A small number of dietary risks had a large impact on health outcomes and has caused a huge burden of disability globally.
A study reported in the Lancet journal has shown that in 2017, more than half of diet-related deaths and two-thirds of diet-relateddisability-adjusted life-years (DALYs) were attributable to high intake of sodium, low intake of whole grains and low intake of fruits.
The study revealed that low intake of whole grains was the leading dietary risk factor for DALYs among men and women and the leading dietary risk factor for mortality among women. Sodium ranked first for mortality among men followed by whole grains and fruit. Low intake of whole grains was the leading risk for deaths and DALYs among young adults
(aged 25–50 years) and sodium ranked first among older adults (≥70 years).
Countries at risk
High intake of sodium was the leading dietary risk for deaths and DALYs in China, Japan, and Thailand.
Low intake of whole grains was the leading dietary risk factor for deaths and DALYs in the USA, India, Brazil, Pakistan, Nigeria, Russia, Egypt, Germany, Iran, and Turkey.
In Bangladesh, low intake of fruits was the leading dietary risk associated with deaths and DALYs.
In Mexico, low intake of nuts and seeds ranked first for diet-related deaths and DALYs. High consumption of red meat, processed meat, trans fat, and sugar-sweetened beverages were towards the bottom in ranking of dietary risks for deaths and DALYs for most high-population countries.
However, this finding suggests that dietary policies focusing on promoting the intake of components of diet for which current intake is less than the optimal level might have a greater effect than policies only targeting sugar and fat, highlighting the need for a comprehensive food system interventions to promote the production, distribution, and consumption of these foods across nations.
Over the past decade, the effectiveness of a range of population-level dietary interventions has been systematically evaluated and several promising interventions have been identified.
These include mass media campaigns, food and menu labelling, food pricing strategies (subsidies and taxation), school procurement policies, and worksite wellness programmes. Cost-effectiveness analyses of these interventions have shown that targeting specific dietary factors (sodium) might not only be cost-effective but cost-saving.
However, improvement of diet through population-level interventions faces several major challenges. First, the observed effects for most of these dietary interventions are far below the level required to achieve optimal diet globally.
Second, there is almost no evidence on the effectiveness of these interventions on several important dietary factors that is nuts, whole grains, seafood, red meat, and processed meat).
Third, cost-effectiveness analyses of dietary interventions are generally based on a range of simplifying assumptions and do not take into account the reactions of consumers (substitution effect), the food industry for example food reformulations and pricing strategies), and other stakeholders in the real world.
Fourth, despite the growing public and political will for the implementation of some of these policies (trans fat bans), few countries have successfully adopted and implemented them.
Fifth, many of these policies only target consumers but not the wide range of interconnected factors, such as food production, processing, and distribution that exist throughout the food system. Indeed, these factors might affect dietary consumption, and it is important to include them to improve diet.
Therefore, in view of the magnitude of the disease burden attributable to diet and the limitations of the existing interventions, development of novel food system interventions is urgently needed.
ANTHONIA OBOKOH
