Search

Dietary risks have always been a major risk factor for cardiovascular diseases (CVDs), especially in young people. This article aimed to provide an updated and comprehensive view of the spatial, temporal and sexual heterogeneity in diet-attributable CVD burdens from 1990 to 2019.Data on diet-attributable CVD burdens were extracted from the Global Burden of Disease (GBD) Study 2019. Numbers and age-standardized rates (ASRs) of deaths, disability-adjusted life years (DALYs) and corresponding estimated annual percentage change (EAPC) were determined. Globally, the number of diet-attributable CVD deaths and DALYs in 2019 were 6.9 million and 153.2 million, marking 43.8% and 34.3% increases since 1990, respectively. However, ASRs of death and DALYs have declined over time. The regions with the highest ASRs of diet-related CVD deaths and DALYs were in Central Asia, whereas the lowest ASRs of CVD deaths and DALYs were observed in the high-income Asia Pacific region. Globally, men suffered higher death and DALY burdens than women. Ischemic heart disease and stroke were the leading causes of CVD deaths and DALYs, globally. Regarding the specific diet group, diets low in whole grains, high in sodium, low in fruits, low in nuts and seeds, low in vegetables and low in seafood omega-3 fatty acids contributed to CVD deaths and DALYs the most. Dietary risks accounted for a higher proportion in people aged less than 65 years old.Diet-attributable CVDs threaten public health, particularly in low SDI countries and younger generations. As diet-related CVDs are nation-specific, the prioritization of public health interventions should be evidence-based.

Hispanics in the USA, particularly those of Caribbean descent, experience high levels of diet-related diseases and dietary risk factors. Restaurants are an increasingly important yet understudied source of food and may present opportunities to positively influence urban food environments. We sought to explore food environments further, by examining the association between neighborhood characteristics and restaurant consumer nutrition environments within New York City's Hispanic Caribbean (HC) restaurant environments. We applied an adapted version of the Nutrition Environment Measurements Survey for Restaurants (NEMS-R) to evaluate a random sample of HC restaurants (n=89). NEMS-HCR scores (continuous and categorized as low, medium, and high based on data distribution) were examined against area sociodemographic characteristics using bivariate and logistic regression analysis. HC restaurants located in Hispanic geographic enclaves had a higher proportion of fried menu items (p6), compared with their medium (aOR: 6.6, 95% CI: 1.8-24.6) and large counterparts (aOR: 5.6, 95% CI: 1.5-21.4). This research is the first to examine the association between restaurant location and consumer nutrition environments, providing information to contribute to future interventions and policies seeking to improve urban food environments in communities disproportionately affected by diet-related conditions, as in the case of HC communities in New York City.

Background: Women at high risk for breast cancer due to genetics or risk factor profiles are counseled to adopt lifestyle, behavioral, and dietary changes to help reduce their risk. These recommendations are based on studies of women at average risk, so their effectiveness in high-risk women is unclear. Methods: We evaluated the impact of physical activity, smoking, alcohol consumption, and intake of folate and carotenoids on mammographic breast density—a proxy for breast cancer risk—among 387 high-risk women. Exposures were self-reported on questionnaires. Breast dense area, nondense area, and percent dense area were measured from screening mammograms with Library for Breast Radiodensity Assessment software. Cross-sectional associations were estimated with multivariable quantile regression models. Results: After adjusting for age, adiposity, reproductive history, and use of postmenopausal hormones, no breast density measure was associated with physical activity level, smoking status, alcohol consumption, or estimated intake of folate, alpha-carotene, beta-carotene, lutein/zeaxanthin, and beta-cryptoxanthin. Lycopene intake was associated with lower dense area when comparing the highest and lowest intake categories (adjusted difference in median = −14 cm2, 95% confidence interval: −29 to 1.3 cm2). This association may be explained by incomplete adjustment for adiposity. Conclusions: Recommended lifestyle, behavioral, and dietary changes to mitigate personal risk of breast cancer do not substantially impact mammographic breast density measures. Impact: Alternative strategies, such as increased uptake of chemoprevention, may better serve risk reduction efforts in women at high risk for breast cancer.

Background: Non-communicable diseases (NCDs) are one of the greatest threats to public health, and have been related to poor quality dietary patterns. This study was conducted to determine the distribution of dietary risk factors in Iran. Methods: Cross-sectional data was gathered between April and November 2016 from 30,541 eligible adults (out of 31 050 individuals who were selected through systematic proportional to size cluster random sampling) living in urban and rural areas, using the WHO-based STEPs risk factor questionnaire. Low intakes of fruits, vegetables, dairy products, and fish, and high intakes of salty processed food (SPF), as well as daily intake of hydrogenated fat (HF) were considered as nutritional risk factors. Results: At the national level, 82.8% (95% CI: 82.4-83.2), 57.8% (95% CI: 57.2-58.4), 80.6% (95% CI: 80.1-81) and 90.3% (95% CI: 90-90.6) of participants of all age groups had sub-optimal intakes of fruits, vegetables, dairy products and fish, respectively. Furthermore, 12.8% (95% CI: 12.4-13.1), and 29.4% (95% CI: 28.9-29.9) of respondents had high SPF intakes and HF use, respectively. At the sub-national level, the highest distribution of suboptimal intake of fruits (97.2%; 95% CI:96-98.3), vegetables (79.2%; 95% CI: 76.3-82.1) and dairy products (92.9%; 95% CI: 91-94.7) was observed in Sistan and Baluchistan. Except for Boushehr and Hormozgan, the majority of the population of other provinces consumed fish less than twice a week. Similarly, the high intake of SPF was found mostly in the population of Yazd (23.7; 95% CI: 20.2-27.2). HF consumption was the highest in North Khorasan (64.2%; 95% CI: 60.3-68.1). Conclusion: These findings highlight the widespread distribution of dietary risk factors in Iran, which should be a priority for the people and the politicians in order to prevent NCDs.

