Ashkan Afshin, Institute for Health Metrics and Evaluation (IHME)
Expert consultation on trade and nutrition
15-16 November 2016, FAO Headquarters, Rome
Ashkan Afshin, Institute for Health Metrics and Evaluation (IHME)
http://www.fao.org/economic/est/est-events-new/tradenutrition/en/
ICT Role in 21st Century Education & its Challenges.pptx
What makes a healthy diet a healthy diet
1. What makes a healthy diet a healthy diet?
Challenges and opportunities for defining, measuring, and evaluating the health impact of diet at the population level
Ashkan Afshin, MD MPH MSc ScD November 15, 2016
Acting Assistant Professor of Global Health
2. Policy
Formulation
Policy
Adoption
Policy
Implementation
Policy
Evaluation
Agenda Setting1. Defining optimal nutrition
2. Quantifying the burden of disease due to malnutrition
3. Evaluating the effectiveness of policies to improve nutrition
4. Evaluating the cost-effectiveness of nutrition policies
5. Evaluating the political/legal feasibility of nutrition policies
6. Evaluating the intensity of implementation of nutrition policies
7. Evaluating the short/long term effects of nutrition policies
3. Policy
Formulation
Policy
Adoption
Policy
Implementation
Policy
Evaluation
Agenda Setting1. Defining optimal nutrition
2. Quantifying the burden of disease due to malnutrition
3. Evaluating the effectiveness of policies to improve nutrition
4. Evaluating the cost-effectiveness of nutrition policies
5. Evaluating the political/legal feasibility of nutrition policies
6. Evaluating the intensity of implementation of nutrition policies
7. Evaluating the short/long term effects of nutrition policies
7. Nutrients Foods Dietary patterns
Biological mechanism No biological knowledge Intercorrelations not a problem
Statistical Power No food composition data needed Between-food interactions
Supplementation Use in dietary advice
Defining diet
7
Absolute Intake
Relative IntakeHealth outcome
Disease endpoints
(CVD, diabetes, cancer)
Intermediate outcomes
(obesity, blood pressure)
8. 8
Evidence Description
RCTs of disease endpoint Number of independent RCTs evaluating the effect of the risk on the disease endpoint
% of independent RCTs showing significant effect in the opposite direction
% of independent RCTs showing no effect
Prospective observational studies of
disease endpoint
Number of independent prospective observational studies evaluating the association of the
risk with the disease endpoint
% of independent prospective observational studies with significant association in the
opposite direction
Strength Lower Limit of RR in observational studies> 1.5 (Yes/No)
Dose response Evidence of the dose-response relationship between the risk and the outcome(Yes/No)
Biologic plausibility
Potential biologic mechanism that could explain the effect of the risk on the disease endpoint
(Yes/No)
Analogy
Evidence on the relationship between the risk factor and a disease endpoint from the same
category (Yes/No)
9. Outcome
RCTs(Number)
RCTswithsignificanteffectin
theoppositedirection(%)
RCTswithnullfindings(%)
Prospectiveobservational
studies(Number)
Prospectiveobservational
studieswithsignificant
LowerlimitofRR>1.5
Dose-responserelationship
Biologicplausibility
Analogy
Lip and oral cavity cancer 0 - - 2 0
Nasopharynx cancer 0 - - 2 0
Other pharynx cancer 0 - - 2 0
Larynx cancer 0 - - 2 0
Oesophageal cancer 0 - - 5 0
Tracheal, bronchus, and lung cancer 0 - - 22 0
Ischaemic heart disease 0 - - 9 0
Ischaemic stroke 0 - - 9 0
Hemorrhagic stroke 0 - - 5 0
Diabetes mellitus 0 - - 9 0
Oesophageal cancer 0 - - 5 0
Ischaemic heart disease 0 - - 9 0
Ischaemic stroke 0 - - 8 0
Hemorrhagic stroke 0 - - 5 0
Ischaemic heart disease 0 - - 7 0
Ischemic stroke 0 - - 6 0
Hemorrhagic stroke 0 - - 6 0
Diabetes mellitus 0 - - 10 0
Diet low in nuts and seeds Ischaemic heart disease 1 0 100 6 0
Diabetes mellitus 1 0 100 5 0
Risk
Diet low in vegetables
Diet low in vegetables
Diet low in vegetables
Diet low in whole grains
Diet low in whole grains
Diet low in nuts and seeds
Diet low in fruits
Diet low in fruits
Diet low in fruits
Diet low in fruits
Diet low in fruits
Diet low in vegetables
Diet low in fruits
Diet low in fruits
Diet low in fruits
Diet low in fruits
Diet low in fruits
Diet low in whole grains
Diet low in whole grains
Epidemiologic evidence supporting causality between dietary risk-outcome pairs
GBD 2015
10. Outcome
RCTs(Number)
RCTswithsignificanteffectin
theoppositedirection(%)
RCTswithnullfindings(%)
Prospectiveobservational
studies(Number)
Prospectiveobservational
studieswithsignificant
LowerlimitofRR>1.5
Dose-responserelationship
Biologicplausibility
Analogy
Colon and rectum cancer cancer 0 - - 7 0
Colon and rectum cancer cancer 0 - - 8 0
Diabetes mellitus 0 - - 9 11
Colon and rectum cancer cancer 0 - - 9 11
Ischaemic heart disease 0 - - 5 0
Diabetes mellitus 0 - - 8 0
Body mass index 10 0 60 22 0 - -
Colon and rectum cancer cancer 0 - - 15 0
Diet low in fibre Ischaemic heart disease 0 - - 12 0
Colon and rectum cancer cancer 0 - - 13 0
Ischaemic heart disease 17 0 94 16 0
Ischaemic heart disease 8 0 75 11 0
Ischaemic heart disease 0 - - 4 0
Systolic blood pressure 45 0 73 - - - -
Stomach cancer 0 - - 3 0
Risk
Diet low in fibre
Diet low in calcium
Diet low in seafood omega-3 fatty acids
Diet low in polyunsaturated fatty acids
Diet high in trans fatty acids
Diet low in milk
Diet high in red meats
Diet high in red meats
Diet high in processed meats
Diet high in processed meats
Diet high in processed meats
Diet high in sugar sweetened beverages
Diet high in sodium
Diet high in sodium
Epidemiologic evidence supporting causality between dietary risk-outcome pairs
GBD 2015
11. Policy
Formulation
Policy
Adoption
Policy
Implementation
Policy
Evaluation
Agenda Setting1. Defining optimal nutrition
2. Quantifying the burden of disease due to malnutrition
3. Evaluating the effectiveness of policies to improve nutrition
4. Evaluating the cost-effectiveness of nutrition policies
5. Evaluating the political/legal feasibility of nutrition policies
6. Evaluating the intensity of implementation of nutrition policies
7. Evaluating the short/long term effects of nutrition policies