Understand the Global Burden of Disease Study on the Health Risks of Diet in Under 5 Minutes

An English Proverb gets credit for the phrase “Don’t dig your grave with your knive and fork”. Is this possible? Do diet choices really influence the risk of death? We need to turn to new data from the Global Burden of Disease (GBD) study to evaluate this question. But what is the GBD?

Global Burden of Disease

The Global Burden of Disease (GBD) endeavors to measure disability and death from a multitude of causes worldwide. It has grown over the past two decades years into an international consortium of more than 3,600 researchers, and its estimates are being updated annually. The GBD enterprise dates to the early 1990s, when the World Bank commissioned the original GBD study and featured it in the landmark World Development Report 1993. The GBD 1990 study had a profound impact on health policy and agenda-setting throughout the world.

The next comprehensive GBD update, the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010). Funded by the Bill & Melinda Gates Foundation, GBD 2010 significantly broadened the scope of previous versions of GBD.

The New GBD Study of Dietary Factors

The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 collected data among adults aged 25 years or older across 195 countries to estimate the effect of individual dietary factor on mortality and quality of life. There were 15 dietary risk factor that met GBD selection criteria for risk factors. Data on disease-specific deaths and disability-adjusted life-years (DALYs) by age, sex, country, and year were obtained from GBD 2017.

Results of GBD 2017

Globally, consumption of nearly all healthy foods and nutrients was suboptimal in 2017. The largest gaps between current and optimal intake were observed for nuts and seeds, and whole grains. The consumption of sugar-sweetened beverages was far higher than the optimal intake. Similarly, global consumption of processed meat was 90% greater than the optimal amount and sodium intake was far above the optimal levels. The global intake of red meat was 18% greater than the optimal intake.

At the regional level, in 2017, the intake of all healthy foods was lower than the optimal level in all 21 GBD regions. The only exceptions were the intake of vegetables in central Asia, seafood omega-3 fatty acids in high-income Asia Pacific, and legumes in the Caribbean, tropical Latin America, south Asia, western sub-Saharan Africa, and eastern sub-Saharan Africa.

Among unhealthy food groups, consumption of sodium and sugar-sweetened beverages were higher than the optimal level in nearly every region. Red meat consumption was highest in Australasia, southern Latin America, and tropical Latin America. High-income North America had the highest processed meat intake followed by high-income Asia Pacific and western Europe. The highest intake of trans fats was observed in high-income North America, central Latin America, and Andean Latin America.

In 2017, more than half of diet-related deaths and two-thirds of diet-related DALYs were attributable to high intake of sodium, low intake of whole grains and low intake of fruits. Low intake of whole grains was the leading dietary risk factor for DALYs among men and women and the leading dietary risk factor for mortality among women. The graph below shows on the right that the top 5 causes of death in the GBD study were excess sodium and inadequate plant food intake.

An appendix to the GBD study indicated which countries had the highest rates of adherence to the 15 predictors of death and DALY. Israel had the world’s healthiest diet, or turned around, the world’s least unhealthy diet. The countries with the lowest rates of diet-related deaths were Israel (89 deaths per 100,000 people), France, Spain, Japan, and Andorra.The UK ranked 23rd (127 deaths per 100,000) above Ireland (24th) and Sweden (25th), and the US ranked 43rd (171 deaths per 100,000) after Rwanda and Nigeria (41st and 42nd), China ranked 140th (350 deaths per 100,000 people), and India 118th (310 deaths per 100,000 people). The countries with the highest rates of diet-related deaths were Uzbekistan (892 deaths per 100,000 people), Afghanistan, Marshall Islands, Papua New Guinea, and Vanuatu.

Implications

What do all these figures and numbers mean? The GBD study indicated that 11 million deaths could have been avoided in 2017 by better dietary choices emphasizing less salt and more whole grains, fruits, vegetables, nuts and seeds. Most of those, around 10 million, were from cardiovascular disease. . The next biggest diet-related killers were cancer, with 913,000 deaths, and Type 2 diabetes, which claimed 339,000 lives. While it may take a while to implement policies to change global food habits, you can start today by passing on the salt shaker and piling your plate high with fruits, whole grains, nuts, seeds, and vegetables. Just like Mom probably told you to do.