Abstract

Across human populations the ways in which food quantity can affect health are well established, in
reference to under-nutrition and over-nutrition, however, knowledge of the importance of food quality
in relation to disease burden and prevention are still relatively poor. The aim of this study is to
quantify the empirical relationship between global patterns of disease and country-level variation in
the balance of macronutrients in the diet with focus on type-2-diabetes mellitus (DM), cardiovascular
disease (CVD), ischemic heart disease (IHD), hypertensive heart disease (HHD) and stroke.
Confounding factors such as age, sex and wealth were included in the analysis with wealth
represented by current health expenditure (CHE), gross domestic product (GDP) and development
status. Development status was shown to have the greatest explanatory effect on both macronutrient
availability and changing patterns in disease. Calorie availability from all macronutrients became
more animal based as development status increased. Transition countries produced the highest results
for prevalence of deaths and disability adjusted life years (DALYs) from all diseases except for DM,
where developing countries suffered more greatly. It was clear that when the percentage of calories in
the diet coming from animal sources were low, deaths and DALYs increased as calories from non-protein energy (NPE) and protein energy increased and reduced when calories from NPE and protein
decreased. When the animal percentage in diets was high however, the occurrence of deaths and
DALYs were more affected by the NPE:P, where prevalence was greatest when calories from NPE
and protein were simultaneously high or simultaneously low and reduced when the ratio of NPE to
protein became more imbalanced, for example, when calories from NPE was low whilst calories from
protein was high and vice versa. The key finding here is that there is no one contributor of changing
patterns of disease, however it is a combination of calories consumed and the source of these calories
(vegetal or animal).