What we aren’t eating is killing us, global study finds

Which risk factor is responsible for more deaths around the world than any other? Not smoking. Not even high blood pressure. It’s a poor diet.

“In many countries, poor diet now causes more deaths than tobacco smoking and high blood pressure,” said Ashkan Afshin, an assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington.

And it’s not just that people are choosing unhealthy options such as red meat and sugary sodas. Just as critical, said Afshin, gtx_ads_conf.ads["ad-manager-58815-5"]= {"custom_css":[],"ad_details":[{"min_width":"","max_width":"","dfp_ad_sizes":[{"dfp_ad_width":"300","dfp_ad_height":"250"}]}],"ad_id":58815,"ad_container":"div-ad-manager-58815-5","ad_placement":"in-article","ad_name":"ad-manager-58815-5","position":"in_article","article_position":2,"out_of_page_ad":null,"lazyload":"global"};

In terms of lowest death rates, the UK ranked 23rd, above Ireland (24th) and Sweden (25th), while the United States ranked 43rd, after Rwanda and Nigeria (41st and 42nd). India ranked 118th, and China ranked 140th.

Highest risk factors

For the United States, India, Brazil, Pakistan, Nigeria, Russia, Egypt, Germany, Iran and Turkey, a lack of whole grains was the greatest risk factor; for many more countries, that came in second or third. That doesn’t mean people in these countries ate no grains but rather that they ate processed grains, with little nutritional value and the potential for high calorie counts.

Reynolds, who published a study in The Lancet on the effect of whole grains this year, cautions that many of the products sold to consumers today as “whole grain” often aren’t.

“Whole grains are being included in ultraprocessed products that may be finely milled down and have added sodium, added free sugars and added saturated fats,” Reynolds said. “I think we all need to be aware of this and not confuse the benefits from the more intact, minimally processed whole grains with what is often advertised as whole-grain products available today.”

A whole grain is defined as the use of the entire seed of a plant: the bran, the germ and the endosperm. The Whole Grains Council provides a stamp, available in 54 countries, that consumers can look for that certifies the degree of whole grains in the product.

Regional challenges

The greatest risk factor for China, Japan, Indonesia and Thailand was the amount of sodium in the diet. That is probably due to the extremely salty rice vinegars, sauces and pastes used to cook traditional Asian foods, Afshin said.

Does that mean those cultures are going to continue to live with that high risk? Not necessarily, said Corinna Hawkes, who directs the Centre for Food Policy at the University of London.

“Anyone who studies the history of food will tell you cultural preferences change over time,” said Hawkes, who was not involved in the new study. “They do shift. But yes, in this case, it will likely involve a culture change.”

In Mexico, the lack of nuts and seeds was the highest risk factor, followed by a lack of vegetables, whole grains, and fruit in the diet. And it was one of the few countries where unhealthy sugary beverages ranked quite high — at No. 5. That’s not only due to a cultural preference for sodas and homemade sugary drinks called aguas frescas, study co-author Christian Razo says, but a lack of access to clean water and even fruits and vegetables.

“We don’t have free clean water to drink,” said Razo, who has a Ph.D. in nutrition from the National Institute of Public Health of Mexico.

“So people have to buy clean water to drink, and if they’re going to have to buy something, they prefer the soda,” she said. “It’s also easier to get processed food than fresh fruits and vegetables.”

Razo says that while Mexico is a huge producer of fresh fruits and vegetables, those are purchased by distributors in the United States and other countries, leaving people in the cities with little access to affordable fresh options or the ability to grow their own.

“We encourage people to buy in local markets, but they are more expensive,” Razo said. “It’s hard to compete with all these huge brands that buy the produce. So, yeah, we have a big challenge.”

As for nuts and seeds, “people just can’t buy them because they’re very expensive,” she said.

Call to action

Policymakers reacted to the study with a call to action.

“Unhealthy diet is the top risk factor for the Global Burden of Disease. The relative importance of this factor has been growing and requires urgent attention,” said Francesco Branca, director of the Department of Nutrition for Health and Development at the World Health Organization.

“The public needs to be aware of the critical links between diet and health and demand public action to improve the access and availability of foods that contribute to healthy diets,” Branca said. “Considering the need for urgent action the UN General Assembly has declared 2016-2025 the UN Decade of Action of Nutrition, and is asking governments to make such commitments.”

That is going to require a coordinated effort between public policymakers, food growers, marketers and distributors, which will be a significant feat, Hawkes said.

Getting back to whole grains, for example, is going to require a complete change in the economics of food production and distribution, she said.

“Refining grains is highly profitable,” Hawkes said. “Take corn, for example. You can refine it into different ingredients: animal feed, refined flours and high-fructose corn syrup to name three. So manufacturers are generating multiple value streams from this refining process.

“If we then say, ‘I’m producing corn to make one product,’ then we need to have dialogues with the industry to ask about where public investment is needed and how we can shift the system, because it’s going to be a big deal. It’s a big, big shift.”

But Hawkes is hopeful. Twenty years ago, she said, when she entered a room of global health policymakers and mentioned the importance of diet, she was seen as “sort of a fringe person. Now, when I enter a room and say that, it’s taken seriously.”