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and 203 [169–243] DALYs per 100 000 population).                            [34–49] of deaths and 50% [43–58] of DALYs). The lowest
Oceania (60 [44–78] deaths per 100 000 population and                       proportions of cardiovascular disease deaths and DALYs
2426 [1737–3198] DALYs per 100 000 population) had the                      were seen in Turkey (42% [38–47] of deaths and 44%
highest age-standardised rate of diet-related diabetes                      [40–49] of DALYs), cancer deaths and DALYs in Egypt (4%
deaths and DALYs, and high-income Asia Pacific had the                      [3–4] of deaths and 3% [3–4] of DALYs), and type 2 diabetes
lowest rates (two [2–3] deaths per 100 000 population and                   deaths and DALYs in Bangladesh (25% [17–34] of deaths
290 [202–395] DALYs per 100 000 population). In 2017,                       and 34% [23–45] of DALYs).
the highest age-standardised proportions of diet-related
deaths and DALYs from cardiovascular disease were                           Impact of individual components of diet on mortality
observed in Oceania (60% [95% UI 56–63] of deaths) and                      A small number of dietary risks had a large impact on
east Asia (64% [60–68] of DALYs), those from cancer in                      health outcomes. In 2017, more than half of diet-related
east Asia (15% [13–18] of deaths and 15% [12–17] of                         deaths and two-thirds of diet-related DALYs were
DALYs), and those from type 2 diabetes in high-income                       attributable to high intake of sodium (3 million [95% UI
North America (41% [34–48] of deaths and 50% [42–58]                        1–5] deaths and 70 million [34–118] DALYs), low intake of
of DALYs; appendix). The lowest age-standardised pro-                       whole grains (3 million [2–4] deaths and 82 million
portions of deaths and DALYs from these causes were in                      [59–109] DALYs), and low intake of fruits (2 million [1–4]
western Europe (42% [38–45] of deaths and 44% [41–47]                       deaths and 65 million [41–92] DALYs; figure 3). Low
of DALYs), western sub-Saharan Africa (5% [4–6] of                          intake of whole grains was the leading dietary risk factor
deaths and 4% [4–5] DALYs), and southeast Asia                              for DALYs among men and women and the leading
(29% [20–38] of deaths and 35% [25–46] of DALYs).                           dietary risk factor for mortality among women. Sodium
  In 2017, among the world’s 20 most populous countries,                    ranked first for mortality among men followed by whole
Egypt had the highest age-standardised rate of all diet-                    grains and fruit. Low intake of whole grains was the
related deaths (552 [95% UI 490–620] deaths per                             leading risk for deaths and DALYs among young adults
100 000 population) and DALYs (11 837 [10 525–13 268]                       (aged 25–50 years) and sodium ranked first among older
DALYs per 100 000 population) and Japan had the lowest                      adults (≥70 years).
rate of all diet-related deaths (97 [89–106)] deaths per                      In 2017, across the 21 GBD regions, a diet low in whole
100 000 population) and DALYs (2300 [2099–2513] DALYs                       grains was the most common leading dietary risk factor
per 100 000 population; figure 2). China had the highest                    for deaths (in 16 regions) and DALYs (in 17 regions;
age-standardised rates of diet-related cardiovascular                       figure 4). A diet high in sodium was the leading dietary
disease deaths (299 [275–324] deaths per 100 000 population)                risk factor for deaths and DALYs in east Asia and high-
and Egypt had the highest DALY rates (10 811 [9577–12 209]                  income Asia Pacific regions (appendix). In southern
DALYs per 100 000 population). China had highest rates of                   sub-Saharan Africa, a diet low in fruits and in central
diet-related cancer deaths and DALYs (42 [34–49] deaths                     Latin America a diet low in nuts and seeds were the
per 100 000 population and 889 [744–1036] DALYs per                         dietary risk factors responsible for the greatest
100 000 population), and Mexico had the highest rates of                    proportion of deaths and DALYs in 2017.
diet-related type 2 diabetes deaths and DALYs (35 [28–44]                     High intake of sodium was the leading dietary risk for
deaths per 100 000 population and 1605 [1231–2034] DALYs                    deaths and DALYs in China, Japan, and Thailand. Low
per 100 000 population). Japan had the lowest rate of                       intake of whole grains was the leading dietary risk factor
diet-related cardiovascular disease deaths and DALYs                        for deaths and DALYs in the USA, India, Brazil, Pakistan,
(69 [63–75] deaths per 100 000 population and 1507                          Nigeria, Russia, Egypt, Germany, Iran, and Turkey. In
[1389–1639] DALYs per 100 000 population) and diabetes                      Bangladesh, low intake of fruits was the leading dietary
deaths and DALYs (one [1–1] death per 100 000 population                    risk associated with deaths and DALYs. In Mexico, low
and 234 [161–321] DALYs per 100 000 population). Egypt                      intake of nuts and seeds ranked first for diet-related
had the lowest rate of diet-related cancer deaths and                       deaths and DALYs. High consumption of red meat,
DALYs (five [4–6] deaths per 100 000 population and                         processed meat, trans fat, and sugar-sweetened beverages
120 [96–146] DALYs per 100 000 population; appendix).                       were towards the bottom in ranking of dietary risks for
The highest age-standardised proportion of all diet-related                 deaths and DALYs for most high-population countries
deaths (30% [27–33]) and DALYs (23% [21–25]) in adults                      (appendix).
aged 25 years or older were observed in Egypt, and the
lowest proportion of all diet-related deaths (11% [9–12])                   Relationship between diet and SDI
and DALYs (7% [6–8]) in the same age group were observed                    Overall, in 2017, the highest age-standardised rates of all
in Nigeria (appendix). The highest proportions of diet-                     diet-related deaths and DALYs were observed in low-
related cardiovascular disease deaths and DALYs in 2017                     middle SDI countries (344 [95% UI 319–369] deaths per
were observed in Pakistan (60% [95% UI 57–64] of deaths                     100 000 population and 7797 [7265–8386] DALYs per
and 66% [62–69] of DALYs), cancer deaths and DALYs in                       100 000 population) and high-middle SDI countries
China (16% [13–18] of deaths and 15% [13–17] of DALYs),                     (347 [324–369] deaths per 100 000 population and 6998
and type 2 diabetes deaths and DALYs in the USA (41%                        [6534–7454] DALYs per 100 000 population; appendix).
www.thelancet.com Published online April 3, 2019 http://dx.doi.org/10.1016/S0140-6736(19)30041-8                                                 7