Greetings..
I posted this in 2008.
JeffN wrote:
1) Tobacco (including second & third hand smoke)
2) Excess Calories ( obesity is now second only to tobacco)
3) Inadequate Fruits & Veggies (and all the beneficial chemicals in them)
4) Inactivity
5) Alcohol (a known carcinogen)
6) Saturated Fat
7) Cholesterol
8 ) Hydrogenated Fats/Trans Fats
9) Sodium
10) Inadequate Fiber
11) Excess refined concentrated sugar/sweeteners
12) Excess refined processed carbohydrates.
The above 12 are responsible for more death than anything else.
Let's look at the supporting data for that...
This one, came out way back in 1993
Actual causes of death in the United States.
JAMA. 1993 Nov 10;270(18):2207-12.
http://www.ncbi.nlm.nih.gov/pubmed/8411605"The most prominent contributors to mortality in the United States in 1990 were:
- tobacco (an estimated 400,000 deaths),
- diet and activity patterns (300,000),
- alcohol (100,000),
- microbial agents (90,000),
- toxic agents (60,000),
- firearms (35,000),
- sexual behavior (30,000),
- motor vehicles (25,000),
- illicit use of drugs (20,000).
And concluded...
"Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities."This study came out in 2004
Actual causes of death in the United States, 2000.
JAMA. 2004 Mar 10;291(10):1238-45.
"The leading causes of death in 2000 were:
- tobacco (435 000 deaths; 18.1% of total US deaths),
- poor diet and physical inactivity (365 000 deaths; 15.2%) [corrected],
- alcohol consumption (85 000 deaths; 3.5%).
Other actual causes of death were:
- microbial agents (75 000),
- toxic agents (55 000),
- motor vehicle crashes (43 000),
- incidents involving firearms (29 000),
- sexual behaviors (20 000),
- illicit use of drugs (17 000).
And concluded..
"These analyses show that smoking remains the leading cause of mortality. However, poor diet and physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along with escalating health care costs and aging population, argue persuasively that the need to establish a more preventive orientation in the US health care and public health systems has become more urgent."
The following study came out in 2009, not long after my post, and I think really highlights the above. Not exact, but similar.
http://www.plosmedicine.org/article/inf ... ed.1000058The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors PLoS Med. 2009 April; 6(4): e1000058. Published online 2009 April 28. doi: 10.1371/journal.pmed.1000058.
Background:
Knowledge of the number of deaths caused by risk factors is needed for health policy and priority setting. Our aim was to estimate the mortality effects of the following 12 modifiable dietary, lifestyle, and metabolic risk factors in the United States (US) using consistent and comparable methods: high blood glucose, low-density lipoprotein (LDL) cholesterol, and blood pressure; overweight–obesity; high dietary trans fatty acids and salt; low dietary polyunsaturated fatty acids, omega-3 fatty acids (seafood), and fruits and vegetables; physical inactivity; alcohol use; and tobacco smoking.
Here is the full listing (the percentage is of the total of the 12)
467,000 --- Tobacco (23.6%)
395,000 --- Blood pressure (19.9%)
216,000 --- Overweight (10.9%)
191,000 --- Insufficient exercise (9.6%)
190,000 --- High blood glucose (9.6%)
113,000 --- High LDL (5.7%)
102,000 --- Excessive salt (5.2%)
84,000 ---- Inadequate Essential Fats (4.2%)
82,000 ---- Trans fats (4.1%)
64,000 ---- Excessive alcohol (3.2%)
58,000 ---- Low fruit and vegetable intake (2.9%)
15,000 ---- Low PUFA intake (0.7%)
In 2010, I discussed this study in this thread here...
http://www.drmcdougall.com/forums/viewt ... 50#p138350Then, in 2013, the following article came out..
US Burden of Disease Collaborators. The State of US Health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors. JAMA. 2013;310(6):591-606. doi:10.1001/jama.2013.13805.
http://jama.jamanetwork.com/article.asp ... id=1710486Here is their 17 risk factors or risk factor clusters in 2010 each of which was associated with more than 0.1% of DALYs.