Background: The study evaluated the relationship of the usual nutrient intake and protein adequacy to the prevalence of child malnutrition. Methods: Data were derived from the 2013 Philippine National Nutrition Survey. A total of 6,565 children aged 6-12 years across all the 17 regions that participated in the survey were analyzed. Two (2) non-consecutive day 24-hour dietary recalls (24hR) were collected to estimate the individual food intake. PC-SIDE version 1.0 software (Software for Intake Distribution Estimation) was used to estimate the usual intake of energy and key nutrients accounting for between - and within-person differences in dietary intake. The 2007 WHO Protein Digestibility Corrected Amino Acid Score (PDCAAS) method was used to measure the protein quality or the utilizable protein intake. Results: School-aged children were found to have lower dietary intake of utilizable protein than total protein. Higher consumption of grains and meat decreased the prevalence of stunting. Furthermore, linear growth of children was found to be associated with the dietary intake of several nutrients including utilizable protein, calcium, vitamin B12, vitamin C and vitamin D. The prevalence of stunting and underweight significantly decreased with a higher consumption of utilizable protein. Milk consumption decreased the prevalence of underweight. The prevalence of underweight also decreases with a higher dietary consumption of calcium, riboflavin and vitamin C. Higher consumption of grains also decreased the prevalence of underweight and wasting. A decreased prevalence of wasting was also found with higher dietary consumption of riboflavin, thiamine and fiber. On the contrary, higher consumption of meat, milk and grains increased the prevalence of obesity. In particular, higher dietary consumption of utilizable protein and vitamin C increased the prevalence of obesity. Conclusions: Even though the dietary total protein intake of school-aged children is considered adequate, the existence of malnutrition among children may be specifically attributed to quality of protein consumed. Therefore, the study suggests that nutrition interventions and policies focusing on child malnutrition should improve not just the quantity, but the quality of protein sources consumed by children to aid in proper growth and development.

Polycyclic aromatic hydrocarbons (PAH) are present and pervasive in the environment. Handling of the foods by the vendors is therefore likely to introduce PAHs into the meals. Quantification of PAH...

Chemicals are present in food and numerous methods have been developed to assess dietary risk associated with these substances, but mainly by studying short periods of exposure. Usually, consumption data used to assess the risk are collected over a short period-of-time. The aim of this paper was to compile existing methods to assess dietary risk and identify their limitations in terms of lifetime risk assessment. To this end, we reviewed the different methods currently used at each step of risk assessment (i.e. methods to collect consumption data, to compute dietary exposures, and then to interpret these exposures in terms of risk for the consumer). Numerous methodologies exist to collect consumption data, contamination data collection, as well as for data treatment and interpretation. These methods consider different hypotheses and therefore lead to numerous uncertainties and discrepancies in the estimation of the exposure. Moreover, changes in eating habits through life, evolutions of food contamination, as well as health risk induced by fluctuating exposures, are rarely studied. A scientific consensus on the current risk assessment approaches is needed between national regulatory authorities. Moreover, additional research activities appear needed to take the evolution of consumption and contamination through time into account and to be able to assess the dietary health risk over the entire life.

Objective:To analyse how much the intake of trans-fatty acids (TFA), an important dietary risk factor for CVD, changed among US children and adolescents over a period of time when food regulations that reduced the presence of TFA in the food supply were enacted.Design:Regression models were used to estimate changes in levels of TFA in plasma and other CVD risk factors among US children and adolescents from 1999–2000 to 2009–2010.Setting:USA.Participants:Nationally representative sample of children (aged 6–11 years) and adolescents (aged 12–19 years) who participated in the 1999–2000 and 2009–2010 cycles of the National Health and Nutrition Examination Survey.Results:Levels of plasma TFA declined significantly by an average of 61·9 % from 1999–2000 to 2009–2010. The average decline in a TFA commonly found in partially hydrogenated oils (elaidic acid, 67·2 %) was larger than the average decline in a TFA naturally occurring in ruminant animals (vaccenic acid, 60·5 %). Significant improvements in a variety of other CVD risk factors (LDL- and HDL-cholesterol, TAG, systolic and diastolic blood pressure, C-reactive protein) were also observed.Conclusions:Between the two time points, 1999–2000 and 2009–2010, there were substantial decreases in plasma TFA levels and improvements in several other important CVD risk factors in the population of US children and adolescents.

Background: Colorectal cancer remains a public health problem worldwide. Dietary risk factors play a key role in the carcinogenesis and progression of colorectal cancer. This study aimed to explore the geographical and temporal trends in various dietary factor-related colorectal cancers.Methods: Data were extracted from the Global Burden of Disease (GBD) 2019 study, including the deaths, disability-adjusted life-years (DALYs), age-standardized rate (ASR), and summary exposure value (SEV) among 4 world regions, 11 age groups, 21 regions, and 204 countries and territories between 1990 and 2019. The estimated annual percentage changes (EAPCs) were calculated to evaluate the variation trend of ASR.Results: Dietary factors were the leading cause of colorectal cancer death and DALY rate, regardless of age. Dietary factor-related deaths and DALYs accounted for 32 and 34% of global colorectal cancer, respectively. Further analysis showed that low whole grain intake remained the leading cause of cancer death and DALY rate, followed by milk and calcium. Diets that were low in whole grains, milk, and calcium accounted for 81.61% of deaths and 81.64% of DALYs. Deaths and DALYs of dietary factors related to colorectal cancer grew by half from 1990 to 2019. All ASRs remained higher for men than women. Asia carried the highest colorectal cancer burden attributed to dietary risks, especially for East Asia [age-standardized death rate (ASDR): EAPC = 1.15, 95% CI:0.88–1.42; DALY: EAPC = 1.08, 95% CI:0.82–1.34]. The heavy burden also existed in high-middle and middle socio-demographic index (SDI) quintiles. China has always had the highest deaths and DALYs of colorectal cancer attributable to dietary risks, followed by the USA, India, and Japan.Conclusions: Large variations existed in the dietary risk-related colorectal cancer burdens among sexes, regions, and countries. More targeted interventions to address modifiable dietary risk factors would save 32% of deaths and 34% of DALYs for colorectal cancer.

OBJECTIVES: Higher financial stress (FS) is associated with undesirable dietary behaviors. However, the relationships are not well characterized among higher education students, and investigations into why these relationships exist are lacking. As FS influences sleep while sleep influences dietary behaviors, sleep may serve as a mediator in these relationships. The current study examined whether poor sleep quality and short sleep duration mediate the relationship between FS and overall dietary risk behavior (ODRB) among higher education students in the U.S during the COVID-19 pandemic. METHODS: This cross-sectional study enrolled students at three large universities in the U.S. between April-May 2020. Eligible students filled out online surveys comprised of validated tools to assess FS, sleep quality and duration, and ODRB. ODRB was measured using the Starting the Conversation questionnaire, which measures eating frequencies of fast foods, fruits, vegetables, soda and sweet tea, high quality proteins, chips and crackers, dessert, and solid fat and provides a global score of ODRB. A higher score indicates more risk behaviors. Multivariate linear regressions were conducted for unadjusted and adjusted estimates, and mediation analysis was conducted using the PROCESS Macro in SPSS 26. RESULTS: A total of 1280 students completed the survey. Higher FS was associated with higher ODRB scores (P = 0.002). The mediation analyses revealed that higher FS was associated with poorer sleep quality (P

