Background Diet is an important risk factor for cancer that is amenable to intervention. Estimating the cancer burden associated with diet informs evidence-based priorities for nutrition policies to reduce cancer burden in the United States. Methods Using a comparative risk assessment model that incorporated nationally representative data on dietary intake, national cancer incidence, and estimated associations of diet with cancer risk from meta-analyses of prospective cohort studies, we estimated the annual number and proportion of new cancer cases attributable to suboptimal intakes of seven dietary factors among US adults ages 20 years or older, and by population subgroups. Results An estimated 80 110 (95% uncertainty interval [UI] = 76 316 to 83 657) new cancer cases were attributable to suboptimal diet, accounting for 5.2% (95% UI = 5.0% to 5.5%) of all new cancer cases in 2015. Of these, 67 488 (95% UI = 63 583 to 70 978) and 4.4% (95% UI = 4.2% to 4.6%) were attributable to direct associations and 12 589 (95% UI = 12 156 to 13 038) and 0.82% (95% UI = 0.79% to 0.85%) to obesity-mediated associations. By cancer type, colorectal cancer had the highest number and proportion of diet-related cases (n = 52 225, 38.3%). By diet, low consumption of whole grains (n = 27 763, 1.8%) and dairy products (n = 17 692, 1.2%) and high intake of processed meats (n = 14 524, 1.0%) contributed to the highest burden. Men, middle-aged (45–64 years) and racial/ethnic minorities (non-Hispanic blacks, Hispanics, and others) had the highest proportion of diet-associated cancer burden than other age, sex, and race/ethnicity groups. Conclusions More than 80 000 new cancer cases are estimated to be associated with suboptimal diet among US adults in 2015, with middle-aged men and racial/ethnic minorities experiencing the largest proportion of diet-associated cancer burden in the United States.

BackgroundFiscal interventions are promising strategies to improve diets, reduce cardiovascular disease and diabetes (cardiometabolic diseases; CMD), and address health disparities. The aim of this study is to estimate the impact of specific dietary taxes and subsidies on CMD deaths and disparities in the US.MethodsUsing nationally representative data, we used a comparative risk assessment to model the potential effects on total CMD deaths and disparities of price subsidies (10%, 30%) on fruits, vegetables, whole grains, and nuts/seeds and taxes (10%, 30%) on processed meat, unprocessed red meats, and sugar-sweetened beverages. We modeled two gradients of price-responsiveness by education, an indicator of socioeconomic status (SES), based on global price elasticities (18% greater price-responsiveness in low vs. high SES) and recent national experiences with taxes on sugar-sweetened beverages (65% greater price-responsiveness in low vs. high SES).ResultsEach price intervention would reduce CMD deaths. Overall, the largest proportional reductions were seen in stroke, followed by diabetes and coronary heart disease. Jointly altering prices of all seven dietary factors (10% each, with 18% greater price-responsiveness by SES) would prevent 23,174 (95% UI 22,024–24,595) CMD deaths/year, corresponding to 3.1% (95% UI 2.9–3.4) of CMD deaths among Americans with a lower than high school education, 3.6% (95% UI 3.3–3.8) among high school graduates/some college, and 2.9% (95% UI 2.7–3.5) among college graduates. Applying a 30% price change and larger price-responsiveness (65%) in low SES, the corresponding reductions were 10.9% (95% UI 9.2–10.8), 9.8% (95% UI 9.1–10.4), and 6.7% (95% UI 6.2–7.6). The latter scenario would reduce disparities in CMD between Americans with lower than high school versus a college education by 3.5 (95% UI 2.3–4.5) percentage points.ConclusionsModest taxes and subsidies for key dietary factors could meaningfully reduce CMD and improve US disparities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0971-9) contains supplementary material, which is available to authorized users.

Objective: To quantify diet-related burdens of cardiometabolic diseases (CMD) by country, age and sex in Latin America and the Caribbean (LAC). Design: Intakes of eleven key dietary factors were obtained from the Global Dietary Database Consortium. Aetiologic effects of dietary factors on CMD outcomes were obtained from meta-analyses. We combined these inputs with cause-specific mortality data to compute country-, age- and sex-specific absolute and proportional CMD mortality of eleven dietary factors in 1990 and 2010. Setting: Thirty-two countries in LAC. Participants: Adults aged 25 years and older. Results: In 2010, an estimated 513 371 (95 % uncertainty interval (UI) 423 286–547 841; 53·8 %) cardiometabolic deaths were related to suboptimal diet. Largest diet-related CMD burdens were related to low intake of nuts/seeds (109 831 deaths (95 % UI 71 920–121 079); 11·5 %), low fruit intake (106 285 deaths (95 % UI 94 904–112 320); 11·1 %) and high processed meat consumption (89 381 deaths (95 % UI 82 984–97 196); 9·4 %). Among countries, highest CMD burdens (deaths per million adults) attributable to diet were in Trinidad and Tobago (1779) and Guyana (1700) and the lowest were in Peru (492) and The Bahamas (504). Between 1990 and 2010, greatest decline (35 %) in diet-attributable CMD mortality was related to greater consumption of fruit, while greatest increase (7·2 %) was related to increased intakes of sugar-sweetened beverages. Conclusions: Suboptimal intakes of commonly consumed foods were associated with substantial CMD mortality in LAC with significant heterogeneity across countries. Improved access to healthful foods, such as nuts and fruits, and limits in availability of unhealthful factors, such as processed foods, would reduce diet-related burdens of CMD in LAC.

