Non-communicable Diseases Deaths Research Articles

CONTROL OF ALCOHOL CONSUMPTION IN THE COUNTRIES OF NORTHERN DIMENSION PARTNERSHIP IN PUBLIC HEALTH ABD SOCIAL WELL­BEING

Alcohol consumption is one of the causes of premature death from the main non­communicable diseases (NCD), such as cardiovascular diseases, malignancies, diabetes. In the countries of Northern Dimension Partnership in Public Health and Social Well­being (NDPHW) alcohol consumption calculated for pure ethanol per person per year ranges from low ~8 L to high ≥12 L. In NDPHW countries where the inhabitants consume alcohol in low amounts, the probability of premature death from NCD is lower than in the countries with high consumption. It was shown that the events on alcohol approachability restriction were stricter in the countries with low consumption rate and hence with lower probability of premature NCD death. All NDPHW countries, except Germany and Estonia, are in the 20 of the countries with the highest score according to the politics of alcohol control that witness on effective implementation of the events for consumption control. Therefore acception and implementation of strict politics may facilitate the decrease of alcohol consumption and then, the rate of NCD premature death.

Insights into the genetics of blood pressure in black South African individuals: the Birth to Twenty cohort

BackgroundCardiovascular diseases (CVDs) are the leading cause of non-communicable disease deaths globally, with hypertension being a major risk factor contributing to CVDs. Blood pressure is a heritable trait, with relatively few genetic studies having been performed in Africans. This study aimed to identify genetic variants associated with variance in systolic (SBP) and diastolic (DBP) blood pressure in black South Africans.MethodsGenotyping was performed using the Metabochip in a subset of participants (mixed sex; median age 17.9) and their adult female caregivers (median age 41.0) from the Birth to Twenty cohort (n = 1947). Data were analysed as a merged dataset (all participants and caregivers together) in GEMMA (v0.94.1) using univariate linear mixed models, incorporating a centered relatedness matrix to account for the relatedness between individuals and with adjustments for age, sex, BMI and principal components of the genotype information.ResultsAssociation analysis identified regions of interest in the NOS1AP (DBP: rs112468105 - p = 7.18 × 10−5 and SBP: rs4657181 - p = 4.04 × 10−5), MYRF (SBP: rs11230796 - p = 2.16 × 10−7, rs400075 - p = 2.88 × 10−7) and POC1B (SBP: rs770373 - p = 7.05 × 10−5, rs770374 - p = 9.05 × 10−5) genes and some intergenic regions (DACH1|LOC440145 (DBP: rs17240498 - p = 4.91 × 10−6 and SBP: rs17240498 - p = 2.10 × 10−5) and INTS10|LPL (SBP: rs55830938 - p = 1.30 × 10−5, rs73599609 - p = 5.78 × 10−5, rs73667448 - p = 6.86 × 10−5)).ConclusionsThe study provided further insight into the contribution of genetic variants to blood pressure in black South Africans. Future functional and replication studies in larger samples are required to confirm the role of the identified loci in blood pressure regulation and whether or not these variants are African-specific.

Non Communicable Disease Admissions in Developing Country as Experienced from the Medical Ward of a Tertiary Centre in Nigeria

Non-Communicable Diseases (NCDs) are chronic medical conditions that are non-infectious. NCDs which include a cluster of illnesses (Diabetes mellitus, Cancers, Chronic respiratory diseases, cardiovascular disease and musculoskeletal disorders) are increasing worldwide due to changing lifestyles and socio-economic status with significant contribution to the global disease burden. It is projected that by 2020, the largest increase in NCD deaths will occur in Africa which currently has a heavy infectious diseases burden. NCDs usually affect adults who are economically productive and bear enormous social responsibilities. The aim of this study is to determine the pattern of non-communicable diseases in the medical wards of the University of Port Harcourt Teaching Hospital (UPTH). It was a retrospective and hospital based study. The admission and discharge registers of the medical wards of UPTH from January 2013 to December 2016 were reviewed and NCD admissions extracted. There were 1096 cases of various NCDs constituting 57.7% of total medical ward admissions of 1898. The male to female ratio was 1:1.2 with a mean age of 54.40±21 years. Subjects ≥50 years of age accounted for 60.5% of total admissions. Diseases of the cardiovascular, endocrine and renal systems were found to be the most prevalent accounting for 46.5%, 18.8% and 12.4% respectively of the NCDs in this study. Hypertension and hypertension-related complications, diabetes mellitus, and chronic renal failure are major and important contributor to NCD admissions in the medical wards of UPTH. Early detection, appropriate management as well as patient education will play significant role in reducing its morbidity and mortality.

