The impact of dietary risk factors on the burden of non-communicable diseases in Ethiopia: findings from the Global Burden of Disease study 2013

Melaku et al. International Journal of Behavioral Nutrition and Physical Activity (2016) 13:122 DOI 10.1186/s12966-016-0447-x RESEARCH Open Access The impact of dietary risk factors on the burden of non-communicable diseases in Ethiopia: findings from the Global Burden of Disease study 2013 Yohannes Adama Melaku1,2* , Awoke Misganaw Temesgen3, Amare Deribew4,5,6, Gizachew Assefa Tessema7,8, Kebede Deribe9,10,11, Berhe W. Sahle1,12, Semaw Ferede Abera1,13, Tolesa Bekele14, Ferew Lemma11, Azmeraw T. Amare15,16,17, Oumer Seid1, Kedir Endris1, Abiy Hiruye11, Amare Worku18, Robert Adams19, Anne W. Taylor2, Tiffany K. Gill2, Zumin Shi2, Ashkan Afshin3 and Mohammad H. Forouzanfar3 Abstract Background: The burden of non-communicable diseases (NCDs) has increased in sub-Saharan countries, including Ethiopia. The contribution of dietary behaviours to the NCD burden in Ethiopia has not been evaluated. This study, therefore, aimed to assess diet-related burden of disease in Ethiopia between 1990 and 2013. Method: We used the 2013 Global Burden of Disease (GBD) data to estimate deaths, years of life lost (YLLs) and disability-adjusted life years (DALYs) related to eight food types, five nutrients and fibre intake. Dietary exposure was estimated using a Bayesian hierarchical meta-regression. The effect size of each diet-disease pair was obtained based on meta-analyses of prospective observational studies and randomized controlled trials. A comparative risk assessment approach was used to quantify the proportion of NCD burden associated with dietary risk factors. Results: In 2013, dietary factors were responsible for 60,402 deaths (95% Uncertainty Interval [UI]: 44,943-74,898) in Ethiopia—almost a quarter (23.0%) of all NCD deaths. Nearly nine in every ten diet-related deaths (88.0%) were from cardiovascular diseases (CVD) and 44.0% of all CVD deaths were related to poor diet. Suboptimal diet accounted for 1,353,407 DALYs (95% UI: 1,010,433-1,672,828) and 1,291,703 YLLs (95% UI: 961,915-1,599,985). Low intake of fruits and vegetables and high intake of sodium were the most important dietary factors. The proportion of NCD deaths associated with low fruit consumption slightly increased (11.3% in 1990 and 11.9% in 2013). In these years, the rate of burden of disease related to poor diet slightly decreased; however, their contribution to NCDs remained stable. Conclusions: Dietary behaviour contributes significantly to the NCD burden in Ethiopia. Intakes of diet low in fruits and vegetables and high in sodium are the leading dietary risks. To effectively mitigate the oncoming NCD burden in Ethiopia, multisectoral interventions are required; and nutrition policies and dietary guidelines should be developed. Keywords: Dietary risks, Non-communicable diseases, Burden of disease, Ethiopia * Correspondence: 1 School of Public Health, Mekelle University, Mekelle, Ethiopia 2 Population Research and Outcome Studies, School of Medicine, The University of Adelaide, Adelaide, SA, Australia Full list of author information is available at the end of the article © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Melaku et al. International Journal of Behavioral Nutrition and Physical Activity (2016) 13:122 Background The burden of non-communicable diseases (NCDs) in sub-Saharan Africa has increased significantly over the past two decades [1–3]. The number of NCD deaths in the region has risen by 68.0% between 1990 and 2013 [4]. In Ethiopia, despite the prevailing high burden of communicable diseases, the proportion of deaths due to NCDs has increased by 73.7% in these years [1–3, 5] and in 2013, more than a third (35.1%) of all deaths were caused by NCDs. CVD was the second most common causes of death behind specific infectious diseases (diarrhoea, lower respiratory and other infectious diseases together), accounting for 121,211 deaths (16.2% of all deaths) in the country [3]. Neoplasms were the fifth most common causes of deaths accounting for 45,520 deaths (6.1% of all deaths) [3, 4]. NCDs are predisposed by various risk factors including behavioural, environmental and metabolic. There is increasing and strong evidence of a causal link between dietary behaviours and patterns, nutrients and NCDs [6, 7]. In sub-Sahara Africa, in addition to problems of undernutrition, dietary factors were responsible for 5.8% of all deaths and 2.2% of all disability-adjusted life years (DALYs) in 2013 [8]. Due to the growing burden of NCDs [3, 4], Ethiopia has developed a comprehensive strategic action plan for the prevention and control of NCDs and associated risk factors focusing on a reduction of risky behaviours including risky dietary habits [9]. Whilst the strategic plan is helpful in guiding interventions, there is a need for a better understanding of the burden of dietary risk factors and their contribution to NCDs in order to achieve the goals of the strategic plan effectively and efficiently. However, there are no adequate national level data or surveillance systems to identify risk factors. In particular, to the best of our knowledge, data on diet quality are lacking, and the contribution of diet to the national burden of disease has not been investigated. For the first time, we systematically assessed dietrelated burden of NCDs (deaths, DALYs, years lived with disability (YLDs) and years of life lost (YLLs)) and the trend over the past two decades in Ethiopia using the Global Burden of Disease (GBD) 2013 data and methods [8, 10]. The study will help to understand the current burden of disease associated with dietary risks in the country. It can be also used as a baseline for the NCDs strategic action plan developed in 2015/16 [9]. Methods The GBD databases (GBD 2013) were used to undertake the present study [10]. Using GBD 2013, this study provided estimates of chronic disease burden related to dietary risks in Ethiopia, by sex and age, between 1990 and 2013. A detailed description of the GBD 2013 Page 2 of 13 methods for estimating the burden of disease associated with risk factors has been published elsewhere [8]. Below, we provide a summary of the dietary data sources and methods of estimating the burden of disease related to dietary risks. Selection of dietary risk factors The GBD 2013 selected dietary risks based on their significance to the burden of disease, availability of sufficient data, strength of epidemiological evidence on causality (...truncated)