Two weeks ago, I wrote an article on the most comprehensive wide-ranging in-depth study on alcohol consumption and recommended alcohol intake ever published. This week I am outlining a similar huge ground breaking study that looked at global diet. The Institute of Health Metrics and Evaluation (IHME) is not a combination of words, or a title, that really perks my interest or inspires me and, I am sure, you could say the same. Would you be a bit more interested if I told you that IHME has just published a huge global study that determines that one in five deaths in the world are preventable. Beyond its sobering conclusion, this study was notable for what it prescribed. Rather than browbeating us to reduce consumption of both fats and sugars, the authors determined that adding healthier foods to global diets was a more effective way to reduce mortality. The study answered key questions such as, is there such a thing as an optimal diet? What is sub-optimal? Which dietary components matter most? And given the necessity to act on climate change and planetary health, what should the world eat? These issues really do deserve our attention!
Everyone, all over the world, deserves to live a long life in full health. In order to achieve this goal, we need a comprehensive picture of what disables and kills people across countries, time, age, and sex and this is what IHME does. You might also be interested in obtaining information like this if you were the Minister of Health and Social Care ( Rt Hon Matt Hancock MP) or if you worked within his department. Information provided by IHME helps policy makers in the both UK and internationally to determine the health status of their population. Their most recent study has just been published in the medical journal The Lancet on April 3rd. It is called the Global Burden of Disease Study (or GBP). The GBD study provides a tool to quantify health loss from hundreds of diseases, injuries, and risk factors, so that health systems all over the world can be improved and disparities can be eliminated.
IHME was launched in 2007 in Seattle in the US, primarily based on huge grant of $105 million largely funded by the Bill & Melinda Gates Foundation. The Gates Foundation also provided them with another grant of $279 million in 2017…deep pockets indeed! The GBD studies collect and analyse data using more 3,600 researchers in more than 145 countries. Their data captures information regarding premature death and disability from more than 350 different diseases in 195 countries from 1990 to the present day. This information allows comparisons of time, across age groups, and among populations. GBD research incorporates both the prevalence of a given disease or risk factor and the relative harm it causes. This knowledge is really the health equivalent of gross domestic product (GDP) data that we use to monitor our economic status. Policy makes in the UK and many other countries collaborate with GDP researchers to help monitor our health. For instance, much of the data included in articles I have already written on nutritional issues, such as red and cured meat consumption, would have originated from IHME. So, what did this very latest study, published in the Lancet, tells us about our health and why should we be interested in it?
The conclusions from the study suggested that unhealthy diets are responsible for 11 million preventable deaths globally per year, this is even more even than smoking tobacco. To date the Global Burden of Disease Study is the most authoritative assessment of mortality rates in every country in the world. Of these 11 million preventable deaths caused by poor diet, around 10 million were from cardiovascular disease, 913,000 deaths from cancer, and 339,000 from Type 2 diabetes. Dr Francesco Branca a senior nutritionist at the World Health Organisation went on record as saying, “These numbers are really striking. This should be a wake-up call for the world.” The biggest issue it would seem is not the junk food and cheap calories we eat, but the nutritious food we don’t eat. The study called for a global shift in policy to promote vegetables, fruit, nuts and legumes. The researchers themselves in the study stated, “Our findings show that sub-optimal diet is responsible for more deaths than any other risks globally, including tobacco smoking, highlighting the urgent need for improving human diet across nations,”
The study found that although diets vary from one country to another, eating too few fruits and vegetables and too much sodium (salt) accounted for half of all deaths. Overall the researchers looked at a total of 15 different nutrients, some beneficial for our health, and some not quite so good. After processing the data, the principle risk factors appeared to be eating not only too much salt, but too few whole grains, fruit, nuts and seeds, vegetables and omega-3 fatty acids from seafood. So, when your Mum said ‘you can’t have any pudding until you eat your greens’ she was right! Other risk factors in the study that were also considered were consuming high levels of red and processed meat and sugary drinks, low milk consumption and low fibre.
Israel had the lowest rate of diet-related deaths, at 89 per 100,000 people, followed by France, Spain and Japan. The UK ranked 23rd, with 127 diet-related deaths per 100,000 and the US was 43rd with 171. Uzbekistan was last, with 892 (due to excess salt intake!). Overall most countries that had a mainly Mediterranean diet appeared to have a lower diet related mortality rate. Nevertheless, the lead author Dr Ashkan Afshin commented that “no country has an optimal level of consumption of all the health foods. Even in countries that have a Mediterranean diet, the current intake of many other dietary factors is not optimal.”
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 intake 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).
Regionally, high sodium intake (above 3g per day) was the leading dietary risk for death and disease in China, Japan, and Thailand. Low intake of whole grains (below 125g per day) was the leading dietary risk factor for death and disease in the USA, India, Brazil, Pakistan, Nigeria, Russia, Egypt, Germany, Iran, and Turkey. In Bangladesh, low intake of fruits (below 250g per day) was the leading dietary risk, and, in Mexico, low intake of nuts and seeds (below 21g per day) ranked first. High consumption of red meat (above 23g per day), processed meat (above 2g per day), trans fat (above 0.5% total daily energy), and sugar-sweetened beverages (above 3g per day) were towards the bottom in ranking of dietary risks for death and disease for highly populated countries.
Too much salt obviously raises our blood pressure and that in turn raises the risk of heart attacks and strokes. Salt can have a direct effect on the heart and blood vessels, increasing our predisposition to heart failure which is clearly why cardiovascular disease features so prominently. China it appears consumes enormous amounts of salt with soy and other salty sauces being a key part of the country’s cuisine. But the rising popularity of processed foods is introducing yet more salt to their diet. It has the highest death rate related to salt intake of any country. Whole grains, fruit and vegetables have the opposite effect – they are cardioprotective and lower the risk of heart problems. This explains why countries with a Mediterranean based diet probably fair a little better. Prof Walter Willett from Harvard University, another co-author of the study, said that all these findings were consistent with a recently published analysis of the benefits for cardiovascular health of replacing red meat with plant sources of protein. “Adoption of diets emphasising soy foods, beans and other healthy plant sources of protein will have important benefits for both human and planetary health,” he said. Over the next couple of weeks, I will be writing a couple of articles on the some of the key 15 nutrients that were the focus of this study to give you more information.
- GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.The Lancet, April 3, 2019; DOI:10.1016/S0140-6736(19)30041-8
- Nita G Forouhi, Nigel Unwin. Global diet and health: old questions, fresh evidence, and new horizons. The Lancet, April 3, 2019; DOI:10.1016/S0140-6736(19)30500-8