Abstract P357: The Impact of Dietary and Metabolic Risk Factors on Cardiovascular and Diabetes Mortality in South Asia: An Analysis from the 2010 Global Burden of Disease (GBD) Study

Abstract

BACKGROUND: Cardiometabolic diseases are rising in South Asia. The impact of modifiable diet and metabolic risk factors on mortality due to these diseases has not been quantified for this region using consistent methodology. OBJECTIVE: To estimate disease-specific mortality effects of major diet and metabolic risk factors by age and sex in South Asia. METHODS: We used a comparative risk assessment analysis (CRA) framework, developed as part of the 2010 GBD study, for six countries of the region (India, Pakistan, Bangladesh, Afghanistan, Nepal, Bhutan). The current national risk factor exposure distribution for these countries was obtained from systematic literature searches of nationally representative surveys and direct author contact. We identified 8 surveys for diet and 50 for metabolic risks. The likely causal effect sizes of risk factor-disease relationships (RRs) were derived from meta-analyses of trials or epidemiological studies. Plausible optimal alternative exposure distributions were identified from other global studies or regions, and total disease-specific deaths were obtained from 2008 WHO data. Missing exposure data were imputed using multi-level hierarchical Bayesian models with time varying covariates. Inputs were combined to compute population attributable fractions and mortality preventable from these risks. We performed sensitivity analyses by varying choice of exposure metrics, causal effect sizes, and alternative distributions. Updated GBD estimates for smoking and physical activity are in progress. RESULTS: Among metabolic risks, high systolic blood pressure and high BMI produced the highest number of preventable cardiometabolic deaths in South Asia in 2008 in both men and women ( Figure ). Other risks, including fruits also contributed to a substantial number of deaths. CONCLUSIONS: Use of CRA methods allows quantification of the impact of specific modifiable risk factors on disease, informing health policy and priority setting to improve diet and lifestyle in people of South Asia.