Introduction
Methods
Data input, scope and modelling
No | Dietary risk factor | Exposure definition | Theoretical minimum risk exposure level (TMREL) per person |
---|---|---|---|
1 | Diet low in fiber | Average daily intake of fibre from all sources including fruits, vegetables, grains, legumes, and pulses | Intake of fiber between 19 and 28 grams per day |
2 | Diet low in fruits | Average daily intake of fruits (fresh, frozen, cooked, canned, or dried fruits, excluding fruit juices and salted or pickled fruits) | Intake of fruits between 200 and 300 grams per day |
3 | Diet low in legumes | Average daily intake of legumes (fresh, frozen, cooked, canned, or dried legumes) | Intake of legumes between 50 and 70 grams per day |
4 | Diet low in nuts and seeds | Average daily intake of nuts and seeds | Intake of nuts and seeds between 16 and 25 grams per day |
5 | Diet low in polyunsaturated fatty acids | Average daily intake of omega-6 fatty acids from all sources, mainly liquid vegetable oils, including soybean oil, corn oil, and safflower oil | Intake of polyunsaturated fatty acids between 9 and 13% of total daily energy |
6 | Diet low in seafood omega-3 fatty acids | Average daily intake of eicosapentaenoic acid and docosahexaenoic acid | Intake of seafood omega-3 fatty acids between 200 and 300 milligrams per day |
7 | Diet low in vegetables | Average daily intake of vegetables (fresh, frozen, cooked, canned, or dried vegetables, excluding legumes and salted or pickled vegetables, juices, nuts, and seeds, and starchy vegetables such as potatoes or corn) | Intake of vegetables between 290 and 430 grams per day |
8 | Diet low in whole grains | Average daily intake of whole grains (bran, germ, and endosperm in their natural proportion) from breakfast cereals, bread, rice, pasta, biscuits, muffins, tortillas, pancakes, and other sources | Intake of whole grains between 100 and 150 grams per day |
9 | Diet high in processed meat | Average daily intake of meat preserved by smoking, curing, salting, or addition of chemical preservatives | Intake of processed meat between 0 and 4 grams per day |
10 | Diet high in sodium | 24 h urinary sodium measured in g/day | 24 h urinary sodium between 1 and 5 grams per day |
11 | Diet high in sugar-sweetened beverages | Average daily intake of beverages with ≥ 50 kcal per 226.8 g serving, including carbonated beverages, sodas, energy drinks, fruit drinks, but excluding 100% fruit and vegetable juices | Intake of sugar-sweetened beverages between 0 and 5 grams per day |
12 | Diet high in trans fatty acids | Average daily intake of trans fat from all sources, mainly partially hydrogenated vegetable oils and ruminant products | Intake of trans fatty acids between 0 and 1% of total daily energy |
Relative risks, theoretical minimum-risk exposure level, mediation
Uncertainty ratios and uncertainty intervals
Adjusting for multiplicity
Results
Deaths attributable to diet-related CVDs in the year 2016
Number of deaths | 95% Uncertainty interval | Uncertainty ratioa | ||
