International food trade contributes to dietary risks and mortality at global, regional and national levels

Abstract

Food trade is generally perceived to increase the availability and diversity of foods available to consumers, but there is little empirical evidence on its implications for human health. Here we show that a substantial proportion of dietary risks and diet-related mortality worldwide is attributable to international food trade and that whether the contributions of food trade are positive or negative depends on the types of food traded. Using bilateral trade data for 2019 and food-specific risk-disease relationships, we estimate that imports of fruits, vegetables, legumes and nuts improved dietary risks in the importing countries and were associated with a reduction in mortality from non-communicable diseases of ~1.4 million deaths globally. By contrast, imports of red meat aggravated dietary risks in the importing countries and were associated with an increase of ~150,000 deaths. The magnitude of our findings suggests that considering impacts on dietary risks will become an important aspect of health-sensitive trade and agriculture policies, and of policy responses to disruptions in food chains.

Fig. 1. Contribution of traded foods to the diet-related disease burden in the importing countries by dietary risk and disease.

Dietary risks include low intake of fruits, vegetables, nuts and legumes, and high intake of red meat. Diseases include coronary heart disease (CHD), stroke, cancer and type 2 diabetes mellitus (T2DM).

Fig. 2. Trade flows of dietary risks, measured in changes in mortality, between exporting and importing regions.

Changes in mortality occur and are estimated in the importing region (right) and traced back to the exporting region (left) to highlight the connection via trade. Please note that the trade flows of diet-related mortality impacts are not strictly conserved between exporting and importing regions. Mortality impacts would differ if the exported foods would be consumed in the exporting country owing to differences in baseline intake and mortality rates.

Fig. 3. Exporters and importers of dietary risks, measured in changes in mortality.

a,b, Changes in mortality occur and are estimated in the importing region (b) and traced back to the exporting region (a) to highlight the connection via trade.

Fig. 4. Leading importers and exporters of dietary risks by food group, measured in changes in mortality.

Changes in mortality occur and are estimated in the importing region and traced back to the exporting region to highlight the connection via trade.

Fig. 5. Trade-related changes in mortality, measured in number of deaths, by risk factor and region linked to Ukraine’s and Russia’s food exports and imports.

a, Exports from Ukraine. b, Imports to Ukraine. c, Exports from Russia. d, Imports to Russia.

Extended Data Fig. 1. Leading exporters and importers of foods related to dietary risk, with trade flows measured in kilo tonnes per year (kt/yr).

The foods include fruits, vegetables, legumes, nuts, and red meat.

Extended Data Fig. 2. Exporters and importers of dietary risks related to foods, measured in changes in mortality.

The foods include fruits (a, b), vegetables (c, d), legumes (e, f), nuts (g, h), and red meat (i, j).