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Which risk factor is responsible for more deaths worldwide than any other? No smoking. Not even high blood pressure. It's a bad diet.
"In many countries, a poor diet causes more deaths than smoking and hypertension," said Ashkan Afshin, an assistant professor at the Institute of Metrology and Health Assessment's University of Washington.
And it's not just that people are choosing unhealthy foods such as red meat and sugary sodas. Afshin, the leading author of a 27-year analysis of the world's diet, published Wednesday in The Lancet, is equally critical, namely the lack of healthy foods in our diet, as well as high levels of salt.
"While traditionally the whole conversation about healthy eating focused on reducing the consumption of unhealthy foods, we showed in this study that, at the population level, low consumption of healthy foods was the most important factor. more importantly, rather than the high consumption of unhealthy foods, "he said.
According to the study, one in five deaths in the world, accounting for about 11 million people, was caused in 2017 by too much sodium and lacks whole grains, fruits and nuts and seeds as well as foods rich in trans fatty acids and sugary drinks. and high levels of red and processed meats.
The large size of the study means that these findings are relevant to everyone no matter where they live, said Andrew Reynolds, a postdoctoral researcher at the University of Otago in New Zealand, who did not participate in the study.
"The findings of the paper will inform policy decisions that determine what foods are available in Western countries, how they are marketed and potentially what it will cost in the coming years," Reynolds said.
15 dietary risk factors
In the analysis, funded by the Bill & Melinda Gates Foundation, Afshin and his colleagues examined 15 food-related risk factors and their impact on deaths and disabilities. High levels of unhealthy red and processed meats, sugary drinks, trans fats and salt – all known for their health hazard – have been compared to the effects of a poor diet in many healthy food. These healthy products included fruits, vegetables, whole grains, milk, calcium, nuts and seeds, fiber, legumes or beans, omega-3 fatty acids from seafood and polyunsaturated fats , the beneficial fats found in salmon and vegetable oils. and nuts and seeds.
With the exception of salt, which was a key risk factor in most countries, the study found that red and processed meats, trans fats and sugary drinks were at the bottom of the table. risks for most countries.
In fact, more than half of the world's food-related deaths in 2017 were due to three risk factors: eating too much salt, not enough whole grains and not enough fruit. According to Afshin, these risks are still valid, regardless of the socio-economic level of most countries.
The new study is part of the annual World Burden of Disease Report, prepared by a consortium of thousands of researchers that tracks premature deaths and disability caused by more than 350 diseases and injuries in 195 countries.
In January, the consortium released its "Healthy Planet Diet," which says halving the consumption of red meat and sugar and increasing the consumption of fruits, vegetables and nuts would help avoid up to 11.6 million premature deaths without harming the planet.
Afshin said that an overview of the current study, but few details, was included in last year's Global Burden of Disease report, making this year's version "the only one in the world." the most comprehensive analysis ever done on the effects of diet on health ", despite some gaps and methodological flaws. in the data of underdeveloped countries.
"It's a good claim," Reynolds said. "Studies are published every year on how we eat. However, the amount of data considered and the overall representativeness make this study worthy of attention. He added that risk ranking provides policy makers with "valuable information about which dietary behaviors to target first".
Dietary deaths by country
Ten million dietary deaths in 2017 were due to cardiovascular disease; cancer was responsible for 913,000 deaths and type 2 diabetes was 339,000. In addition, 66% of the disabilities due to various chronic diseases in 2017 were due to these three factors.
It is worth noting that obesity is not a leading contributor, ranking sixth on the list of global health risks, Afshin said.
Uzbekistan recorded the largest number of diet-related deaths, followed by Afghanistan, the Marshall Islands, Papua New Guinea and Vanuatu. Israel had the lowest number, followed by France, Spain, Japan and Andorra, a tiny principality between France and Spain.
In terms of the lowest mortality rates, the United Kingdom ranked 23rd, ahead of Ireland (24th) and Sweden (25th), while the United States ranked 43rd after the United Kingdom. Rwanda and Nigeria (41st and 42nd). India is ranked 118th and China, 140th.
