Global Health Metrics

Dietary risks—Level 2 risk

Summary Globally, dietary risks were responsible for 188 million (95% UI 156–225) DALYs and 7·94 million (6·47–9·76) deaths among adults
aged 25 years and older in 2019. It was the fifth-leading Level 2 risk factor for attributable DALYs.

Definition This is an aggregate risk factor for all GBD dietary risks: diet low in whole grains, fruit, fibre, legumes, nuts and seeds, omega-3
fatty acids, PUFAs, vegetables, milk, and calcium; and diet high in sodium, trans fats, red or processed meat, and sugar-sweetened beverages.

Total What is new in GBD 2019?

sources
Exposure 1461
• Changes in dietary intake estimation included updates on the method of bias adjustment for dietary surveys and the use of data
from UN Food and Agriculture Organization supply utilisation accounts rather than food balance sheets.
Relative risk 442
• Based on the most recent epidemiological evidence and a newly developed method for characterising the risk curve, we updated
Table 1: Total sources all dietary relative risks with risk curves and dropped five risk–outcome pairs and added eight risk–outcome pairs.
used in GBD 2019 • TMRELs for harmful risks other than sodium were set to zero. TMRELs for protective dietary factors were updated on the basis of
estimation the most recent systematic review of evidence.

Deaths YLLs YLDs DALYs

Number Rate Number Rate Number Rate Number Rate

(millions) (per 100 000) (millions) (per 100 000) (millions) (per 100 000) (millions) (per 100 000)
2019
Both sexes 7·94 101·0 167 2041·6 20·3 245·7 188 2287·3
(6·47 to 9·76) (81·9 to 124·4) (138 to 203) (1683·4 to 2475·7) (14·1 to 27·8) (170·9 to 336·0) (156 to 225) (1899·6 to 2750·7)
Females 3·48 79·4 64·3 1477·4 10·1 232·3 74·3 1709·6
(2·78 to 4·37) (63·5 to 99·7) (52·2 to 79·1) (1200·5 to 1818·8) (7·03 to 13·7) (162·6 to 315·7) (60·6 to 91·0) (1395·6 to 2091·6)
Males 4·47 126·0 103 2650·9 10·3 260·6 113 2911·5
(3·65 to 5·45) (102·7 to 154·5) (84·6 to 124) (2178·8 to 3200·9) (7·16 to 14·1) (181·6 to 357·5) (93·4 to 136) (2402·2 to 3495·1)
Percentage change 2010–19
Both sexes 16·0% –11·4% 11·4% –11·9% 32·3% 5·0% 13·4% –10·4%
(9·8 to 22·0) (–16·0 to –7·0) (4·7 to 18·0) (–17·2 to –6·8) (29·9 to 34·8) (3·1 to 7·0) (7·2 to 19·4) (–15·2 to –5·7)
Females 16·8% –11·4% 12·9% –11·4% 31·7% 4·7% 15·1% –9·5%
(9·0 to 24·9) (–17·3 to –5·3) (4·1 to 21·9) (–18·3 to –4·5) (29·3 to 34·2) (2·8 to 6·9) (7·2 to 23·1) (–15·8 to –3·2)
Males 15·3% –11·5% 10·5% –12·2% 32·9% 5·2% 12·2% –10·9%
(7·1 to 23·5) (–17·4 to –5·7) (1·6 to 18·9) (–19·1 to –5·7) (30·2 to 35·6) (3·1 to 7·5) (4·1 to 20·0) (–17·2 to –4·8)
Numbers in parentheses are 95% uncertainty intervals.