Adults in Samoa have the third highest obesity prevalence in the world, and the prevalence is higher in women than men. The nutritional status of a household in most low- and middle-income countries is positively influenced by the level of control women have over financial resources. Our analysis examined how consumption of specific dietary groups was associated with different sociodemographic and individual health risk factor groups for women who participated in the 2014 Samoa Demographic and Health Survey. Our research question was explored through multivariate analysis of the 2014 Samoa Demographic and Health Survey dataset. The sociodemographic and health behaviour groups included in our analysis were: urban vs. rural residence, wealth quintile, education level, participation in physical activity program, lives with husband/partner, household size, parity, age, smoking, and alcohol consumption. The following diet variables were included: fruit, vegetables, seafood, high-fat food, sugary drinks, high-salt food, and high-sugar food consumption. There was a high prevalence of unhealthy food consumption and unhealthy dietary patterns among a) a large proportion of the population, and b) across sociodemographic and health behaviour groups, with a higher prevalence of particular at-risk patterns in some specific groups including women of younger age and women of higher wealth. Our analysis highlighted some specific opportunities for policy action, including the need to create an enabling environment for healthier food consumption for Samoan women.

This study was performed to highlight the relationship between single dietary risk factors and cardiovascular diseases (CVDs) in the WHO European Region. We used the comparative risk assessment framework of the Global Burden of Disease Study to estimate CVD mortality attributable to diet; comprising eleven forms of CVDs, twelve food and nutrient groups and 27 risk-outcome pairs in four GBD regions including 51 countries by age and sex between 1990 and 2016. In 2016, dietary risks were associated with 2.1 million cardiovascular deaths (95% uncertainty interval (UI), 1.7–2.5 million) in the WHO European Region, accounting for 22.4% of all deaths and 49.2% of CVD deaths. In terms of single dietary risks, a diet low in whole grains accounted for approximately 429,000 deaths, followed by a diet low in nuts and seeds (341,000 deaths), a diet low in fruits (262,000 deaths), a diet high in sodium (251,000 deaths), and a diet low in omega-3 fatty acids (227,000 deaths). Thus, with an optimized, i.e. balanced diet, roughly one in every five premature deaths could be prevented. Although age-standardized death rates decreased over the last 26 years, the absolute number of diet-related cardiovascular deaths increased between 2010 and 2016 by 25,600 deaths in Western Europe and by 4300 deaths in Central Asia. In 2016, approximately 601,000 deaths (28.6% of all diet-related CVD deaths) occurred among adults younger than 70 years. Compared to other behavioural risk factors, a balanced diet is a potential key lever to avoid premature deaths. Electronic supplementary material The online version of this article (10.1007/s10654-018-0473-x) contains supplementary material, which is available to authorized users.

ObjectiveTo assess trends of mortality attributable to child and maternal undernutrition (CMU), overweight/obesity and dietary risks of non-communicable diseases (NCD) in sub-Saharan Africa (SSA) using data from the Global Burden of Disease (GBD) Study 2015.DesignFor each risk factor, a systematic review of data was used to compute the exposure level and the effect size. A Bayesian hierarchical meta-regression analysis was used to estimate the exposure level of the risk factors by age, sex, geography and year. The burden of all-cause mortality attributable to CMU, fourteen dietary risk factors (eight diets, five nutrients and fibre intake) and overweight/obesity was estimated.SettingSub-Saharan Africa.ParticipantsAll age groups and both sexes.ResultsIn 2015, CMU, overweight/obesity and dietary risks of NCD accounted for 826204 (95 % uncertainty interval (UI) 737346, 923789), 266768 (95 % UI 189051, 353096) and 558578 (95 % UI 453433, 680197) deaths, respectively, representing 10·3 % (95 % UI 9·1, 11·6 %), 3·3 % (95 % UI 2·4, 4·4 %) and 7·0 % (95 % UI 5·8, 8·3 %) of all-cause mortality. While the age-standardized proportion of all-cause mortality accounted for by CMU decreased by 55·2 % between 1990 and 2015 in SSA, it increased by 63·3 and 17·2 % for overweight/obesity and dietary risks of NCD, respectively.ConclusionsThe increasing burden of diet- and obesity-related diseases and the reduction of mortality attributable to CMU indicate that SSA is undergoing a rapid nutritional transition. To tackle the impact in SSA, interventions and international development agendas should also target dietary risks associated with NCD and overweight/obesity.

Background Burden of non-communicable diseases (NCD) is increasing worldwide. Risk factor surveillance informs public health interventions in NCD control. This study describes the dietary risk factors for NCD found in the Kenya STEPS survey, 2015. Methods We performed secondary analysis of the STEPS dataset to determine prevalence of dietary NCD risk factors and their determinants. New variables were created; high dietary salt, defined as addition of salt while eating or intake of processed foods high in salt and high dietary sugar, defined as intake of processed foods or drinks high in sugar in most meals or addition of sugar to beverages already with sugar, on a daily basis. We used the World Health Organization definition of minimum required intake of fruits and vegetables as consumption of less than five servings of fruits and vegetables per day. Perceptions of respondents on diet and health were also assessed. Accounting for complex survey sampling, we calculated prevalence of the various dietary modifiable determinants and adjusted odds ratios (AOR) to identify factors independently associated with dietary NCD risk factors. Results Of the 4484 individuals surveyed; mean age was 40.5 years (39.9–41.1 years), 60% were female. Prevalence of high reported dietary salt intake was 18.3% (95% CI 17.2%, 19.5%) and sugar 13.7% (95% CI 11.7–15.8%). Awareness of health risk from dietary salt was 88% and 91% for dietary sugar. Approximately 56% of the respondents were implementing strategies to reduce dietary salt and 54% were doing the same for dietary sugar. Only 6.0% (95% CI 4.3–7.6%) of the respondents reported intake of a minimum of five servings of both fruits and vegetables daily. Unhealthy diet was associated with being male (AOR 1.33, 95% CI 1.04, 1.70,), age below 46 years (AOR 1.78, 95% CI 1.42, 2.12) and being a student (AOR 15.6, 95% CI 2.44, 99.39). Conclusion Dietary risk communication should be targeted to males and people under 45 years of age, especially students. Further research is necessary to understand the knowledge: practice mismatch on unhealthy diets.

