Global Burden of Cardiovascular Disease from 1990 to 2019 Attributable to Dietary Factors

Bei Zhang; Liyuan Pu; Tian Zhao; Li Wang; Chang Shu; Shan Xu; Jing Sun; Ruijie Zhang; Liyuan Han

doi:10.1016/j.tjnut.2023.03.031

Global Burden of Cardiovascular Disease from 1990 to 2019 Attributable to Dietary Factors

J Nutr. 2023 Jun;153(6):1730-1741. doi: 10.1016/j.tjnut.2023.03.031. Epub 2023 Mar 30.

Authors

Bei Zhang¹, Liyuan Pu², Tian Zhao¹, Li Wang³, Chang Shu⁴, Shan Xu⁵, Jing Sun⁶, Ruijie Zhang⁷, Liyuan Han⁸

Affiliations

¹ Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
² Hwa Mei Hospital, Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
³ Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
⁴ Tianjin Cerebral Vascular and Neural Degenerative Disease Key Laboratory, Tianjin Neurosurgery Institute, Tianjin Huanhu Hospital, Tianjin, China.
⁵ Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, Guangdong, China.
⁶ School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, Queensland Q4222, Australia.
⁷ Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China; Hwa Mei Hospital, Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.
⁸ Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China; Hwa Mei Hospital, Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China. Electronic address: hanliyuan@ucas.ac.cn.

PMID: 37003507
DOI: 10.1016/j.tjnut.2023.03.031

Abstract

Background: Although dietary factors play a crucial role in the incidence of cardiovascular disease (CVD), the specific dietary risk factors vary across regions and require further investigation.

Objective: We aimed to analyze the burden of CVD due to different dietary factors by sex, age, and sociodemographic index (SDI) for 204 countries and territories between 1990 and 2019.

Methods: Data were extracted from the Global Burden of Disease 2019 and analyzed to determine population attributable fractions (PAFs), mortality, disability-adjusted life years (DALYs), and trends thereof, for CVDs attributable to dietary risk factors from 1990 to 2019. We used a generalized linear model with a Gaussian distribution to calculate the estimated annual percentage changes (EAPCs) in CVD mortality and DALY rates attributable to dietary risk factors. We also used a comparative risk-assessment framework to estimate CVD mortality and DALYs attributable to dietary risk factors.

Results: Approximately 40% of CVD mortality and DALY rates were attributable to dietary risk factors, with high-sodium intake, low whole grain intake, and low legume intake being the greatest dietary risk factors globally. Moreover, high SDI regions had the highest PAFs for CVD mortality and DALYs associated with high red and processed meat intake, middle SDI regions had the highest PAFs with high-sodium intake, and low SDI regions had the highest PAFs with low fruit and vegetable intake. The highest PAFs for CVD mortality and DALYs were associated with low whole grain intake in 13 and 9 regions, respectively.

Conclusion: Reducing sodium intake and increasing whole grain and legume intake should be the top priority worldwide for improving regional diets and thereby decreasing CVD burdens. Other priorities should be set for regions with different SDIs, depending on the predominant dietary risk factors for CVDs in the respective regions.

Keywords: Global Burden of Disease; cardiovascular disease; dietary factors; estimated annual percentage change; sociodemographic index.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases* / epidemiology
Fabaceae*
Global Burden of Disease
Global Health
Humans
Quality-Adjusted Life Years
Risk Factors
Sodium, Dietary*
Vegetables

Substances

Sodium, Dietary