Poor diet is a factor in one in five deaths, global disease study reveals

Study compiling data from every country finds people are living longer but millions are eating wrong foods for their health

Poor diet is a factor in one in five deaths around the world, according to the most comprehensive study ever carried out on the subject.

Millions of people are eating the wrong sorts of food for good health. Eating a diet that is low in whole grains, fruit, nuts and seeds and fish oils and high in salt raises the risk of an early death, according to the huge and ongoing study Global Burden of Disease.

The study, based at the Institute of Health Metrics and Evaluation at the University of Washington, compiles data from every country in the world and makes informed estimates where there are gaps. Five papers on life expectancy and the causes and risk factors of death and ill health have been published by the Lancet medical journal.

It finds that people are living longer. Life expectancy in 2016 worldwide was 75.3 years for women and 69.8 for men. Japan has the highest life expectancy at 84 years and the Central African Republic has the lowest at just over 50. In the UK, life expectancy for a man born in 2016 is 79, and for a woman 82.9.

Diet is the second highest risk factor for early death after smoking. Other high risks are high blood glucose which can lead to diabetes, high blood pressure, high body mass index (BMI) which is a measure of obesity, and high total cholesterol. All of these can be related to eating the wrong foods, although there are also other causes.

causes of death graphic

This is really large, Dr Christopher Murray, IHMEs director, told the Guardian. It is amongst the really big problems in the world. It is a cluster that is getting worse. While obesity gets attention, he was not sure policymakers were as focused on the area of diet and health as they needed to be. That constellation is a really, really big challenge for health and health systems, he said.

The problem is often seen as the spread of western diets, taking over from traditional foods in the developing world. But it is not that simple, says Murray. Take fruit. It has lots of health benefits but only very wealthy people eat a lot of fruit, with some exceptions.

Sugary drinks are harmful to health but eating a lot of red meat, the study finds, is not as big a risk to health as failing to eat whole grains. We need to look really carefully at what are the healthy compounds in diets that provide protection, he said.

undernourishment graphic

Prof John Newton, director of health improvement at Public Health England, said the studies show how quickly diet and obesity-related disease is spreading around the world. I dont think people realise how quickly the focus is shifting towards non-communicable disease [such as cancer, heart disease and stroke] and diseases that come with development, in particular related to poor diet. The numbers are quite shocking in my view, he said.

The UK tracks childhood obesity through the school measurement programme and has brought in measures to try to tackle it. But no country in the world has been able to solve the problem and it is a concern that we really need to think about tackling globally, he said.

Today, 72% of deaths are from non-communicable diseases for which obesity and diet are among the risk factors, with ischaemic heart disease as the leading cause worldwide of early deaths, including in the UK. Lung cancer, stroke, lung disease (chronic obstructive pulmonary disorder) and Alzheimers are the other main causes in the UK.

The success story is children under five. In 2016, for the first time in modern history, fewer than 5 million children under five died in one year a significant fall compared with 1990, when 11 million died. Increased education for women, less poverty, having fewer children, vaccinations, anti-malaria bed-nets, improved water and sanitation are among the changes in low-income countries that have brought the death rate down, thanks to development aid.

People are living longer but spending more years in ill health. Obesity is one of the major reasons. More than a billion people worldwide are living with mental health and substance misuse disorders. Depression features in the top 10 causes of ill health in all but four countries.

Our findings indicate people are living longer and, over the past decade, we identified substantial progress in driving down death rates from some of the worlds most pernicious diseases and conditions, such as under age-five mortality and malaria, said Murray Yet, despite this progress, we are facing a triad of trouble holding back many nations and communities obesity, conflict, and mental illness, including substance use disorders.

In the UK, the concern is particularly about the increase in ill-health that prevents people from working or having a fulfilling life, said Newton. A man in the UK born in 2016 can expect only 69 years in good health and a woman 71 years.

This is yet another reminder that while were living longer, much of that extra time is spent in ill-health. It underlines the importance of preventing the conditions that keep people out of work and put their long term health in jeopardy, like musculoskeletal problems, poor hearing and mental ill health. Our priority is to help people, including during the crucial early years of life and in middle age, to give them the best chance of a long and healthy later life, he said.

Read more: https://www.theguardian.com/society/2017/sep/14/poor-diet-is-a-factor-in-one-in-five-deaths-global-disease-study-reveals

Are women really stronger than men? | Angela Saini

When it comes to longevity, surviving illness and coping with trauma, one gender comes out on top. Angela Saini meets the scientists working out why

Four years ago, completely spent, blood transfused into me in a frantic effort to allow me to walk, I lay on a hospital bed having given birth the day before. To the joy of my family, I had brought them a son. Blue balloons foretold a man in the making. Not just the apple of my eye, but the one who would one day open jam jars for me. The hero who would do the DIY and put out the rubbish. He who was born to be strong because he is male.

