The ongoing Global Burden of Disease Study (GBD), which began in 2010, is the most comprehensive study to examine the causes of death and disease worldwide.

Using data from dozens of epidemiological (population) studies covering 195 countries, it quantifies rates of death and disease from major diseases, injuries, and health risk factors at global, national and regional levels.

In 2018, researchers who analyzed GBD data collected over the past 30 years published a comprehensive report on the health effects of diet, and found that poor diets cause more deaths globally than tobacco, high blood pressure, or any other health risk.

Specifically, the 2018 analysis of GBD data linked one in every five deaths worldwide — about 11 million people in 2017 — to poor diet, and found that diet exerts the biggest positive and negative effects on risk for cardiovascular disease (CVD), followed by risks for cancer and type 2 diabetes.

Recently, a large international research team published an analysis of GBD study data that revealed the most helpful and harmful dietary factors linked to the risk of early death from cardiovascular disease.

Let’s take a quick look at their major findings — which undermine some common myths — and then delve into the revealing details.

The top takeaways about diet and heart deaths
Most strikingly, this massive new data analysis delivered five major findings about the effects of diet on the risk for death from cardiovascular disease.

Getting good foods outweighs avoiding bad: While both factors matter, the analysis found that heart health depends more on getting plenty of healthy food then on strict avoidance of junky foods.

Whole grains help hearts: The comprehensive new analysis undermines the fears about whole grains fostered by recent bestsellers and echoed by many bloggers.

Aside from this study, virtually all the available evidence links diets high in whole grains to better heart and overall health outcomes — except among the few people who suffer from celiac disease or who are genuinely gluten-sensitive. (Sensitivity to common FODMAP compounds in vegetables yields similar symptoms: see Gluten Often Plays the Gut-Health Patsy.)

Milk and dairy matter: The findings defy baseless charges against milk and dairy, whose general healthfulness — especially whole-fat and fermented dairy foods (e.g., yogurt) — is supported by most other evidence.

Seafood and its omega-3s are heart-savers: The scientific team’s calculations underscore the need for Americans to eat more fish, shellfish, and/or omega-3 fish oil.

Saturated-fats aren’t the problem: Confirming the increasingly discredited status of the saturated fat theory of heart disease, red meat and saturated animal fats didn’t make the list of risks for death from cardiovascular disease.

Analysis of huge global database ranked dietary heart heroes and villains
Their analysis was conducted by a group of 132 scientists from nearly 40 countries, called the GBD 2017 Diet Collaborators, which included two famous names in the field: Harvard’s Walter Willett, MD, and Dariush Mozaffarian, MD, DrPH, of Tufts University.

Given the steady decline in the quality of global diets — which increasingly mimic the unhealthy standard American/Western diet — it may be no coincidence that the number of deaths attributed to CVD globally rose from 12.3 million to more than 17.6 million between 1990 and 2016, making it the leading cause of death.

And, analysis of the 2016 data from the Global Burden of Disease Study (GBD) revealed that more than half (52%) of the 9.1 million premature CVD-related deaths worldwide were caused by poor diets — especially ones low in healthy foods.

The GBD data analyzed by the collaborators covered 15 dietary heart-risk factors:

  • Too much red meat, processed meat, sugar-sweetened beverages, trans fatty acids (i.e., partially hydrogenated vegetable oils), or sodium.
  • Not enough fruits, vegetables, legumes (i.e., beans, lentils, and peas), whole grains, nuts and seeds, milk, fiber, calcium (linked mostly to lack of milk), seafood-source omega-3 fatty acids (DHA and EPA), or polyunsaturated omega-6 fats (from vegetable oil).

And the GBD collaborators' analysis yielded these headline findings:

  • Lack of healthy foods cause more CVD-related deaths than eating too much unhealthy food.
  • The most CVD-related deaths were linked to a lack of whole grains, nuts-seeds, and fruits and too much sodium.
  • The proportion of diet-related deaths from CVD was lowest in Israel. And, compared with the UK and the US, China and India had much lower proportions. Uzbekistan ranked 1st (highest proportion of diet-related CVD deaths), the UK ranked 23rd, the United States ranked 43rd, China ranked 140th, and India ranked 118th.

One of the GBD 2017 Diet study’s lead authors was Dr. Christopher Murray, Director of the independent Institute for Health Metrics and Evaluation at the University of Washington’s Seattle campus — which hosts the groundbreaking Global Burden of Disease data project, as well as the world’s most comprehensive health-related database, called the Global Health Data Exchange (GHDx).

As Dr. Murray said, “This study affirms … that poor diet is responsible for more deaths than any other risk factor in the world … our assessment suggests the leading dietary risk factors are high intake of sodium, or low intake of healthy foods ...”.

Quantifying the risk by food category
The GBD 2017 Diet Collaborators calculated the percentage of CVD-related deaths caused primarily by each different diet factor.

Unfortunately, when it came to diets high in processed meat, trans fatty acids, and sodium, the data was too poor to reliably calculate the proportions of CVD-related deaths attributable to those factors.

These were the detailed calculations of risk for too few healthy foods and too many unhealthy foods:

CVD-related deaths from lack of healthy foods

  • Whole Grains – 20.4% of deaths (429,000 people annually)
  • Nuts/Seeds – 16.2% of deaths (341,000 people annually)
  • Fruits – 12.5% of deaths (262,000 people annually)
  • Omega-3s from Seafood – 10.8% of deaths (227,000 people annually)

CVD- related deaths from excess of unhealthy foods

  • Sodium – 12.0% of CVD-related deaths (251,000 people annually)
  • Processed meat, trans fatty acids*, and sodium – uncertain; likely to be relatively low

*Trans fatty acids — typically of the omega-6 fat family — result when vegetable oil is partially hydrogenated to make it harder and longer-lasting. Production in America of foods containing trans fatty acids has dropped sharply, but that’s not true everywhere.

Details of the heart-attacking diet deficiencies and excesses
The steepest shortfalls in optimal daily intakes among healthy foods were seen for nuts and seeds, milk, and whole grains — which seems unsurprising, given the large roles that low intakes play in raising CVD death risks:

  • Nuts/seeds – 12% of the optimal 21 grams
  • Milk – 16% of the optimal 435 grams
  • Whole Grains – 23% of the optimal 125 grams

On average, the most overeaten unhealthful foods worldwide were sugar-sweetened beverages, processed meat, and sodium.

  • Sugary drinks – 10 times more than the recommended maximum
  • Sodium – Almost double (86% more than) the recommended maximum
  • Processed Meat – Almost double (90% more than) the recommended maximum

All in all, the findings of this study — which drew on more data than any before it — support the general advice to eat a broad-based diet that favors whole foods over processed ones.

And while they underscore the need for more seafood in American diets, they undermine false or misplaced fears about dairy foods, whole grains, red meats, and saturated animal fats.


  • GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019 May 11;393(10184):1958-1972. doi: 10.1016/S0140-6736(19)30041-8. Epub 2019 Apr 4.
  • Meier T, Gräfe K, Senn F, Sur P, Stangl GI, Dawczynski C, März W, Kleber ME, Lorkowski S. Cardiovascular mortality attributable to dietary risk factors in 51 countries in the WHO European Region from 1990 to 2016: a systematic analysis of the Global Burden of Disease Study. Eur J Epidemiol. 2019 Jan;34(1):37-55. doi: 10.1007/s10654-018-0473-x. Epub 2018 Dec 14.