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comparative risk assessment approach

The relationship between dietary habits and chronic non-communicable diseases (NCDs) has been extensively investigated.12345 Long-term randomised trials with NCD endpoints have not been feasible for most dietary factors, but synthesis of other lines of epidemiological evidence, including long-term prospective observational studies and short-term trials of intermediate outcomes, have provided supporting evidence for potential causal relationships between specific dietary factors (eg, fruits, vegetables, processed meat, and trans fat intake) and NCDs (ischaemic heart disease, diabetes, and colorectal cancer).234567 These findings have been widely used to inform national and international dietary guidelines aimed at preventing NCDs.89 However, because of the complexities of characterising dietary consumption across different nations, assessment of the health effects of suboptimal diet at the population level has not been possible.In the past decade, efforts have been made to quantify the burden of disease attributable to specific dietary factors.10111213141516171819 These efforts, although useful, had several important limitations, including insufficient geographically representative data on dietary consumption, inaccurate characterisation of population distribution of dietary intake, insufficient accounting for biases of different sources of dietary assessment, standardisation of the intake to 2000 kcal per day, and insufficient accounting for within-person variation of intake of dietary factors.To address these limitations, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we systematically collected geographically representative dietary data from multiple sources, characterised the population distribution of intake for 15 foods and nutrients among adults aged 25 years or older across 195 countries, estimated the effect of each individual dietary factor on NCD mortality, and quantified the overall impact of poor dietary habits on NCD mortality. We also evaluated the relationship between diet and socioeconomic development, and assessed the trends in disease burden of diet over time. This analysis supersedes all previous results from GBD with respect to dietary risks by comprehensively reanalysing all data from 1990 to 2017, using consistent methods and definitions.