Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: a comparative risk assessment

Background High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods We used data for exposure to risk factors by country, age group, and sex from pooled analyses of populationbased health surveys. We obtained relative risks for the eff ects of risk factors on cause-specifi c mortality from metaanalyses of large prospective studies. We calculated the population attributable fractions for- each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the eff ects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specifi c population attributable fractions by the number of disease-specifi c deaths. We obtained cause-specifi c mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the fi nal estimates. Findings In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10\ub78 million deaths, 95% CI 10\ub71\u201311\ub75) of deaths from these diseases in 2010 were attributable to the combined eff ect of these four metabolic risk factors, compared with 67% (7\ub71 million deaths, 6\ub76\u20137\ub76) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined eff ects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing eff ect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the globalresponse to non-communicable diseases

A Mediterranean diet pattern with low consumption of liquid sweets and refined cereals is negatively associated with adiposity in adults from rural Lebanon

International audienceBackground: The beneficial impact of the traditional Mediterranean diet pattern on adiposity is still under debate, and this has never been assessed in a developing Mediterranean country. Objectives: To assess the relationships between adherence to a traditional Mediterranean diet and adiposity indexes, that is, body mass index (BMI) and waist circumference (WC), in a sample from rural Lebanon. Design: A sample of 798 adults, aged 40–60 years, was selected in continental rural areas of Lebanon for a cross-sectional study. The questionnaire included socio-demographic, anthropometric and dietary sections. The daily consumption frequencies of selected food groups, categorized as positive or negative components, were calculated based on a food frequency questionnaire. Adherence to the Mediterranean diet was assessed using six a priori scores; including the widely used Mediterranean diet score (MDS). Associations between diet scores and BMI and WC were assessed. Results: Overall, the diet of the study sample only partially matched the traditional Mediterranean diet. A total of 17.0% of men and 33.7% women were obese. The MDS was negatively associated (P<0.05) with WC, but not BMI, in men and women. The constructed composite Mediterranean score combining positive components of the diet (whole cereals, vegetables, legumes and fruit, olive oil and fish) and negative components adapted to this sample (refined cereals and pastries, and liquid sweets) was consistently and negatively associated with both BMI and WC for men and women in multivariate models. A 2-point increase in that score was associated with a decrease in BMI of 0.51 and 0.78 kg m–2 and a decrease in WC of 2.77 and 4.76 cm in men and women, respectively. Conclusion: The results demonstrate that a Mediterranean diet is negatively associated with obesity and visceral adiposity in a rural population of a developing Mediterranean countr