A) Risk factors and related deaths
- Dietary risks
- Tobacco smoking
- High blood pressure
- High body mass index
- Physical inactivity and low physical activity
- High fasting plasma glucose
- High total cholesterol
- Ambient particulate matter pollution
- Alcohol use
- Drug use
- Lead exposure
- Occupational risks
- Low bone mineral density
- Residential radon
- Ambient ozone pollution
- Intimate partner violence
- Childhood sexual abuse
B) Risk factors as a percentage of disability-adjusted life-years
- Dietary risks
- Tobacco smoking
- High body mass index
- High blood pressure
- High fasting plasma glucose
- Physical inactivity and low physical activity
- Alcohol use
- High total cholesterol
- Drug use
- Ambient particulate matter pollution
- Occupational risks
- Childhood sexual abuse
- Intimate partner violence
- Lead exposure
- Low bone mineral density
- Residential radon
- Ambient ozone pollution
The researchers also analyzed 14 key components of the American diet and their relation to disease, disability, and death. They found that the most damaging dietary risks in the U.S. are diets that are:
- Low in fruits
- Low in nuts and seeds
- High in sodium
- High in processed meats
- Low in vegetables
- High in trans fats
Other damaging dietary factors, ranked in order of importance, are diets that are:
- Low in omega-3 fatty acids (Good sources of omega-3 fatty acids are fish.)
- Low in whole grains
- Low in fiber
- High in sugar-sweetened beverages
- Low in polyunsaturated fatty acids
This one came out in 2015
Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
Forouzanfar, Mohammad H et al.
The Lancet
September 2015
http://www.thelancet.com/pdfs/journals/ ... 40-6736(15)00128-2.pdf
Summary
Background
The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.
Methods
Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk–outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990–2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta- regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.
Findings
All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8–58·5) of deaths and 41·6% (40·1–43·0) of DALYs. Risks quantified account for 87·9% (86·5−89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.
Interpretation
Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.
From the above study
Changes in risks from 2000 to 2013
(top chart is 2000, bottom chart is 2013)
Figure 5: Global DALYs attributed to level 2 risk factors in 2000 for both sexes combined (A) and global DALYs attributed to level 2 risk factors in 2013 for both sexes combined (B)
DALYs=disability-adjusted life-years
In regard to Dietary Risks
"The aggregation of the 14 specific components of diet accounted for nearly one tenth of global DALYs in 2013. At the global level, the most important contributors to the overall burden of diet are low fruit, high sodium, low whole grains, low vegetables, and low nuts and seeds."
On BMI
"Our estimates for the burden attributable to high BMI are substantially higher than those in GBD 2010 for two reasons. First, based on new published pooled cohort or meta-analyses, we added several new outcomes related to high BMI. Second, we have more accurately captured the fraction of the population with high BMI using the beta distribution compared with the assumption of a normal distribution. There remains some debate in the literature on the risks associated with overweight. Flegal and colleagues76 reported in a meta-analysis of studies reporting on broad categories of BMI that risk is lowest in the category of overweight.21
Pooled cohort analysis with more detailed BMI categories with a much larger number of person-years of exposure found a regular association with rising BMI from 23 onwards.77 Part of the discrepancy in the findings is also related to how many years of observation are excluded from the analysis to remove the bias of sick individuals having lowered BMIs.
Stokes and colleagues showed that re-analysing NHANES follow-up data by maximum lifetime BMI suggested that people in the overweight category were at substantially elevated risk (relative risk 1·28) compared with normal weight individuals.78, 79, 80, 81 We believe that the balance of the evidence clearly supports our TMREL of 21–23 and that the pooled cohort studies provide the most robust relative risks available to date for this analysis.
Regardless of this debate, however, the burden attributable to high BMI more generally is large and increasing at the global level. Intensified research and policy experimentation into the options to reduce BMI or to slow its increase is needed.
It has been 24 years since form the first one and little progress, if any, has been made.
As you can see, when you look at the these reports and my list, we may differ slightly on a few of the items and their exact ranking, but our lists are very similar.
I am going to crunch some numbers and come out with a new list called, The Real Dirty Dozen: The 12 Deadliest Dietary and Lifestyle Factors.
In Health
Jeff