Estimating the global and regional burden of suboptimal nutrition on chronic disease: methods and inputs to the analysis
Estimating the global and regional burden of suboptimal nutrition on chronic disease: methods and inputs to the analysis
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DOI：
10.1038/ejcn.2011.147
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发表时间：
2012-01-01
影响因子：
4.7
通讯作者：
Mozaffarian, D.
中科院分区：
文献类型：
--
作者：
Micha, R.;Kalantarian, S.;Mozaffarian, D.
背景/目的：全球心血管疾病（CVD）、糖尿病和癌症的负担正在上升。关于饮食对这些疾病的全球影响的定量数据很少。本研究的目的是开发系统的和可比的方法，以定量评估全球和世界21个地区的次优饮食习惯对心血管疾病、糖尿病和癌症负担的影响。使用比较风险评估框架，我们开发了一些方法，为选定的饮食风险因素建立可能或令人信服的饮食-疾病因果关系的效应量，替代最小风险暴露分布和暴露分布。这些输入，连同疾病的特定死亡率，允许计算的事件的数量归因于每个dietary factor.Results：使用世界卫生组织和类似的证据标准令人信服/可能的因果关系，我们确定了14个潜在的饮食疾病的关系。效应量和不确定性范围将来自试验或高质量观察性研究的系统性综述和荟萃分析。替代的最小风险分布是根据对应于人群中最低疾病率的数量确定的。根据用于量化有害或保护效应的数据，为每种接触确定了最佳和替代定义。我们开发了从全国代表性调查中识别和获取数据的方法。一个排名量表被开发来评估调查质量和膳食评估方法的有效性。多层次的分层模型将被开发，以填补缺失的data.Conclusions：这些新的方法将允许，第一次，评估全球特定的饮食因素对慢性病死亡率的影响。这种全球评估不仅是可能的，而且对于确定优先事项和决策也是必要的。《欧洲临床营养学杂志》（2012）66，119-129; doi：10.1038/ejcn.2011.147; 2011年9月14日在线发表
Background/Objectives: Global burdens of cardiovascular disease (CVD), diabetes and cancer are on the rise. Little quantitative data are available on the global impact of diet on these conditions. The objective of this study was to develop systematic and comparable methods to quantitatively assess the impact of suboptimal dietary habits on CVD, diabetes and cancer burdens globally and in 21 world regions.Subjects/Methods: Using a comparative risk assessment framework, we developed methods to establish for selected dietary risk factors the effect sizes of probable or convincing causal diet-disease relationships, the alternative minimum-risk exposure distributions and the exposure distributions. These inputs, together with disease-specific mortality rates, allow computation of the numbers of events attributable to each dietary factor.Results: Using World Health Organization and similar evidence criteria for convincing/probable causal effects, we identified 14 potential diet-disease relationships. Effect sizes and ranges of uncertainty will be derived from systematic reviews and meta-analyses of trials or high-quality observational studies. Alternative minimum-risk distributions were identified based on amounts corresponding to the lowest disease rates in populations. Optimal and alternative definitions for each exposure were established based on the data used to quantify harmful or protective effects. We developed methods for identifying and obtaining data from nationally representative surveys. A ranking scale was developed to assess survey quality and validity of dietary assessment methods. Multi-level hierarchical models will be developed to impute missing data.Conclusions: These new methods will allow, for the first time, assessment of the global impact of specific dietary factors on chronic disease mortality. Such global assessment is not only possible but is also imperative for priority setting and policy making. European Journal of Clinical Nutrition (2012) 66, 119-129; doi:10.1038/ejcn.2011.147; published online 14 September 2011