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Close to half of European cardiovascular deaths linked to poor nutrition

Of the 4.3m cardiovascular deaths in Europe in 2016, 2.1m were the result of poor nutrition. The 28 EU member states account for around 900,000, Russia for 600,000 and the Ukraine for 250,000 of these deaths. Every second to third premature cardiovascular death could be prevented by better nutrition.

These were the findings of an international research team led by the Martin Luther University Halle-Wittenberg (MLU), the Friedrich Schiller University Jena, the nutriCARD competence cluster and the University of Washington in the US.

For the study, the team evaluated representative data from the Global Burden of Disease Study (GBD) which were collected between 1990 to 2016. They analysed the prevalence of cardiovascular diseases, such as heart attacks and strokes, in the 51 countries that the World Health Organisation (WHO) has designated as "European region."

In addition to the EU member states and other European countries, several states in the Middle East and Central Asia were also included, such as Armenia, Azerbaijan, Israel, Kazakhstan, Kyrgyzstan, Tajikistan, Turkey, Turkmenistan and Uzbekistan.

Based on food consumption and other risk factors in the respective countries, the researchers calculated the percentage of deaths attributable to an unbalanced diet, for example, the under-consumption of whole grain products, nuts, seeds and vegetables, as well as the over-consumption of salt.

A comparison of the countries revealed clear differences: In 2016, 160,000 deaths (46% of all cardiovascular deaths) were associated with an unbalanced diet in Germany, 97,000 (41%) in Italy, 75,000 (41%) in Great Britain and 67,000 (40%) in France. In Israel and Spain, however, only one in three premature cardiovascular deaths was diet-related.

Specific country profiles were published as part of the study: "In Sweden and Norway the under-consumption of nuts and seeds is most strongly associated with cardiovascular diseases, while in many Central and Eastern European and Central Asian countries the low intake of whole grain products poses the greatest risk. Or to put it another way: Increased consumption of low-fibre white flour products has led to an increase in cardiovascular disease in recent years. In Albania, Azerbaijan and Uzbekistan, the number of cases has more than doubled in the period under review," says Dr Toni Meier from MLU, who heads the study.

"Our findings are crucially relevant for health policy and should be incorporated in the development of future prevention strategies," adds Professor Stefan Lorkowski of the University of Jena, co-author of the study and spokesperson for the nutriCARD competence cluster. "We must make better use of the potential of a balanced and healthy diet, otherwise cardio-metabolic diseases will be the cause of even more preventable deaths in the future."

The team also found significant differences in terms of age and gender: men tended to be affected at a younger age, while women were only affected from the age of 50 onwards. In 2016, around 601,000 people under the age of 70 died from diet-related cardiovascular disease, 420,000 of them men and 181,000 women. The highest proportion of diet-related deaths among the under-70s was observed in Central Asia, where the figure was 42.5%.

In the EU member states, the researchers identified 178,000 premature diet-related deaths – 132,000 of them men and 46,000 of them women – which corresponds to almost 20% of cardiovascular deaths.

With the help of a calculation model, the researchers were also able to determine the effects of other risk factors such as obesity, high blood pressure, lack of exercise and smoking, thereby identifying the specific proportion of cardiovascular disease caused by an improper diet.

"It should also be emphasised that the well-known risk factor of alcohol was not taken into account by our study. In countries with a high consumption of alcohol the degree of diet-related cardiovascular disease could be even higher," remarks nutritionist Professor Gabriele Stangl from the MLU.

Abstract
This study was performed to highlight the relationship between single dietary risk factors and cardiovascular diseases (CVDs) in the WHO European Region. We used the comparative risk assessment framework of the Global Burden of Disease Study to estimate CVD mortality attributable to diet; comprising eleven forms of CVDs, twelve food and nutrient groups and 27 risk-outcome pairs in four GBD regions including 51 countries by age and sex between 1990 and 2016. In 2016, dietary risks were associated with 2.1 million cardiovascular deaths (95% uncertainty interval (UI), 1.7–2.5 million) in the WHO European Region, accounting for 22.4% of all deaths and 49.2% of CVD deaths. In terms of single dietary risks, a diet low in whole grains accounted for approximately 429,000 deaths, followed by a diet low in nuts and seeds (341,000 deaths), a diet low in fruits (262,000 deaths), a diet high in sodium (251,000 deaths), and a diet low in omega-3 fatty acids (227,000 deaths). Thus, with an optimized, i.e. balanced diet, roughly one in every five premature deaths could be prevented. Although age-standardized death rates decreased over the last 26 years, the absolute number of diet-related cardiovascular deaths increased between 2010 and 2016 by 25,600 deaths in Western Europe and by 4300 deaths in Central Asia. In 2016, approximately 601,000 deaths (28.6% of all diet-related CVD deaths) occurred among adults younger than 70 years. Compared to other behavioural risk factors, a balanced diet is a potential key lever to avoid premature deaths.

Authors
Toni Meier, Kira Gräfe, Franziska Senn, Patrick Sur, Gabriele I Stangl, Christine Dawczynski, Winfried März, Marcus E Kleber, Stefan Lorkowski

[link url="https://www.sciencedaily.com/releases/2019/01/190110112953.htm"]Martin-Luther-Universität Halle-Wittenberg material[/link]
[link url="https://link.springer.com/article/10.1007%2Fs10654-018-0473-x"]European Journal of Epidemiology abstract[/link]

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