College students in general commonly present unhealthy habits and, as a result, they can develop chronic non-communicable diseases. The present study aimed to assess the prevalence of clustering of dietary risk behaviors for chronic non-communicable diseases and associated factors among medical students. A cross-sectional study was carried out with 231 students in the 1st, 7th and 11th semesters of undergraduate medical courses at three institutions in northern Minas Gerais, Brazil. Information on food intake was obtained through a survey of risk and protection factors for chronic diseases conducted by telephone. Statistical analysis was carried out using Poisson regression with robust variance. With regard to the clustering of dietary risk behaviors for chronic diseases, 30.8% of the students had three or more such behaviors. In the multivariate analysis, it was found that the prevalence of dietary risk behaviors was significantly higher among first-semester students. It is believed that students in other semesters had a lower prevalence of clustering of dietary risk behaviors because they had in-depth knowledge about the benefits of a healthy diet.

The coronavirus disease 2019 (COVID-19) pandemic worsened financial stress for higher education students in the U.S. Financial stress is associated with poor dietary behaviors, however, factors that might influence this relationship are not well characterized. The present cross-sectional study investigated the associations between financial stress and dietary intake and dietary risk scores among higher education students (undergraduate and graduate students) in the U.S. and examined whether poor sleep quality and short sleep duration mediated the relationship between financial stress and dietary risk score. Validated tools were used to assess financial stress, sleep quality, sleep duration, dietary intake, and dietary risk. A total of 1280 students from three large U.S. universities completed the study. Results indicated that higher financial stress was associated with lower vegetable, fruit, fiber, and calcium intake, higher added sugar intake from sugar sweetened beverages, and higher dietary risk score. Further, the positive relationship between financial stress and dietary risk score was completely mediated by poor sleep quality among students who reported poor sleep quality and by short sleep duration among students who slept less than 7 h per night. These findings suggest that students might benefit from both financial management training and sleep education services to reduce undesirable dietary behaviors.

A retrospective cumulative risk assessment of dietary exposure to pesticide residues was conducted for chronic inhibition of acetylcholinesterase. The pesticides considered in this assessment were identified and characterised in a previous scientific report on the establishment of cumulative assessment groups of pesticides for their effects on the nervous system. The exposure assessments used monitoring data collected by Member States under their official pesticide monitoring programmes in 2016, 2017 and 2018, and individual food consumption data from 10 populations of consumers from different countries and from different age groups. Exposure estimates were obtained by means of a two‐dimensional probabilistic model, which was implemented in SAS ® software. The characterisation of cumulative risk was supported by an uncertainty analysis based on expert knowledge elicitation. For each of the 10 populations, it is concluded with varying degrees of certainty that cumulative exposure to pesticides contributing to the chronic inhibition of acetylcholinesterase does not exceed the threshold for regulatory consideration established by risk managers.

Background: An unhealthy diet is associated with increased risk of cardiovascular diseases (CVD). This study quantified the burden of CVDs attributable to dietary risk factors in Australia between 1990 and 2019. Methods: We used data from the Global Burden of Diseases (GBD) study and quantified the rate (per 100,000) of deaths, disability-adjusted life years (DALYs), years lived with a disability (YLDs), and years of life lost (YLLs) for 21 CVDs attributable to 13 dietary risk factors (eight food groups and five nutrients) in Australia by sex and age groups (≥25 years and over). Findings: In 2019, the age-standardised rates of deaths, YLDs, YLLs, and DALYs attributable to dietary risk factors attributable to CVDs in the Australian population were 26.5, 60.8, 349.9, and 410.8 per 100,000 in women and 46.1, 62.6, 807.0, and 869.6 in men. Between 1990 and 2019, YLLs consistently contributed more towards the rates of DALYs than YLDs. Over the 30 year period, CVD deaths, YLLs, and DALYs attributable to dietary risk factors declined in both women and men. The leading dietary risk factors for CVD deaths and DALYs were a diet high in red meat (6.1 deaths per 100,000 [3.6, 8.7] and 115.6 DALYs per 100,000 [79.7, 151.6]) in women and a diet low in wholegrains (11.3 deaths [4.4, 15.1] and 220.3 DALYs [86.4, 291.8]) in men. Sex differences were observed in the contribution of dietary risk factors to disease over time such that the lowest rate of decrease in deaths and DALYs occurred with diets high in sodium in women and diets high in processed meat in men. Interpretation: Although the burden of diet-related CVD has decreased significantly in the Australian population over the past 30 years, diets low in wholegrains and high in red meat continue to contribute significantly to the overall CVD burden. Future nutrition programs and policies should focus on these dietary risk factors. Funding Information: The GBD Study is funded by the Bill and Melinda Gates Foundation. Declaration of Interests: None. Ethics Approval Statement: GBD received approval from the University of Washington Institutional Review Board Committee (STUDY00009060).

Background: Dietary risks raised attention around worldwide during the past decades. The aims of this burden-of-disease study were to evaluate the global dietary risks for non-communicable diseases (NCDs) from 1990 to 2019 and quantify their impact on mortality and disability-adjusted life-years (DALYs). Data from the 2019 Global Burden of Disease Study on deaths and DALYs from NCDs attributable to worldwide dietary risks were obtained and underwent deep analysis by year, age, gender, location, leading risks, and leading causes, and their associations were examined. The Socio-demographic Index (SDI) was used as an indicator of national socioeconomic status, and the relationships between age-standardized rates of deaths or DALYs and socioeconomic status. Results: In 2019, 7.9 million deaths and 187.7 million DALYs were attributable to dietary risk factors. High intake of sodium and low intake of whole grains and fruits were leading dietary risks for deaths and DALYs worldwide. However, both indexes showed a decreasing trend by year, an increase by age, and a higher disease burden in males. The main distribution of dietary-related NCDs was located in highly populated countries. A negative association between the SDI and disease burden, and a positive association between the SDI and male preponderance were found. Conclusions: Dietary risk factors for NCDs increased significantly and varied across regions during 1990-2019. Therefore, greater efforts are needed to raise public awareness of interventions and improve dietary practices to reduce the disease burden caused by suboptimal dietary intake, especially in developing countries and among males.