But then, physical strength can be defined in different ways. What I was yet to learn was that, beneath our skin, women bubble with a source of power that even science has yet to fully understand. We are better survivors than men. Whats more, we are born this way.

Pretty much at every age, women seem to survive better than men, says Steven Austad, an international expert on ageing, and chair of the biology department at the University of Alabama. For almost two decades, he has been studying one of the best-known yet under-researched facts of human biology: that women live longer than men. His longevity database shows that all over the world and as far back as records have been kept, women outlive men by around five or six years. He describes them as being more robust.

Robustness, toughness or pure power whatever its called this survival ability cracks apart the stereotype. The physically strong woman is almost a myth. We gaze upon great female athletes as though theyre other-worldly creatures. Greek legend could only imagine the Amazons, female warriors as powerful as men. They break the laws of nature. No, we everyday women, we have just half the upper body strength of men. We are six inches shorter, depending on where we live. We wield power, but its emotional and intellectual, we tell ourselves. Its not in our bodies.

Not so, says Austad. He is among a small cadre of researchers who believe that women may hold the key to prolonging life. In extremely old age, the gap between the sexes becomes a glaring one.

According to a tally maintained by the global Gerontology Research Group, today, 43 people around the world are known to be living past the age of 110. Of these supercentenarians, 42 are women. Interviews with the worlds current oldest person, 117-year-old Violet Brown, who lives in Jamaica, reveal she enjoys eating fish and mutton. She once worked as a plantation worker. Her lifestyle betrays few clues as to how she has lived so long. But one factor we know has helped is being a woman.

An
Grey power: 42 of the 43 people over the age of 110 are women. Photograph: Phil Fisk for the Observer

Yet there is bizarrely little research to explain the biology behind this. What scientists do know is that this edge doesnt emerge in later life. It is there from the moment a girl is born. When we were there on the neonatal unit and a boy came out, you were taught that, statistically, the boy is more likely to die, says Joy Lawn, director of the Centre for Maternal, Adolescent, Reproductive, and Child Health at the London School of Hygiene and Tropical Medicine. She explains that, globally, a million babies die on the day of their birth every year.

But if they receive exactly the same level of care, males are statistically at a 10% greater risk than females. What makes baby girls so robust remains mostly a mystery. Research published in 2014 by scientists at the University of Adelaide suggests that a mothers placenta may behave differently depending on the sex of the baby, doing more to maintain the pregnancy and increase immunity against infections. For reasons unknown, girls may be getting an extra dose of survivability in the womb.

Wherever it comes from, women seem to be shielded against sickness later on. Cardiovascular disease occurs much earlier in men than women. The age of onset of hypertension [high blood pressure] also occurs much earlier in men than women. And theres a sex difference in the rate of progression of disease, says Kathryn Sandberg, director of the Centre for the Study of Sex Differences in Health, Ageing and Disease at Georgetown University.

Austad found that in the United States in 2010, women died at lower rates than men from 12 of the 15 most common causes of death, including cancer and heart disease, when adjusted for age. Of the three exceptions, their likelihood of dying from Parkinsons or stroke was about the same. And they were more likely than men to die of Alzheimers disease. Once I started investigating, I found that women had resistance to almost all the major causes of death, he says.

The
Age of reason: Violet Brown, centre, the worlds oldest person, was born in Jamaica in 1900. Photograph: Raymond Simpson/AP

Even when it comes to everyday coughs and colds, women have the advantage. If you look across all the different types of infections, women have a more robust immune response, adds Sandberg. If theres a really bad infection, they survive better. If its about the duration of the infection, women will respond faster. One explanation for this is hormones. Higher levels of oestrogen and progesterone could be protecting women in some way, not only by making our immune systems stronger, but also more flexible. This may help maintain a healthy pregnancy. A womans immune system is more active in the second half of her menstrual cycle, when shes able to conceive.

On the downside, a powerful immune response also makes women more susceptible to autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis. The body is so good at fighting off infection that it attacks its own cells. And this may explain why women tend to report more pain and sickness than men. This is one of the penalties of being a better survivor. You survive, but maybe not quite as intact as you were before, says Austad. Another factor is simply that men are dying more. Part of the reason there are more women than men around in ill health is to do with the fact that women have survived events that would kill men, so the equivalent men are no longer with us, he adds.

When it comes to biological sex difference, though, everything isnt always as it seems. At least some of the gaps in health and survival may be social, reflecting gender behaviour. Women may be more likely to seek medical help, for instance. Men may have less healthy diets or do more dangerous work. Nonetheless, Austad and Sandberg are convinced that nature accounts for a good deal of what we see.

If they are right, this raises a deeper scientific conundrum. Our bodies adapted over millennia to our environments. So what could it have been in our evolutionary past that gave the female body a little more of this magical robustness? How and why would one sex have developed a survival edge over the other?