Evaluation of Knowledge about Risk Factors of Heart Disease in Tabuk City between Adult Population

Background: According to World Health Organization (WHO), heart disease especially coronary heart disease is the leading cause of death globally and one of the major health burdens worldwide. A report released by the Media and Health Awareness Information Center at the Ministry of Health (MOH) in Saudi Arabia, pointed out that, cardiovascular diseases (CVD), including heart attacks and strokes, are the cause of 42 percent of the Kingdom's non-communicable diseases deaths in 2010. Vascular injury accumulates in adolescence, making it necessary for primary preventive measures to be taken from childhood. Therefore, there is increasing emphasis on preventing atherosclerosis by modifying risk factors, such as healthy diet, exercise and avoidance of smoking. Methods: We have conducted a descriptive cross-sectional study in Tabuk city population, Saudi Arabia. The study was conducted during the period from May to September 2017. The participants were selected by random sampling. Sampling was stratified for the different geographical areas of the city. The total sample obtained was 460. All the pupils were approached to obtain the desired sample size. A self-administered questionnaire about heart disease risk factors knowledge and awareness was filled by participants. Results: the majority of participants showed right answers and were aware about some of the risk factors of heart disease. The majority agreed to the following statements: (Being overweight increases a person's risk for heart disease-96.7%), (Smoking is a risk factor for heart disease-92.4%), (High cholesterol is a risk factor for developing heart disease-92.4%) and (High blood pressure is a risk factor for heart disease-86.5%). Conclusion: more attention is needed on primary prevention programs that focus on diet, exercise and the danger of heart disease and its risk factors should be emphasized.

Sustainable development goals and noncommunicable diseases: Roadmap till 2030 – A plenary session of world noncommunicable diseases congress 2017

The global epidemic of noncommunicable diseases (NCDs) was recognized by the United Nations and is addressed by the Sustainable Development Goals (SDGs) to be achieved by 2030. This review article describes the proceedings of the plenary session “SDGs and NCDs: Roadmap till 2030” of the first “World NCD Congress 2017” held at Chandigarh, India. The plenary session emphasized the need for political commitment to take up NCD agenda at the national level to prevent and reduce the premature NCD deaths. Establishing the national action plan and monitoring framework for prevention and control of NCDs are the major initial initiatives to implement the best buy NCD interventions. Primary prevention of four common and shared risk factors and health system strengthening are the important interventions to achieve the SDG goal 3.4. The implementation strategies at subnational level and engagement of sectors other than health on prevention and control of NCDs can be reviewed and further researched for effective implementation of the identified interventions.

Challenges for clinical practice and research in family medicine in reducing the risk of chronic diseases. Notes on the EGPRN Spring Conference 2017 in Riga

Chronic diseases in most cases belong to the category of non-communicable diseases (NCDs), which are the main cause of mortality globally. Cardiovascular diseases, diabetes, chronic obstructive pulmonary disease and cancer are the four NCDs responsible for 82% of NCD deaths. Prevention of NCDs implies health promotion activities that encourage healthy lifestyle and limit the initial onset of chronic diseases. Prevention also includes early detection activities, such as screening at-risk populations, as well as strategies for appropriate management of existing diseases and related complications. Early intervention, reducing morbidity and mortality rates could be an appealing idea for patients, physicians and governmental institutions but could also cause harm. Healthcare is undergoing profound changes, and the role of technology in diagnostics and management of chronic diseases in primary healthcare (PHC) is increasing remarkably. However, studies show that the standards of care for chronic diseases and preventive care are met by less than 50%. We still lack clear standards for patients with multiple chronic diseases. The applicability of a single evidence-based guideline to multimorbid patients is limited and can be problematic. Well-designed PHC studies focusing on the impact of medical interventions on morbidity, mortality and quality of life in the fields of early diagnosis, early treatment and multimorbidity are still needed.

Scaling up action on the prevention and control of noncommunicable diseases in the WHO Eastern Mediterranean Region

Noncommunicable diseases (NCDs) are the leading causes of death worldwide. They are responsible for approximately 68% of global mortality each year, with cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases being the four main NCD killers. It is estimated that annually, 16 million people die prematurely (before the age of 70) as a result of NCD. The majority of NCD deaths (74%) occur in low- and middle-income countries, where this public health crisis is especially challenging due to severe social and economic conditions already faced.

