People in almost every region of the world could benefit
from rebalancing their diets to eat optimal amounts of various foods and
nutrients, according to the Global Burden of Disease study tracking trends in
consumption of 15 dietary factors from 1990 to 2017 in 195 countries, published
in The Lancet.
The study estimates that one in five deaths globally —
equivalent to 11 million deaths — are associated with poor diet, and diet
contributes to a range of chronic diseases in people around the world. In 2017,
more deaths were caused by diets with too low amounts of foods such as whole
grains, fruit, nuts and seeds than by diets with high levels of foods like
trans fats, sugary drinks, and high levels of red and processed meats.
The authors say that their findings highlight the urgent
need for coordinated global efforts to improve diet, through collaboration with
various sections of the food system and policies that drive balanced diets.
“This study affirms what many have thought for several
years — that poor diet is responsible for more deaths than any other risk
factor in the world,” says study author Dr Christopher Murray, Director of
the Institute for Health Metrics and Evaluation, University of Washington, USA.
“While sodium, sugar, and fat have been the focus of policy debates over
the past two decades, our assessment suggests the leading dietary risk factors
are high intake of sodium, or low intake of healthy foods, such as whole
grains, fruit, nuts and seeds, and vegetables. The paper also highlights the
need for comprehensive interventions to promote the production, distribution,
and consumption of healthy foods across all nations.”
The study evaluated the consumption of major foods and
nutrients across 195 countries and quantified the impact of poor diets on death
and disease from non-communicable diseases (specifically cancers,
cardiovascular diseases, and diabetes). It tracked trends between 1990 and
The study looked at 15 dietary elements — diets low in
fruits, vegetables, legumes, whole grains, nuts and seeds, milk, fibre,
calcium, seafood omega-3 fatty acids, polyunsaturated fats, and diets high in
red meat, processed meat, sugar-sweetened beverages, trans fatty acids, and
sodium. The authors note that there were varying levels of data available for
each dietary factor, which increases the statistical uncertainty of these
estimates — for example, while data on how many people ate most dietary
factors was available for almost all countries (95%), data for the sodium
estimates was only available for around one in four countries.
Overall in 2017, an estimated 11 million deaths were
attributable to poor diet. Diets high in sodium, low in whole grains, and low
in fruit together accounted for more than half of all diet-related deaths
globally in 2017.
The causes of these deaths included 10 million deaths from
cardiovascular disease, 913 000 cancer deaths, and almost 339 000 deaths from
type 2 diabetes. Deaths related to diet have increased from 8 million in 1990,
largely due to increases in the population and population aging.
Global trends in
The authors found that intakes of all 15 dietary elements
were suboptimal for almost every region of the world — no region ate the
optimal amount of all 15 dietary factors, and not one dietary factor was eaten
in the right amounts by all 21 regions of the world.
Some regions did manage to eat some dietary elements in the
right amounts. For example, intake of vegetables was optimal in central Asia,
as was seafood omega-3 fatty acids intake in high-income Asia Pacific, and
legume intake in the Caribbean, tropical Latin America, south Asia, western
sub-Saharan Africa, and eastern sub-Saharan Africa.
The largest shortfalls in optimal intake were seen for nuts
and seeds, milk, whole grains, and the largest excesses were seen for sugar
sweetened beverages, processed meat and sodium. On average, the world only ate
12% of the recommended amount of nuts and seeds (around 3g average intake per
day, compared with 21g recommended per day), and drank around ten times the
recommended amount of sugar sweetened beverages (49g average intake, compared
with 3g recommended).
In addition, the global diet included 16% of the recommended
amount of milk (71g average intake per day, compared with 435g recommended per
day), about a quarter (23%) of the recommended amount of whole grains (29g
average intake per day, compared with 125g recommended per day), almost double
(90% more) the recommended range of processed meat (around 4g average intake
per day, compared with 2g recommended per day), and 86% more sodium (around 6g
average intake per day, compared with 24 h urinary sodium 3g per day).
The magnitude of diet-related disease highlights that many
existing campaigns have not been effective and the authors call for new food
system interventions to rebalance diets around the world. Importantly, they
note that changes must be sensitive to the environmental effects of the global
food system to avoid adverse effects on climate change, biodiversity loss, land
degradation, depleting freshwater, and soil degradation.
In January 2019, The Lancet published the
EAT-Lancet Commission, which provides the first scientific targets for a
healthy diet from a sustainable food production system that operates within
planetary boundaries for food. This report used 2016 data from the Global
Burden of Disease study to estimate how far the world is from the healthy diet