International audience; BACKGROUND: Alcohol and drug use (AandD) and dietary risks are two increasingly important risk factors. This study examines whether there is a relationship between the burden of these risk factors in countries of specific income bands as defined by the World Bank, and the number of primary studies included in Cochrane Systematic Reviews (CSRs) conducted in those countries.METHODS: Data was extracted from primary studies included in CSRs assessing two risk factors as outcomes. For each risk factor, data was obtained on its overall burden in disability-adjusted life years (DALYs) by World Bank Income Levels and examined for a link between DALYs, the number of primary studies and participants.RESULTS: A total of 1601 studies from 95 CSRs were included. Only 18.3% of the global burden for AandD is in high income-countries (HICs) but they produced 90.5% of primary studies and include 99.5% of participants. Only 14.2% of the dietary risk burden is in HICs but they produced 80.5% of primary studies and included 98.1% of participants.CONCLUSIONS: This study demonstrates the unequal output of research heavily weighted towards HICs. More initiatives with informed contextual understanding are required to address this inequality and promote health research in low and middle-income countries.

Esophageal cancer (EC) has become one of the most alarming cancers in the world. There are significant differences in incidence and risk factors associated with the two most common histological subtypes of EC, esophageal squamous cell carcinoma and esophageal adenocarcinoma, between regions. This systematic review was undertaken to analyze dietary risk factors specific to EC and its two subtypes based on World Health Organization regions.A systematic search of five databases (Global Health, Google Scholar, PubMed, Scopus, and Web of Science) for the past 5 y (2015-2020) was conducted from March 2020 to July 2020. Titles and abstracts were screened to determine the primary inclusion eligibility, followed by an examination of the full-text articles. Finally, 59 articles were reviewed to identify EC risk factors and compare these by region. Data were extracted using a table developed by the research team. Risk factors found in50% of regions were highlighted.The study identified some major dietary risk factors for EC that were previously reported, as well as some uncommon dietary risk factors, such as salty foods and beverages, unpiped drinking water, sugar-related factors (e.g., sweet intake), and foods with high glycemic index.EC risk factors extend beyond those previously identified. Targeting all EC risk factors by region will assist the World Health Organization and other health agencies in providing a tailored, culturally appropriate response to effectively reduce the incidence and prevalence of EC within a region.

Background For years the United States Department of Agriculture’s Pesticide Data Program and the United Kingdom’s Food Standards Agency have published annual or quarterly data on pesticide residues in foods. Both programs report residues in conventionally grown, organic, and imported foods. The US program has tested about 288,000 food samples since 1992, primarily fruits and vegetables consumed by children. Since 1999 the UK has tested about 72,000 samples of a wider range of foods. These data are vital inputs in tracking trends in pesticide dietary risks. Methods The Dietary Risk Index (DRI) system facilitates detailed analyses of US and UK pesticide residue data, trends, and chronic risk distributions. The DRI value for a pesticide is the dietary intake of that pesticide from a single serving of food divided by the pesticide’s acceptable daily intake as set by the US Environmental Protection Agency. It can be calculated based on average annual residue concentrations, and on residue levels in individual samples of food. DRI values can be aggregated over multiple pesticides in single foods, and over individual pesticides in multiple foods. Results The DRI system provides insights into the levels, trends, and distribution of pesticide dietary risk across most widely consumed foods. By drawing on both US Pesticide Data Program and UK-Food Standards Agency residue data, the DRI is capable of assessing pesticide risks in a significant portion of the global food supply. Substantial reductions in pesticide dietary risks occurred in the early 2000s, primarily from replacement of organophosphate insecticides with seemingly lower-risk neonicotinoids. However, there remain several areas of concern and opportunities to reduce risks. Both herbicide and fungicide dietary risks are rising. Organically grown produce poses risks far lower than corresponding, conventionally grown produce. Risk differences are inconsistent between domestic and imported foods. Conclusions The surest ways to markedly reduce pesticide dietary risks are to shift relatively high-risk fruits and vegetables to organic production. For other foods, reducing reliance on pesticides overall, and especially high-risk pesticides, will incrementally lower risks. The DRI system can help focus such efforts and track progress in reducing pesticide dietary risk.

Background The burden of malnutrition across the world remains unacceptably high. Children under five years are facing multiple burdens, including stunting and wasting; conversely, overweight and obesity among adults are at record levels while global trends in chronic non-communicable diseases (NCDs) are rising globally. Methods Data from the NCD Risk Factor Collaboration (NCD-RisC) and the Global Burden of Disease (GBD) Study and insights from the Global Nutrition Report will be discussed. Results No changes in age-standardised mean BMI in girls and boys from 1975 to 2016 were registered in eastern Europe, while an increase of up to 1.00 kg/m2 per decade was reported in central Latin America (for girls) and in Polynesia and Micronesia (for boys), with lower but significant variations over time all around the world. There has been some progress in reducing malnutrition at a global level but there are significant disparities in progress at the national and subnational level. Fewer than one in five children aged 6 to 23 months eat a minimally acceptable diet while only half of children aged 6 to 23 months get the recommended minimum number of meals. Regardless of wealth, children, adolescents and adults are eating too many refined grains and sugary foods and drinks, and not enough foods that promote health such as fruits, vegetables, legumes and whole grains. A total of 11 million deaths are attributable to dietary risk factors. High intake of sodium, low intake of whole grains, and low intake of fruits are the leading dietary risk factors for deaths globally. However, important differences between regions and outcome (i.e., cardiovascular disease vs. cancer) have been registered. Conclusions Current data allow us to assess what people are eating at global level, but nutrition quality in all countries and wealth groups pose a significant threat to achieving ideal targets. Focus on healthy diets to drive better nutrition everywhere is crucial to prevent NCDs globally.

A probabilistic dietary risk assessment on mycotoxins was conducted using the Monte Carlo Risk Assessment software, with consumption data from the 2008/2009 Brazilian Household Budget Survey for individuals who were at least 10 years old and occurrence data for 646 samples of rice, maize, wheat, and their products, collected in the Federal District and in the state of Rio Grande do Sul, Brazil. Processing factors were estimated and applied to concentration data. Chronic exposure was estimated for fumonisins (free and bound/hidden), deoxynivalenol (DON) (including the acetylated forms) and zearalenone (ZON) (including alfa-zearalenol) and acute exposure was estimated for DON. For the general population, the chronic exposure exceeded the safe exposure levels at the 95P for DON and at the 99P for fumonisins. Additionally, safe level exceedance occurred at the 97.5P for fumonisins and at the 95P for DON for teenagers, as well as at the 99P for fumonisins for women of child-bearing-age. No exceedances were found for chronic exposure to ZON and acute exposure to DON. Maize couscous contributed most of the total fumonisins (91%) and ZON intakes (~40%) and bread to total intake of DON (~30%). Further studies should be conducted with updated Brazilian consumption data, which should include information for individuals aged less than 10 years old.

