A huge new study reveals that what you don't eat might matter more than what you do.
In what is being called "the most comprehensive analysis on the health effects of diet ever conducted," researchers have found that a poor diet is killing more people globally than any other risk factor. In 2017, 11 million people (1 in 5) died from diet-related diseases, which makes poor nutrition more harmful than smoking.
There's a difference between too much of a bad thing and not enough of a good thing, and this study, published in the Lancet, reveals that a lack of healthy foods affects health more profoundly than a surplus of unhealthy ones. In the words of Ashkan Afshin, an associate professor at the University of Washington who was involved in the research,
"While traditionally all the conversation about healthy diet has been focused on lowering the intake of unhealthy food, in this study we have shown that, at the population level, a low intake of healthy foods is the more important factor, rather than the high intake of unhealthy foods."
The study analyzed consumption of 15 dietary elements across 195 nations using 27 years of data (1990-2017). These dietary elements were: diets low in fruits, vegetables, legumes, whole grains, nuts and seeds, milk, fibre, calcium, seafood omega-3 fatty acids, polyunsaturated fats, and diets high in red meat, processed meat, sugar-sweetened beverages, trans fatty acids, and sodium.
The researchers found that those countries with diets most closely aligned to the Mediterranean model fared best. Israel took first place for lowest number of diet-related deaths, followed by France, Spain, Japan, and Andorra. The highest number of diet-related deaths occurred in Uzbekistan, Afghanistan, the Marshall Islands, Papua New Guinea, and Vanuatu. The USA ranked 43rd, after Rwanda and Nigeria (41 and 42). The UK came in at 23rd.
The researchers found that, while some countries consume optimal levels of certain elements, i.e. vegetable intake was good in central Asia, legumes in tropical Latin America, and omega-3 fatty acids in high-income Asia Pacific, no country consumes optimal levels of all elements.
Some countries, like Mexico, had mixed results. It ranked 11th for lowest risk of diet-related disease, and yet has one of the highest intake levels of sugar-sweetened beverages (driven in part by lack of access to free clean drinking water). This appears to be offset somewhat by high whole grain consumption in the form of tortillas. Other regions, like Asia, struggle with sodium levels because of a preference for soy sauce and other salty condiments.
From a press release:
"The largest shortfalls in optimal intake were seen for nuts and seeds, milk, whole grains, and the largest excesses were seen for sugar sweetened beverages, processed meat and sodium. On average, the world only ate 12% of the recommended amount of nuts and seeds, and drank around ten times the recommended amount of sugar sweetened beverages."
These findings show the importance of shifting the conversation away from warning against unhealthy foods and toward encouraging consumption of healthy ones. And, in the words of Prof. Nita Forouhi of the University of Cambridge, it "endorses a case for moving from nutrient-based to food-based guidelines." Perhaps like Brazil's impressive food guidelines?
Currently, the world does not produce enough fruits, vegetables, and whole grains for all humans to consume an ideal amount (based on another fascinating study from the University of Guelph), but the global agriculture system can adapt to meet evolving demands. NPR cites Evan Fraser, co-author of that study:
"We produce too much fat, too much sugar and too many starchy products. So, food companies and farmers play a role, too. At a global level, we have a mismatch between what we should be eating, and what we're producing."
Repairing that mismatch first requires a willingness on the part of governments, health care providers, educational institutions, and households to prioritize intake of healthier foods – and then the food production industry will take note. Studies such as this one are key in driving awareness and the subsequent mental shift.
Read the full study here.