Articles
estimate gaps in intake or excess of intake of individual                     At the regional level, in 2017, the intake of all healthy
components of diet, we compared the current intake of                       foods was lower than the optimal level in all 21 GBD
each dietary factor with the midpoint of its optimal range                  regions (figure 1). The only exceptions were the intake of
of intake (table). High intake of a dietary component                       vegetables in central Asia, seafood omega-3 fatty acids in
refers to an intake level higher than the midpoint of the                   high-income Asia Pacific, and legumes in the Caribbean,
optimal range of intake, and low intake refers to an intake                 tropical Latin America, south Asia, western sub-Saharan
level lower than the midpoint of the optimal range of                       Africa, and eastern sub-Saharan Africa. Among un-
intake.                                                                     healthy food groups, consumption of sodium and sugar-
   To incorporate the uncertainty of parameters (exposure,                  sweetened beverages were higher than the optimal level
relative risk, optimal level of intake, and mortality) as                   in nearly every region. Red meat consumption was
well as modelling uncertainty, we followed a Monte Carlo                    highest in Australasia, southern Latin America, and
approach. We repeated all calculations 1000 times using                     tropical Latin America. High-income North America had
one draw of each parameter at each iteration. Using                         the highest processed meat intake followed by high-
these 1000 draws, we calculated the mean and                                income Asia Pacific and western Europe. The highest
95% uncertainty interval (UI) for the final estimates.                      intake of trans fats was observed in high-income
   All statistical analyses were done in Python, version 3.5.               North America, central Latin America, and Andean Latin
                                                                            America.
Role of the funding source
The funder of the study had no role in study design, data                   Overall impact of diet on mortality
collection, data analysis, data interpretation, or writing                  Globally, in 2017, dietary risks were responsible for
of the report. The first author and the corresponding                       11 million [95% UI 10–12] deaths (22% [95% UI 21–24] of
author had full access to all the data in the study and                     all deaths among adults) and 255 million (234–274) DALYs
had final responsibility for the decision to submit for                     (15% [14–17] of all DALYs among adults; appendix).
publication.                                                                Cardiovascular disease was the leading cause of diet-
                                                                            related deaths (10 million [9–10] deaths) and DALYs
Results                                                                     (207 million [192–222] DALYs), followed by cancers
Consumption of major foods and nutrients                                    (913 090 [743 345–1 098 432] deaths and 20 million [17–24]
Globally, consumption of nearly all healthy foods and                       DALYs) and type 2 diabetes (338 714 deaths [244 995–447 003]
nutrients was suboptimal in 2017 (figure 1). The largest                    and 24 million [16–33] DALYs). More than 5 million
gaps between current and optimal intake were observed                       (95% UI 5–5) diet-related deaths (45% [43–46] of total diet-
for nuts and seeds, milk, and whole grains, with mean                       related deaths) and 177 million (163–192) diet-related
consumption at 12% (95% UI 12–13; 3 g [2–3] of nuts and                     DALYs (70% [68–71] of total diet-related DALYs) occurred
seeds per day), 16% (16–17; 71 g [70–72] of milk per day),                  among adults aged younger than 70 years.
and 23% (23–23; 29 g [29–29] of whole grains per day) of                      Across the 21 GBD regions, in 2017, the highest
the optimal levels (percentages calculated on the basis of                  age-standardised rates of all diet-related deaths and
data before rounding). In parallel with suboptimal healthy                  DALYs among adults aged 25 years or older were ob-
food consumption, daily intake of all unhealthy foods and                   served in Oceania (678 [95% UI 616–746] deaths per
nutrients exceeded the optimal level globally (figure 1).                   100 000 population and 17 804 [16 041–19 907] DALYs per
The consumption of sugar-sweetened beverages (49 g per                      100 000 population; appendix). The lowest rates of
day) was far higher than the optimal intake. Similarly,                     all diet-related deaths among adults (aged 25 years or
global consumption of processed meat (4 g [4–4] per day,                    older) were observed in high-income Asia Pacific
90% greater than the optimal amount) and sodium (6 g                        (97 [89–106] deaths per 100 000 population) and the
[5–6] per day, 86% greater than the optimal amount) were                    lowest rates of all diet-related DALYs were observed in
far above the optimal levels. The global intake of red meat                 Australasia (2182 [1955–2444] DALYs per 100 000 pop-
(27 g [26–28] per day) was 18% greater than the optimal                     ulation). The regions with the highest rates of diet-
intake. Men generally had a higher intake of both healthy                   related cardiovascular disease deaths and DALYs were
and unhealthy foods than did women. Intake of both                          central Asia (613 [566–658] deaths per 100 000 pop-
healthy and unhealthy foods was generally higher among                      ulation) and Oceania (14 755 [13 212–16 512] DALYs per
middle-aged adults (50–69 years) and lowest among young                     100 000 population), whereas the lowest rate of
adults (25–49 years) with a few exceptions. The highest                     cardiovascular disease deaths and DALYs were observed
intake of sugar-sweetened beverages and legumes were                        in high-income Asia Pacific (68 [63–75] deaths per
observed among young adults and showed a decreasing                         100 000 population and 1443 [1329–1573] DALYs per
trend with age.                                                             100 000 population). Diet-related cancer death and DALY
                                                                            rates were highest in east Asia (41 [34–49] deaths per
                                                                            100 000 population and 878 [736–1023] DALYs per
Figure 1: Age-standardised intake of dietary factors among adults           100 000 population) and lowest in north Africa and the
aged 25 years or older at the global and regional level in 2017             Middle East (nine [8–11] deaths per 100 000 population
www.thelancet.com Published online April 3, 2019 http://dx.doi.org/10.1016/S0140-6736(19)30041-8                                                  5