Cardiovascular mortality attributable to dietary risk factors in 51 countries in the WHO European Region from 1990 to 2016: a systematic analysis of the Global Burden of Disease Study.

This study was performed to highlight the relationship between single dietary risk factors and cardiovascular diseases (CVDs) in the WHO European Region. We used the comparative risk assessment framework of the Global Burden of Disease Study to estimate CVD mortality attributable to diet; comprising eleven forms of CVDs, twelve food and nutrient groups and 27 risk-outcome pairs in four GBD regions including 51 countries by age and sex between 1990 and 2016. In 2016, dietary risks were associated with 2.1 million cardiovascular deaths (95% uncertainty interval (UI), 1.7-2.5 million) in the WHO European Region, accounting for 22.4% of all deaths and 49.2% of CVD deaths. In terms of single dietary risks, a diet low in whole grains accounted for approximately 429,000 deaths, followed by a diet low in nuts and seeds (341,000 deaths), a diet low in fruits (262,000 deaths), a diet high in sodium (251,000 deaths), and a diet low in omega-3 fatty acids (227,000 deaths). Thus, with an optimized, i.e. balanced diet, roughly one in every five premature deaths could be prevented. Although age-standardized death rates decreased over the last 26 years, the absolute number of diet-related cardiovascular deaths increased between 2010 and 2016 by 25,600 deaths in Western Europe and by 4300 deaths in Central Asia. In 2016, approximately 601,000 deaths (28.6% of all diet-related CVD deaths) occurred among adults younger than 70 years. Compared to other behavioural risk factors, a balanced diet is a potential key lever to avoid premature deaths.

Global smoking-attributable burden of periodontal disease in 186 countries in the year 2015.

AIM: We aimed to quantify the smoking-attributable burden of periodontal disease (PD). METHODS: The association between smoking and PD was evaluated. Population, smoking and PD data from the Global Burden of Disease Study were used, and the burden in different sex and age groups in 186 countries in 2015 calculated, adjusted for PD prevalence and numbers of cigarettes smoked. No adjustment was performed in a sensitivity analysis. RESULTS: The global smoking-attributable burden was 251,160 disability-adjusted life years (DALYs; 95% uncertainty interval: 190,721-324,241; sensitivity analysis: 344,041 DALYs) or 38.5 million cases. The burden was lower in females than males, and highest in the age group of the 50- to 69-year-olds. On super-regional level, the burden was highest in South-East Asia, East Asia and Oceania (83,052 DALYs), and high-income North America and Asia Pacific (55,362 DALYs). On regional level, it was highest in East Asia (70,845 DALYs), South Asia (30,808 DALYs) and North Africa and the Middle East (24,095 DALYs). On national level, it was highest in China (69,148 DALYs), India (29,362 DALYs) and the United States (12,714 DALYs). The relative smoking-attributable burden ranged between >25% in Suriname and <1% in Chad. CONCLUSIONS: There is great need to monitor and tackle the smoking-attributable burden of PD.

Balancing virtual land imports by a shift in the diet. Using a land balance approach to assess the sustainability of food consumption. Germany as an example.

Nutrition is considered as one of the main drivers of global environmental change. Dietary patterns in particular, embedded in the international trade of foods and other biomass based commodities, determine the dimension of beneficial or harmful environmental impacts of the agri-food sector - both domestically and abroad. In this study we analysed different dietary scenarios from a virtual land flow perspective, based on representative consumption data for Germany in the years 2006 and 1985-89. Further we identified the consumer groups that would have to adapt most to balance Germany's virtual land import and analysed the impact reduced food wastage. For the study, official data sets concerning production, trade and consumption were used. We derived land use data from environmentally extended input-output data sets and FAO statistics. The conversion of agricultural raw products to consumed commodities is based on official processing and composition data. Subgroup-specific intake data from the last representative National Nutrition Survey in Germany were used. We analysed 42 commodities, aggregated into 23 product groups, seven land use types and six nutrition scenarios. The results show that in the baseline scenario the average nutrition in the year 2006 leads to a virtual land import of 707m(2)p(-1)a(-1), which represents 30% of the total nutrition-induced land demand of 2365m(2)p(-1)a(-1). On the other hand, the German agri-food sector exports virtual land, in the form of commodities, equivalent to 262m(2)p(-1)a(-1). In this paper we calculate that the resulting net import of virtual land could be balanced by way of a shift to an officially recommended diet and a reduction in the consumption of stimulants (cocoa, coffee, green/black tea, wine). A shift to an ovo-lacto-vegetarian or vegan diet would even lead to a positive virtual land balance (even with maintained consumption of stimulants). Moreover, we demonstrate that a shift in the average diet profile could lead to maintained or even expanded export competitiveness and simultaneously enable environmental benefits. Since such a diet shift complies with official dietary recommendations, it follows that public health benefits may well result. We show further that a reduction of avoidable food losses/wastage would not be sufficient to level out the virtual land balance of the average nutrition in Germany. Regarding the dietary developments in the last 20years, we argue that a dietary shift resulting in a zero land balance is within reach. The population groups that would have to be addressed most are younger and middle-aged men. Nevertheless, women's land saving potentials should not be ignored neither. Due to the fact that a western-style diet prevails in Germany, we argue that our basic findings are applicable to other industrialised and densely populated countries.

