Introduction: An unhealthy diet is a modifiable risk factor for non-communicable diseases (NCDs), one of the most important public health problems in Brazil. This study aimed to analyze the burden of NCDs attributable to dietary risks in Brazil between 1990-2019. Methods: Secondary data from the Global Burden of Disease Study were used to estimate the burden attributable to fifteen dietary risks in Brazil. The main sources of data for Brazil were national surveys and international databases. A comparative risk assessment was used to obtain the population attributable fraction. We described the intake of each dietary risk and the distribution of number and rates of deaths and Disability-adjusted life years (DALYs) attributable to diet by sex, age, state, and year from 1990-2019. Results: Cardiovascular diseases, diabetes mellitus, and neoplasms were the main NCDs attributable to an unhealthy diet. Age-standardized mortality and DALYs rates attributable to unhealthy diet decreased between 1990-2019 (-51.5% and -48.8, respectively). Diet high in red meat and sodium, and low in whole grains were the three main risk factors contributing to the burden of NCDs both in 1990 and 2019. The burden of NCDs was higher among males in the middle-aged population (around 50 years), as well as in the states of Maranhão, Rio de Janeiro, and Alagoas. Conclusions: The present study found a suboptimum diet among the Brazilian population. The major contributors to this burden were diet high in red meat and sodium and low in whole grains. This study supports priorities in public policies on food and nutrition to reduce the burden of NCDs.
High-sodium diet leads to significant health problems such as high blood pressure, chronic kidney disease, ventricular hypertrophy and stroke. In Brazil, 2008 survey data have shown an average intake of 4.7 g/day of sodium, equivalent to 12 g/day of salt. In 2014, the average ofsalt intake estimated was 9.3 g/day. In both surveys, the numbers are higher than the international recommendation of 5g/day of salt. Considering this excessive consumption and the invisibility of the major consequences of such lifestyle, the aim of this study was to estimate the burden of diseases due to a high-sodium diet in Brazil. We used the high-sodium diet attributable disability-adjusted life-years (DALYs) and deaths estimates of the Global Burden of Disease study in 2017 among Brazilian. The burden of high-sodium diet was assessed using a comparative risk assessment approach, which allows the calculation of the population attributable fraction of each disease that has an established relation with this behavior. Input data from Brazil to reach such estimates have included surveys that report the dietary sodium. Data on disease occurrence and mortality were obtained from health information systems and health surveys. In 2017, high-sodium diet contributed with a significant number of deaths (51,434, 95% U.I.: 9,266-105,118) and DALYs (988,258, 95% U.I.: 139,943-2,149,179) in Brazil. The states of Northern Region presented lower mortality rates (Roraima: 11.1/100,000; 95% U.I.: 1.5-24.0 and Amapa: 10.6/100,000; 1.5-23.5), while those in the Southeast have higher mortality rates (Rio de Janeiro: 33.2/100,000; 95% U.I.: 5.4-68.1 and São Paulo: 32.0/100,000; 95% U.I.: 3.5-49.6). The same pattern by states was observed for DALYs. These findings are significant and support the urgent necessity of strategies to reinforce the promotion of a healthy diet, restricted in ultra-processed foods high in sodium, among the Brazilian population in order to prevent early morbidity and mortality. Key messages Salt consumption in Brazil is high and contributes to a significant number of deaths and DALYs. It is necessary to increase and reinforce actions that promote the Brazilian traditional food, such as the Brazilian Food Guide, and also the sodium reduction agreements with industries.
INTRODUCTION: Excessive sodium consumption is associated with increased blood pressure, which is an important risk factor for non-communicable diseases (NCDs). This study therefore aimed to describe the burden of NCDs attributable to excessive sodium consumption among Brazilians. METHODS: This observational study used mortality and Disability Adjusted Life Years (DALY) rates , and their respective uncertainty intervals (UI), from the Global Burden of Disease Study 2019 (GBD 2019) . The burden was obtained by the population attributable fraction of each NCD, considering the minimum theoretical value of risk (intake of 0-3g of sodium/day); the excessive consumption proportion in the population, obtained through population inquiries; and the relative risks obtained through meta-analyses. RESULTS: Excessive sodium consumption was the third highest dietary risk contributing to deaths (30,814; 95% UI = 2,034 - 84,130) and DALYs (699,119; 95% UI= 43,130 - 1,914,066) in 2019. States from the Northeast region had the highest age-standardized rates of deaths and DALYs, and the male population was more affected by NCDs caused by excessive sodium consumption. Cardiovascular diseases were the main contributing factors in the burden attributable to excessive sodium consumption. CONCLUSIONS: Regardless of the progress in addressing NCDs related to this risk factor, the impact remains high, especially among men and in the Northeast region. More effective measures are needed to reduce sodium in industrialized products, such as health promotion actions to combat sodium consumption, in order to prevent and control NCDs in Brazil.
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