The impact of poor-diet quality on the burden of non-communicable diseases in Ethiopia—a call for action

The number of non-communicable diseases (NCDs) are rising in developing countries. An article published today in the International Journal of Behavioral Nutrition and Physical Activity, investigates the burden of NCDs associated with dietary risk factors. Here, author Yohannes Adama Melaku tells us more.

The prevalence of non-communicable diseases (NCDs), such as cardiovascular diseases, diabetes and cancer, have rapidly risen in developing countries. According to the Global Burden of Diseases (GBD) Study 2015, an estimated 285,301 (41.9%) deaths and 14.9 million (36.1%) disability-adjusted life years (DALYs) were caused by NCDs in Ethiopia–an increase by 25.1% and 36.2% since 1990, respectively.

98.9% of the people consumed less than five servings of fruits and vegetables per day in the capital, Addis Ababa.

Poor quality diet, on the top of the already existing problem of inadequate food and food supply, is one of the factors that fuels the increasing NCD burden in Ethiopia. In the 2006 World Health Organization study, it was reported that 98.9% of the people consumed less than five servings of fruits and vegetables per day in the capital, Addis Ababa.

Quantifying the burden

To help the current intervention efforts against NCDs and their risk factors in Ethiopia, it is important to quantify the burden of diet-related diseases. However, this type of research has never been conducted in the country. For the first time, we investigated the burden of NCDs associated with dietary risk factors using data from the GBD Study 2013.

We found that almost a quarter (60,402 deaths) of NCD deaths in Ethiopia were associated with dietary risks. Nine in every ten diet-related deaths (88%) were caused by cardiovascular disease (the leading NCD cause of death in the country). Furthermore, of all cardiovascular deaths, 44.0% were associated with suboptimal diet quality.

Nine in every ten diet-related deaths (88%) were caused by cardiovascular disease.

In the study, we highlighted that diets low in fruits, vegetables, nuts and seeds and seafood omega-3 fatty acids, and high in sodium were the five most important dietary risks associated with NCDs. Several factors, such as social and cultural preferences for animal products, and inability to access for seafood could contribute to this burden.

The determinants of population dietary patterns are complex and include global (e.g. food trade and industry), national (e.g. food marketing), community (e.g. culture and food availability) and individual (e.g. income) level factors. Understanding the influence of these determinants on the current and prospective NCD burden in Ethiopia is a crucial step towards mitigating the problem of poor diet.

Modifying dietary behaviours

Dietary behaviors are modifiable risk factors of NCDs. In addition, there is a strong body of evidence that shows interventions which target diet are effective. Therefore, in Ethiopia, evidence-based dietary interventions would be one of the effective and efficient strategies through which metabolic risks of NCDs and their consequences could be addressed.

Today, while it is essential to act on the problems of inadequate food intake (undernutrition), it is equally important to also address diet quality. Ethiopia should develop nutrition policies and dietary guidelines for the general population to deal with this problem. Strengthening the implementation of nutrition sensitive agricultural policies is also essential.

Unlike developed countries, dietary data in low-income countries are very limited, making it difficult to draw robust evidence for policy and decision making. Therefore, weak or absent routine health information and risk factor surveillance systems are the daunting challenges in combating the NCD burden.

The GBD Study, based at the Institute of Health Metrics and Evaluation in The University of Washington, is a collaborative effort of experts across the globe that measures the burden of diseases and their risk factors at global, regional, country and sub-national levels. The outputs of the GBD are important in guiding health policies and interventions as well as in evaluating performance of nations.

However, the data being used by the GBD are collected systematically from published and unpublished data sources. Therefore, expanding and strengthening the collection of quality data at local and national levels would assist the efforts towards obtaining accurate estimates in addition to providing first hand evidence for policy makers and stakeholders.

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