A growing number of Americans are learning that doctors don’t have miracle cures for all that ails us. The Institute for Health Metrics and Evaluation (IHME) at the University of Washington has just released chilling data on the burden of disease in America, the driving forces behind disease and ill health, and modifiable risk factors for contemporary health problems.
On July 10, 2013, IHME released a table showing the top 10 risk factors for morbidity in 2010 and the number of deaths attributable to each factor. That same day, IHME also released a second paper focusing on the importance of two lifestyle factors – diet and physical activity. This paper sets forth the 17 leading risk factors for what the IHME calls DALY, or “disability-adjusted life years.” This is a measure of the number of years lost to premature death, plus years of life impaired by a major chronic disease.
“Dietary risks” top of the list of risk factors and was linked to 678,282 deaths in 2010, more than smoking (465,651), high blood pressure (442,656), and high body mass index (363,991). Researchers at IHME have also broken out the 14 leading dietary risk factors contributing to DALY.
Not surprisingly, the number one dietary characteristic linked to DALY is low fruit intake, followed by low intakes of seeds and nuts, and then, diets high in sodium. According to IHME, “Dietary risks were the leading cause of disease burden in the US and contributed to more health loss in 2010 than smoking, high blood pressure, and high blood sugar.” According to IHME, dietary risk factors account for 14% of all health loss in America – a staggering 11.5 million DALYs.
If a person needs any more information to be convinced dietary choices matter, consider as well that food choices and food quality play a significant role in triggering and managing both high blood pressure and diabetes. To a significant degree, dietary choice is not just the number one risk driver for DALY, it is also a major factor triggering heart disease and diabetes.
Hopefully these new data will reinforce the need for major changes in the typical American diet. It is no surprise that inadequate whole food and fruit and vegetable intakes were highlighted by IHME. To simply stop inadequate intakes from triggering more disease and ever-higher DALY, the average American must about double fruit, vegetable, and nut intakes. And while we are at it, most of us need to work harder at lowering trans fat and omega-6 intakes by dramatically reducing consumption of foods fried in soy or corn oil. For those who cannot face life without French fries and deep-fried chicken, there are cooking oil options available that have much improved omega fatty acid profiles.
As Americans think more deeply about their dietary choices, they will have to sort through a vast array of quick-fix claims and reassuring messages from the food industry. Organizations promoting the virtues of different types of food, and even individual crops and livestock products, all are working with hundreds of teams of scientists to develop data showing that food X, Y or Z fits nicely into a healthy diet. The catch is very little is said about what constitutes a healthy diet, and much of what is said is either biased or not very useful.
This is why the Measure to Manage (M2M) program will focus in the coming year on refining and making available online our Nutritional Quality Index (NQI). The NQI is one of over a dozen “nutrient profiling systems” currently in use as a research tool or in support of a nutrition labeling scheme. These systems strive to boil down to a single number the contribution of apples or oranges or yogurt or pepperoni pizza to a healthy diet. They do so by adding together the portion, or share, or each “essential nutrient” (there are about 25 nutrients in this category) consumed in a given quantity of different foods.
Most nutrient profiling systems are designed to allow comparisons across foods in three ways – by calorie (say 100 calories worth of each food), by weight (e.g., 100 grams of each food), or by a common serving size (e.g., one-half cup of many vegetables). The NQI supports all three methods, and can also alter calculations based on an individual’s unique dietary and health goals.
A unique feature of the NQI is the ability to apply it to a person’s daily diet. In short, based on all foods and beverages a person consumes in a day, the system will estimate how close that person came that day in covering all their nutritional needs. It will highlight nutrients or dietary components consumed in excess, or at inadequate levels, and importantly, which foods did not carry their nutritional weight relative to their share of the person’s overall daily caloric intake. For example, a bag of chips might account for 20% of a person’s daily calories, yet contribute only 3% toward their NQI. For most fresh fruits and vegetables, the opposite is usually the case, with one serving contributing 10% to 20% of daily NQI, at the caloric “expense” of just a few percent of daily caloric intake. We intend to make the NQI available online in the coming year.
Our hope is that as more Americans are motivated to improve their diet, the tools and information will be readily accessible to guide them along the path, so that over the years, they do not contribute much, or at all to tomorrow’s DALY totals.