What is the risk factor leading to the largest number of deaths in the world? No smoking. And not even high blood pressure. This is bad food.
“In many countries, poor nutrition is more likely to cause death than tobacco smoking or high blood pressure,” said Ashkan Afshin, assistant professor of health indicators at the University of Washington.
And it's not just that people choose unhealthy foods like red meat and soda. Equally important is the lack of healthy foods in our diets and the fact that these foods are too salty, says Afshin, lead author of the analysis, which, after 27 years of research, was published Wednesday in the Lancet.
“While traditionally all discussions on this issue have focused on reducing unhealthy food intake, we have shown in our study that, at the general population level, inadequate intake of healthy food is more important than high intake of unhealthy foods.” he said.
A study found that in 2017, one in five deaths worldwide - 11 million people - was caused by too much salt in the diet and a lack of whole grains, fruits, nuts and seeds, rather than trans fats, sugary drinks and too much red. meat and dishes with it.
The large volume of the study means that the results are relevant to everyone, no matter where the person lives, says Andrew Reynolds, a research fellow at Ohio University in New Zealand who was involved in the study.
“The findings of the study will inform policy decisions that determine what foods are available in Western countries, how they are marketed, and possibly also their value in the coming years,” Reynolds said.
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15 risk factors associated with nutrition
In a work funded by the Bill & Melinda Gates Foundation, Afshin and his colleagues looked at 15 dietary risk factors and their links to mortality and disability. Large amounts of unhealthy red meat and red meat-containing foods high in sugar, trans fatty acids, and salt (which have long been known to pose a health hazard) have been compared to the health effects of low-consumption diets. These healthy foods included fruits, vegetables, whole grains, milk, calcium, nuts and seeds, fiber, legumes, seafood omega-3s and polyunsaturated fats, healthy fats from salmon, and vegetable fats.
With the exception of salt, which was a key risk factor almost everywhere, the study found that red meat and foods with it, trans fats and sugary drinks are at the bottom of the risk chart for most countries.
In fact, more than half of all food-related deaths in the world in 2017 were attributed to just three risk factors: eating too much salt, not eating enough whole grains, and not eating enough fruit. These risks remain the same regardless of the socio-economic level of most countries, Afshin said.
This new study is part of the annual Global Burden of Disease report, produced by a pool of thousands of researchers who track premature deaths and disabilities due to over 350 diseases and injuries in 195 countries.
In January, the group released its "Diet for a Healthy Planet," which implies that cutting red meat and sugar in half and increasing consumption of fruits, vegetables and nuts could prevent up to 11.6 million premature deaths without harming the planet.
Afshin said that the study was outlined in last year's report on the Global Burden of Disease, however, without details, so this year's version has become "the most comprehensive analysis of the impact of diet on health", despite some methodological weaknesses and data gaps from the underdeveloped countries.
“This is a good try,” Reynolds said. "Studies of our diet are published annually, but this work is noteworthy for the sheer scale of the data covered and its global representation." He added that the risk ratings provide government policymakers "invaluable information on which eating behavior should be pursued first."
Diet-related mortality by country
Ten million diet-related deaths in 2017 were due to cardiovascular disease, cancer was responsible for 913,000 deaths and type 2 diabetes was responsible for 339,000 deaths. In addition, in 2017, these three factors caused a number of chronic diseases, accounting for 66% of cases of disability.
Interestingly, obesity did not become one of the main factors and took only sixth place in the list of global risks associated with diseases, Afshin said.
Uzbekistan has the highest number of food-related deaths, followed by Afghanistan, the Marshall Islands, Papua New Guinea and Vanuatu. Israel had the lowest number of such deaths, followed by France, Spain, Japan and Andorra, a tiny principality between France and Spain.
In the ranking of low mortality rates, the UK ranked 23rd, overtaking Ireland (24) and Sweden (25), while the United States came in 34th, after Rwanda and Nigeria (41 and 42). India ranked 118th and China 140th.