Throughout the world, more than six billion people consume milk and milk products yearly. The safety and quality of dairy milk are regularly monitored in most countries worldwide. The Israeli monitoring program of chemical residues in milk has not changed in the last decades, focusing only on major veterinary drugs and few selected environmental contaminants such as heavy metals and persistent organic pollutants. Consequently, a knowledge gap exists regarding the potential occurrence of other chemicals such as human pharmaceuticals and non-monitored pesticides in milk. In this survey, 51 commercial bovine and goat milk samples were analysed by LC-MS/MS and pharmaceutical and pesticide residues are reported in the range of 0.1-93 µg/L. Israeli milk samples revealed at least one and up to five chemical residues simultaneously. The pesticides found in milk were below the European maximum residue limit values. The risk assessment performed, indicated negligible risk.

Usually health risk related to food contaminants is assessed based on consumption data collected on a few days. Consequently, this approach considers neither the evolution of exposures over time nor the potential accumulation of the substance. The aim of the present study was to develop a method to assess lifetime dietary risk due to cadmium exposure. Three methods were compared, respectively based on age, dietary pattern and sociodemographic characteristics. Additionally, exposure trajectories were converted into cadmium body burden trajectories using a PBTK-TD model ultimately predicting the occurrence of renal effects. It was shown that dietary exposures to cadmium, as well as exceedances of health based guidance values, greatly vary with age and individual profiles. The developed methods allowed identifying parameters affecting dietary exposure to cadmium and distinguishing at-risk subpopulations. Furthermore, this study demonstrated that it is necessary to consider individual changes through life and kinetic of the substance to assess risk properly.

Background Dental erosion is the dissolution of dental hard tissues caused by acids of a non-bacterial origin. Dietary acids are considered the predominant and most controllable factor. Aim To synthesise the literature on the effects of dietary acids and habits on dental erosion in the permanent dentition of 10- to 19-year-old adolescents. Materials and methods An electronic literature search was undertaken in Cochrane, MEDLINE, CINAHL, Dentistry & Oral Sciences Source via EBSCOhost, and Embase with no restriction on the date of publication. Results The initial search identified 449 articles, and 338 remained after removal of duplicates. Seventy-seven articles remained after screening of titles and abstracts, and 52 were eligible for the full-text review. A considerable variety of beverages, food, and dietary habits were reported as risk factors for dental erosion. The most consistent findings implicated the erosive potential of carbonated beverages and the consumption of acidic drinks at bedtime. Conclusions Although results were not consistent between cohort and cross-sectional studies, this review suggests certain dietary risk factors may contribute to dental erosion in adolescents. There is a need for more high-quality cohort studies to establish more conclusive evidence on the role of dietary acids and habits on dental erosion.

Background/Objectives. To determine the prevalence and determinants of blood haemoglobin level and mild, moderate, and severe anemia in a sample of adults from rural Tamil Nadu, India.Subjects/Methods. We recruited a sample of men and nonpregnant women aged 20 years and older. Clinical health measures included blood haemoglobin concentration and body mass index. We assessed associations between anemia outcomes and sociodemographic and dietary factors using linear and logistic regression modeling.Results. A total of 753 individuals (412 women and 341 men) participated in this study. The prevalence of anemia was 57.2% among women and 39.3% among men (PPP>0.05). Iron intake was low; 11.7% women and 24.1% of men reported iron intakes above recommended dietary allowances (PConclusion. Both women and men in this region may be particularly vulnerable to anemia, and future research must expand beyond dietary risk factors to examine the impacts of sociodemographic and environmental factors.

BACKGROUND As India is considered as the diabetic capital of the world, a huge burden of undiagnosed Metabolic Syndrome (MetS) is a possibility. Early intervention can be planned if MetS can be detected early along with risk factor assessment to avert cardiovascular morbidities. The aim of this study was to assess the dietary risk factor of metabolic syndrome. MATERIALS AND METHODS Community based cross-sectional study was conducted in Dibrugarh District of Assam with multistep sampling. Study area, i.e. four rural sub-centres and two urban electoral blocks were selected randomly. From the list of population of selected area, the consenting eligible were included. Sample size was 1700 population with MetS. Socio-demographic information, World Health Organisation’s STEPS questionnaire for behavioural risk factors along with dietary history, anthropometric assessment and laboratory investigations were conducted in three stages. Food frequency questionnaire was used for dietary assessment. Statistical analysis was done using rates, ratio, proportion, univariate and multivariate analysis. RESULTS MetS was 47.6% (1606 of 3372 screened). Mean age of study population was 47.1 ± 10.9 years. Behavioural risk factors like tobacco, alcohol consumption was high and significantly associated with metabolic syndrome (p= 0.000). Similarly financial stress, feeling stressed in last one year (p=0.034), lower physical activity level were also significantly associated with metS (p=0.000). Consumption of meat (p=0.000), egg (p=0.000), fast food (p=0.000), pickled vegetable (p=0.000) and sweet snacks (p=0.000) was found significantly higher amongst those with metabolic syndrome. Significant association was also seen with number of meals served per day and metS (p=0.000). CONCLUSION Dietary risk factors of cardiovascular diseases were rampant amongst persons with MetS. Dietary risk factor survey and counselling on healthy diet can be implemented in these population to give opportunity for early intervention.

Cardiovascular disease is developed across a lifetime accumulation of risk. Numerous independent and synergistic cardiovascular risk factors can be induced by unhealthy dietary patterns. Epidemiological, mechanistic, clinical, and translational research point to refined sugars, processed and fatty meats, synthetic oils, and sodium as major dietary risk factors. The purpose of this review is to integrate these learnings into key principles for dietary frameworks aimed at improving overall cardiovascular health.

Nonylphenols (NPs) are endocrine-disrupting compounds commonly found in the environment and a number of food products. In this study, we constructed a probabilistic risk framework incorporating a Bayesian inference of exposure level in foodstuffs in conjunction with effect analysis of reproduction and renal disease. Our objective was to contrast the risk of dietary exposure to NPs among individuals in various age groups, with a particular focus on fertile females. In this study, seafood presented relatively high NP concentrations; however, seafood accounts for only a small proportion of the total food intake of most individuals. Rice was shown to make the largest contribution to NP daily intake among males and females in most age groups. Chicken made the largest contribution in the 12-16 and 16-18 year age groups. The mean average daily dose of NPs tended to decrease with age, regardless of gender. The estimated distribution of hazard quotients of1 in all groups means that the risk of reproductive or renal abnormalities due to dietary exposure to NPs is negligible within most of the Taiwanese population. Nonetheless, preschoolers (3-6-year-olds) appear to be more vulnerable to NPs than do individuals in other age groups. There has been growing concern among researchers concerning the neurotoxic effects of NPs on offspring via maternal exposure. We recommend conducting a comprehensive assessment of exposure to NPs via multiple exposure routes, particularly among fertile women and preschoolers.

