Study: The poor diet behind most deaths in the world

ATLANTA (CNN) – Which risk factor is responsible for more deaths in the world than any other? No smoking. Not even high blood pressure. It's a poor diet.

"In many countries, a poor diet causes more deaths than smoking and high blood pressure," said Ashkan Afshin, an assistant professor at the Institute of Metrology and Health Assessment's the University of Washington.

And it's not just that people are choosing unhealthy options 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 entire discussion about healthy eating was focused on reducing the consumption of unhealthy foods, we showed in this study that at the population level, low consumption of food was a major contributor to healthy eating. Healthy food is the most important factor, and not unhealthy food consumption, "he said.

According to the study, one in five deaths in the world – about 11 million people – in 2017 is due to too much sodium and a lack of whole grains, fruits and nuts and seeds. 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 the food products available in Western countries, their marketing and, possibly, costs in the coming years," said Reynolds.

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-fatty acids and salt – all known for their health hazard – have been compared to the effects of a diet poor in many foods. healthy. 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 "Plan for a Healthy Planet", which stipulated that halving the consumption of red meat and sugar and increasing the consumption of fruits, vegetables and nuts would prevent up to 11.6 million premature deaths without harming the planet.

Afshin said that an overview of the current study, but few details, appeared in last year's report on the global burden of disease, making this year's version "The most comprehensive analysis ever done on the effects of diet on health", despite some shortcomings and methodological flaws. in the data of underdeveloped countries.

"It's a good claim," Reynolds said. "Studies are published every year on our diet, however, the amount of data taken into account 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".

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.

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 products sold to consumers today like "whole grains" often are 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 grain more intact and minimally processed with what is often advertised as a full 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.

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 who studies 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 that 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 rank high – fifth. This is not only due to a cultural preference for sodas and sugary homemade drinks called frescas, says co-author Christian Razo of access to drinking water and even fruits and vegetables.

"We do not have free drinking water," said Razo, PhD. in nutrition of the National Institute of Public Health of Mexico.

"So people have to buy drinking water for drinking and if they prefer 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.

Decision makers reacted to the study by calling for action.

"Poor nutrition is the main risk factor for the global burden of the disease.The relative importance of this factor is increasing and requires urgent attention," said Francesco Branca, director of the Nutrition Department for Health and Development of the World Health Organization.

"The public must be aware of the critical links between diet and health and ask its audience to improve its access and availability to foods that contribute to a healthy diet," said Branca. "Given the need for urgent action, the UN General Assembly has declared the 2016-2025 UN Decade of Action for Nutrition 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.

"The refining of grain is very profitable," said Hawkes. "Take corn, for example, and you can refine it to name three: animal feed, refined flours, and high fructose corn syrup, so manufacturers generate multiple 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 industry to find out where public investment is needed and how we can change the system because it will be a big problem, it's a big change. "

But Hawkes is optimistic. Twenty years ago, when she entered a room of global health policymakers and mentioned the importance of food, she was perceived as a "marginal person." enter a room and say that, it is taken seriously ".

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