Blog
Poor diet caused 4 million deaths from ischemic heart disease in one year
Conducted across more than 200 countries, study investigates the relationship between diet and the incidence of heart disease, as well as estimates deaths and disabilities associated with 13 types of foods
Ischemic heart disease is caused by the narrowing of the arteries that carry blood to the heart muscle. By 2050, the disease will continue to be the leading cause of cardiovascular death worldwide, with approximately 20 million deaths, according to projections from the Global Burden of Disease study – Photo: Freepik Assistente
An inadequate diet remains one of the main risk factors for ischemic heart disease, a condition caused by reduced blood flow in the coronary arteries. According to a 30-year analysis conducted across 204 countries, the disease is one of the leading causes of death worldwide, with poor diet being one of the most significant preventable factors in reversing this scenario.
Men and older adults account for the highest number of diet-related cardiac deaths worldwide, exacerbated by an increase of up to 361% in the consumption of sugar-sweetened beverages and processed meats in regions of Asia and Africa between 1990 and 2023.
The study, published on March 30 in the journal Nature Medicine, is part of the Global Burden of Disease (GBD) study, an international collaboration led by the University of Washington that brings together thousands of researchers worldwide. By analyzing data from the medical literature and official statistics, the group developed a computational model to understand both risk factors and mortality from cardiovascular diseases.
According to the estimates, in 2023 alone, inadequate diets were responsible for more than 4 million deaths from ischemic heart disease, with nearly 97 million Disability-Adjusted Life Years (DALYs) lost. This metric, used in the health field, represents the equivalent of one “lost” year due to disability and reduced quality of life.
Diets high in sodium and low in nuts, seeds, whole grains, and fruits were associated with a higher burden of deaths from ischemic heart disease, as was the low intake of omega-6 polyunsaturated fatty acids – essential fats for cellular health, involved in energy production, immune function, and inflammatory response.
“What we see as risk factors for cardiovascular disease are generally diets low in fruits, vegetables, nuts, and seeds, and high in salt and added sugar. A common feature across all these diets is the high consumption of ultra-processed foods”, said Itamar de Souza Santos, a professor in the Department of Internal Medicine at the Medical School (FM) at USP and one of the authors of the article, in an interview with Jornal da USP. He is part of the Longitudinal Study of Adult Health (ELSA-Brasil), which investigates the incidence and risk factors for chronic diseases in 15,000 employees from six public higher education institutions in the Northeast, South, and Southeast regions of Brazil.
Itamar de Souza Santos is a professor at the Medical School at USP – Photo: Lattes
Data collected by ELSA-Brasil served as a model for studying the relationship between risk factors and a clinical outcome considered unfavorable. “This article addresses cardiovascular disease, but we know that many of these foods are also linked to the incidence of cancer, for example. In other publications by the group, this perspective is also addressed”, said the USP professor regarding the Global Burden of Disease study, which is updated approximately every two years.
Localized analysis
The study selected 13 distinct dietary factors – such as eating patterns and nutrient intake – to estimate the burden of deaths from ischemic heart disease between 1990 and 2023 in a global, regional, and national analysis.
According to the publication, the absolute number of diet-related cases of the disease has increased, but age-standardized rates have decreased by 44% per 100,000 inhabitants, suggesting population growth and overall improvements in health.
However, the authors reported significant differences between regions and population groups, with the burden of disease particularly pronounced in countries with low and medium sociodemographic indices. Regionally, Australasia (which includes Australia, New Zealand, New Guinea, and neighboring islands), Western Europe, and North America showed the greatest reductions in deaths from ischemic heart disease attributable to diet since 1990. In contrast, Central Sub-Saharan Africa recorded a 21% increase over the same period.
“Most of these variations follow an economic pattern, largely related to income”, he said. “And this determines many health outcomes: from the prevalence of risk factors, access to healthy food, to treatment and consequent mortality. The advantage of this type of study is that it brings ideas of strategies that worked in one region and that could be tested in other locations”.
A subgroup analysis showed that individuals over 65 years of age had higher mortality rates compared to those under 45. Specifically, men exhibited a greater burden of diet-related ischemic heart disease across all age groups. The impact of sugar-sweetened beverages on mortality increased in East Asia (361%) and Western Sub-Saharan Africa (332%), as did the burden of deaths associated with processed meats, with increases observed in East Asia (84%) and Southeast Asia (48%).
Consumption of processed beverages, such as soft drinks and sugar-sweetened juices, and processed meats, such as sausages and cured meats, is the main driver of the increase in deaths from ischemic heart disease in some regions – Photo: Cecília Bastos/USP Imagens
Harmful vs. protective foods
While developing countries often face the burden of disease associated with malnutrition and limited access to protective foods (such as whole grains, fruits, vegetables, and omega-3 and omega-6 fatty acids), developed countries are more commonly affected by excessive consumption of harmful components (such as ultra-processed foods, processed meats, and sugar-sweetened beverages).
The dietary components analyzed also showed regional variations in mortality burden. Diets low in omega-3 fatty acids from seafood were classified as a high-risk factor in most regions; however, developed countries in the Asia-Pacific region showed a lower burden of mortality from ischemic heart disease.
A similar pattern was observed for diets low in vegetables: although responsible for only a small portion of the mortality burden from ischemic heart disease in most regions—ranking 10th among 13 globally—low vegetable intake accounted for a larger proportion of deaths in certain regions, ranking 1st among 13 causes per 100,000 inhabitants in Central Sub-Saharan Africa and 3rd among 13 in Oceania.
The data collection enabled a highly detailed regional analysis, reaching state-level data in some countries. “When you look at the database and compare two [locations] with similar income levels, for example, but observe differences in outcomes, you ask: what was different here? Sometimes it was an anti-smoking strategy or a diet-related intervention that worked”, said Itamar Santos.
According to the professor, Brazil has a robust amount of data that supports scientific analysis. “Otherwise, we would have to assume that we function like other countries, ‘importing’ external data”, he said. However, addressing poor diet still requires health literacy.
“This is an issue that is sensitive to public policy measures that mandate reductions in certain components or provide very clear information to consumers about what is contained in a given food. Brazil has made progress in recent decades, but it is still worthwhile to invest in public education so that people can make better use of this information, with more informed choices”.
The article Global, regional and national burden of ischemic heart disease attributable to suboptimal diet, 1990–2023: a Global Burden of Disease study is available online.
More information: itamarss@usp.br, with Itamar de Souza Santos
English version: Nexus Traduções, edited by Denis Pacheco
Política de uso
A reprodução de matérias e fotografias é livre mediante a citação do Jornal da USP e do autor. No caso dos arquivos de áudio, deverão constar dos créditos a Rádio USP e, em sendo explicitados, os autores. Para uso de arquivos de vídeo, esses créditos deverão mencionar a TV USP e, caso estejam explicitados, os autores. Fotos devem ser creditadas como USP Imagens e o nome do fotógrafo.
A reprodução de matérias e fotografias é livre mediante a citação do Jornal da USP e do autor. No caso dos arquivos de áudio, deverão constar dos créditos a Rádio USP e, em sendo explicitados, os autores. Para uso de arquivos de vídeo, esses créditos deverão mencionar a TV USP e, caso estejam explicitados, os autores. Fotos devem ser creditadas como USP Imagens e o nome do fotógrafo.