In Poland and Croatia, similarly as for a number of European countries, anemia and osteoporosis are common diet-related diseases in women, while for both the proper nutritional behaviors and preventive education are crucial. However, for the proper nutritional education there are some barriers, including those associated with an educator, his own nutritional behaviors and beliefs. The aim of the study was to assess the dietary health risk factors for women in the Polish and Croatian population based on the nutritional behaviors of junior health professionals. The study was conducted in Polish (n = 70) and Croatian (n = 80) female students of the faculties associated with public health at the universities in capital cities. Their diets were assessed based on 3-day dietary records. Nutritional value and consumption of food products, as well as the dietary risk factors for anemia and osteoporosis, were compared. While assessing the risk factors for anemia, in the Polish group, the higher intake of iron and folate, as well as vitamin B12 per 1000 kcal, was observed; and for folate, the higher frequency of inadequate intake was stated for Croatian women. While assessing the risk factors for osteoporosis, in the Polish group, compared with the Croatian, the higher intake of calcium per 1000 kcal was observed, but for vitamin D, there were no differences. Differences of the intake between the Polish and the Croatian group of junior health professionals may result in various dietary health risks for women. Based on the assessment of dietary intake, for anemia, compared to Polish women, a higher risk may be indicated for Croatian women, but for osteoporosis, similar risks may be indicated for Polish and Croatian women. Therefore, for public health, adequate nutritional education of junior health professionals is necessary.

Current diets are neither healthy nor sustainable. Dietary risk factors that describe unhealthy consumption patterns, such as diets low in fruits and vegetable and high in red and processed meat, are together responsible for the greatest health burden on mortality globally and in most regions. At the same time, food production is a significant driver of climate change, biodiversity loss via land-use changes, and chemical pollution of aquatic and terrestrial ecosystems. In addressing these challenges, a large body of literature has emerged that explores ways to reduce the environmental and health impacts of the food system, both from the consumption and the production side. Here I summarize and contextualize the current state of the literature on sustainable diets. I base this chapter on global studies on the environmental impacts of agriculture, recent reviews of the sustainable-diet literature, and meta-analyses of epidemiological studies that detail the health associations of dietary changes.

The article presents the results of research on the territory of the Khakas Republic products in terms of chemical food safety. Established the value of non-cancer risk in relation to food consumption. The analysis of the levels of alimentary-dependent diseases. Suggestions for reducing dietary risk factors.

Risk assessment of chemicals occurring in our diet is commonly performed for single chemicals without considering exposure to other chemicals. We performed a case study on risk assessment of combined dietary exposure to chemicals from different regulatory silos, i.e. pesticides (PPRs), persistent organic pollutants (POPs) and food additives (FAs). Chemicals were grouped into the cumulative assessment group (CAG) liver steatosis using a component-based approach. Based on literature, the CAG included 144 PPRs, 49 POPS and 7 FAs for which concentration data were available. For each silo, chronic combined dietary exposure was assessed for adults and children of nine European countries following the most commonly used exposure methodologies in Europe and by using a relative potency factor approach. For risk characterization, a Margin of Exposure (MOE) was calculated. To overarch the risk across silos, a normalised combined margin of exposure (nMOET) approach was proposed. This case study demonstrated that risk assessment of combined exposure to chemicals can be performed within regulatory silos. It also highlighted important differences in the conservatism of exposure scenarios, the derivation of point of departures and the subsequent acceptable MOEs between the silos. To overarch the risk despite these differences, a nMOET approach can be used.

Consumers are constantly exposed to trace levels of residues present in food commodities, arising from the use of pesticides. For this reason, assessing the risk caused by pesticide residues present in food requires not only identification and toxicological properties assessment of the active substance, but also of its metabolites, isomers, and degradates. This requires the use of many laboratory animals. On the other hand, currently there is an emphasis on minimizing the use of animals in toxicological research. This review article presents current activities of the European Food Safety Authority (EFSA) and the European Commission's Joint Research Centre (JRC) aiming to replace at least a part of toxicological tests on substances of unknown toxicity with the alternative methods. Quantitative Structure-Activity Relationship (QSAR) and Threshold of Toxicological Concern (TTC) can be used for this purpose in procedure of establishing residue definitions applied for dietary risk assessment.

Background/objectives Dietary factors are important contributors to cardiometabolic and cancer mortality. We examined the secular trends of nine dietary factors (fruits, vegetables, whole grains, nuts and seeds, milk, red meat, processed meat, sugar-sweetened beverages, and calcium) and the associated burdens of cardiometabolic and cancer mortality in Korea using representative cross-sectional survey data from 1998 to 2016. Subjects/methods Using dietary data from Korean adults aged ≥ 25 years in the Korea National Health and Nutrition Examination Survey (KNHANES), we characterized secular trends in intake levels. We performed comparative risk assessment to estimate the population attributable fraction and the number of cardiometabolic and cancer deaths attributable to each dietary factor. Results A total of 231,148 cardiometabolic and cancer deaths were attributable to nine dietary risk factors in Korea from 1998 to 2016. Suboptimal intakes of fruits and whole grains were the leading contributors. Although the intakes of fruits, vegetables, and whole grains moderately improved over time, the intake levels in 2016 (192.1 g/d, 225.6 g/d, and 10.9 g/d, respectively) remained far below the optimal levels. Deaths attributable to the low intakes of nuts and seeds (4.5 g/d), calcium (440.5 mg/d), and milk (37.1 g/d) and the high intakes of red meat (54.7 g/d), processed meat (4.7 g/d), and sugar-sweetened beverages (33.0 g/d) increased since 1998. Compared with older age groups (≥ 45 years), more unfavorable changes in dietary patterns were observed in the younger population aged 25-44 years, including more sharply increased intakes of processed meat. Conclusions We observed improvement in the intakes of fruits, vegetables, and whole grains and unfavorable changes in the intakes of processed meat and sugar-sweetened beverages over the past few decades. Our data suggest that to reduce the chronic disease burden in Korea, more effective nutritional policies and interventions are needed to target these dietary risk factors.

