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Unhealthy diets now kill more people than tobacco and high blood pressure, study finds

Poor diet is associated with 1 in 5 deaths worldwide, according to a new, large study. That's equivalent to 11 million deaths a year, making unhealthy eating habits responsible for more deaths than tobacco and high blood pressure.

"Poor dietary habits, which is a combination of high intake of unhealthy foods, such as red meat, processed meat, and sugar-sweetened beverages and a low intake of healthy foods such as fruits, vegetables, nuts, whole grains, and seeds, overall causes more deaths than any other risk factors globally," study author Dr. Ashkan Afshin, an assistant professor of Health Metrics Sciences  at the University of Washington, told CBS News.

The study, published in the journal The Lancet, tracked trends in consumption of 15 dietary elements from 1990 to 2017 in 195 countries. These included diets low in fruits, vegetables, legumes, whole grains, nuts and seeds, milk, fiber, calcium, seafood omega-3 fatty acids, polyunsaturated fats, and diets high in red meat, processed meat, sugar-sweetened beverages, trans fatty acids, and sodium.

An analysis found that an estimated 11 million deaths were attributable to unhealthy diets in 2017. The causes of these deaths included 10 million deaths from heart disease, 913,000 deaths from obesity-related cancers, and nearly 339,000 deaths from type 2 diabetes

Diets high in sodium, low in whole grains, and low in fruit together accounted for more than half of all diet-related deaths around the world. Out of the 195 countries studied, Israel had the lowest rate of diet-related deaths; Uzbekistan had the most. The U.S. ranked 43rd.

Focus on eating more healthy foods

Strikingly, the researchers found more deaths were associated with not eating enough healthy foods rather than with eating too many unhealthy foods.

"While historically the conversation around diet and nutrition has been focused on a high intake of unhealthy foods, mainly salt, sugar and fats and reducing their consumption, our study shows that in many countries, the main problem is low intake of healthy foods," Afshin said.

For example, not eating enough whole grains was the leading dietary risk factor in several countries, including the United States. High sodium was the leading risk factor in many Asian countries, while a diet low in fruits was the biggest problem in sub-Saharan Africa and low intake of nuts and seeds ranked first in Mexico.

On the flip side, consuming too much red meat, processed meat, trans fat, and sugar-sweetened beverages were also among the risk factors. 

Afshin said these findings have major health implications. "This concept of increasing intake of healthy food should be added to current policy debates for improving diets," he said. "It's important both policy makers and the food industry work together to be part of the solution to increase the consumption of not only fruits and vegetables but also whole grains, nuts, seeds, and legumes."

He said instead of just focusing on messages that people should avoid unhealthy foods like processed meat and sugary drinks, "the ideal scenario would focus on healthy replacements for unhealthy foods. That should be the focus of public health interventions."

The authors note several important limitations to the study. While the research uses the best available data, there are gaps in the data available for intake of key foods and nutrients around the world, which increases the statistical uncertainty of these estimates.

Still, they conclude that people in almost every corner for the world could benefit from rebalancing their diets and consuming more healthy foods and less unhealthy foods.

In an accompanying editorial, Professor Nita Forouhi of the University of Cambridge School of Clinical Medicine said that despite the limitations, the study's findings "provide evidence to shift the focus, as the authors argue, from an emphasis on dietary restriction to promoting healthy food components in a global context."