Poor daily diet linked to 20% of deaths worldwide

GBD 2017 Diet Collaborators | 2019| Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017| The Lancet | DOI:https://doi.org/10.1016/S0140-6736(19)30041-8

An international study that looked at the diet of inhabitants in 195 countries in the years between 1990 and 2017, presents a comprehensive picture of the potential impact of suboptimal diet on non-communicable disease (NCD) mortality and morbidity, highlighting the need for improving diet across the globe. 

The systematic evaluation of eating patterns shows the health consequences of poor dietary habits at population level.

The study found the leading dietary risk factors for mortality are diets 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. In fact more deaths were caused by suboptimal diet than any other risks globally, including tobacco smoking (Source: GBD 2017 Diet Collaborators)




Suboptimal diet is an important preventable risk factor for non-communicable diseases (NCDs); however, its impact on the burden of NCDs has not been systematically evaluated. This study aimed to evaluate the consumption of major foods and nutrients across 195 countries and to quantify the impact of their suboptimal intake on NCD mortality and morbidity.


By use of a comparative risk assessment approach, we estimated the proportion of disease-specific burden attributable to each dietary risk factor (also referred to as population attributable fraction) among adults aged 25 years or older. The main inputs to this analysis included the intake of each dietary factor, the effect size of the dietary factor on disease endpoint, and the level of intake associated with the lowest risk of mortality. Then, by use of disease-specific population attributable fractions, mortality, and disability-adjusted life-years (DALYs), we calculated the number of deaths and DALYs attributable to diet for each disease outcome.


In 2017, 11 million (95% uncertainty interval [UI] 10–12) deaths and 255 million (234–274) DALYs were attributable to dietary risk factors. High intake of sodium (3 million [1–5] deaths and 70 million [34–118] DALYs), low intake of whole grains (3 million [2–4] deaths and 82 million [59–109] DALYs), and low intake of fruits (2 million [1–4] deaths and 65 million [41–92] DALYs) were the leading dietary risk factors for deaths and DALYs globally and in many countries. Dietary data were from mixed sources and were not available for all countries, increasing the statistical uncertainty of our estimates.


This study provides a comprehensive picture of the potential impact of suboptimal diet on NCD mortality and morbidity, highlighting the need for improving diet across nations. Our findings will inform implementation of evidence-based dietary interventions and provide a platform for evaluation of their impact on human health annually.


Bill & Melinda Gates Foundation.


The article is available to read and download from The Lancet 

In the news:

BBC News The diets cutting one in five lives short every year

Science Daily Globally, one in five deaths are associated with poor diet

National Diet and Nutrition Survey

Public Health England & Food Standards Agency | January 2019 |National Diet and Nutrition Survey: Years 1 to 9 of the Rolling Programme (2008/2009 – 2016/2017): Time trend and income analyses

Public Health England & Food Standards Agency have published the National Diet and Nutrition Survey (NDNS RP), the survey takes place annually using a representative sample (of around 1000 people: 500 adults and 500 children) take part in the NDNS RP each year. The NDNS RP comprises an interview, a 4-day estimated diet diary, physical measurements and a blood and urine sample.


Key findings: 

  • There was little change in intake of fruit and vegetables over the 9-year period.
  • All age/sex groups had a mean fruit and vegetable intake below the 5 A Day
    recommendation over the 9-year period.
  • There was a downward linear trend in intake of fruit juice over time among consumers in all age/sex groups although there was little change in the proportions drinking it.
  • There was little change in intake of oily fish over the 9-year period while intake of red and processed meat showed a downward trend over time.
  • Over the 9 years, the proportion of children consuming sugar-sweetened soft drinks dropped by 26, 35 and 17 percentage points for those aged 1.5 to 3 years, 4 to 10 years and 11 to 18 years respectively.
  • For those children who drank sugar-sweetened soft drinks, intake also fell significantly over time. (Source: Public Health England & Food Standards Agency)

Read the full report National Diet and Nutrition Survey

High-fibre diet cuts risk of death from cancer, stroke and heart disease by up to a third

Observational studies and clinical trials conducted over nearly 40 years reveal the health benefits of eating at least 25g to 29g or more of dietary fibre a day, according to a series of systematic reviews and meta-analyses published in The Lancet | via ScienceDaily

Eating more fibre, found in wholegrain cereals, pasta and bread as well as nuts and pulses, will reduce people’s chances of heart disease and early death, according to a landmark review published in The Lancet. The study was commissioned by the World Health Organization to inform the development of new recommendations for optimal daily fibre intake and to determine which types of carbohydrate provide the best protection against non-communicable diseases (NCDs) and weight gain.

The results suggest a 15-30% decrease in all-cause and cardiovascular related mortality when comparing people who eat the highest amount of fibre to those who eat the least. Eating fibre-rich foods also reduced incidence of coronary heart disease, stroke, type 2 diabetes and colorectal cancer by 16-24%. Per 1,000 participants, the impact translates into 13 fewer deaths and six fewer cases of coronary heart disease.


In addition, a meta-analysis of clinical trials suggested that increasing fibre intakes was associated with lower bodyweight and cholesterol, compared with lower intakes.

While their study did not show any risks associated with dietary fibre, the authors note that high intakes might have ill-effects for people with low iron or mineral levels, for whom high levels of whole grains can further reduce iron levels. They also note that the study mainly relates to naturally-occurring fibre rich foods rather than synthetic and extracted fibre, such as powders, that can be added to foods.