ObjectivesOver the past 10 years, the burden of chronic diseases in Korea has increased. However, there are currently no quantitative estimates of how changes in diet and metabolic factors have contributed to these shifting burdens. This study aims to evaluate the contributions of dietary and metabolic risk factors to death from cardiometabolic diseases (CMDs) such as cardiovascular conditions, strokes and diabetes in Korea, and to estimate how these contributions have changed over the past 10 years (1998–2011).Design and methodsWe used data on 6 dietary and 4 metabolic risk factors by sex, age and year from the Korea National Health and Nutrition Examination Survey. The relative risks for the effects of the risk factors on CMD mortality were obtained from meta-analyses. The population-attributable fraction attributable to the risk factors was calculated by using a comparative risk assessment approach across sex and age strata (males and females, age groups 25–34, 35–44, 45–54, 55–64, 65–74 and 75+ years) from 1998 to 2011.ResultsThe results showed that a suboptimal diet and high blood pressure were the main risk factors for CMD mortality in Korea. High blood pressure accounted for 127 096 (95% uncertainty interval (UI): 121 907 to 132 218) deaths from CMD. Among the individual dietary risk factors, a high intake of sodium (42 387 deaths; 95% UI: 42 387 to 65 094) and a low intake of fruit (50 244 deaths; 95% UI: 40 981 to 59 178) and whole grains (54 248 deaths; 95% UI: 47 020 to 61 343) were responsible for the highest number of CMD deaths in Korea.ConclusionsIndicating the relative importance of risk factors in Korea, the results suggest that metabolic and dietary risk factors were major contributors to CMD mortality.

Background Sugar-sweetened beverage (SSB) consumption contributes to obesity, a risk factor for 13 cancers. While SSB taxes can reduce intake, the health and economic impact on reducing cancer burdens in the United States (US) are unknown, especially among low-income Americans with higher SSB intake and obesity-related cancer burdens. Methods We used the Dietary Cancer Outcome Model (DiCOM), a probabilistic cohort state-transition model, to project health gains and economic benefits of a penny-per-ounce national SSB tax on reducing obesity-associated cancers among US adults age 20+ years by income. Results A national SSB tax was estimated to prevent 22,075 (95% uncertainty interval [UI] = 16,040 to 28,577) new cancers cases and 13,524 (95% UI = 9,841 to 17,681) cancer deaths among US adults over a lifetime. The policy was estimated to cost $1.70 (95% UI = $1.50 to $1.95) billion for government implementation and $1.70 (95% UI = $1.48 to $1.96) billion for industry compliance, while saving $2.28 (95% UI = $1.67 to $2.98) billion cancer-related healthcare costs. The SSB tax was highly cost-effective from both a government affordability perspective (incremental cost-effectiveness ratio [ICER] = $1,486, 95% UI = -$3,516 to $9,265 per quality-adjusted life year [QALY]) and a societal perspective (ICER = $13,220, 95% UI = $3,453 to $28,120 per QALY). Approximately 4,800 more cancer cases and 3,100 more cancer deaths would be prevented, and $0.34 billion more healthcare cost savings would be generated among low-income (federal poverty-to-income ratio [FPIR] ≤1.85) than higher-income individuals (FPIR >1.85). Conclusions A penny-per-ounce national SSB tax is cost-effective for cancer prevention in the US, with the largest health gains and economic benefits among lower-income Americans.