The Impact of Selected Groups of Non-communicable Disease Deaths on Life Expectancy in the Slovak Republic.

The aim of this study was to compute the potential gains in life expectancy (PGLEs) if the five main groups of non-communicable disease deaths were eliminated in the Slovak population during 1996-2014, and to decompose PGLEs by five-year age groups. PGLEs were computed from mortality reports for deaths from ischaemic heart disease (I20-25), cerebrovascular diseases (I60-I69), cancer (C00-C97), diabetes mellitus (E10-E14), and chronic respiratory diseases (J30-J98) using the life table decomposition technique. In 2014, life expectancy at birth was 76.87 years compared to 72.87 in 1996. The highest impact on life expectancy was recorded for ischaemic heart disease and PGLEs have changed from 3.9 years to 4.6 over 1996-2014. However, the trends for other diseases did not fluctuate. The PGLEs of cancer, as the second most influential disease, increased from 3.3 years to 3.6. Conversely, a slight decline was observed in cerebrovascular diseases from 1.13 years to 1.12, and diabetes mellitus from 0.14 years to 0.13. The proportion of diabetes mellitus and chronic respiratory diseases in PGLEs was low, approaching zero. As far as PGLEs among age groups in 2014 are concerened: whereas PGLEs for ischaemic heart disease mortality reduction are very similar among all age groups they are mostly on the decrease from other causes of death. However, PGLEs reached a value of 0.13 years in the 0-54 years age-group for diabetes mellitus; this means that the number of years of life lost are the same for 54 year old people and younger, with the impact of diabetes mellitus declining at age 55 and over. The same scenario is apparent for cerebrovascular diseases. The impact of mortality from other causes of death is decreasing with age. Our findings suggest that optimum benefit would be gained from prevention programs for reduction of ischaemic heart disease mortality in all age groups.

Income Inequality in Non-communicable Diseases Mortality among the Regions of the Slovak Republic.

A great amount of non-communicable disease deaths poses a threat for all people and therefore represents the challenge for health policy makers, health providers and other health or social policy actors. The aim of this study is to analyse regional differences in non-communicable disease mortality in the Slovak Republic, and to quantify the relationship between mortality and economic indicators of the Slovak regions. Standardised mortality rates adjusted for age, sex, region, and period were calculated applying direct standardisation methods with the European standard population covering the time span from 2005 to 2013. The impact of income indicators on standardised mortality rates was calculated using the panel regression models. The Bratislava region reaches the lowest values of standardised mortality rate for non-communicable diseases for both sexes. On the other side, the Nitra region has the highest standardised mortality rate for non-communicable diseases. Income quintile ratio has the highest effect on mortality, however, the expected positive impact is not confirmed. Gini coefficient at the 0.001 significance level and social benefits at the 0.01 significance level look like the most influencing variables on the standardised mortality rate. By addition of one percentage point of Gini coefficient, mortality rate increases by 148.19 units. When a share of population receiving social benefits increases by one percentage point, the standardised mortality rate will increase by 22.36 units. Non-communicable disease mortality together with income inequalities among the regions of the Slovak Republic highlight the importance of economic impact on population health.

Social determinants of adult mortality from non-communicable diseases in northern Ethiopia, 2009-2015: Evidence from health and demographic surveillance site.

