Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

GBD 2017 Diet Collaborators, Ashkan Afshin, Patrick John Sur, Kairsten A Fay, Leslie Cornaby, Giannina Ferrara, Joseph S Salama, Erin C Mullany, Kalkidan Hassen Abate, Cristiana Abbafati, Zegeye Abebe, Mohsen Afarideh, Anju Aggarwal, Sutapa Agrawal, Tomi Akinyemiju, Fares Alahdab, Umar Bacha, Victoria F Bachman, Hamid Badali, Alaa Badawi, Isabela M Bensenor, Eduardo Bernabe, Sibhatu Kassa K Biadgilign, Stan H Biryukov, Leah E Cahill, Juan J Carrero, Kelly M Cercy, Lalit Dandona, Rakhi Dandona, Anh Kim Dang, Meaza Girma Degefa, Maysaa El Sayed Zaki, Alireza Esteghamati, Sadaf Esteghamati, Jessica Fanzo, Carla Sofia E Sá Farinha, Maryam S Farvid, Farshad Farzadfar, Valery L Feigin, Joao C Fernandes, Luisa Sorio Flor, Nataliya A Foigt, Mohammad H Forouzanfar, Morsaleh Ganji, Johanna M Geleijnse, Richard F Gillum, Alessandra C Goulart, Giuseppe Grosso, Idris Guessous, Samer Hamidi, Graeme J Hankey, Sivadasanpillai Harikrishnan, Hamid Yimam Hassen, Simon I Hay, Chi Linh Hoang, Masako Horino, Nayu Ikeda, Farhad Islami, Maria D Jackson, Spencer L James, Lars Johansson, Jost B Jonas, Amir Kasaeian, Yousef Saleh Khader, Ibrahim A Khalil, Young-Ho Khang, Ruth W Kimokoti, Yoshihiro Kokubo, G Anil Kumar, Tea Lallukka, Alan D Lopez, Stefan Lorkowski, Paulo A Lotufo, Rafael Lozano, Reza Malekzadeh, Winfried März, Toni Meier, Yohannes A Melaku, Walter Mendoza, Gert B M Mensink, Renata Micha, Ted R Miller, Mojde Mirarefin, Viswanathan Mohan, Ali H Mokdad, Dariush Mozaffarian, Gabriele Nagel, Mohsen Naghavi, Cuong Tat Nguyen, Molly R Nixon, Kanyin L Ong, David M Pereira, Hossein Poustchi, Mostafa Qorbani, Rajesh Kumar Rai, Christian Razo-García, Colin D Rehm, Juan A Rivera, Sonia Rodríguez-Ramírez, Gholamreza Roshandel, Gregory A Roth, Juan Sanabria, Tania G Sánchez-Pimienta, Benn Sartorius, Josef Schmidhuber, Aletta Elisabeth Schutte, Sadaf G Sepanlou, Min-Jeong Shin, Reed J D Sorensen, Marco Springmann, Lucjan Szponar, Andrew L Thorne-Lyman, Amanda G Thrift, Mathilde Touvier, Bach Xuan Tran, Stefanos Tyrovolas, Kingsley Nnanna Ukwaja, Irfan Ullah, Olalekan A Uthman, Masoud Vaezghasemi, Tommi Juhani Vasankari, Stein Emil Vollset, Theo Vos, Giang Thu Vu, Linh Gia Vu, Elisabete Weiderpass, Andrea Werdecker, Tissa Wijeratne, Walter C Willett, Jason H Wu, Gelin Xu, Naohiro Yonemoto, Chuanhua Yu, Christopher J L Murray, GBD 2017 Diet Collaborators, Ashkan Afshin, Patrick John Sur, Kairsten A Fay, Leslie Cornaby, Giannina Ferrara, Joseph S Salama, Erin C Mullany, Kalkidan Hassen Abate, Cristiana Abbafati, Zegeye Abebe, Mohsen Afarideh, Anju Aggarwal, Sutapa Agrawal, Tomi Akinyemiju, Fares Alahdab, Umar Bacha, Victoria F Bachman, Hamid Badali, Alaa Badawi, Isabela M Bensenor, Eduardo Bernabe, Sibhatu Kassa K Biadgilign, Stan H Biryukov, Leah E Cahill, Juan J Carrero, Kelly M Cercy, Lalit Dandona, Rakhi Dandona, Anh Kim Dang, Meaza Girma Degefa, Maysaa El Sayed Zaki, Alireza Esteghamati, Sadaf Esteghamati, Jessica Fanzo, Carla Sofia E Sá Farinha, Maryam S Farvid, Farshad Farzadfar, Valery L Feigin, Joao C Fernandes, Luisa Sorio Flor, Nataliya A Foigt, Mohammad H Forouzanfar, Morsaleh Ganji, Johanna M Geleijnse, Richard F Gillum, Alessandra C Goulart, Giuseppe Grosso, Idris Guessous, Samer Hamidi, Graeme J Hankey, Sivadasanpillai Harikrishnan, Hamid Yimam Hassen, Simon I Hay, Chi Linh Hoang, Masako Horino, Nayu Ikeda, Farhad Islami, Maria D Jackson, Spencer L James, Lars Johansson, Jost B Jonas, Amir Kasaeian, Yousef Saleh Khader, Ibrahim A Khalil, Young-Ho Khang, Ruth W Kimokoti, Yoshihiro Kokubo, G Anil Kumar, Tea Lallukka, Alan D Lopez, Stefan Lorkowski, Paulo A Lotufo, Rafael Lozano, Reza Malekzadeh, Winfried März, Toni Meier, Yohannes A Melaku, Walter Mendoza, Gert B M Mensink, Renata Micha, Ted R Miller, Mojde Mirarefin, Viswanathan Mohan, Ali H Mokdad, Dariush Mozaffarian, Gabriele Nagel, Mohsen Naghavi, Cuong Tat Nguyen, Molly R Nixon, Kanyin L Ong, David M Pereira, Hossein Poustchi, Mostafa Qorbani, Rajesh Kumar Rai, Christian Razo-García, Colin D Rehm, Juan A Rivera, Sonia Rodríguez-Ramírez, Gholamreza Roshandel, Gregory A Roth, Juan Sanabria, Tania G Sánchez-Pimienta, Benn Sartorius, Josef Schmidhuber, Aletta Elisabeth Schutte, Sadaf G Sepanlou, Min-Jeong Shin, Reed J D Sorensen, Marco Springmann, Lucjan Szponar, Andrew L Thorne-Lyman, Amanda G Thrift, Mathilde Touvier, Bach Xuan Tran, Stefanos Tyrovolas, Kingsley Nnanna Ukwaja, Irfan Ullah, Olalekan A Uthman, Masoud Vaezghasemi, Tommi Juhani Vasankari, Stein Emil Vollset, Theo Vos, Giang Thu Vu, Linh Gia Vu, Elisabete Weiderpass, Andrea Werdecker, Tissa Wijeratne, Walter C Willett, Jason H Wu, Gelin Xu, Naohiro Yonemoto, Chuanhua Yu, Christopher J L Murray

