2010年中东和北非国家饮食习惯及代谢危险因素对心血管疾病和糖尿病死亡率的影响：一项比较风险评估分析

The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis.

作者信息

Afshin Ashkan, Micha Renata, Khatibzadeh Shahab, Fahimi Saman, Shi Peilin, Powles John, Singh Gitanjali, Yakoob Mohammad Yawar, Abdollahi Morteza, Al-Hooti Suad, Farzadfar Farshad, Houshiar-Rad Anahita, Hwalla Nahla, Koksal Eda, Musaiger Abdulrahman, Pekcan Gulden, Sibai Abla Mehio, Zaghloul Sahar, Danaei Goodarz, Ezzati Majid, Mozaffarian Dariush

机构信息

Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA.

Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece.

出版信息

BMJ Open. 2015 May 20;5(5):e006385. doi: 10.1136/bmjopen-2014-006385.

OBJECTIVE/DESIGN: We conducted a comparative risk assessment analysis to estimate the cardiometabolic disease (CMD) mortality attributable to 11 dietary and 4 metabolic risk factors in 20 countries of the Middle East by age, sex and time. The national exposure distributions were obtained from a systematic search of multiple databases. Missing exposure data were estimated using a multilevel Bayesian hierarchical model. The aetiological effect of each risk factor on disease-specific mortality was obtained from clinical trials and observational studies. The number of disease-specific deaths was obtained from the 2010 Global Burden of Disease mortality database. Mortality due to each risk factor was determined using the population attributable fraction and total number of disease-specific deaths.

SETTING/POPULATION: Adult population in the Middle East by age, sex, country and time.

RESULTS

Suboptimal diet was the leading risk factor for CMD mortality in 11 countries accounting for 48% (in Morocco) to 72% (in the United Arab Emirates) of CMD deaths. Non-optimal systolic blood pressure was the leading risk factor for CMD deaths in eight countries causing 45% (in Bahrain) to 68% (in Libya) of CMD deaths. Non-optimal body mass index and fasting plasma glucose were the third and fourth leading risk factors for CMD mortality in most countries. Among individual dietary factors, low intake of fruits accounted for 8% (in Jordan) to 21% (in Palestine) of CMD deaths and low intake of whole grains was responsible for 7% (in Palestine) to 22% (in the United Arab Emirates) of CMD deaths. Between 1990 and 2010, the CMD mortality attributable to most risk factors had decreased except for body mass index and trans-fatty acids.

CONCLUSIONS

Our findings highlight key similarities and differences in the impact of the dietary and metabolic risk factors on CMD mortality in the countries of the Middle East and inform priorities for policy measures to prevent CMD.

目的/设计：我们进行了一项比较风险评估分析，以按年龄、性别和时间估算中东20个国家中11种饮食和4种代谢风险因素所致的心血管代谢疾病（CMD）死亡率。通过系统检索多个数据库获取各国的暴露分布情况。使用多级贝叶斯分层模型估算缺失的暴露数据。各风险因素对特定疾病死亡率的病因学影响来自临床试验和观察性研究。特定疾病死亡人数来自2010年全球疾病负担死亡率数据库。使用人群归因分数和特定疾病死亡总数确定各风险因素所致的死亡率。

背景/人群：中东地区按年龄、性别、国家和时间划分的成年人群。

结果

在11个国家中，饮食不合理是CMD死亡率的主要风险因素，占CMD死亡人数的48%（摩洛哥）至72%（阿拉伯联合酋长国）。在8个国家中，非最佳收缩压是CMD死亡的主要风险因素，导致CMD死亡人数的45%（巴林）至68%（利比亚）。在大多数国家，非最佳体重指数和空腹血糖是CMD死亡率的第三和第四大主要风险因素。在个体饮食因素中，水果摄入量低占CMD死亡人数的8%（约旦）至21%（巴勒斯坦），全谷物摄入量低占CMD死亡人数的7%（巴勒斯坦）至22%（阿拉伯联合酋长国）。1990年至2010年期间，除体重指数和反式脂肪酸外，大多数风险因素所致的CMD死亡率有所下降。