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Interventions and Public Health Nutrition

Estimating the global and regional burden of suboptimal nutrition on chronic disease: methods and inputs to the analysis

Abstract

Background/Objectives:

Global burdens of cardiovascular disease (CVD), diabetes and cancer are on the rise. Little quantitative data are available on the global impact of diet on these conditions. The objective of this study was to develop systematic and comparable methods to quantitatively assess the impact of suboptimal dietary habits on CVD, diabetes and cancer burdens globally and in 21 world regions.

Subjects/Methods:

Using a comparative risk assessment framework, we developed methods to establish for selected dietary risk factors the effect sizes of probable or convincing causal diet–disease relationships, the alternative minimum-risk exposure distributions and the exposure distributions. These inputs, together with disease-specific mortality rates, allow computation of the numbers of events attributable to each dietary factor.

Results:

Using World Health Organization and similar evidence criteria for convincing/probable causal effects, we identified 14 potential diet–disease relationships. Effect sizes and ranges of uncertainty will be derived from systematic reviews and meta-analyses of trials or high-quality observational studies. Alternative minimum-risk distributions were identified based on amounts corresponding to the lowest disease rates in populations. Optimal and alternative definitions for each exposure were established based on the data used to quantify harmful or protective effects. We developed methods for identifying and obtaining data from nationally representative surveys. A ranking scale was developed to assess survey quality and validity of dietary assessment methods. Multi-level hierarchical models will be developed to impute missing data.

Conclusions:

These new methods will allow, for the first time, assessment of the global impact of specific dietary factors on chronic disease mortality. Such global assessment is not only possible but is also imperative for priority setting and policy making.

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Acknowledgements

We thank Barbara Bowman, Patricia Constante Jamie, Saman Fahimi, Karen Lock, Verena Nowak and Joceline Pomerleau for their expert advice on developing the methodology. We also thank Louise Dekker, Jenna Golan, Shahab Khatibzadeh, Mayuree Rao, Peilin Shi, Liesbeth Smit and Georgina Waweru for providing analytic and administrative support. We also are enormously grateful to each of our corresponding authors from all involved nations for providing unpublished data—their names are listed in the Supplementary Appendix. This work was undertaken as a part of the Global Burden of Diseases, Injuries, and Risk Factors Study. A grant from the Bill and Melinda Gates Foundation supported the Study's core activities and partially supported the epidemiological reviews in this paper.

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Correspondence to R Micha or D Mozaffarian.

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The authors declare no conflict of interest.

Additional information

Contributors: RM, SK and PW contributed to the study concept and design; systematic searches; data collection; interpretation of data; critical revision of the manuscript for important intellectual content and approval of the final manuscript for submission. RM and DM contributed in drafting of manuscript. TB, GD, ED, IE, EG, JP, SS-W, ME and DM contributed to the study concept and design; interpretation of data; critical revision of the manuscript for important intellectual content and approval of the final manuscript for submission.

Supplementary Information accompanies the paper on European Journal of Clinical Nutrition website

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Micha, R., Kalantarian, S., Wirojratana, P. et al. Estimating the global and regional burden of suboptimal nutrition on chronic disease: methods and inputs to the analysis. Eur J Clin Nutr 66, 119–129 (2012). https://doi.org/10.1038/ejcn.2011.147

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Keywords

  • global burden of disease
  • diet
  • cardiovascular disease
  • diabetes
  • cancer

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