Abstract P279: Major Dietary Risk Factors for Cardiometabolic Disease: Current Evidence for Causal Effects and Effect Sizes From the Global Burden of Diseases (GBD) 2015 Study

Abstract

Background: Dietary habits are major contributors to cardiometabolic diseases. Estimating the impact of diet on these conditions requires identification and quantification of evidence for causal effects. Objectives: To comprehensively evaluate the current evidence and quantify the effects of major dietary factors on CHD, stroke, and diabetes as part of the Global Burden of Diseases (GBD) 2015 study. Methods: We assessed probable or convincing evidence for causal effects based on Bradford-Hill, World Health Organization, and WCRF/AICR criteria. We searched PubMed through April 2015 to identify systematic reviews and meta-analyses of well-designed observational studies and clinical trials. Meta-analyses were evaluated and selected based on design, number of studies and events, definition of dietary exposure and disease outcomes, length of follow-up, statistical methods, evidence of bias, and control for confounders. Effect sizes and uncertainty were quantified per standardized units. We focused on dose-response meta-analyses. When necessary, original data were extracted from individual studies within each meta-analysis to perform de novo dose-response meta-analyses using generalized least squares for trend estimation. Results: We identified 11 dietary factors with probable or convincing evidence for causal effects on CHD, 4 on stroke, and 7 on diabetes. ( Table ). Examples of other factors not yet meeting probable or convincing evidence for causal effects included coffee and tea (consistent dose-response, yet plausible biology not well-established), eggs, and dietary cholesterol. Conclusion: This evaluation provides the best current evidence-based quantitative estimates of effects of major dietary factors on CHD, stroke, and diabetes. These findings enable quantitative estimation of disease burdens of suboptimal diet in the US and globally, and also inform policy planning and priorities.