Objectives Inadequate fruit and vegetable intake contributes to cardiovascular diseases (CVD), and the impacts of fruits and vegetables on CVD risk worldwide has not been well established by country, age, and sex. Our objective was to derive comprehensive and accurate estimates of the burdens of CVD attributable to fruit and vegetable consumption using the largest standardized global dietary database currently available. Methods National intakes of fruit and vegetables (including legumes) were estimated using a Bayesian hierarchical model using individual-level intake data from nationally and sub-nationally representative diet surveys and country-level availability data (266 surveys representing 1630,069 individuals from 113 of 187 countries─ 82% of the world's population). The effects of fruits and vegetables on coronary heart disease (CHD) and stroke mortality, collectively referred to as CVD mortality, were derived from the most recent meta-analyses of prospective cohorts. Disease specific mortality data were obtained from the Global Burden of Diseases study. A comparative risk assessment framework was used to estimate the proportional attributable fraction (PAF) and number of disease-specific deaths. Results In 2010, suboptimal intakes of fruit were estimated to result in 521,395 (95% uncertainty interval [UI] 498,254–542,808) CHD deaths (PAF: 7.5%; 7.2–7.8%) and 1255,978 (1187,716–1325,879) stroke deaths (PAF: 21.7%; 20.5–22.9%) globally per year. Suboptimal intakes of vegetables were estimated to result in 809,425 (783,362–836,687) CHD deaths (PAF: 11.6%; 11.3–12.0%) and 210,849 (196,297–226,577) stroke deaths (PAF: 3.6%; 3.4–3.9%). The proportion of CVD deaths from suboptimal fruit and vegetable intake was higher in males and younger adults. Among the 20 most populous countries, China (541,564; 482,709–608,314; PAF: 20.3%) had the largest absolute CVD deaths from suboptimal fruit intake and India (199,364; 176,961–222,688; PAF: 11.6%) from vegetables. Results for the global burden of fruits and vegetables on CVD in 1990 and 2015 will be presented at the meeting. Conclusions Suboptimal fruit and vegetable intake each contribute to significant CVD mortality, demonstrating a pressing need for public health and policy priorities to increase intake. Funding Sources Gates Foundation. Supporting Tables, Images and/or Graphs

Objectives Empirical evidence on the relationship between diet quality metrics and child growth outcomes is sparse. We investigated the associations between the Infant and Young Child Minimum Dietary Diversity (IYCMDD) and Dietary Approaches to Stop Hypertension (DASH) scores, and under-5 mortality and disability-adjusted life years (DALYs) due to stunting, wasting, underweight and overweight/obesity in children aged 6–59 months. Methods The Global Dietary Database (GDD) uses Bayesian hierarchical modeling methods to combine individual-level dietary intake from national and sub-nationally representative surveys with other country-level data to estimate mean national intakes for 55 dietary factors. Dietary data for children from 185 countries was obtained from the GDD. Data on under-5 mortality rates and disease specific DALYs were obtained from the World Bank's World Development Indicators and the Global Burden of Diseases study, respectively. We assessed country- and sex-stratum level cross-sectional associations between the IYCMDD and DASH scores, and mortality and DALYs using Poisson regression models, adjusting for individual and national-level confounders (sex, education, urbanicity, unemployment rate, poverty rate, income, and geographic region). Results In 2015, a higher IYCMDD score was associated with a lower risk of under-5 mortality (odds ratio [OR] 0.88, 95% CI 0.86–0.90, P-value < 0.001 for a 1-unit increase) and DALYs linked to stunting (0.67, 0.67–0.68, P-value < 0.001), wasting (0.70, 0.69–0.70, P-value < 0.001), and underweight (0.70, 0.70–0.71, P-value < 0.001). No significant association with overweight/obesity (0.99, 0.97–1.01, P-value = 0.479) was observed. A higher DASH score was associated with a decreased risk of DALYs linked to under-5 mortality (0.94, 95% 0.93–0.95, P-value < 0.001), stunting (0.87, 0.87–0.88, P-value < 0.001), wasting (0.89, 0.88–0.89, P-value < 0.001), and underweight (0.88, 0.87–0.89, P-value < 0.001), and an increased risk of overweight/obesity (1.02, 1.01–1.02, P-value < 0.01). Conclusions Higher IYCMDD and DASH scores were protective against the risk of death and stunting and wasting in children, but not overweight/obesity. Our findings suggest a need to prioritize appropriate metrics relevant to the double burden of malnutrition. Funding Sources Gates Foundation.

Objectives. To quantify disparities in health and economic burdens of cancer attributable to suboptimal diet among US adults. Methods. Using a probabilistic cohort state-transition model, we estimated the number of new cancer cases and cancer deaths, and economic costs of 15 diet-related cancers attributable to suboptimal intake of 7 dietary factors (a low intake of fruits, vegetables, dairy, and whole grains and a high intake of red and processed meats and sugar-sweetened beverages) among a closed cohort of US adults starting in 2017. Results. Suboptimal diet was estimated to contribute to 3.04 (95% uncertainty interval [UI] = 2.88, 3.20) million new cancer cases, 1.74 (95% UI = 1.65, 1.84) million cancer deaths, and $254 (95% UI = $242, $267) billion economic costs among US adults aged 20 years or older over a lifetime. Diet-attributable cancer burdens were higher among younger adults, men, non-Hispanic Blacks, and individuals with lower education and income attainments than other population subgroups. The largest disparities were for cancers attributable to high consumption of sugar-sweetened beverages and low consumption of whole grains. Conclusions. Suboptimal diet contributes to substantial disparities in health and economic burdens of cancer among young adults, men, racial/ethnic minorities, and socioeconomically disadvantaged groups. (Am J Public Health. Published online ahead of print October 14, 2021:e1–e11. https://doi.org/10.2105/AJPH.2021.306475 )