Cardiovascular mortality attributable to dietary risk factors in 54 countries in the WHO European Region from 1990 to 2019: an updated systematic analysis of the Global Burden of Disease Study.

This study aimed to estimate the association between single dietary risk factors and cardiovascular diseases (CVDs) in the WHO European Region (WHO ER) by age and sex using the data of the Global Burden of Diseases Study (GBD) from 1990 to 2019. For this purpose, 13 dietary risks and 13 forms of CVDs were included in the study, and the comparative risk assessment framework of the GBD was used to estimate the deaths attributable to them. The study included four regions, with a total of 54 countries. In 2019, 1.55 million (95% UI, 1.2-1.9 million) people in the WHO ER died from CVDs attributable to suboptimal diet. Diet-related CVD deaths (DRCDs) accounted for 16.4% of total deaths and 36.7% of CVD deaths in 2019. Between 1990 and 2019, there was a DRCDs reduction of 8.1% and the age-standardised death rate decreased. The deaths were almost equally distributed between women (777,714 deaths) and men (772,519 deaths). The distribution of death numbers between the sexes has changed only slightly over the study period. The largest percentage across the age groups were found in the group 85+ years (32.1%). Most DRCDs in the WHO ER were caused by a diet low in whole grains (326,755 deaths), followed by a diet low in legumes (232,918 deaths) and a diet high in sodium (193,713 deaths). Overall, 80.3% of deaths were due to ischaemic heart disease, which was the most common cause of death in all countries.

This study aimed to estimate the association between single dietary risk factors and cardiovascular diseases (CVD) in the WHO European Region (WHO ER) by age and sex using the data of the Global Burden of Diseases Study from 1990 to 2019. Key findings:In 2019, 1.55 million people in the WHO ER died from diet-related CVD deaths (DRCDs), which accounted for 16.4% of total deaths and was a DRCDs reduction of 8.1% since 1990.Most DRCDs in the WHO ER were caused by a diet low in whole grains, followed by a diet low in legumes and a diet high in sodium.

Environmental impacts of dietary recommendations and dietary styles: Germany as an example.

Besides technical improvements and a reduction of food losses in the food chain, diet shifts offer practicable opportunities to reduce environmental impacts in the agri-food sector on a low-cost basis. In this paper we analyze the environmental impacts of nutrition in Germany in the year 2006. Based on an equalized daily energy uptake of 2000 kcal person(-1) day(-1), we compared these impacts with those of four dietary scenarios (D-A-CH, UGB, ovo-lacto vegetarian, vegan) and with average nutrition from 20 years ago, differentiating between effects caused by altering food losses, food wastage, and changed diets. In the year 2006 gender-related impacts were considered separately. With regard to the scenarios analyzed, the highest impact changes would be expected from the vegan and the ovo-lacto vegetarian diet. The impact potentials of the recommendations of UGB and D-A-CH rank third and fourth, but are still significant. Concerning gender, the average female diet is already closer to the recommendations than men's. In comparison to the years 1985-1989, all indicators (with the exception of blue water) show lower impacts, due mainly to changes in diet. In comparison to this, impact changes resulting from food wastage were lower and mainly contrarian, which could be explained by higher food wastage in 2006 compared to 1985-1989.

Nutritional Assessment of Ready-to-Eat Salads in German Supermarkets: Comparison of the nutriRECIPE-Index and the Nutri-Score.

Globally, an unbalanced diet causes more deaths than any other factor. Due to a lack of knowledge, it is difficult for consumers to select healthy foods at the point of sale. Although different front-of-pack labeling schemes exist, their informative value is limited due to small sets of considered parameters and lacking information on ingredient composition. We developed and evalauated a manufacture-independent approach to quantify ingredient composition of 294 ready-to eat salads (distinguished into 73 subgroups) as test set. Nutritional quality was assessed by the nutriRECIPE-Index and compared to the Nutri-Score. The nutriRECIPE-Index comprises the calculation of energy-adjusted nutrient density of 16 desirable and three undesirable nutrients, which are weighted according to their degree of supply in the population. We show that the nutriRECIPE-Index has stronger discriminatory power compared to the Nutri-Score and discriminates as well or even better in 63 out of the 73 subgroups. This was evident in groups where seemingly similar products were compared, e.g., potato salads (Nutri-Score: C only, nutriRECIPE-Index: B, C and D). Moreover, the nutriRECIPE-Index is adjustable to any target population's specific needs and supply situation, such as seniors, and children. Hence, a more sophisticated distinction between single food products is possible using the nutriRECIPE-Index.