Abstract

Background: Suboptimal diet is an important preventable risk factor for non-communicable diseases (NCDs); however, its impact on the burden of NCDs has not been systematically evaluated. This study aimed to evaluate the consumption of major foods and nutrients across 195 countries and to quantify the impact of their suboptimal intake on NCD mortality and morbidity.

Methods: By use of a comparative risk assessment approach, we estimated the proportion of disease-specific burden attributable to each dietary risk factor (also referred to as population attributable fraction) among adults aged 25 years or older. The main inputs to this analysis included the intake of each dietary factor, the effect size of the dietary factor on disease endpoint, and the level of intake associated with the lowest risk of mortality. Then, by use of disease-specific population attributable fractions, mortality, and disability-adjusted life-years (DALYs), we calculated the number of deaths and DALYs attributable to diet for each disease outcome.

Findings: In 2017, 11 million (95% uncertainty interval [UI] 10-12) deaths and 255 million (234-274) DALYs were attributable to dietary risk factors. High intake of sodium (3 million [1-5] deaths and 70 million [34-118] DALYs), low intake of whole grains (3 million [2-4] deaths and 82 million [59-109] DALYs), and low intake of fruits (2 million [1-4] deaths and 65 million [41-92] DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries. Dietary data were from mixed sources and were not available for all countries, increasing the statistical uncertainty of our estimates.

Interpretation: This study provides a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations. Our findings will inform implementation of evidence-based dietary interventions and provide a platform for evaluation of their impact on human health annually.

Funding: Bill & Melinda Gates Foundation.

Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Age-standardised intake of dietary factors among adults aged 25 years or older at the global and regional level in 2017
Figure 2
Figure 2
Age-standardised mortality rate per 100 000 population (A) and DALY rate per 100 000 population (B) attributable to diet in 2017 ATG=Antigua and Barbuda. Isl=Islands. FSM=Federated States of Micronesia. LCA=Saint Lucia. TLS=Timor-Leste. TTO=Trinidad and Tobago. VCT=Saint Vincent and the Grenadines.
Figure 3
Figure 3
Number of deaths and DALYs and age-standardised mortality rate and DALY rate (per 100 000 population) attributable to individual dietary risks at the global and SDI level in 2017 DALY=disability-adjusted life-year. SDI=Socio-demographic Index.
Figure 4
Figure 4
Age-standardised proportions of deaths and DALYs attributable to individual dietary risks at the global and regional level in 2017 DALYs=disability-adjusted life-years.

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