Bill & Melinda Gates Foundation.

Summary Background Quantification of the disease burden caused by different risks informs prevention by providing an account of health loss different to that provided by a disease-by-disease analysis. No complete revision of global disease burden caused by risk factors has been done since a comparative risk assessment in 2000, and no previous analysis has assessed changes in burden attributable to risk factors over time. Methods We estimated deaths and disability-adjusted life years (DALYs; sum of years lived with disability [YLD] and years of life lost [YLL]) attributable to the independent effects of 67 risk factors and clusters of risk factors for 21 regions in 1990 and 2010. We estimated exposure distributions for each year, region, sex, and age group, and relative risks per unit of exposure by systematically reviewing and synthesising published and unpublished data. We used these estimates, together with estimates of cause-specific deaths and DALYs from the Global Burden of Disease Study 2010, to calculate the burden attributable to each risk factor exposure compared with the theoretical-minimum-risk exposure. We incorporated uncertainty in disease burden, relative risks, and exposures into our estimates of attributable burden. Findings In 2010, the three leading risk factors for global disease burden were high blood pressure (7·0% [95% uncertainty interval 6·2–7·7] of global DALYs), tobacco smoking including second-hand smoke (6·3% [5·5–7·0]), and alcohol use (5·5% [5·0–5·9]). In 1990, the leading risks were childhood underweight (7·9% [6·8–9·4]), household air pollution from solid fuels (HAP; 7·0% [5·6–8·3]), and tobacco smoking including second-hand smoke (6·1% [5·4–6·8]). Dietary risk factors and physical inactivity collectively accounted for 10·0% (95% UI 9·2–10·8) of global DALYs in 2010, with the most prominent dietary risks being diets low in fruits and those high in sodium. Several risks that primarily affect childhood communicable diseases, including unimproved water and sanitation and childhood micronutrient deficiencies, fell in rank between 1990 and 2010, with unimproved water we and sanitation accounting for 0·9% (0·4–1·6) of global DALYs in 2010. However, in most of sub-Saharan Africa childhood underweight, HAP, and non-exclusive and discontinued breastfeeding were the leading risks in 2010, while HAP was the leading risk in south Asia. The leading risk factor in Eastern Europe, most of Latin America, and southern sub-Saharan Africa in 2010 was alcohol use; in most of Asia, North Africa and Middle East, and central Europe it was high blood pressure. Despite declines, tobacco smoking including second-hand smoke remained the leading risk in high-income north America and western Europe. High body-mass index has increased globally and it is the leading risk in Australasia and southern Latin America, and also ranks high in other high-income regions, North Africa and Middle East, and Oceania. Interpretation Worldwide, the contribution of different risk factors to disease burden has changed s...

Background In 2010, overweight and obesity were estimated to cause 3.4 million deaths, 3.9% of years of life lost, and 3.8% of DALYs globally. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparative, up-to-date information on levels and trends is essential both to quantify population health effects and to prompt decision-makers to prioritize action. Methods We systematically identified surveys, reports, and published studies (n = 1,769) that included information on height and weight, both through physical measurements and self-reports. Mixed effects linear regression was used to correct for the bias in self-reports. Age-sex-country-year observations (n = 19,244) on prevalence of obesity and overweight were synthesized using a spatio-temporal Gaussian Process Regression model to estimate prevalence with 95% uncertainty intervals. Findings Globally, the proportion of adults with a body mass index (BMI) of 25 or greater increased from 28.8% (95% UI: 28.4-29.3) in 1980 to 36.9% (36.3-37.4) in 2013 for men and from 29.8% (29.3-30.2) to 38.0% (37.5-38.5) for women. Increases were observed in both developed and developing countries. There have been substantial increases in prevalence among children and adolescents in developed countries, with 23.8% (22.9-24.7) of boys and 22.6% (21.7-23.6) of girls being either overweight or obese in 2013. The prevalence of overweight and obesity is also rising among children and adolescents in developing countries as well, rising from 8.1% (7.7-8.6) to 12.9% (12.3-13.5) in 2013 for boys and from 8.4% (8.1-8.8) to 13.4% (13.0-13.9) in girls. Among adults, estimated prevalence of obesity exceeds 50% among men in Tonga and women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has stabilized. Interpretation Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Contrary to other major global risks, there is little evidence of successful population-level intervention strategies to reduce exposure. Not only is obesity increasing, but there are no national success stories over the past 33 years. Urgent global action and leadership is required to assist countries to more effectively intervene.

Scientific Targets for Healthy Diets* Food group Food subgroup Reference diet (g/day) Possible ranges (g/day) Whole Grains All grains 232 0 to 60% of energy Tubers/Starchy Vegetables Potatoes, cassava 50 0 to 100 Vegetables All vegetables 300 200 to 600 Fruits All Fruits 200 100 to 300 Dairy Foods Dairy Foods 250 0 to 500 Beef, lamb, pork 14 0 to 28 Protein Sources Chicken, other poultry 29 0 to 58 Eggs 13 0 to 25 Fish 28 0 to 100 Dry beans, lentils, peas 50 0 to 100 Soy 25 0 to 50 Nuts 50 0 to 75 Added fats Unsaturated oils 40 20-80 Added sugars All sweeteners 31 0 to 31 * See Table 1 for a complete list of scientific targets for a 2500 kcal/day healthy reference diet The Commission has integrated, with the quantification of universal healthy diets, global scientific targets for sustainable food systems. The objective is to provide scientific boundaries to reduce environmental degradation arising from food production at all scales. The quantification of scientific targets for the safe operating space of food systems in the world, was done for the key environmental systems and processes where food production plays a dominant role in determining the state of the planet. There is strong scientific evidence that food production is among the largest drivers of global environmental change due to its contributions to greenhouse gas (GHG) emissions, biodiversity loss, freshwater use, eutrophication, and land-system change (as well as chemical pollution, which is not assessed by this Commission). In turn, food production depends upon the continued functioning of these biophysical systems and processes in regulating and maintaining a stable Earth system. These systems and processes thereby provide a necessary set of globally systemic indicators of what constitutes sustainable food production. The Commission concludes that these quantitative scientific targets for sustainable food systems, constitute universal and scalable planetary boundaries for the food system, (Table 2). However, the uncertainty range for these food boundaries remain high, due to the inherent complexity in Earth system dynamics from local ecosystems to the functioning of the biosphere and the climate system. Scientific Targets for Sustainable Food Production Earth system process Control variable Boundary Uncertainty Range Climate change GHG (CH4 and N2O) emissions 5 Gt CO2-eq yr-1 (4.7-5.4 Gt CO2-eq yr-1) Nitrogen cycling N application 90 Tg N yr-1 (65-90 Tg N yr-1) (90-130 Tg N yr-1) Phosphorus cycling P application 8 Tg P yr-1 (6-12 Tg P yr-1) (8-16 Tg P yr-1) Freshwater use Consumptive water use 2,500 km 3 yr-1 (1000-4000 km 3 yr-1) Biodiversity loss Extinction rate 10 E/MSY (1-80 E/MSY) Land-system change Cropland use 13 M km 2 (11-15 M km 2)