When considering risk factors responsible for most deaths around the world, you might think that smoking, or even high blood pressure, might top the list. But a major new study has revealed that unhealthy eating is responsible for one in five deaths equivalent to 11 million deaths globally.
Although there is a lot of focus these days on maintaining a healthy diet and lowering the intake of unhealthy foods, this study has found that quite the opposite is true in real terms. A low intake of healthy foods is, by far, the more important factor, than high intake of unhealthy foods when the general population is taken into consideration. This research titled, “Global Burden of Disease Study”, looked at dietary consumption between 1990 and 2017 in 195 countries, focusing on 15 types of foods or nutrients.
In the report, published in The Lancet, the researchers show that due to its contribution to non-communicable diseases, poor diet accounted for approximately 11 million deaths globally, in 2017. The vast majority of those deaths, around 10 million, were from cardiovascular disease and the rest were mainly from cancer and type-2 diabetes.
The data collected for this study, to rank countries from lowest to highest rates of diet-related deaths, puts Israel first, with 89 deaths per 100,000 people and Uzbekistan last, with 892 deaths per 100,000. The United States, with 171 deaths per 100,000, comes at the 43rd place and the United Kingdom at the 23rd place, with 127 deaths per 100,000. India is ranked at the 118th place and China at 140th.
“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 Dr Christopher Murray, the author of the study and director of the Institute for Health Metrics and Evaluation, University of Washington. “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, sugar or low intake of healthy foods, such as whole grains, fruit, nuts and seeds and vegetables.”
In their analysis of global diets, the researchers looked at 15 items - fruits, vegetables, nuts and seeds, legumes, whole grains, fibre, calcium, milk, omega-3 fatty acids from seafood, polyunsaturated fats, trans-fats, red meat, processed meat, sugary drinks and sodium. They found that, in 2017, the global diet contained less than the ideal amounts of nearly all healthy food items. The biggest deficiency was in nuts and seeds, milk and whole grains. Consumption of nuts and seeds, for instance, was on average only three grams per day or around 12% of the optimal intake. Similarly, consumption of milk was only 16% of the optimal intake and whole grains intake was only 23%. Alongside these, daily intakes of unhealthy dietary items exceeded the optimal level globally. Sugary drink consumption for example, “was far higher than the optimal intake,” followed by the consumption of processed meat and sodium.
An important finding of the study was that insufficient intake of healthy food could be just as, if not more, damaging than eating too many unhealthy foods. Researchers have noted that the diets that were related to the most deaths were, “high in sodium, low in whole grains, low in fruit, low in nuts and seeds, low in vegetables, and low in omega-3 fatty acids.” They have reported that each of these dietary factors accounted for more than 2% of global deaths.
Additionally, just three of these - whole grains, fruits and sodium - accounted for more than half of the diet-related deaths and two-thirds of the years lost to diet-related ill health and disability. Dr Murray says that these results contrast with the fact that, over the past 20 years, policy discussions have tended to focus more on restricting unhealthy foods. He and his colleagues suggest that campaigns should concentrate on re-balancing diets. They also urge that any changes in food production and distribution aimed to achieve this must consider the environmental impact on the climate, land, water and soil.
In a separate but linked editorial, Prof Nita G Forouhi and Prof Nigel Unwin, both of the medical research council epidemiology unit at the University of Cambridge in the UK, agree with the authors in that, in a global context and despite its limitations, the study offers evidence to shift the focus from restricting unhealthy food items to increasing healthy ones. They suggest that it confirms the need to emphasise foods rather than nutrients. However, they also highlight some of the challenges of shifting the global diet towards a more healthy one, such as the prohibitive costs of fruits and vegetables. For instance, in low-income countries, “Two servings of fruits and three servings of vegetables per day per individual accounted for 52% of household income,” compared with just 2% in high-income nations.
The authors of this study are hopeful that the findings would urge people to try to eat better and policymakers to create and promote policies that aim to increase consumption of healthy foods. The study has further highlighted a need for comprehensive food system interventions to promote the production, distribution and consumption of healthy foods across nations.