The burden of disease attributable to dietary risks in China, 1990-2019: a systematic subnational analysis for the Global Burden of Disease Study 2019 (Preprint)

Abstract

BACKGROUND Temporal trends and geographical variations in non-communicable diseases (NCDs) attributable to suboptimal diets in China have not been systematically investigated. OBJECTIVE This study aimed to estimate the disease burden related to major foods and nutrients at national and provincial levels in China from 1990 to 2019. METHODS Following the methods of the Global Burden of Disease Study (GBD) 2019, all-cause and cause-specific and province-specific mortality and disability-adjusted life-years (DALYs) burden attributable to diet were comprehensively evaluated across the 33 province-level administrative units in China between 1990 and 2019. RESULTS Nationally, in 2019, 2.0 million (95% uncertainty interval [UI]: 1.5, 2.6) deaths and 46.8 million (35.6, 60.0) DALYs were attributable to dietary risks in China, of which cardiovascular diseases accounted for the highest proportion among all cause outcomes (1.7 million [1.3, 2.3] deaths, 39.0 million [29.2, 49.7] DALYs). The age-standardized death and DALY rates associated with dietary risks were 162 (121, 211) deaths per 100 000 population in 1990 and 115 (85, 152) deaths per 100 000 population in 2019, and 3 570 (2 740, 4 544) DALYs per 100 000 population in 1990 and 2 394 (1 823, 3 071) DALYs per 100 000 population in 2019, with percentage change of -28.8% and -32.9% from the 1990’s estimates. High consumption of sodium (855 385 [320 611, 1 546 463] deaths; 21.1 million [35.6, 9.3] DALYs), low consumption of whole grains (383 478 [192 387, 502 816] deaths; 8.6 million [4.6, 11.3] DALYs), and high consumption of red meat (323 380 [204 050, 456 381] deaths; 8.7 million [6.1, 11.8] DALYs) were the leading dietary risk factors for deaths and DALYs of estimated burden in 2019. The burden of disease caused by dietary risks varied substantially across China, with the western and northeastern provinces demonstrating a comparatively high age-standardized rate linked to dietary risks. CONCLUSIONS Although the age-standardized death and DALY rates associated with dietary factors have declined since 1990, the impact of suboptimal diet on the burden of NCDs and regional disparities across China remains an important public health concern. The results from our study hold the potential for guiding the development of effective and localized dietary interventions that can enhance the quality of diets and alleviate the burden of dietary-related diseases.