Behavioral and dietary risk factors for noncommunicable diseases.

Copyright © 2013 Massachusetts Medical Society. Except in eastern Europe and parts of Africa, mortality among adults has declined in most countries for decades.1 Lower rates of death from infectious diseases were the early driver of this improvement, but there have been subsequent declines in mortality from cardiovascular disease and some cancers.2,3 There have also been important trends in various cancers2 — for example, the rise and subsequent decline in lung-cancer incidence and mortality among men in many high-income countries, a decline in stomach-cancer incidence and mortality as economies develop, and the worldwide increase in breast-cancer incidence. The hazardous effects of behavioral and dietary risk factors on noncommunicable diseases, and the metabolic and physiological conditions that mediate their effects, have been established in prospective cohort studies and randomized trials. This knowledge, together with data from risk-factor surveillance, has helped to establish the mortality and disease burden attributable to risk factors, globally and by region and country.4-7 There is less information on risk-factor trends, which makes it difficult to assess how they have affected population health in the past or how they may do so in the future. In this article, we summarize the available data on trends in selected behavioral and dietary risk factors for noncommunicable diseases and examine the effects they have had, or may have in the future, on the health of populations around the world. Risk factors such as smoking, alcohol consumption, excess weight, and dietary factors are responsible for a large share of the global disease burden, directly or through conditions such as high blood pressure and elevated blood glucose and cholesterol levels (Fig. 1).4,5