title: The impact of dietary habits and metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis.
abstract: OBJECTIVE
  We conducted a comparative risk assessment analysis to estimate the cardiometabolic disease (CMD) mortality attributable to 11 dietary and 4 metabolic risk factors in 20 countries of the Middle East by age, sex and time. The national exposure distributions were obtained from a systematic search of multiple databases. Missing exposure data were estimated using a multilevel Bayesian hierarchical model. The aetiological effect of each risk factor on disease-specific mortality was obtained from clinical trials and observational studies. The number of disease-specific deaths was obtained from the 2010 Global Burden of Disease mortality database. Mortality due to each risk factor was determined using the population attributable fraction and total number of disease-specific deaths.
  
  
  METHODS
  Adult population in the Middle East by age, sex, country and time.
  
  
  RESULTS
  Suboptimal diet was the leading risk factor for CMD mortality in 11 countries accounting for 48% (in Morocco) to 72% (in the United Arab Emirates) of CMD deaths. Non-optimal systolic blood pressure was the leading risk factor for CMD deaths in eight countries causing 45% (in Bahrain) to 68% (in Libya) of CMD deaths. Non-optimal body mass index and fasting plasma glucose were the third and fourth leading risk factors for CMD mortality in most countries. Among individual dietary factors, low intake of fruits accounted for 8% (in Jordan) to 21% (in Palestine) of CMD deaths and low intake of whole grains was responsible for 7% (in Palestine) to 22% (in the United Arab Emirates) of CMD deaths. Between 1990 and 2010, the CMD mortality attributable to most risk factors had decreased except for body mass index and trans-fatty acids.
  
  
  CONCLUSIONS
  Our findings highlight key similarities and differences in the impact of the dietary and metabolic risk factors on CMD mortality in the countries of the Middle East and inform priorities for policy measures to prevent CMD.
authors.affiliation: Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Afshin
authors.affiliation: Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece.
authors.forename: Renata
authors.initials: R
authors.lastname: Micha
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Shahab
authors.initials: S
authors.lastname: Khatibzadeh
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Saman
authors.initials: S
authors.lastname: Fahimi
authors.affiliation: Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Peilin
authors.initials: P
authors.lastname: Shi
authors.affiliation: Department of Public Health and Primary Care, Cambridge Institute of Public Health, Cambridge, UK.
authors.forename: John
authors.initials: J
authors.lastname: Powles
authors.affiliation: Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Gitanjali
authors.initials: G
authors.lastname: Singh
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Mohammad Yawar
authors.initials: MY
authors.lastname: Yakoob
authors.affiliation: National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Morteza
authors.initials: M
authors.lastname: Abdollahi
authors.affiliation: Kuwait Institute for Scientific Research, Kuwait, Kuwait.
authors.forename: Suad
authors.initials: S
authors.lastname: Al-Hooti
authors.affiliation: Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Farshad
authors.initials: F
authors.lastname: Farzadfar
authors.affiliation: National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Anahita
authors.initials: A
authors.lastname: Houshiar-Rad
authors.affiliation: Faculty of Agricultural & Food Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Nahla
authors.initials: N
authors.lastname: Hwalla
authors.affiliation: Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey.
authors.forename: Eda
authors.initials: E
authors.lastname: Koksal
authors.affiliation: Arab Center for Nutrition, Manama, Bahrain.
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Musaiger
authors.affiliation: Department of Nutrition and Dietetics, Hacettepe University, Ankara, Turkey.
authors.forename: Gulden
authors.initials: G
authors.lastname: Pekcan
authors.affiliation: Faculty of Agricultural & Food Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Abla Mehio
authors.initials: AM
authors.lastname: Sibai
authors.affiliation: Department of Nutrition Requirements and Growth, National Nutrition Institute, Cairo, Egypt.
authors.forename: Sahar
authors.initials: S
authors.lastname: Zaghloul
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Goodarz
authors.initials: G
authors.lastname: Danaei
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.affiliation: Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts, USA.
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
mesh_terms: D000328:Adult; D000352:Africa, Northern / Q000453:epidemiology; D000368:Aged; D001499:Bayes Theorem; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D003431:Cross-Cultural Comparison; D003920:Diabetes Mellitus / Q000401:mortality*; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose