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. 2016 Mar 18;11(3):e0151503.
doi: 10.1371/journal.pone.0151503. eCollection 2016.

The Impact of Dietary and Metabolic Risk Factors on Cardiovascular Diseases and Type 2 Diabetes Mortality in Brazil

Marcia C de Oliveira Otto  1 , Ashkan Afshin  2 , Renata Micha  2   3 , Shahab Khatibzadeh  4 , Saman Fahimi  4 , Gitanjali Singh  2 , Goodarz Danaei  4 , Rosely Sichieri  5 , Carlos A Monteiro  6 , Maria L C Louzada  6 , Majid Ezzati  7 , Dariush Mozaffarian  2 ; Global Burden of Diseases, Injuries, and Risk Factors Metabolic Risk Factors of Chronic Diseases Expert Group; Nutrition and Chronic Diseases Expert Group (NutriCoDE)
Collaborators, Affiliations

The Impact of Dietary and Metabolic Risk Factors on Cardiovascular Diseases and Type 2 Diabetes Mortality in Brazil

Marcia C de Oliveira Otto et al. PLoS One. .

Abstract

Background: Trends in food availability and metabolic risk factors in Brazil suggest a shift toward unhealthy dietary patterns and increased cardiometabolic disease risk, yet little is known about the impact of dietary and metabolic risk factors on cardiometabolic mortality in Brazil.

Methods: Based on data from Global Burden of Disease (GBD) Study, we used comparative risk assessment to estimate the burden of 11 dietary and 4 metabolic risk factors on mortality due to cardiovascular diseases and diabetes in Brazil in 2010. Information on national diets and metabolic risks were obtained from the Brazilian Household Budget Survey, the Food and Agriculture Organization database, and large observational studies including Brazilian adults. Relative risks for each risk factor were obtained from meta-analyses of randomized trials or prospective cohort studies; and disease-specific mortality from the GBD 2010 database. We quantified uncertainty using probabilistic simulation analyses, incorporating uncertainty in dietary and metabolic data and relative risks by age and sex. Robustness of findings was evaluated by sensitivity to varying feasible optimal levels of each risk factor.

Results: In 2010, high systolic blood pressure (SBP) and suboptimal diet were the largest contributors to cardiometabolic deaths in Brazil, responsible for 214,263 deaths (95% uncertainty interval [UI]: 195,073 to 233,936) and 202,949 deaths (95% UI: 194,322 to 211,747), respectively. Among individual dietary factors, low intakes of fruits and whole grains and high intakes of sodium were the largest contributors to cardiometabolic deaths. For premature cardiometabolic deaths (before age 70 years, representing 40% of cardiometabolic deaths), the leading risk factors were suboptimal diet (104,169 deaths; 95% UI: 99,964 to 108,002), high SBP (98,923 deaths; 95%UI: 92,912 to 104,609) and high body-mass index (BMI) (42,643 deaths; 95%UI: 40,161 to 45,111).

Conclusion: suboptimal diet, high SBP, and high BMI are major causes of cardiometabolic death in Brazil, informing priorities for policy initiatives.

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Conflict of interest statement

Competing Interests: Dr. Otto was supported by unrestricted educational grants from Bunge LLC and from Swiss Re. Dr. Mozaffarian reports ad hoc honoraria or consulting from Bunge, Haas Avocado Board, Nutrition Impact, Amarin, Astra Zeneca, Boston Heart Diagnostics, GOED, and Life Sciences Research Organization; and scientific advisory boards, Unilever North America and Elysium Health. Harvard University holds a patent, listing Dr. Mozaffarian as one of three co-inventors, for use of trans-palmitoleic acid to prevent and treat insulin resistance, type 2 diabetes, and related conditions. The other authors report no conflicts. There are no products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Fig 1
Fig 1. Cardiometabolic deaths attributable to suboptimal dietary and metabolic factors in Brazilian men in 2010.
Fig 2
Fig 2. Cardiometabolic deaths attributable to suboptimal dietary and metabolic factors in Brazilian women in 2010.
Fig 3
Fig 3. Premature cardiometabolic deaths attributable to suboptimal dietary and metabolic factors in Brazilian men 25-69y in 2010.
Fig 4
Fig 4. Premature cardiometabolic deaths attributable to suboptimal dietary and metabolic factors in Brazilian women 25-69y in 2010.
See this image and copyright information in PMC

References

    1. Ministerio da Saude Brasil. Informacoes de Saude 2013 [June 2015]. Available: http://www.datasus.gov.br.
    1. Levy RB, Claro RM, Mondini L, Sichieri R, Monteiro CA. Regional and socioeconomic distribution of household food availability in Brazil, in 2008–2009. Rev Saude Publica. 2012;46(1):6–15. Epub 2011/12/21. . - PubMed
    1. Martins AP, Levy RB, Claro RM, Moubarac JC, Monteiro CA. Increased contribution of ultra-processed food products in the Brazilian diet (1987–2009). Rev Saude Publica. 2013;47(4):656–65. 10.1590/S0034-8910.2013047004968 . - DOI - PubMed
    1. Conde WL, Monteiro CA. Nutrition transition and double burden of undernutrition and excess of weight in Brazil. Am J Clin Nutr. 2014;100(6):1617S–22S. 10.3945/ajcn.114.084764 . - DOI - PubMed
    1. Schmidt MI, Duncan BB, Azevedo e Silva G, Menezes AM, Monteiro CA, Barreto SM, et al. Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet. 2011;377(9781):1949–61. Epub 2011/05/13. 10.1016/S0140-6736(11)60135-9 . - DOI - PubMed

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