Table 2: Attributable global deaths, YLLs, YLDs, and DALYs in counts and age-standardised rates for both sexes combined, females, and males, 2019, with percentage change between
2010 and 2019

Deaths YLLs YLDs DALYs Females Males

YLDs YLDs
1990 5th 6th 9th 6th YLLs YLLs
2010 3rd 5th 8th 5th 25 000

2019 3rd 5th 8th 5th

20 000
DALYs (in thousands)

Table 3: Rank among attributable Level 2 risks of global deaths, YLLs,

YLDs, and DALYs in 1990, 2010, and 2019 for both sexes combined 15 000

10 000

Cardiovascular diseases 5000

Diabetes and kidney diseases

0
Po neo tal
on l
4y l
s
–1 ars

20 9 ye s
25 4 ye s
30 9 ye s
35 4 ye s
40 9 ye s
45 4 ye s
50 9 ye s
55 4 ye s
60 9 ye s
65 4 ye s
s
–7 ars

80 9 ye s
85 4 ye s
90 9 ye s
4y s
5y s
rs
ne ta
1– ata
5– ear

–1 ar
–2 ar
–2 ar
–3 ar
–3 ar
–4 ar
–4 ar
–5 ar
–5 ar
–6 ar
–6 ar

–7 ar
–8 ar
–8 ar
–9 ar
≥9 ear

Neoplasms
ea
te na
st na

10 9 ye
15 ye

70 9 ye
75 4 ye
La neo

0 50 000 100 000 150 000 200 000

rly
Ea

DALYs (in thousands) Age group

Figure 1: Composition of attributable global DALYs by constituent Level 2 Figure 2: Composition of attributable global DALYs by YLLs and YLDs, age group, and sex, 2019
causes for both sexes combined, 2019

S268 www.thelancet.com Vol 396 October 17, 2020

 Global Health Metrics

<29∙6 38∙7 – <40∙1

29∙6 – <32∙0 40∙1 – <42∙4
32∙0 – <33∙1 42∙4 – <45∙0
33∙1 – <36∙0 45∙0 – <53∙5
36∙0 – <38∙7 53∙5 – ≤87∙1

Eastern
West Africa Mediterranean
Caribbean and central America Persian Gulf The Balkans Southeast Asia

Northern Europe

Figure 3: Age-standardised all-cause SEV by location, both sexes combined, 2019

GBD super-region
High income Central Europe, eastern Europe, and central Asia
South Asia Southeast Asia, east Asia, and Oceania
Sub-Saharan Africa Latin America and Caribbean
North Africa and Middle East
40

■
20 ◆ ■
▼ ▲ ■
● ◆ ■ ■
◆ ▼
SEV percentage change

◆▲
▼ ▲ ▼
● ● ● ⬣
▲
⬣ ■■ ■
■
⬣ ● ● ▲⬣ ⬣ ✱⬣ ■■
⬣ ▼ ⬣ ⬣ ⬣ ⬣ ✱ ⬣ ⬣ ▼■ ■ ■
● ⬣ ▲ ▲ ⬣
0 ●
●● ●● ⬣ ●
▲
●● ▲ ▲◆⬣▲ ▲ ▲
▲▲⬣● ▲▲ ▲▼ ▲▲▲ ▲■ ▼ ■ ▼
■ ■
▼ ● ● ●● ▼ ▲ ▼ ■ ▼ ■■▼
■ ■
● ▲ ✱ ■
● ●
● ● ▲▲ ● ⬣
■ ▼ ▲ ▲✱ ■■ ■
● ✱ ✱
● ▼●▼▲ ●● ■ ▲
▼ ✱✱ ■✱ ■⬣ ■
▲ ▲ ✱ ✱
● ▼ ✱ ✱✱
⬣ ▼ ⬣ ✱ ✱ ✱
⬣ ✱ ✱ ✱
-20 ● ⬣ ⬣ ▼ ✱✱
● ● ● ● ● ⬣✱ ⬣
● ● ●● ●● ✱
⬣ ⬣ ⬣⬣
⬣
⬣ ✱ ⬣
● ● ✱ ✱ ✱

■
-40
0 50 100
SDI

Figure 4: Percentage change in all-cause age-standardised SEV by SDI, both sexes combined, 1990–2019

www.thelancet.com Vol 396 October 17, 2020 S269