---|---|---|---|---|
(a) Due to disease group | ||||
Ischemic heart disease | 1,757,053 | 1,448,146 | 2,085,227 | 0.36 |
Ischemic stroke | 175,202 | 141,174 | 216,754 | 0.42 |
Hemorrhagic stroke | 132,749 | 112,348 | 160,875 | 0.36 |
Hypertensive heart disease | 18,886 | 3214 | 42,018 | 1.72 |
Cardiomyopathy and myocarditis | 3394 | 897 | 6002 | 1.48 |
Atrial fibrillation and flutter | 2553 | 445 | 4699 | 1.65 |
Aortic aneurysm | 1840 | 367 | 3165 | 1.58 |
Peripheral vascular disease | 840 | 131 | 1562 | 1.69 |
Rheumatic heart disease | 799 | 144 | 1559 | 1.66 |
Endocarditis | 662 | 91 | 1280 | 1.73 |
Other cardiovascular and circulatory diseases | 5659 | 1234 | 9719 | 1.55 |
Sum | 2099,637 | 1,708,193 | 2,532,859 | 0.39 |
(b) Due to food or nutrient group | ||||
Diet low in whole grains | 429,220 | 374,656 | 492,324 | 0.27 |
Diet low in nuts and seeds | 341,185 | 297,925 | 391,234 | 0.27 |
Diet low in fruits | 261,965 | 211,927 | 317,216 | 0.40 |
Diet high in sodium | 251,437 | 179,195 | 328,682 | 0.59 |
Diet low in seafood omega-3 PUFA | 227,276 | 182,913 | 276,161 | 0.41 |
Diet low in vegetables | 188,915 | 146,685 | 234,904 | 0.46 |
Diet low in legumes | 148,668 | 121,269 | 179,024 | 0.38 |
Diet low in fiber | 120,241 | 101,607 | 141,269 | 0.33 |
Diet low in PUFA | 78,101 | 62,833 | 94,923 | 0.41 |
Diet high in processed meat | 34,113 | 23,666 | 45,238 | 0.63 |
Diet high in trans fatty acids | 16,182 | 11,369 | 21,318 | 0.61 |
Diet high in sugar-sweetened beverages | 2334 | 1997 | 2717 | 0.31 |
Sum | 2099,637 | 1,708,193 | 2,532,859 | 0.39 |
Number of deaths | Deaths in % | Deaths per 100,000 people (age-standardized) | |
---|---|---|---|
Western Europe
|
594,295
|
14.2
|
64
|
(496,931–700,631) | (11.9–16.7) | (54–75) | |
Andorra | 94 | 12.9 | 54 |
(71–121) | (9.7–16.6) | (40–70) | |
Austria | 15,186 | 18.4 | 83 |
(12,158–18,203) | (14.7–22.1) | (68–99) | |
Belgium | 13,608 | 12.0 | 59 |
(11,059–16,384) | (9.8–14.5) | (48–70) | |
Cyprus | 1195 | 16.5 | 88 |
(984–1419) | (13.6–19.6) | (73–104) | |
Denmark | 5854 | 11.1 | 55 |
(4716–7190) | (8.9–13.6) | (44–67) | |
Finland | 10,029 | 19.4 | 87 |
(8335–11,766) | (16.1–22.7) | (72–102) | |
France | 66,801 | 11.4 | 46 |
(55,087–79,825) | (9.4–13.6) | (38–54) | |
Germany | 164,639 | 17.9 | 87 |
(136,783–194,795) | (14.9–21.2) | (73–103) | |
Greece | 25,785 | 20.2 | 100 |
(20,764–31,139) | (16.3–24.4) | (81–119) | |
Iceland | 353 | 15.7 | 69 |
(297–413) | (13.2–18.4) | (58–81) | |
Ireland | 4984 | 16.0 | 79 |
(4033–5947) | (13.0–19.2) | (64–95) | |
Israel | 4486 | 9.8 | 43 |
(3279–5815) | (7.1–12.6) | (32–57) | |
Italy | 96,977 | 14.5 | 61 |
(76,694–118,592) | (11.5–17.8) | (49–74) | |
Luxembourg | 568 | 13.8 | 62 |
(450–694) | (10.9–16.9) | (49–76) | |
Malta | 644 | 18.7 | 87 |
(506–805) | (14.7–23.3) | (68–108) | |
Netherlands | 16,301 | 11.0 | 52 |
(13,435–19,917) | (9.1–13.5) | (43–63) | |
Norway | 5818 | 13.9 | 61 |
(4657–7055) | (11.1–16.9) | (49–74) | |
Portugal | 14,499 | 13.0 | 63 |