The most significant risk factors
For the United States, India, Brazil, Pakistan, Nigeria, Russia, Egypt, Germany, Iran, and Turkey, the biggest risk factor was a lack of whole grains in the diet; in many other countries this factor was ranked second or third. This does not mean that people in these countries do not eat grains, but rather that they are eating processed grains with little nutritional value and potentially more calories.
Reynolds, who published research on the health effects of whole grains in the Lancet this year, warns that many of the foods marketed to consumers today as “whole grains” are often not.
“Whole grains are included in highly processed foods that can be highly crushed and have added sodium, free sugars and saturated fats,” Reynolds says. "I think we should all be mindful of this and not confuse the benefits of minimally processed whole grains with what is often advertised as whole grains today."
By definition, a whole grain in a product is the use of the entire seed of a plant: bran, embryo, and endosperm. The Whole Grain Council has created a label used in 54 countries to certify the level of whole grains in a product and which consumers can look for when making a selection.
Regional problems
For China, Japan, Indonesia and Thailand, dietary sodium was found to be the largest risk factor. This is likely due to the extremely salty rice vinegars, sauces and pastes used to prepare traditional Asian dishes, Afshin said.
Does this mean that these cultures will continue to live in high-risk conditions? Not necessarily, says Corinna Hawkes, director of the Center for Food Policy at the University of London.
"Anyone who has studied food history will tell you that cultural food preferences change over time," says Hawkes, who was not involved in the new study. - They really change. But yes, in this case, it is likely to entail cultural changes."
In Mexico, the highest risk factor was found to be lack of nuts and seeds, followed by a lack of vegetables, whole grains and fruits in the diet. And it was one of the few countries where unhealthy sugary drinks were ranked high enough - at number five. This is due not only to a cultural love of sodas, including homemade sodas called aguas frescas, study co-author Christian Razo says, but also to the problem of access to clean water and fruit. and vegetables.
“We don't have clean drinking water,” said Razo, who received her Ph. D. in nutrition from Mexico's National Institute of Public Health.
“So people have to buy clean water to drink, and if they buy something, they prefer soda,” she said. "It's also easier to get processed food than fresh fruits and vegetables."
Razo says that while Mexico is a major producer of fresh fruits and vegetables, distributors in the United States and other countries are buying them out, leaving people in Mexican cities without access to inexpensive fresh produce or the ability to grow their own.
“We encourage people to buy in local markets, but it’s more expensive there,” Razo says. “It's hard to compete with all these huge brands that are buying up products. So yes, we have big problems."
As for nuts and seeds, “people just don't buy them because they are very expensive,” she says.
Call to action
Policymakers responded to the study with a call to action.
“Unhealthy diet is a major risk factor for the Global Burden of Disease. The relative importance of this factor is growing and urgently needs attention,”said Francesco Branca, Director of Nutrition for Health and Development at the World Health Organization.
“The public needs to be aware of the critical link between nutrition and health and demand government action to improve the availability of foods that are included in a healthy diet,” Branca said. “Given the urgent need for action, the UN General Assembly has declared 2016-2025 the UN Decade for Nutrition and is asking governments to make this commitment.”
This will require a coordinated effort from government officials, food manufacturers, marketers and distributors, Hawkes said, which will be a significant achievement.
Going back to whole grains again would require dramatic changes in the economics of production and distribution of food, she said.
“Grain processing is very profitable,” says Hawkes. “Take corn, for example. You can process it into a variety of foods: animal feed, refined flour, high fructose corn syrup, and so on. Thus, through this processing, manufacturers generate multiple value streams.”
"If we now say, 'I produce corn to get one product,' we will need to establish a dialogue with the industry to understand where public investment is needed in order to change the system, because the changes will be large. This is a serious task."
But Hawkes is hopeful. Twenty years ago, she said, when she spoke to global health policymakers about the importance of diet, she was “treated as a marginalized person. Now, when I come and say this, they take me seriously."
Sandee LaMotte