NCDs and Diet

Non-communicable chronic diseases (NCDs) are not transmissible diseases that can affect anyone, anywhere, regardless of age or gender. NCDs are primarily cardiovascular diseases (CVDs), cancers, chronic respiratory diseases and diabetes.

Reducing air pollution, tobacco use, obesity, hypertension, unhealthy diets, physical inactivity and harmful alcohol consumption could greatly reduce the risk of these diseases. In 2016, NCDs were responsible for 71 % (41 million) of the 57 million deaths that occurred globally.

The major NCDs responsible for these deaths included cardiovascular diseases (CVD, 31% of global deaths), cancers (16 % of global deaths), chronic respiratory diseases (7 % of global deaths) and diabetes (3 % of global deaths).

Figure 1: Global Mortality (% of total deaths), all ages, both sexes, 2016. WHO 2018

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NCDs and Healthy Eating

There is robust scientific evidence that healthy eating patterns are associated with a reduced risk of CVD, obesity and type 2 diabetes. These NCDs are potentially preventable through healthy lifestyle choices, including diet and physical activity.

Obesity is a major risk factor for diabetes. Overweight and obesity are associated with increased risk of disease or death from diabetes, CVD and several types of cancer by increasing high blood pressure, blood cholesterol, insulin resistance and inflammation as well as hormone levels. Both obesity and diabetes are also considered as pandemics of the 21st century.

Poor Diet and NCDs

A poor diet, as defined by a cluster of dietary risks, is the leading cause of death and one of the biggest contributors to NCDs. Of these dietary risks, the most important are low consumption of whole grains, high sodium intake, or low consumption of fruits, nuts and seeds, or vegetables.

Figure 2: Risk factor contribution to deaths. Gloabl deaths by risk factor for all ages, both sexes, 2017. BMJ 2019

Some food components (dietary fiber, phenolic compounds, vitamins, minerals, proteins) composing vegetables, fruits, whole grains, beans, nuts and seeds are considered healthy. Other food components are harmful when consumed in high amounts (for examples: saturated fats, sodium, simple sugars) and increase the risk of CVD and diabetes.

Healthy Foods Combat NCDs

Therefore, by increasing the intake of foods with protective compounds and reducing the intake of harmful ones, you can significantly reduce the risk of NCDs.

The basis of a healthy diet for reducing the risk of NCDs is as follow:

1. Lots of plants, vegetables, fruits, legumes, whole grains, nuts and seeds.
2. Adequate proteins from plant origin such as beans, lentils, soy products, nuts and seeds.
3. Minimally processed foods and whole foods are the main characters of a healthy diet.
4. Limited saturated fats, added sugars and sodium.
5. Balance is important to get the nutrients needed without consuming many calories.

Some specific diets meet the principles of a healthy diet and show evidence in reducing the risk of NCDs.

NCDs and COVID-19

It has been reported that NCDs aggravate the prognosis of COVID-19. This is why COVID-19 is now considered a “syndemic”. A syndemic is defined as a synergistic interaction between socioecological and biological factors, resulting in adverse health outcomes.

Therefore, maintaining a healthy diet is also of great importance during an infection. In this context, “immunonutrition”, the potential to modulate the activity of the immune system by interventions with specific nutrients, could have an important preventive role by helping the body to fight against potentially lethal viruses, such as SARS-CoV-2.

Plant-Based Diets

Clinical trials and observational research indicate that plant-based diets are suitable for preventing overweight and obesity and promoting weight loss. The main plant-based diets are:

• Vegan
• Vegetarian
• Flexitarian

Traditional Regional Diets

• Mediterranean diet. Several studies have shown positive effects of the Mediterranean diet on cardiovascular risk factors such as blood pressure, body mass index (BMI) and blood lipids. In addition, epidemiological studies indicate that there is an actual link between this diet and lower incidence of NCDs and mortality.
• Nordic diet. This diet is associated with improvements in risk factors for both cardiovascular disease and type 2 diabetes. In hypercholesterolemic individuals, the Nordic diet improved their blood lipid profile and insulin sensitivity, in addition to reducing blood pressure.

Diets to Fight NCDs

• Anti-inflammatory diet. This diet is essentially a Mediterranean diet with Asian influences. There is no direct evidence on the effects of this diet; however, many studies support the health promoting properties of many of the components of the diet.
• Ornish diet. It is very low in fat (10 % of calories), refined carbohydrates and animal protein. The complete Ornish program promotes exercise, stress reduction and social relationships. Multiple randomized controlled trials support the effects of this program on the reduction of atherosclerosis, blood pressure and cholesterol.
• DASH diet. The “Dietary Approaches to Stop Hypertension” (DASH) diet was developed to lower blood pressure without medication. The DASH diet helps lower blood glucose levels, triglycerides, LDL-C, and insulin resistance.
• MIND diet. The “Mediterranean-DASH Intervention for Neurodegenerative Delay” diet takes the best from both diets for a correct cognitive function. Observational studies suggest that the MIND diet may reduce cognitive decline and a controlled randomized trial is currently being carried out to confirm these therapeutic effects.
• Portfolio diet. This vegan diet focuses on foods that lower cholesterol (LDL). This diet has been studied in randomized controlled trials in people with high cholesterol and type 2 diabetes patients, and in both cases, participants following the portfolio diet have better outcomes compared to participants not following this diet.
• TLC Program diet. The “Therapeutic Lifestyle Changes” (TLC) Program is also intended to reduce high cholesterol. Several clinical trials have demonstrated a reduction in cholesterol, triglycerides and oxidative stress in participants following this diet.

In summary, strategies to achieve a global health must be based on guaranteeing sufficient, quality, safe, healthy and personalized nutrition and on educating the population in healthy nutritional habits.

A healthy diet is the best medicine for reducing the risk of NCDs worldwide. In fact, diet may be used also as a treatment for alleviating their symptoms. This is why consumers demand healthy diets for a sustainable health.

Do you know of any diets that claim to be good for preventing NCDs?

Authors: Dr Dolores del Castillo and Dr. Iriondo-DeHond