The nutriRECIPE-Index - development and validation of a nutrient-weighted index for the evaluation of recipes.

BACKGROUND: Our objective was to develop a nutrient-based index for evaluating and improving menus in public catering. The nutriRECIPE-Index comprises 24 nutrients and nutrient groups. In developing the index, the following steps were included: setting the goals of the index, nutrient selection, target metrics and scaling, weighting, proof of concept and validation of the index. Furthermore, a unique database was created to integrate bioactive plant compounds in the assessment. An assessment of standard recipes and supposedly healthy recipes should show a significant difference in the results of the nutriRECIPE-Index. Finally, the nutriRECIPE-Index should generate similar or more specific results than existing indices such as the Nutri-Score and the Healthy Meal Index. METHODS: A whole meal cycle (comprising 6 weeks, 106 recipes and including different menu lines, partially with different side dishes) at a university canteen was analysed with the Federal Food Code (BLS) and the nutriRECIPE-Index. The Healthy Meal Index (comprising 3 nutritionally relevant items) and the Nutri-Score algorithm (comprising 7 items) were used to validate the nutrient composition and the results of the nutriRECIPE-Index. RESULTS: The resulting scores of the recipes and menu lines showed substantial differences, wherein the meals of a health-promoting menu line usually received higher scores than the standard recipes. A correlation between the nutriRECIPE-Index and the Healthy Meal Index (0.604) and the Nutri-Score (0.591) was observed. The nutriRECIPE-Index was better at identifying the worst menus and could better separate mediocre menus from good menus. CONCLUSION: The nutriRECIPE-Index is a useful and comprehensive tool for evaluating the nutritional value of recipes and is the first to consider bioactive plant compounds. Further adjustments to different target populations, settings, and cultural backgrounds are possible.

Review of a priori dietary quality indices in relation to their construction criteria.

A multitude of indices measure the healthiness of dietary patterns. Because validation results with respect to health outcomes do not sufficiently facilitate the choice of a specific dietary quality index, the decision of which index to use for a particular research objective should be based on other criteria. This review aims to provide guidance on which criteria to focus upon when choosing a dietary index for a specific research question. A review of 57 existing specifications of dietary quality indices was conducted, taking explicitly into account relevant construction criteria explicated in the Organisation for Economic Co-operation and Development handbook on constructing composite indicators. Index construction choices regarding the following criteria were extracted: theoretical framework, indicator selection, normalization and valuation functions, and aggregation methods. Preferable features of dietary indices are discussed, and a summarizing toolbox is provided to help identify indices with the most appropriate construction features for the respective study aim and target region and with regard to the available database. Directions for future efforts in the specification of new diet quality indices are given.

Healthcare Costs Associated with an Adequate Intake of Sugars, Salt and Saturated Fat in Germany: A Health Econometrical Analysis.

Non-communicable diseases (NCDs) represent not only the major driver for quality-restricted and lost life years; NCDs and their related medical treatment costs also pose a substantial economic burden on healthcare and intra-generational tax distribution systems. The main objective of this study was therefore to quantify the economic burden of unbalanced nutrition in Germany--in particular the effects of an excessive consumption of fat, salt and sugar--and to examine different reduction scenarios on this basis. In this study, the avoidable direct cost savings in the German healthcare system attributable to an adequate intake of saturated fatty acids (SFA), salt and sugar (mono- & disaccharides, MDS) were calculated. To this end, disease-specific healthcare cost data from the official Federal Health Monitoring for the years 2002-2008 and disease-related risk factors, obtained by thoroughly searching the literature, were used. A total of 22 clinical endpoints with 48 risk-outcome pairs were considered. Direct healthcare costs attributable to an unbalanced intake of fat, salt and sugar are calculated to be 16.8 billion EUR (CI95%: 6.3-24.1 billion EUR) in the year 2008, which represents 7% (CI95% 2%-10%) of the total treatment costs in Germany (254 billion EUR). This is equal to 205 EUR per person annually. The excessive consumption of sugar poses the highest burden, at 8.6 billion EUR (CI95%: 3.0-12.1); salt ranks 2nd at 5.3 billion EUR (CI95%: 3.2-7.3) and saturated fat ranks 3rd at 2.9 billion EUR (CI95%: 32 million-4.7 billion). Predicted direct healthcare cost savings by means of a balanced intake of sugars, salt and saturated fat are substantial. However, as this study solely considered direct medical treatment costs regarding an adequate consumption of fat, salt and sugars, the actual societal and economic gains, resulting both from direct and indirect cost savings, may easily exceed 16.8 billion EUR.