Studies of hunter-gatherer societies, who live the way we all may have done before fixed settlements and agriculture, provide a few clues. Many anthropologists studying tribal communities in Africa, South America, Asia and Australia believe early humans lived fairly equal lives, sharing responsibility for food, shelter and raising children. The Flintstones model, with wife at home and husband bringing back the bacon, just doesnt stand up. Instead, the evidence shows that women would have done at least the same physical work as men, but with the added burden of bearing children.

Theres a general consensus now that hunting-gathering societies, while not perfectly egalitarian, were less unequal, particularly with regard to gender equality, says Melvin Konner, professor of anthropology at Emory University in Atlanta, who has spent years doing fieldwork with hunter-gatherers in Africa. Because of the scale of the group dynamics, it would be impossible for men to exclude women.

The more research that is done, the more this is reinforced. Even hunting that prototypical male activity is being recast as a female one, too. Anthropologist Rebecca Bliege Bird, a professor at Pennsylvania State University, offers me the example of the Martu, an aboriginal tribe in Western Australia. When Martu women hunt, one of their favourite prey are feral cats. Its not a very productive activity, but its a chance for women to show off their skill acquisition.

Paula
Keep on running: Paula Radcliffe continued to train through her two pregnancies. Photograph: Getty Images

Indeed, women are known to be particularly good at endurance running, notes Marlene Zuk, who runs a lab focusing on evolutionary biology at the University of Minnesota. In her 2013 book Paleofantasy, she writes that womens running abilities decline extremely slowly into old age. Theyve been known to go long distances even while pregnant. In 2011, for example, Amber Miller ran the Chicago marathon before giving birth seven hours later. World record holder Paula Radcliffe has trained through two pregnancies.

Why, then, are we not all Amazons? Why do we imagine femininity to mean small, waif-like bodies? The lives of most ordinary women, outside the pages of magazines, destroy this notion. Visiting Indias cities, I see female construction workers lining the streets, hauling piles of bricks on their heads to building sites. In Kenya, I meet female security guards everywhere, patrolling offices and hotels. Out in rural areas, there are women doing hard physical labour, often hauling their children in slings. Our ancestors would have done the same.

In evolutionary terms, these were the circumstances under which our bodies were forged. For an enormous chunk of early human history, as we migrated through Africa to the rest of the world, women would also have travelled hundreds or thousands of miles, sometimes under extreme environmental conditions. Just reproducing and surviving in these conditions, talk about natural selection! Im told by Adrienne Zihlman, an anthropologist at the University of California, Santa Cruz, when I visit her at her home in San Francisco.

Zihlman has dedicated her career to understanding human anatomy, and in particular the evolution of womens bodies. Women have to reproduce. That means being pregnant for nine months. Theyve got to lactate. Theyve got to carry these kids. Theres something about being a human female that was shaped by evolution. Theres a lot of mortality along the way that really can account for it.

When I gave birth to my son, I did the most physically demanding thing a human can do. Yet I am considered the weaker sex. Zihlman reminds me that my body was made strong by the struggles of countless generations of women who went before. There is something about the female form, the female psyche, just the whole package, that was honed over thousands and thousands, even millions, of years to survive, she smiles. I happen to remember, in that moment, that at home I do all the DIY.

Myths and misses: five more things you didnt know about women and men

Separate symptoms Women and men present different symptoms for the same medical conditions. Women are more likely to have insomnia and fatigue in the weeks before they have a heart attack, rather than the chest pain commonly experienced by men.

Changes of life Women in India, Japan and China experience far fewer menopause symptoms than western women who commonly report hot flushes, night sweats, depression and insomnia. Scientists at Kings College London argue this could be due to women lumping together their experience of growing older with the menopause.

Casual sex Women are choosier but not more chaste than men. A study by two German researchers, Andreas Baranowski and Heiko Hecht, found that women want casual sex just as much as men and were as likely as males to have sex with a stranger, as long as it was in a safe environment.

Boys toys A 2010 study by Professor Melissa Hines at the University of Cambridge found that girls on average were genetically predisposed to prefer dolls while boys liked to play with mechanical toys such as trains.

Risky business Testosterone is associated with higher levels of optimism, rather than aggression. Saliva samples taken from traders on the London Stock Exchange confirmed they had higher than average testosterone levels. Scientists from Britain, the USA and Spain concluded this increase made the traders more optimistic so more likely to take big financial risks.

Inferior: How Science Got Women Wrong and the New Research Thats Rewriting the Story by Angela Saini is published by Fourth Estate

Main photograph: Acrobats JD and Nikki; Stylist Hope Lawrie; special effects make-up Julia Bowden

Read more: https://www.theguardian.com/world/2017/jun/11/the-weaker-sex-science-that-shows-women-are-stronger-than-men