Disability adjusted life years (DALYs) is a health burden metric that combines years of life lost due to disease disability and premature mortality. The Global Burden of Disease (GBD) has been using DALYs to determine the health burden associated with numerous health risks, including risks associated with dietary intakes, at the global and national level. To translate such information at the food level in the U.S., variables in What We Eat in America (WWEIA) need to be aligned with those in the GBD. In this paper, we develop the necessary new variables needed to account for differences in definitions and units between WWEIA and the GBD. We use the Food Patterns Equivalents Database, Food Patterns Equivalents Ingredient Database, Food and Nutrient Database for Dietary Studies, and Standard Reference databases that provide data for WWEIA to develop food group and nutrient variables that align with definitions and units used in the GBD. Considerable effort was needed to disaggregate mixed dishes to GBD components. We also developed a new &ldquo, non-starchy&rdquo, vegetable variable, since the GBD vegetables do not include potatoes and corn, and we report fruits and vegetables in grams instead of household measures. New fiber variables were created to avoid double counting of fiber from legumes, whole grains, fruits, and vegetables. Regression analyses were used to predict trans-fat content for foods in WWEIA with missing or incomplete information. The majority of foods in various U.S. Department of Agriculture (USDA) categories contain multiple GBD food groups (e.g., vegetables, whole grains, and processed meat). For most nutrients considered in the GBD, composition is more evenly distributed across the main food categories, however, seafood omega-3 fats were predominantly from either protein foods or mixed dishes and sugar sweetened beverages were from a single category. Dietary intakes in the U.S. fall short of recommendations for all food groups/nutrients with established theoretical minimum-risk targets in GBD. To our knowledge, this is the first approach that aligns WWEIA intake variables with those used in the health burden-based GBD reports. These methods will facilitate researchers to begin comparing data from the U.S. with that from other countries, as well as assess food sustainability performances by concomitantly evaluating DALYs for environmental and nutritional impacts.

Objective A systematic review was conducted to determine the health burden of preventable disease in Australia. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines were followed to identify, screen and describe the protocols used in the systematic review. Results Eleven studies were included in the review. Data on the health burden associated with lifestyle-related risk factors were extracted by disease with outcomes reported in attributable number and proportion of deaths, years of life lost, years lived with disability and disability-adjusted life years (DALYs). Around one-third of DALYs was attributed to all modifiable risk factors. The range of estimates of DALYs attributable to each prioritised risk factor was: combined dietary risk factors, 7.2% to 9.7%; tobacco, 7.9% to 9.0%; alcohol, 5.1% to 12.2%; high body mass, 5.5% to 8.3%; and physical inactivity, 1.2% to 5.5%. Conclusions Although the methods used to estimate preventable health burden varied greatly between studies, all found that a substantial amount of death and disability was attributable to lifestyle-related risk factors. Implications for public health: There is a large health burden in Australia caused by modifiable risk factors and further action is warranted to address this burden.

Cumulative dietary risks for the German population owing to pesticide residues in foods were assessed using food monitoring and consumption data. Based on grouping principles for cumulative assessment groups (CAG) as defined by the European Food Safety Authority, probabilistic modelling gave cumulative long- and short-term dietary exposures relevant to the nervous and thyroid system. Compound specific toxicological reference values were considered to assess the total margins of exposure (MoEs) for each CAG, allowing an assessment of the cumulative dietary consumer risk. For the German population, no public health concerns were identified for 6 of 11 CAGs. For three CAGs high uncertainties remained, since MoEs were less than the usually required threshold of 100 for the upper confidence interval of the modelling uncertainty. For two CAGs relevant to the nervous and thyroid system, possible health risks cannot be excluded with the selected approach. Most potent risk drivers were chlorpyrifos and the group of dithiocarbamates (expressed as propineb). For regulatory decisions on possible cumulative dietary health risks the limitations of the published approaches and the absence of harmonized data sources for robust refinements have to be considered. Future research to reduce this high uncertainty is considered necessary in this area.

Agent Orange (AO) was the main defoliant used by the US in Vietnam from 1961 to 1971; AO was contaminated with dioxin (2,3,7,8-tetrachlorodibenzo-p-dioxin, or TCDD). Three major dioxin “hot spots” remain from previous AO storage and use at former US bases at Bien Hoa, Da Nang, and Phu Cat, posing potential health risks for Vietnamese living on or near these hot spots. We evaluated potential risk factors contributing to serum TCDD levels in Vietnamese residents at and near contaminated sites in Da Nang and Bien Hoa, Vietnam. We used multiple linear regression to analyze possible associations of blood dioxin concentrations with demographic, socioeconomic, lifestyle, and dietary risk factors for residents living on or near these hot spots. For the Da Nang study, fish farming on the site, living on property flooded from monsoon rains, and age were among the factors showing significant positive associations with serum TCDD concentrations. For the Bien Hoa study, fish farmers working at this site and their immediate family members had significantly higher serum TCDD concentrations. Our results suggest that water-related activities, especially fish-farming, at the hot spots increased the risk of exposure to dioxin.

Background: Diet is a major determining factor for many non-communicable chronic diseases (NCDs). However, evidence on diet-related NCD burden remains limited. We assessed the trends in diet-related NCDs in Australia from 1990 to 2015 and compared the results with other countries of the Organization for Economic Co-operation and Development (OECD). Methods: We used data and methods from the Global Burden of Disease (GBD) 2015 study to estimate the NCD mortality and disability-adjusted life years (DALYs) attributable to 14 dietary risk factors in Australia and 34 OECD nations. Countries were further ranked from the lowest (first) to highest (35th) burden using an age-standardized population attributable fraction (PAF). Results: In 2015, the estimated number of deaths attributable to dietary risks was 29,414 deaths [95% uncertainty interval (UI) 24,697 − 34,058 or 19.7% of NCD deaths] and 443,385 DALYs (95% UI 377,680–511,388 or 9.5% of NCD DALYs) in Australia. Young (25–49 years) and middle-age (50–69 years) male adults had a higher PAF of diet-related NCD deaths and DALYs than their female counterparts. Diets low in fruits, vegetables, nuts and seeds and whole grains, but high in sodium, were the major contributors to both NCD deaths and DALYs. Overall, 42.3% of cardiovascular deaths were attributable to dietary risk factors. The age-standardized PAF of diet-related NCD mortality and DALYs decreased over the study period by 28.2% (from 27.0% in 1990 to 19.4% in 2015) and 41.0% (from 14.3% in 1990 to 8.4% in 2015), respectively. In 2015, Australia ranked 12th of 35 examined countries in diet-related mortality. A small improvement of rank was recorded compared to the previous 25 years. Conclusions: Despite a reduction in diet-related NCD burden over 25 years, dietary risks are still the major contributors to a high burden of NCDs in Australia. Interventions targeting NCDs should focus on dietary behaviours of individuals and population groups. Refereed/Peer-reviewed