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a comparative risk assessment approach

Selection of dietary risk factors

We selected 15 dietary risk factors (table) that met GBD selection criteria for risk factors.10111213 These criteria include the importance of the risk factor to either disease burden or policy; the availability of sufficient data to estimate risk factor exposure; the strength of the epidemiological evidence supporting a causal relationship between risk factor exposure and disease endpoints, and availability of data to quantify the magnitude of this relationship per unit of change in the exposure; and evidence supporting the generalisability of the effects to all populations. The process of evaluation of the strength of epidemiological evidence for the causal relationship of each diet–disease pair is described elsewhere10111213 and summarised in the appendix.TableDietary risk factor exposure definitions, optimal level, and data representativeness index, 1990–2017

Exposure definitionOptimal level of intake (optimal range of intake)Data representativeness index (%)
Diet low in fruitsMean daily consumption of fruits (fresh, frozen, cooked, canned, or dried fruits, excluding fruit juices and salted or pickled fruits)250 g (200–300) per day94·9
Diet low in vegetablesMean daily consumption of vegetables (fresh, frozen, cooked, canned, or dried vegetables, excluding legumes and salted or pickled vegetables, juices, nuts, seeds, and starchy vegetables such as potatoes or corn)360 g (290–430) per day94·9
Diet low in legumesMean daily consumption of legumes (fresh, frozen, cooked, canned, or dried legumes)60 g (50–70) per day94·9
Diet low in whole grainsMean daily consumption of whole grains (bran, germ, and endosperm in their natural proportion) from breakfast cereals, bread, rice, pasta, biscuits, muffins, tortillas, pancakes, and other sources125 g (100–150) per day94·9
Diet low in nuts and seedsMean daily consumption of nut and seed foods21 g (16–25) per day94·9
Diet low in milkMean daily consumption of milk including non-fat, low-fat, and full-fat milk, excluding soy milk and other plant derivatives435 g (350–520) per day94·9
Diet high in red meatMean daily consumption of red meat (beef, pork, lamb, and goat, but excluding poultry, fish, eggs, and all processed meats)23 g (18–27) per day94·9
Diet high in processed meatMean daily consumption of meat preserved by smoking, curing, salting, or addition of chemical preservatives2 g (0–4) per day36·9
Diet high in sugar-sweetened beveragesMean daily consumption of beverages with ≥50 kcal per 226·8 serving, including carbonated beverages, sodas, energy drinks, fruit drinks, but excluding 100% fruit and vegetable juices3 g (0–5) per day36·9
Diet low in fibreMean daily intake of fibre from all sources including fruits, vegetables, grains, legumes, and pulses24 g (19–28) per day94·9
Diet low in calciumMean daily intake of calcium from all sources, including milk, yogurt, and cheese1·25 g (1·00–1·50) per day94·9
Diet low in seafood omega-3 fatty acidsMean daily intake of eicosapentaenoic acid and docosahexaenoic acid250 mg (200–300) per day94·9
Diet low in polyunsaturated fatty acidsMean daily intake of omega-6 fatty acids from all sources, mainly liquid vegetable oils, including soybean oil, corn oil, and safflower oil11% (9–13) of total daily energy94·9
Diet high in trans fatty acidsMean daily intake of trans fat from all sources, mainly partially hydrogenated vegetable oils and ruminant products0·5% (0·0–1·0) of total daily energy36·9
Diet high in sodium24 h urinary sodium measured in g per day3 g (1–5) per day*26·2