title: The impact of dietary risk factors on the burden of non-communicable diseases in Ethiopia: findings from the Global Burden of Disease study 2013.
abstract: BACKGROUND
  The 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  In 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.
  
  
  CONCLUSIONS
  Dietary 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.
authors.affiliation: School of Public Health, Mekelle University, Mekelle, Ethiopia. adamayohannes@gmail.com.|Population Research and Outcome Studies, School of Medicine, The University of Adelaide, Adelaide, SA, Australia. adamayohannes@gmail.com.
authors.forename: Yohannes Adama
authors.identifier: http://orcid.org/0000-0002-3051-7313
authors.initials: YA
authors.lastname: Melaku
authors.affiliation: Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA.
authors.forename: Awoke Misganaw
authors.initials: AM
authors.lastname: Temesgen
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.|Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.|St. Paul Millennium Medical College, Addis Ababa, Ethiopia.
authors.forename: Amare
authors.initials: A
authors.lastname: Deribew
authors.affiliation: Department of Reproductive Health, University of Gondar, Gondar, Ethiopia.|School of Public Health, The University of Adelaide, Adelaide, Australia.
authors.forename: Gizachew Assefa
authors.initials: GA
authors.lastname: Tessema
authors.affiliation: Brighton & Sussex Medical School, Brighton, UK.|School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.|Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Kebede
authors.initials: K
authors.lastname: Deribe
authors.affiliation: School of Public Health, Mekelle University, Mekelle, Ethiopia.|Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Berhe W
authors.initials: BW
authors.lastname: Sahle
authors.affiliation: School of Public Health, Mekelle University, Mekelle, Ethiopia.|Institute of Biological Chemistry and Nutrition, Hohenheim University, Stuttgart, Germany.
authors.forename: Semaw Ferede
authors.initials: SF
authors.lastname: Abera
authors.affiliation: Department of Public Health, Madda Walabu University, Bale Goba, Ethiopia.
authors.forename: Tolesa
authors.initials: T
authors.lastname: Bekele
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Ferew
authors.initials: F
authors.lastname: Lemma
authors.affiliation: Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, Australia.|School of Medicine and Health Sciences, Bahir dar University, Bahir Dar, Ethiopia.|Department of Epidemiology, University Medical Center Groningen, the University of Groningen, Groningen, The Netherlands.
authors.forename: Azmeraw T
authors.initials: AT
authors.lastname: Amare
authors.affiliation: School of Public Health, Mekelle University, Mekelle, Ethiopia.
authors.forename: Oumer
authors.initials: O
authors.lastname: Seid
authors.affiliation: School of Public Health, Mekelle University, Mekelle, Ethiopia.
authors.forename: Kedir
authors.initials: K
authors.lastname: Endris
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Abiy
authors.initials: A
authors.lastname: Hiruye
authors.affiliation: Department of Public Health, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
authors.forename: Amare
authors.initials: A
authors.lastname: Worku
authors.affiliation: Health observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, The University of Adelaide, Adelaide, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Adams
authors.affiliation: Population Research and Outcome Studies, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Taylor
authors.affiliation: Population Research and Outcome Studies, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.
authors.forename: Tiffany K
authors.initials: TK
authors.lastname: Gill
authors.affiliation: Population Research and Outcome Studies, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.
authors.forename: Zumin
authors.initials: Z
authors.lastname: Shi
authors.affiliation: Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA.
authors.forename: Ashkan
authors.initials: A
authors.lastname: Afshin
authors.affiliation: Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Forouzanfar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001499:Bayes Theorem; D002318:Cardiovascular Diseases / Q000401:mortality*; D004032:Diet; D005002:Ethiopia / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D000071219:Global Burden of Disease / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
keywords: Burden of disease; Dietary risks; Ethiopia; Non-communicable diseases