IntroductionIn developing countries, mortality and disability from non-communicable diseases (NCDs) is rising considerably. The effect of social determinants of NCDs-attributed mortality, from the context of developing countries, is poorly understood. This study examines the burden and socio-economic determinants of adult mortality attributed to NCDs in eastern Tigray, Ethiopia.MethodsWe followed 45,982 adults implementing a community based dynamic cohort design recording mortality events from September 2009 to April 2015. A physician review based Verbal autopsy was used to identify the most probable causes of death. Multivariable Cox proportional hazards regression was performed to identify social determinants of NCD mortality.ResultsAcross the 193,758.7 person-years, we recorded 1,091 adult deaths. Compared to communicable diseases, NCDs accounted for a slightly higher proportion of adult deaths; 33% vs 34.5% respectively. The incidence density rate (IDR) of NCD attributed mortality was 194.1 deaths (IDR = 194.1; 95% CI = 175.4, 214.7) per 100,000 person-years. One hundred fifty-seven (41.8%), 68 (18.1%) and 34 (9%) of the 376 NCD deaths were due to cardiovascular disease, cancer and renal failure, respectively. In the multivariable analysis, age per 5-year increase (HR = 1.35; 95% CI: 1.30, 1.41), and extended family and non-family household members (HR = 2.86; 95% CI: 2.05, 3.98) compared to household heads were associated with a significantly increased hazard of NCD mortality. Although the difference was not statistically significant, compared to poor adults, those who were wealthy had a 15% (HR = 0.85; 95% CI: 0.65, 1.11) lower hazard of mortality from NCDs. On the other hand, literate adults (HR = 0.35; 95% CI: 0.13, 0.9) had a significantly decreased hazard of NCD attributed mortality compared to those adults who were unable to read and write. The effect of literacy was modified by age and its effect reduced by 18% for every 5-year increase of age among literate adults.ConclusionIn summary, the study indicates that double mortality burden from both NCDs and communicable diseases was evident in northern rural Ethiopia. Public health intervention measures that prioritise disadvantaged NCD patients such as those who are unable to read and write, the elders, the extended family and non-family household co-residents could significantly reduce NCD mortality among the adult population.

Estimation of the impact of risk factors control on non-communicable diseases mortality, life expectancy and the labor force lost in China in 2030

Objective: To estimate the impact of risk factors control on non-communicable diseases (NCDs) mortality, life expectancy and the numbers of labor force lost in China in 2030. Methods: We used the results of China from Global Burden of Disease Study 2013, according to the correlation between death of NCDs and exposure of risk factors and the comparative risk assessment theory, to calculate population attributable fraction (PAF) and disaggregate deaths of NCDs into parts attributable and un-attributable. We used proportional change model to project risk factors exposure and un-attributable deaths of NCDs in 2030, then to get deaths of NCDs in 2030. Simulated scenarios according to the goals of global main NCDs risk factors control proposed by WHO were constructed to calculate the impact of risk factors control on NCDs death, life expectancy and the numbers of labor force lost. Results: If the risk factors exposure changed according to the trend of 1990 to 2013, compared to the numbers (8.499 million) and mortality rate (613.5/100 000) of NCDs in 2013, the death number (12.161 million) and mortality rate (859.2/100 000) would increase by 43.1% and 40.0% respectively in 2030, among which, ischemic stroke (increasing by 103.3% for death number and 98.8% for mortality rate) and ischemic heart disease (increasing by 85.0% for death number and 81.0% for mortality rate) would increase most quickly. If the risk factors get the goals in 2030, the NCDs deaths would reduce 2 631 thousands. If only one risk factor gets the goal, blood pressure (1 484 thousands NCDs deaths reduction), smoking (717 thousands reduction) and BMI (274 thousands reduction) would be the most important factors affecting NCDs death. Blood pressure control would have greater impact on ischemic heart disease (662 thousands reduction) and hemorrhagic stroke (449 thousands reduction). Smoking control would have the greatest effect on lung cancer (251 thousands reduction) and chronic obstructive pulmonary disease (201 thousands reduction). BMI control would have the greatest impact on ischemic heart disease (86 thousands reduction) and hypertensive heart disease (45 thousands reduction). If the risk factors exposure changed according to the trend of 1990 to 2013, in 2030, the life expectancy of Chinese population would reach to 79.0 years old, compared to 2013, increasing by 3.3 years old, the labor force at the age of 15-64 years old would loss 1.932 million. If the risk factors get the goals in 2030, life expectancy would increase to 81.7 years old and the number of labor force lost would decrease to 1.467 million. Blood pressure, smoking and BMI control would have much greater impact on life expectancy (4.9, 4.0 and 3.8 years old respectively) and labor force lost (630 thousands, 496 thousands and 440 thousands respectively). Conclusion: Risk factors control would play an important role in reducing NCD death, improving life expectancy of residents and reducing loss of labor force. Among them, the control of blood pressure raising, smoking and BMI raising would have a greater contribution to the improvement of population health status.

Excess burden of non-communicable disease years of life lost from heat in rural Burkina Faso: a time series analysis of the years 2000–2010

ObjectivesInvestigate the association of heat exposure on years of life lost (YLL) from non-communicable diseases (NCD) in Nouna, Burkina Faso, between 2000 and 2010.DesignDaily time series regression analysis using distributed...

A multidisciplinary approach to prevention.

Cardiovascular disease accounts for 17,500 deaths globally, representing nearly half of all non-communicable disease deaths. The World Health Organization has set nine lifestyle, risk factor and medicines targets to achieve by 2025 with the aim of reducing premature mortality from non-communicable diseases by 25%. In order to succeed in this, we need to equip our global health professional workforce with the skills to support patients and their families with making lifestyle changes and being in concordance with cardioprotective medication regimes at every opportunity. Success depends on collegiate working through effective interdisciplinary team-based care characterised by shared goals, clear roles, mutual trust, effective communication and measurable processes and outcomes, with the patient and family at the centre of care. Nurses are the largest sector of the health professional workforce and their role in prevention should be optimised. Nurse coordinated care is proven to be effective, especially where they work in an interdisciplinary way with other health professionals such as doctors, pharmacists and psychologists, who provide equally important expertise for supporting holistic care. Successful care models are those that comprehensively target all adverse lifestyles and risk factors that are responsible for the development of cardiovascular disease. These characteristics should be reflected in the standards and core components of prevention and rehabilitation programmes.

Tracing Africa\u2019s progress towards implementing the Non-Communicable Diseases Global action plan 2013\u20132020: a synthesis of WHO country profile reports

BackgroundHalf of the estimated annual 28 million non-communicable diseases (NCDs) deaths in low- and middle-income countries (LMICs) are attributed to weak health systems. Current health policy responses to NCDs are fragmented and vertical particularly in the African region. The World Health Organization (WHO) led NCDs Global action plan 2013–2020 has been recommended for reducing the NCD burden but it is unclear whether Africa is on track in its implementation. This paper synthesizes Africa’s progress towards WHO policy recommendations for reducing the NCD burden.MethodsData from the WHO 2011, 2014 and 2015 NCD reports were used for this analysis. We synthesized results by targets descriptions in the three reports and included indicators for which we could trace progress in at least two of the three reports.ResultsMore than half of the African countries did not achieve the set targets for 2015 and slow progress had been made towards the 2016 targets as of December 2013. Some gains were made in implementing national public awareness programmes on diet and/or physical activity, however limited progress was made on guidelines for management of NCD and drug therapy and counselling. While all regions in Africa show waning trends in fully achieving the NCD indicators in general, the Southern African region appears to have made the least progress while the Northern African region appears to be the most progressive.ConclusionOur findings suggest that Africa is off track in achieving the NCDs indicators by the set deadlines. To make sustained public health gains, more effort and commitment is urgently needed from governments, partners and societies to implement these recommendations in a broader strategy. While donors need to suit NCD advocacy with funding, African institutions such as The African Union (AU) and other sub-regional bodies such as West African Health Organization (WAHO) and various country offices could potentially play stronger roles in advocating for more NCD policy efforts in Africa.

Indirect cost of non-communicable diseases deaths in the World Health Organization African Region

Background: In 2012, a total of 9 398 809 deaths from all causes occurred in the WHO African Region; out of which 2 788 381 (29.67%) were due to non-communicable diseases (NCD). The objective of this study was to estimate future gross domestic product (GDP) losses associated with NCD deaths in the African Region for use to advocate for increased investments into prevention and management of NCDs. Methods: Human capital approach is used to estimate non-health GDP losses associated with NCD deaths. Future non-health GDP losses were discounted at 3%. The analysis was done for three income groups of countries and six age groups. One-way sensitivity analysis at 5% and 10% discount rates was undertaken to assess the impact on expected non-health GDP loss estimates.Results: The 2 788 381 NCD deaths that occurred in the African Region in 2012 are estimated to have resulted in a total discounted GDP loss of Int$ 61 302 450 005. Out of that total loss, 20.36% was borne by those aged 0-4 years; 12.76% by 5-14 years; 16.64% by 15-29 years; 44.93% by 30-59 years; 2.99% by 60-69 years; and 2.33% by those aged 70 years and above. Thus, those aged between 15 and 59 years bore 61.57% of the GDP losses.Approximately 47.4%, 33.1% and 19.5% of the total loss was borne by high and upper middle-, lower middle- and low-income countries respectively. The average total non-health GDP loss was Int$ 21 985 per NCD death. The average non-health GDP lost per NCD death was Int$ 54 534 for Group 1, Int$ 21 492 for Group 2 and Int$ 9 096 for Group 3. Conclusion: Premature NCD deaths are associated with substantive GDP losses in countries of the African Region. Therefore, unless African countries and their development partners bolster their investments to assure universal population coverage of cost-effective promotive, preventive and management interventions for NCDs, prospects of achieving the United Nations General Assembly Sustainable Development Goals (SDG) might be greatly undermined in Africa.Key words: Non-communicable diseases, non-health GDP loss, NCD prevention and management, human capital approach

Premature Mortality From Noncommunicable Diseases in the Federated States of Micronesia, 2003-2012.