Highest risk factors
For the United States, India, Brazil, Pakistan, Nigeria, Russia, Egypt, Germany, Iran and Turkey, the main risk factor was the lack of whole grains. for many other countries, this is ranked second or third. This does not mean that people in these countries are not eating cereals, but rather processed cereals with low nutritional value and high calorie content.
Reynolds, who published this year a study on the effect of whole grains in The Lancet, warns that many of today's products sold to consumers as "whole grains" do not are often not.
"Whole grains are included in ultra-processed products that can be finely ground and added sodium, free sugars and saturated fats," Reynolds said. "I think we all need to be aware of this and not to confuse the benefits of whole grains more intact and minimally processed with what is often advertised as a whole grain product available today."
An entire grain is defined as the use of the whole seed of a plant: the sound, the germ and the endosperm. The Whole Grains Council provides a buffer, available in 54 countries, that consumers can research and that certifies the degree of whole grains in the product.
Regional challenges
The most important risk factor for China, Japan, Indonesia and Thailand was the amount of sodium in the diet. This is probably due to the extremely salty vinegars, sauces and rice pasta used to cook traditional Asian dishes, Afshin said.
Does this mean that these crops will continue to live with this high risk? Not necessarily, said Corinna Hawkes, director of the Center for Food Policy at the University of London.
"Anyone studying the history of food will tell you that cultural preferences change over time," said Hawkes, who did not participate in the new study. "They change. But yes, in this case, it will probably involve a change of culture. "
In Mexico, lack of nuts and seeds was the highest risk factor, followed by a lack of vegetables, whole grains and fruits in the diet. And it's one of the few countries where unhealthy sugary drinks are high enough – fifth place. This is not only due to a cultural preference for sodas and sugary drinks made at home, called aguas frescas, from co-author Christian Razosays access to drinking water and even fruits and vegetables.
"We do not have free drinking water to drink," said Razo, PhD. in nutrition of the National Institute of Public Health of Mexico.
"So people have to buy safe water to drink, and if they have to buy something, they prefer soda," she said. "It's also easier to get processed foods than fresh fruits and vegetables."
Razo says that if Mexico is a huge producer of fresh fruits and vegetables, these are bought by distributors in the US and other countries, leaving city dwellers without access to new affordable options and to the possibility of growing them.
"We encourage people to buy in local markets, but they are more expensive," said Razo. "It's hard to compete with all those big brands that buy the products. So, yes, we have a big challenge. "
As for nuts and seeds, "people simply can not buy them because they are so expensive," she said.
Call for action
Decision makers reacted to the study by calling for action.
"Poor nutrition is the main risk factor for the global burden of disease. The relative importance of this factor has increased and requires urgent attention, "said Francesco Branca, director of the Department of Nutrition for Health and Development at the World Health Organization.
"The public must be aware of the critical links between diet and health and ask its audience to improve access and availability of foods that contribute to a healthy diet," said Branca. "Considering the need for urgent action, the UN General Assembly declared the 2016-2025 UN Decade of Nutrition Action and calls on governments to make such commitments."
This will require a coordinated effort among policy makers, food producers, distributors and distributors, which will be a significant feat, Hawkes said.
To go back to whole grains, for example, will require a complete change in the economics of food production and distribution, she said.
"Grain refining is very profitable," Hawkes said. "Take corn, for example. You can refine it with different ingredients: animal feed, refined flours and high fructose corn syrup, to name just three. Manufacturers therefore generate several streams of value from this refining process.
"If we then say," I produce corn to make a single product, "we need to engage with the sector to find out where public investment is needed and how we can change the system because it will be a big problem. treat. It's a very big change. "
But Hawkes is optimistic. Twenty years ago, she said, when she entered a room of world health policymakers and mentioned the importance of food, she was considered a "Marginal person. Now, when I get into a room and say that, it's taken seriously. "
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