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BMJ Open. 2015 May 20;5(5):e006385. doi: 10.1136/bmjopen-2014-006385.

The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis.

Author information

1
Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA.
2
Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece.
3
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
4
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
5
Department of Public Health and Primary Care, Cambridge Institute of Public Health, Cambridge, UK.
6
Johns Hopkins University, Baltimore, Maryland, USA.
7
National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
8
Kuwait Institute for Scientific Research, Kuwait, Kuwait.
9
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
10
Faculty of Agricultural & Food Sciences, American University of Beirut, Beirut, Lebanon.
11
Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey.
12
Arab Center for Nutrition, Manama, Bahrain.
13
Department of Nutrition and Dietetics, Hacettepe University, Ankara, Turkey.
14
Department of Nutrition Requirements and Growth, National Nutrition Institute, Cairo, Egypt.
15
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
16
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

Abstract

OBJECTIVE/DESIGN:

We conducted a comparative risk assessment analysis to estimate the cardiometabolic disease (CMD) mortality attributable to 11 dietary and 4 metabolic risk factors in 20 countries of the Middle East by age, sex and time. The national exposure distributions were obtained from a systematic search of multiple databases. Missing exposure data were estimated using a multilevel Bayesian hierarchical model. The aetiological effect of each risk factor on disease-specific mortality was obtained from clinical trials and observational studies. The number of disease-specific deaths was obtained from the 2010 Global Burden of Disease mortality database. Mortality due to each risk factor was determined using the population attributable fraction and total number of disease-specific deaths.

SETTING/POPULATION:

Adult population in the Middle East by age, sex, country and time.

RESULTS:

Suboptimal diet was the leading risk factor for CMD mortality in 11 countries accounting for 48% (in Morocco) to 72% (in the United Arab Emirates) of CMD deaths. Non-optimal systolic blood pressure was the leading risk factor for CMD deaths in eight countries causing 45% (in Bahrain) to 68% (in Libya) of CMD deaths. Non-optimal body mass index and fasting plasma glucose were the third and fourth leading risk factors for CMD mortality in most countries. Among individual dietary factors, low intake of fruits accounted for 8% (in Jordan) to 21% (in Palestine) of CMD deaths and low intake of whole grains was responsible for 7% (in Palestine) to 22% (in the United Arab Emirates) of CMD deaths. Between 1990 and 2010, the CMD mortality attributable to most risk factors had decreased except for body mass index and trans-fatty acids.

CONCLUSIONS:

Our findings highlight key similarities and differences in the impact of the dietary and metabolic risk factors on CMD mortality in the countries of the Middle East and inform priorities for policy measures to prevent CMD.

PMID:
25995236
PMCID:
PMC4442236
DOI:
10.1136/bmjopen-2014-006385
[Indexed for MEDLINE]
Free PMC Article

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