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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
These analyses demonstrate a clear log-linear (proportional) dose-response relationship between blood pressure and cardiovascular disease at any age.
“These analyses demonstrate a clear log-linear (proportional) dose-response relationship between BP and CVD at any age (Figure S3).”
From Global Sodium Consumption and Death from Cardiovascular Causes (2014) · cites this paper as [14]
These prior pooling projects pooled individual-level data across multiple prospective studies, together totaling 99 cohorts, 1.38 million participants, and 65,000 cardiovascular events, with consistent adjustment for confounders and accounting for regression dilution bias based on serial measures of blood pressure over time.
“These studies pooled individual level data across multiple prospective studies, together totaling 99 cohorts, 1.38 million participants, and 65,000 cardiovascular events; with consistent adjustment for confounders and accounting for regression dilution bias based on serial measures of BP over time.”
From Global Sodium Consumption and Death from Cardiovascular Causes (2014) · cites this paper as [14]
The dose-response relationship between blood pressure and cardiovascular disease mortality has been established in prior pooling projects including the Prospective Studies Collaborative and the Asia Pacific Cohort Studies Collaborative.
“The dose-response relationship between BP and CVD mortality has been established in prior pooling projects including the Prospective Studies Collaborative and the Asia Pacific Cohort Studies Collaborative.14,15”
From Global Sodium Consumption and Death from Cardiovascular Causes (2014) · cites this paper as [14]
For each major class of anti-hypertensive drugs (thiazides, beta blockers, ACE inhibitors, ARBs, calcium channel blockers), the achieved risk reductions for CHD and stroke in randomized trials were very similar to the predicted benefits based on their blood-pressure-lowering.
“For each class including thiazides, beta blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers, the achieved risk reductions for CHD and stroke in the trials were very similar to the predicted benefits based on their BP-lowering, based on the observed association between BP and CVD risk in prospective cohorts.14”
From Global Sodium Consumption and Death from Cardiovascular Causes (2014) · cites this paper as [14]
The effects of systolic blood pressure on cardiovascular mortality were quantified by combining results from two large international pooling projects that pooled individual-level data, consistently adjusted for confounding, and accounted for regression dilution bias based on serial measures of blood pressure over time.
“We quantified the effects of systolic blood pressure on cardiovascular mortality by combining the results from two large international pooling projects 14,15 which pooled individual-level data, consistently adjusted for confounding, and accounted for regression dilution bias based on serial measures of blood pressure over time.16”
From Global Sodium Consumption and Death from Cardiovascular Causes (2014) · cites this paper as [14]
The main findings from one pooling project were based on individual-level data across 61 prospective observational studies including 958,074 participants, 12.7 million person-years of follow-up, 34,000 coronary heart disease deaths, and 12,000 stroke deaths.
“based on individual-level data across 61 prospective observational studies including 958,074 participants, 12.7 million person-years of follow-up, 34,000 coronary (ischemic) heart disease (IHD) deaths, and 12,000 stroke deaths.14”
From Global Sodium Consumption and Death from Cardiovascular Causes (2014) · cites this paper as [14]
The effects of systolic blood pressure on cardiovascular mortality were quantified by combining the results from two large international pooling projects that pooled individual-level data, consistently adjusted for confounding, and accounted for regression dilution bias based on serial measures of blood pressure over time.
“We quantified the effects of systolic blood pressure on cardiovascular mortality by combining the results from two large international pooling projects14,15 which pooled individual-level data, consistently adjusted for confounding, and accounted for regression dilution bias based on serial measures of blood pressure over time.16”
From Global Sodium Consumption and Death from Cardiovascular Causes (2014) · cites this paper as [14]
The main findings from one of the two pooling projects are based on individual-level data across 61 prospective observational studies including 958,074 participants, 12.7 million person-years of follow-up, 34,000 coronary (ischemic) heart disease (IHD) deaths, and 12,000 stroke deaths.
“This Figures shows the main findings from one of these two pooling projects, based on individual-level data across 61 prospective observational studies including 958,074 participants, 12.7 million person-years of follow-up, 34,000 coronary (ischemic) heart disease (IHD) deaths, and 12,000 stroke deaths.14”
From Global Sodium Consumption and Death from Cardiovascular Causes (2014) · cites this paper as [14]
The citation lists haven’t been fetched yet
References 37 · Cited by 123
- Authors
- Micha, R., Kalantarian, S., Wirojratana, P., Byers, T., Danaei, G., Elmadfa, I., Ding, E., Giovannucci, E., Powles, J., Smith-Warner, S., Ezzati, M., Mozaffarian, D., & on behalf of the Global Burden of Diseases, N. A. C. D. E. G.
- Affiliations
- Harvard University (US)
- Colorado School of Public Health (US)
- University of Vienna (AT)
- Brigham and Women's Hospital (US)
- University of Cambridge (GB)
- Corresponding author
- Micha, R
- Mozaffarian, D
- Venue
- European Journal of Clinical Nutrition
- Published
- 2011-09-14
- Volume
- 66
- Issue
- 1
- Pages
- 119-129
- ISSN
- 0954-3007 (ISSN-L)
- 1476-5640
- OpenAlex
- W2036545856
- Cited by
- 123
- References
- 37
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 6 · 2023: 10 · 2022: 12 · 2021: 13 · 2020: 5 · 2019: 10 · 2018: 8 · 2017: 9 · 2016: 8 · 2015: 10 · 2014: 8 · 2013: 7 · 2012: 5
- FWCI
- 6.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Life Sciences › Agricultural and Biological Sciences › Food Science › Nutrition, Health, and Society Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- dietary risk factors, chronic disease burden, cardiovascular disease, diabetes mellitus, cancer, comparative risk assessment, attributable mortality, diet-disease relationships, missing data imputation, global burden of disease
- MeSH terms
- Cardiovascular Diseases, Chronic Disease, Diabetes Mellitus, Diet, Feeding Behavior, Humans, Neoplasms, Nutritional Physiological Phenomena, Risk Factors, Global Health, World Health Organization, Risk Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
