Imperial College London


Faculty of MedicineSchool of Public Health

Chair in Global Environmental Health



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BibTex format

author = {Otto, MCDO and Afshin, A and Micha, R and Khatibzadeh, S and Fahimi, S and Singh, G and Danaei, G and Sichieri, R and Monteiro, CA and Louzada, MLC and Ezzati, M and Mozaffarian, D},
doi = {10.1371/journal.pone.0151503},
journal = {PLOS One},
title = {The Impact of Dietary and Metabolic Risk Factors on Cardiovascular Diseases and Type 2 Diabetes Mortality in Brazil},
url = {},
volume = {11},
year = {2016}

RIS format (EndNote, RefMan)

AB - BackgroundTrends in food availability and metabolic risk factors in Brazil suggest a shift toward unhealthy dietary patterns and increased cardiometabolic disease risk, yet little is known about the impact of dietary and metabolic risk factors on cardiometabolic mortality in Brazil.MethodsBased on data from Global Burden of Disease (GBD) Study, we used comparative risk assessment to estimate the burden of 11 dietary and 4 metabolic risk factors on mortality due to cardiovascular diseases and diabetes in Brazil in 2010. Information on national diets and metabolic risks were obtained from the Brazilian Household Budget Survey, the Food and Agriculture Organization database, and large observational studies including Brazilian adults. Relative risks for each risk factor were obtained from meta-analyses of randomized trials or prospective cohort studies; and disease-specific mortality from the GBD 2010 database. We quantified uncertainty using probabilistic simulation analyses, incorporating uncertainty in dietary and metabolic data and relative risks by age and sex. Robustness of findings was evaluated by sensitivity to varying feasible optimal levels of each risk factor.ResultsIn 2010, high systolic blood pressure (SBP) and suboptimal diet were the largest contributors to cardiometabolic deaths in Brazil, responsible for 214,263 deaths (95% uncertainty interval [UI]: 195,073 to 233,936) and 202,949 deaths (95% UI: 194,322 to 211,747), respectively. Among individual dietary factors, low intakes of fruits and whole grains and high intakes of sodium were the largest contributors to cardiometabolic deaths. For premature cardiometabolic deaths (before age 70 years, representing 40% of cardiometabolic deaths), the leading risk factors were suboptimal diet (104,169 deaths; 95% UI: 99,964 to 108,002), high SBP (98,923 deaths; 95%UI: 92,912 to 104,609) and high body-mass index (BMI) (42,643 deaths; 95%UI: 40,161 to 45,111).Conclusionsuboptimal diet, high SBP, and high BMI are m
AU - Otto,MCDO
AU - Afshin,A
AU - Micha,R
AU - Khatibzadeh,S
AU - Fahimi,S
AU - Singh,G
AU - Danaei,G
AU - Sichieri,R
AU - Monteiro,CA
AU - Louzada,MLC
AU - Ezzati,M
AU - Mozaffarian,D
DO - 10.1371/journal.pone.0151503
PY - 2016///
SN - 1932-6203
TI - The Impact of Dietary and Metabolic Risk Factors on Cardiovascular Diseases and Type 2 Diabetes Mortality in Brazil
T2 - PLOS One
UR -
UR -
VL - 11
ER -