This study was conducted to assess status, and understand burden, of premature and leading causes of deaths from noncommunicable diseases (NCDs) in the Federated States of Micronesia (FSM). From 2003 to 2012, ICD-10 coded mortality data from the national Health Information System were analyzed. Proportional mortality was calculated and a ranking list of the leading causes of premature death was produced. Of the 2349 premature deaths reported, 1970 (83.9%) were due to NCDs, and 1680 (71.5%) were from 4 main NCD groups-cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases. Diabetes (19.5%), ischemic heart diseases (13.2%), and cerebrovascular diseases (7.1%) were the leading causes of premature deaths. The findings indicate that the burden of premature NCD deaths in FSM is higher than global levels, and existing efforts need to be strengthened to alter their course.

Cancer registration challenges in low- and middle-income countries-the case of the Pacific Islands.

Cancer registration challenges in low- and middle-income countries-the case of the Pacific Islands.

The Global Burden of Disease Study and the Preventable Burden of NCD.

Noncommunicable diseases (NCD) now account for more than one-half of the global burden of disease. Cardiovascular diseases account for about one-half of NCD deaths, and the majority of cardiovascular disease deaths occur in low- and middle-income countries. The GBD (Global Burden of Disease) study measures and benchmarks health loss from death or disability from more than 300 diseases in over 100 countries. According to GBD analyses, the rise of NCD is in part due to increased life expectancy due to reduced premature mortality from communicable, child, and maternal illnesses, but preventable risk factors also contribute and present targets for NCD control efforts. In addition to traditional NCD risk factors, like tobacco smoking, high blood pressure, and unhealthful diet, nontraditional risk factors like air pollution and unhealthful alcohol consumption also play a role. The GBD study continues to grow by gathering more data from country partners than ever before, and by measuring health at the national and subnational levels and in smaller time increments. The GBD study will continue to provide the data to set priorities for and measure progress in the global effort to control the rising burden of NCD.

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

BackgroundThe 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.MethodWe 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.ResultsIn 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.ConclusionsDietary 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-016-0447-x) contains supplementary material, which is available to authorized users.

Prevention: some important steps forward, but many unmet needs in a world with cardiovascular disease as the leading cause of death.

![Graphic][1] Prevention is better than cure: the proverb remains as important as is has been for decades and centuries. Without a doubt, we have made substantial progress: we can lower blood pressure, if it is too high,1 we can treat hyperlipidaemia as again outlined in the 2016 ESC Guidelines,2 and indeed for the first time we can prevent cardiovascular mortality in diabetics3—nevertheless, we do not do enough, It is of note that many patients with high blood pressure do not reach recommended targets, many patients with hyperlipidaemia are inadequately treated or stop drugs when negative media reports appear,4 and diabetics are often far from being well controlled. Thus, the ‘ Epidemiological update 2016 for c ardiovascular disease in Europe ,5 by Nick Townsend and colleagues from the British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention in Oxford, UK comes at the right time to remind us of the unmet needs in cardiovascular medicine. Of note, the current report is the fourth in a series of papers describing the burden of cardiovascular disease within Europe. Not surprisingly, as the implementation of preventive measures is still less than perfect, cardiovascular disease remains the most common cause of death worldwide, with the 2013 Global Burden of Disease study estimating that cardiovascular disease caused 17.3 million deaths globally. It accounted for 31.5% of all deaths and 45% of all non-communicable disease deaths, more than twice that caused by cancer, as well as more than all communicable, maternal, neonatal, and nutritional disorders combined. The 2013 Global Burden of Disease study also reported that cardiovascular disease caused a greater number of deaths and was responsible for a greater percentage of all deaths than in 1990 when 12.3 million deaths were attributed to cardiovascular disease, corresponding to 25.9% of … [1]: /embed/inline-graphic-1.gif