(11,574–17,620) | (10.3–15.8) | (51–76) | |
Spain | 44,617 | 10.7 | 43 |
(35,661–54,825) | (8.5–13.1) | (35–53) | |
Sweden | 16,164 | 17.2 | 77 |
(12,849–19,567) | (13.7–20.8) | (61–93) | |
Switzerland | 10,349 | 15.4 | 60 |
(7580–13,259) | (11.3–19.8) | (44–76) | |
United Kingdom | 75,343 | 12.3 | 62 |
(66,069–85,339) | (10.8–13.9) | (55–70) | |
Central Europe
|
341,032
|
25.9
|
177
|
(288,961–393,849) | (21.9–29.9) | (144–214) | |
Albania | 6085 | 27.2 | 174 |
(4813–7475) | (21.5–33.4) | (137–212) | |
Bosnia and Herzegovina | 9081 | 23.4 | 153 |
(7224–11,195) | (18.6–28.9) | (121–188) | |
Bulgaria | 35,298 | 32.2 | 260 |
(28,440-43,692) | (25.9–39.8) | (211–319) | |
Croatia | 14,208 | 25.5 | 170 |
(11,607–17,005) | (20.8–30.5) | (140–203) | |
Czech Republic | 28,574 | 26.4 | 159 |
(24,428–32,717) | (22.6–30.2) | (136–181) | |
Hungary | 33,539 | 25.7 | 192 |
(27,930–39,812) | (21.4–30.5) | (160–228) | |
Macedonia | 4948 | 22.7 | 197 |
(3852–6211) | (17.7–28.5) | (152–249) | |
Montenegro | 1582 | 26.6 | 186 |
(1276–1922) | (21.4–32.3) | (150–226) | |
Poland | 94,291 | 24.2 | 150 |
(78,937–110,004) | (20.3–28.2) | (125–175) | |
Romania | 70,166 | 27.6 | 206 |
(56,558–85,548) | (22.2–33.6) | (167–250) | |
Serbia | 23,971 | 22.4 | 168 |
(18,949–29,963) | (17.7–28.1) | (134–209) | |
Slovakia | 15,643 | 29.0 | 206 |
(13,002–18,262) | (24.1–33.8) | (171–240) | |
Slovenia | 3646 | 17.7 | 86 |
(2889–4515) | (14.0–21.9) | (69–106) | |
Eastern Europe
|
936,950
|
32.2
|
304
|
(738,494–1162,390) | (25.4–40.0) | (240–376) | |
Belarus | 44,568 | 36.8 | 313 |
(36,132–53,629) | (29.9–44.3) | (254–374) | |
Estonia | 4491 | 28.3 | 170 |
(3484–5538) | (21.9–34.9) | (133–209) | |
Latvia | 9004 | 31.7 | 232 |
(7428–10,536) | (26.1–37.1) | (192–270) | |
Lithuania | 12,187 | 30.5 | 214 |
(10,339–14,157) | (25.9–35.4) | (182–247) | |
Moldova | 14,746 | 34.2 | 328 |
(12,420–17,069) | (28.8–39.6) | (276–381) | |
Russia | 598,759 | 30.0 | 291 |
(432,818–794,563) | (21.7–39.8) | (212–385) | |
Ukraine | 253,196 | 38.2 | 349 |
(196,460–328,161) | (29.6–49.5) | (271–450) | |
Central Asia + Turkey
|
227,360
|
23.7
|
289
|
(183,808–275,990) | (19.2–28.8) | (240–343) | |
Armenia | 7686 | 28.2 | 204 |
(6392–8963) | (23.5–32.9) | (171–238) | |
Azerbaijan | 22,418 | 32.0 | 319 |
(17,743–27,380) | (25.4–39.1) | (254–391) | |
Georgia | 16,486 | 34.4 | 278 |
(13,290–19,833) | (27.7–41.4) | (227–333) | |
Kazakhstan | 39,632 | 29.5 | 306 |
(31,982–19,833) | (23.8–35.9) | (248–371) | |
Kyrgyzstan | 10,627 | 29.5 | 350 |
(9137–12,225) | (25.4–34.0) | (299–402) | |
Tajikistan | 9932 | 24.0 | 310 |
(8369–11,930) | (20.2–28.9) | (260–371) | |
Turkey | 44,298 | 12.1 | 67 |
(33,452–57,146) | (9.2–15.7) | (50–87) | |
Turkmenistan | 10,483 | 31.9 | 376 |
(9186–11,876) | (28.0–36.2) | (326–427) | |
Uzbekistan | 65,799 | 32.2 | 394 |
(54,256–78,339) | (26.6–38.3) | (323–472) | |
EU-28
|
894,241
|
17.1
|
85
|
(736,198–1065,840) | (14.4–19.8) | (72–98) | |
Sum/ weighted average
|
2099,637
|
22.4
|
208
|
(1,708,193–2,532,859) | (18.2–27.0) | (171–249) |