Full story at ScienceDaily

Link to the research: Reynolds, A. et al. | Carbohydrate quality and human health: a series of systematic reviews and meta-analyses | The Lancet | Published January 10, 2019


Hunger, malnutrition and food insecurity in the UK

New report says the Government has failed to recognise and respond to the issues of hunger, malnutrition and obesity in the UK and should appoint a minister to ensure cross-departmental action. | Environmental Audit Committee

A new report finds that food insecurity in the UK, defined as “limited access to food … due to lack of money or other resources”, is significant and growing. Levels are among the worst in Europe, especially for children, with 19% of under 15s living with an adult who is moderately or severely food insecure.

knife-and-fork-2754149_1920 The Committee heard how food insecurity can lead to both malnutrition and obesity, with people forced to rely on the very cheapest foods, which are often nutrient-poor but calorie-rich. The Government’s obesity strategy makes no mention of food insecurity and only the Department for International Development mentions hunger in its Single Departmental Plan.

Chair of the Environmental Audit Committee, Mary Creagh MP, said “Instead of seeing hunger as an issue abroad, the Government’s New Year resolution should be one of taking urgent action at home to tackle hunger and malnutrition. This can only be addressed by setting clear UK-wide targets and by appointing a Minister for Hunger to deliver them.” 

See also:

Liverpool study will address barriers to sweetener use

University of Liverpool| January 2019 | Liverpool study will address barriers to sweetener use

A collaboration between the University of Liverpool and Copenhagen will study the risks and benefits of sweeteners and sweetness enhancers ( S&Es) in the diet. Researchers will review evidence on long term benefits and potential risks involved in using sugar replacements in  the context of public health and safety, obesity, and sustainability.


As part of this project the research team will also conduct a two-year randomised controlled trial, which will recruit over 600 adult and child participants with overweight or obesity from four European countries. The participants will undertake a two-month weight loss diet. During this period, they will be randomly assigned to one of two treatments:  either consuming food and drink with sweeteners or without (Source: University of Liverpool).

Full details of the research from the University of Liverpool

10 year olds in the UK have consumed 18 years’ worth of sugar

Public Health England | December 2018 |10 year olds in the UK have consumed 18 years’ worth of sugar 

According to figures produced by Public Health England, children are still consuming around 8 excess sugar cubes every day, a figure equivalent to approximately 2,800 excess sugar cubes each year. Although sugar consumption by children has been reduced in recent years, these statistics indicate that children have already exceeded the maximum recommended sugar intake for an 18 year old by the time they reach their tenth birthday. This is based on their total sugar consumption from the age of 2.


To help parents manage this, Change4Life is encouraging them to ‘Make a swap when you next shop’. Making simple everyday swaps can reduce children’s sugar intake from some products (yoghurts, drinks and breakfast cereals) by half – while giving them healthier versions of the foods and drinks they enjoy.

Change4Life recommends swapping:

  • a higher-sugar yoghurt (for example split-pot) for a lower sugar one, to halve their sugar intake from 6 cubes of sugar to 3
  • a sugary juice drink for a no-added sugar juice drink, to cut back from 2 cubes to half a cube
  • a higher-sugar breakfast cereal (such as a frosted or chocolate cereal) for a lower sugar cereal, to cut back from 3 cubes to half a cube per bowl

Making these changes could remove around 2,500 sugar cubes per year from a child’s diet, but swapping chocolate, puddings, sweets, cakes and pastries for healthier options such as malt loaf, sugar-free jellies, lower-sugar custards and rice puddings would reduce their intake even further (Source: PHE).

See PHE for the full story 

BBC News Children ‘exceed recommended sugar limit by age 10’

The Independent Average 10 year old has already eaten more sugar than maximum recommended for an adult, study finds 

(Over)eating out at major UK restaurant chains: observational study of energy content of main meals

Robinson, E., Whitelock, V., Mead, B. R., & Haynes, A. | 2018 | (Over)eating out at major UK restaurant chains: observational study of energy content of main meals|BMJ |363|k4982

Researchers have discovered that meals served in major UK restaurant chains are more calorific than those available in fast food chains. The study published in the BMJ, exmained main meals in 27 food outlets- a combination of 21 restaurants and 6 fast food were sampled.  The research team found that only a small proportion of meals that met public health recommendations for energy content was low. 



Objectives To examine the energy content of main meals served in major UK restaurant chains and compare the energy content of meals in fast food and “full service” restaurant chains.

Design Observational study.

Setting Menu and nutritional information provided by major UK restaurant chains.

Main outcome measures Mean energy content of meals, proportion of meals meeting public health recommendations for energy consumption (less than or equal to 600 kcal), and proportion of meals with excessive energy content (more than or equal to1000 kcal).

Results Main meals from 27 restaurant chains (21 full service; 6 fast food) were sampled. The mean energy content of all eligible restaurant meals (13 396 in total) was 977 (95% confidence interval 973 to 983) kcal. The percentage of all meals that met public health recommendations for energy content was low (9%; n=1226) and smaller than the percentage of meals with an excessive energy content (47%; 6251). Compared with fast food restaurants, full service restaurants offered significantly more excessively calorific main meals, fewer main meals meeting public health recommendations, and on average 268 (103 to 433) kcal more in main meals.

Conclusions The energy content of a large number of main meals in major UK restaurant chains is excessive, and only a minority meet public health recommendations. Although the poor nutritional quality of fast food meals has been well documented, the energy content of full service restaurant meals in the UK tends to be higher and is a cause for concern.

Full article available from the BMJ 

In the news:

BBC News Restaurant dishes ‘contain more calories than fast-food meals’