was obtained from clinical trials and observational studies. The number of disease-specific deaths was obtained from the 2010 Global Burden of Disease mortality database. Mortality due to each risk factor was determined using the population attributable fraction and total number of disease-specific deaths.

Setting/population: Adult population in the Middle East by age, sex, country and time.

Results: Suboptimal diet was the leading risk factor for CMD mortality in 11 countries accounting for 48% (in Morocco) to 72% (in the United Arab Emirates) of CMD deaths. Non-optimal systolic blood pressure was the leading risk factor for CMD deaths in eight countries causing 45% (in Bahrain) to 68% (in Libya) of CMD deaths. Non-optimal body mass index and fasting plasma glucose were the third and fourth leading risk factors for CMD mortality in most countries. Among individual dietary factors, low intake of fruits accounted for 8% (in Jordan) to 21% (in Palestine) of CMD deaths and low intake of whole grains was responsible for 7% (in Palestine) to 22% (in the United Arab Emirates) of CMD deaths. Between 1990 and 2010, the CMD mortality attributable to most risk factors had decreased except for body mass index and trans-fatty acids.

Conclusions: Our findings highlight key similarities and differences in the impact of the dietary and metabolic risk factors on CMD mortality in the countries of the Middle East and inform priorities for policy measures to prevent CMD.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
National levels of metabolic risk factors (A) and national intakes of protective (B) and harmful (C) dietary factors in the Middle East and North Africa, by country (2010). Red line represents the optimal level.
Figure 1
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Figure 1
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Figure 2
Figure 2
Cardiometabolic deaths attributable to dietary and metabolic risk factors in the Middle East and North Africa among (A) men, (B) women, (C) total adult population (2010). Other cardiovascular diseases (CVDs) include hypertensive heart disease, aortic aneurysm, rheumatic heart disease, inflammatory heart disease, other unspecified CVDs.

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