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Health Effects of Dietary Risks in 195 Countries, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017 Publisher Pubmed



Afshin A1, 2 ; Sur PJ2, 7 ; Fay KA2 ; Cornaby L2 ; Ferrara G2 ; Salama JS2 ; Mullany EC2 ; Abate KH8 ; Abbafati C9 ; Abebe Z10 ; Afarideh M12 ; Aggarwal A3 ; Agrawal S18, 34 ; Akinyemiju T19 Show All Authors
Authors
  1. Afshin A1, 2
  2. Sur PJ2, 7
  3. Fay KA2
  4. Cornaby L2
  5. Ferrara G2
  6. Salama JS2
  7. Mullany EC2
  8. Abate KH8
  9. Abbafati C9
  10. Abebe Z10
  11. Afarideh M12
  12. Aggarwal A3
  13. Agrawal S18, 34
  14. Akinyemiju T19
  15. Alahdab F20
  16. Bacha U21
  17. Bachman VF4
  18. Badali H22
  19. Badawi A23, 24
  20. Bensenor IM25
  21. Bernabe E28
  22. Biryukov SH2
  23. Biadgilign SKK29
  24. Cahill LE30, 31
  25. Carrero JJ33
  26. Cercy KM2
  27. Dandona L2, 34
  28. Dandona R2
  29. Dang AK35
  30. Degefa MG36
  31. El Sayed Zaki M37
  32. Esteghamati A12
  33. Esteghamati S13
  34. Fanzo J38, 41
  35. Farinha CSES40
  36. Farvid MS31
  37. Farzadfar F14
  38. Feigin VL2, 43
  39. Fernandes JC44
  40. Flor LS45, 46
  41. Foigt NA47
  42. Forouzanfar MH2
  43. Ganji M12
  44. Geleijnse JM48
  45. Gillum RF49
  46. Goulart AC25, 27
  47. Grosso G50
  48. Guessous I51, 52
  49. Hamidi S53
  50. Hankey GJ54, 55
  51. Harikrishnan S56
  52. Hassen HY57, 58
  53. Hay SI1, 2
  54. Hoang CL59
  55. Horino M60
  56. Ikeda N61
  57. Islami F62
  58. Jackson MD63
  59. James SL2
  60. Johansson L64
  61. Jonas JB65, 67
  62. Kasaeian A15, 17
  63. Khader YS68
  64. Khalil IA1, 2
  65. Khang YH69
  66. Kimokoti RW70
  67. Kokubo Y71
  68. Kumar GA34
  69. Lallukka T72, 73
  70. Lopez AD2, 75
  71. Lorkowski S76, 78
  72. Lotufo PA26
  73. Lozano R2
  74. Malekzadeh R16, 79
  75. Marz W66, 80
  76. Meier T77, 81
  77. Melaku YA11, 82
  78. Mendoza W83
  79. Mensink GBM84
  80. Micha R85
  81. Miller TR86, 87
  82. Mirarefin M60
  83. Mohan V88
  84. Mokdad AH1, 2
  85. Mozaffarian D85
  86. Nagel G89
  87. Naghavi M1, 2
  88. Nguyen CT35
  89. Nixon MR2
  90. Ong KL2
  91. Pereira DM90, 91
  92. Poustchi H16
  93. Qorbani M92
  94. Rai RK93, 94
  95. Razogarcia C95
  96. Rehm CD98
  97. Rivera JA96
  98. Rodriguezramirez S96
  99. Roshandel G16, 99
  100. Roth GA2, 5
  101. Sanabria J100, 101
  102. Sanchezpimienta TG97
  103. Sartorius B102
  104. Schmidhuber J42
  105. Schutte AE103, 104
  106. Sepanlou SG16, 79
  107. Shin MJ105
  108. Sorensen RJD2, 6
  109. Springmann M106
  110. Szponar L107
  111. Thornelyman AL32, 39
  112. Thrift AG108
  113. Touvier M109
  114. Tran BX110
  115. Tyrovolas S111, 112
  116. Ukwaja KN113
  117. Ullah I114, 115
  118. Uthman OA116
  119. Vaezghasemi M117
  120. Vasankari TJ118
  121. Vollset SE1, 2
  122. Vos T1, 2
  123. Vu GT59
  124. Vu LG59
  125. Weiderpass E33, 119
  126. Werdecker A120, 121
  127. Wijeratne T74, 122
  128. Willett WC31, 123
  129. Wu JH124
  130. Xu G125
  131. Yonemoto N126
  132. Yu C127
  133. Murray CJL1, 2
Show Affiliations
Authors Affiliations
  1. 1. Department of Health Metrics Sciences, University of Washington, Seattle, WA, United States
  2. 2. Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
  3. 3. Department of Epidemiology, University of Washington, Seattle, WA, United States
  4. 4. School of Medicine, University of Washington, Seattle, WA, United States
  5. 5. Division of Cardiology, University of Washington, Seattle, WA, United States
  6. 6. Department of Global Health, University of Washington, Seattle, WA, United States
  7. 7. School of Medicine, University of California Riverside, Riverside, CA, United States
  8. 8. Department of Population and Family Health, Jimma University, Jimma, Ethiopia
  9. 9. Department of Law, Philosophy and Economic Studies, La Sapienza University, Rome, Italy
  10. 10. Human Nutrition Department, University of Gondar, Gondar, Ethiopia
  11. 11. Institute of Public Health, University of Gondar, Gondar, Ethiopia
  12. 12. Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
  13. 13. Endocrine Research Center, Tehran University of Medical Sciences, Tehran, Iran
  14. 14. Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
  15. 15. Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
