Trends of mortality attributable to child and maternal undernutrition, overweight/obesity and dietary risk factors of non-communicable diseases in sub-Saharan Africa, 1990-2015: findings from the Global Burden of Disease Study 2015

Abstract

Objective: To assess trends of mortality attributable to child and maternal undernutrition (CMU), overweight/obesity and dietary risks of non-communicable diseases (NCD) in sub-Saharan Africa (SSA) using data from the Global Burden of Disease (GBD) Study 2015.

Design: For each risk factor, a systematic review of data was used to compute the exposure level and the effect size. A Bayesian hierarchical meta-regression analysis was used to estimate the exposure level of the risk factors by age, sex, geography and year. The burden of all-cause mortality attributable to CMU, fourteen dietary risk factors (eight diets, five nutrients and fibre intake) and overweight/obesity was estimated.

Setting: Sub-Saharan Africa.ParticipantsAll age groups and both sexes.

Results: In 2015, CMU, overweight/obesity and dietary risks of NCD accounted for 826204 (95 % uncertainty interval (UI) 737346, 923789), 266768 (95 % UI 189051, 353096) and 558578 (95 % UI 453433, 680197) deaths, respectively, representing 10·3 % (95 % UI 9·1, 11·6 %), 3·3 % (95 % UI 2·4, 4·4 %) and 7·0 % (95 % UI 5·8, 8·3 %) of all-cause mortality. While the age-standardized proportion of all-cause mortality accounted for by CMU decreased by 55·2 % between 1990 and 2015 in SSA, it increased by 63·3 and 17·2 % for overweight/obesity and dietary risks of NCD, respectively.

Conclusions: The increasing burden of diet- and obesity-related diseases and the reduction of mortality attributable to CMU indicate that SSA is undergoing a rapid nutritional transition. To tackle the impact in SSA, interventions and international development agendas should also target dietary risks associated with NCD and overweight/obesity.

Keywords: Child and maternal undernutrition; Dietary risks of non-communicable diseases; Double burden of malnutrition; Mortality; Overweight and/or obesity.

Fig. 1

(colour online) Hierarchies of included risk factors (adapted from the Global Burden of Disease (GBD) 2015 risk factors study^{( 2 )}). The figure depicts a summary of child and maternal undernutrition, dietary risk factors of non-communicable diseases and overweight/obesity as risk factors of mortality; more detailed methods can be accessed elsewhere^{( 2 )}

Fig. 2

(colour online) Number, proportion (of all-cause) and rate of deaths associated with child and maternal undernutrition (CMU), overweight/obesity and dietary risks of non-communicable diseases (NCD) in sub-Saharan Africa by age in 2015: , CMU number/proportion; , CMU rate; , overweight/obesity number/proportion; , overweight/obesity rate; , dietary risks of NCD number/proportion; , dietary risks of NCD rate. Numbers and proportions are mean values with their 95 % uncertainty intervals represented by vertical bars

Fig. 3

(colour online) Age-standardized rate and proportion of deaths (all-cause) associated with child and maternal undernutrition (CMU), overweight/obesity and dietary risks of non-communicable diseases (NCD) in sub-Saharan countries between 1990 and 2015: , CMU rate; , CMU proportion; , overweight/obesity rate; , overweight/obesity proportion; , dietary risks of NCD rate; , dietary risks of NCD proportion. Rates are mean values with their 95 % uncertainty intervals represented by vertical bars