  16. 16. Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  17. 17. Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  18. 18. Vital Strategies, Gurugram, India
  19. 19. Department of Epidemiology, University of Kentucky, Lexington, KY, United States
  20. 20. Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, United States
  21. 21. School of Health Sciences, University of Management and Technology, Lahore, Pakistan
  22. 22. Department of Medical Mycology, Mazandaran University of Medical Sciences, Sari, Iran
  23. 23. Public Health Risk Sciences Division, Public Health Agency of Canada, Toronto, ON, Canada
  24. 24. Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
  25. 25. Department of Internal Medicine, University of Sao Paulo, Sao Paulo, Brazil
  26. 26. Department of Medicine, University of Sao Paulo, Sao Paulo, Brazil
  27. 27. Center for Clinical and Epidemiological Research, University of Sao Paulo, Sao Paulo, Brazil
  28. 28. Dental Institute, King’s College London, London, United Kingdom
  29. 29. Addis Ababa, Ethiopia
  30. 30. Department of Medicine, Dalhousie University, Halifax, NS, Canada
  31. 31. Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
  32. 32. T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
  33. 33. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  34. 34. Public Health Foundation of India, Gurugram, India
  35. 35. Institute for Global Health Innovations, Duy Tan University, Hanoi, Viet Nam
  36. 36. Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
  37. 37. Department of Clinical Pathology, Mansoura University, Mansoura, Egypt
  38. 38. Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, United States
  39. 39. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
  40. 40. National Statistical Office, Lisbon, Portugal
  41. 41. Nutrition and Food Systems Division, Food and Agriculture Organization of the United Nations, Rome, Italy
  42. 42. Trade and Markets Division, Food and Agriculture Organization of the United Nations, Rome, Italy
  43. 43. National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
  44. 44. Center for Biotechnology and Fine Chemistry, Catholic University of Portugal, Porto, Portugal
  45. 45. Sergio Arouca National School of Public Health, Rio De Janeiro, Brazil
  46. 46. Federal University of Espirito Santo, Vitoria, Brazil
  47. 47. Institute of Gerontology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
  48. 48. Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
  49. 49. Department of Community and Family Medicine, Division of General Internal Medicine, Howard University, Washington, DC, United States
  50. 50. Registro Tumori Integrato, Vittorio Emanuele University Hospital Polyclinic, Catania, Italy
  51. 51. Unit of Population Epidemiology, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
  52. 52. Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
  53. 53. School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
  54. 54. School of Medicine, University of Western Australia, Perth, WA, Australia
  55. 55. Neurology Department, Sir Charles Gairdner Hospital, Perth, WA, Australia
  56. 56. Cardiology Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
  57. 57. Public Health Department, Mizan-Tepi University, Teppi, Ethiopia
  58. 58. Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Wilrijk, Belgium
  59. 59. Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Viet Nam
  60. 60. Nevada Division of Public and Behavioral Health, Carson City, NV, United States
  61. 61. Section of Population Health Metrics, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
  62. 62. Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
  63. 63. Department of Community Health and Psychiatry, University of the West Indies, Mona, Jamaica
  64. 64. Eiksmarka, Norway
  65. 65. Department of Ophthalmology, Heidelberg University, Mannheim, Germany
  66. 66. Medical Clinic V, Heidelberg University, Mannheim, Germany
  67. 67. Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China
  68. 68. Department of Public Health and Community Medicine, Jordan University of Science and Technology, Ramtha, Jordan
  69. 69. Institute of Health Policy and Management, Department of Health Policy and Management, Seoul National University, Seoul, South Korea
  70. 70. Department of Nutrition, Simmons College, Boston, MA, United States
  71. 71. Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
  72. 72. Population and Work Ability Program, Finnish Institute of Occupational Health, Helsinki, Finland
  73. 73. Department of Public Health, University of Helsinki, Helsinki, Finland
  74. 74. Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
  75. 75. University of Melbourne, Melbourne, VIC, Australia
  76. 76. Institute of Nutrition, Friedrich Schiller University Jena, Jena, Germany
  77. 77. Innovation Office, Jena, Germany
  78. 78. Competence Cluster for Nutrition and Cardiovascular Health (NUTRICARD), Jena, Germany
  79. 79. Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  80. 80. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
  81. 81. Institute for Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
  82. 82. Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
  83. 83. Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru
  84. 84. Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
  85. 85. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
  86. 86. Pacific Institute for Research and Evaluation, Calverton, MD, United States
  87. 87. School of Public Health, Curtin University, Perth, WA, Australia
  88. 88. Department of Diabetology, Madras Diabetes Research Foundation, Chennai, India
  89. 89. Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
  90. 90. REQUIMTE/LAQV, University of Porto, Oporto, Portugal
  91. 91. Cartagena University, Cartagena, Colombia
  92. 92. Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
  93. 93. Society for Health and Demographic Surveillance, Suri, India
  94. 94. Department of Economics, University of Goettingen, Gottingen, Germany
  95. 95. Center for Population Health Research, Cuernavaca, Mexico
  96. 96. Center for Nutrition and Health Research, Cuernavaca, Mexico
  97. 97. National Institute of Public Health, Cuernavaca, Mexico
  98. 98. Department of Epidemiology & Population Health, Montefiore Medical Center, Bronx, NY, United States
  99. 99. Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
  100. 100. Department of Surgery, Marshall University, Huntington, WV, United States
  101. 101. Department of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, OH, United States
  102. 102. Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa
  103. 103. Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
  104. 104. Unit for Hypertension and Cardiovascular Disease, South African Medical Research Council, Cape Town, South Africa
  105. 105. Korea University, Seoul, South Korea
  106. 106. Oxford Martin Programme on the Future of Food, Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
  107. 107. National Food and Nutrition Institute, Warsaw, Poland
  108. 108. Monash University, Melbourne, VIC, Australia
  109. 109. Nutritional Epidemiology Research Team, National Institute of Health and Medical Research, Paris, France
  110. 110. Department of Health Economics, Hanoi Medical University, Hanoi, Viet Nam
  111. 111. Research and Development Unit, San Juan de Dios Sanitary Park, Sant Boi De Llobregat, Spain
  112. 112. Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain
  113. 113. Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
  114. 114. Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan
  115. 115. TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
  116. 116. Division of Health Sciences, University of Warwick, Coventry, United Kingdom
  117. 117. Department of Social Work, Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
  118. 118. UKK Institute, Tampere, Finland
  119. 119. Department of Research, Cancer Registry of Norway, Oslo, Norway
  120. 120. Demographic Change and Ageing Research Area, Federal Institute for Population Research, Wiesbaden, Germany
  121. 121. Staufenberg, Germany
  122. 122. Department of Psychology, La Trobe University, Melbourne, VIC, Australia
  123. 123. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
  124. 124. The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
  125. 125. School of Medicine, Nanjing University, Nanjing, China
  126. 126. Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
  127. 127. Global Health Institute, Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China

Source: The Lancet Published:2019


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