(CNN) – Which risk factor is responsible for more deaths around the world than any other? Not smoking. Not even high blood pressure. It’s a poor diet.
“In many countries, poor diet now causes more deaths than tobacco smoking and high blood pressure,” said Ashkan Afshin, an assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington.
And it’s not just that people are choosing unhealthy options such as red meat and sugary sodas. Just as critical, said Afshin, the lead author of a 27-year global diet analysis published Wednesday in the journal the Lancet, is the lack of healthy foods in our diets, along with high levels of salt.
“While traditionally all the conversation about healthy diet has been focused on lowering the intake of unhealthy food, in this study, we have shown that, at the population level, a low intake of healthy foods is the more important factor, rather than the high intake of unhealthy foods,” he said.
One in five deaths globally — that’s about 11 million people — in 2017 occurred because of too much sodium and a lack of whole grains, fruit and nuts and seeds, the study found, rather than from diets packed with trans fats, sugar-sweetened drinks and high levels of red and processed meats.
The large study size means these findings are relevant to everyone, no matter where they live, said Andrew Reynolds, a postdoctoral research fellow at the University of Otago in New Zealand, who was not involved in the study.
“The findings of the paper will inform policy decisions that shape what food is available in Western countries, how it is marketed and potentially what it costs in the coming years,” Reynolds said.
15 dietary risk factors
In the analysis, funded by the Bill & Melinda Gates Foundation, Afshin and his colleagues looked at 15 dietary risk factors and their impact on death and disability. High levels of unhealthy red and processed meats, sugar-sweetened beverages, trans fatty acids and salt — all known to be health risks — were compared with the effects of a diet low in many healthy foods. Those healthy items included fruits, vegetables, whole grains, milk, calcium, nuts and seeds, fiber, legumes or beans, omega-3 fatty acids from seafood, and polyunsaturated fats, the good-for-you fats found in salmon, vegetable oils and some nuts and seeds.
Except salt, which was a key risk factor in most countries, the study found red and processed meats, trans fats and sugary drinks toward the bottom of the risk chart for most countries.
In fact, more than half of all global diet-related deaths in 2017 were due to just three risk factors: eating too much salt, not enough whole grains and not enough fruit. Those risks held true regardless of socioeconomic level of most nations, Afshin said.
The new study is part of the yearly Global Burden of Disease report, prepared by a consortium of thousands of researchers that tracks premature death and disability from more than 350 diseases and injuries in 195 countries.
In January, the consortium released its “diet for a healthy planet,” which said that cutting red meat and sugar consumption in half and upping intake of fruits, vegetables and nuts could prevent up to 11.6 million premature deaths without harming the planet.
Afshin said an overview of the current study, but few of the details, was in last year’s Global Burden of Disease report, making this year’s version “the most comprehensive analysis on the health effects of diet ever conducted,” despite some methodological flaws and gaps in data from underdeveloped countries.
“That’s a good claim,” Reynolds said. “Studies are published every year on how we eat; however, the amount of data considered and the global representativeness make this study worth attention.” He added that the risk rankings provide public policymakers with “invaluable information on what dietary behaviors to target first.”
Diet-related deaths by country
Ten million diet-related deaths in 2017 were from cardiovascular disease; cancer was responsible for 913,000 deaths, and Type 2 diabetes accounted for 339,000 deaths. In addition, 66% of disabilities in 2017 from a range of chronic diseases were due to those three factors.
Interestingly, obesity was not a top-tier contributor, coming in at sixth on the list of global disease risks, Afshin said.
Uzbekistan had the highest number of diet-related deaths, followed by Afghanistan, the Marshall Islands, Papua New Guinea and Vanuatu. Israel had the lowest number, followed by France, Spain, Japan and Andorra, a tiny principality between France and Spain.
In terms of lowest death rates, the UK ranked 23rd, above Ireland (24th) and Sweden (25th), while the United States ranked 43rd, after Rwanda and Nigeria (41st and 42nd). India ranked 118th, and China ranked 140th.
Highest risk factors
For the United States, India, Brazil, Pakistan, Nigeria, Russia, Egypt, Germany, Iran and Turkey, a lack of whole grains was the greatest risk factor; for many more countries, that came in second or third. That doesn’t mean people in these countries ate no grains but rather that they ate processed grains, with little nutritional value and the potential for high calorie counts.
Reynolds, who published a study in The Lancet on the effect of whole grains this year, cautions that many of the products sold to consumers today as “whole grain” often aren’t.
“Whole grains are being included in ultraprocessed products that may be finely milled down and have added sodium, added free sugars and added saturated fats,” Reynolds said. “I think we all need to be aware of this and not confuse the benefits from the more intact, minimally processed whole grains with what is often advertised as whole-grain products available today.”
A whole grain is defined as the use of the entire seed of a plant: the bran, the germ and the endosperm. The Whole Grains Council provides a stamp, available in 54 countries, that consumers can look for that certifies the degree of whole grains in the product.
The greatest risk factor for China, Japan, Indonesia and Thailand was the amount of sodium in the diet. That is probably due to the extremely salty rice vinegars, sauces and pastes used to cook traditional Asian foods, Afshin said.
Does that mean those cultures are going to continue to live with that high risk? Not necessarily, said Corinna Hawkes, who directs the Centre for Food Policy at the University of London.
“Anyone who studies the history of food will tell you cultural preferences change over time,” said Hawkes, who was not involved in the new study. “They do shift. But yes, in this case, it will likely involve a culture change.”
In Mexico, the lack of nuts and seeds was the highest risk factor, followed by a lack of vegetables, whole grains, and fruit in the diet. And it was one of the few countries where unhealthy sugary beverages ranked quite high — at No. 5. That’s not only due to a cultural preference for sodas and homemade sugary drinks called aguas frescas, study co-author Christian Razo says, but a lack of access to clean water and even fruits and vegetables.
“We don’t have free clean water to drink,” said Razo, who has a Ph.D. in nutrition from the National Institute of Public Health of Mexico.
“So people have to buy clean water to drink, and if they’re going to have to buy something, they prefer the soda,” she said. “It’s also easier to get processed food than fresh fruits and vegetables.”
Razo says that while Mexico is a huge producer of fresh fruits and vegetables, those are purchased by distributors in the United States and other countries, leaving people in the cities with little access to affordable fresh options or the ability to grow their own.
“We encourage people to buy in local markets, but they are more expensive,” Razo said. “It’s hard to compete with all these huge brands that buy the produce. So, yeah, we have a big challenge.”
As for nuts and seeds, “people just can’t buy them because they’re very expensive,” she said.
Call to action
Policymakers reacted to the study with a call to action.
“Unhealthy diet is the top risk factor for the Global Burden of Disease. The relative importance of this factor has been growing and requires urgent attention,” said Francesco Branca, director of the Department of Nutrition for Health and Development at the World Health Organization.
“The public needs to be aware of the critical links between diet and health and demand public action to improve the access and availability of foods that contribute to healthy diets,” Branca said. “Considering the need for urgent action the UN General Assembly has declared 2016-2025 the UN Decade of Action of Nutrition, and is asking governments to make such commitments.”
That is going to require a coordinated effort between public policymakers, food growers, marketers and distributors, which will be a significant feat, Hawkes said.
Getting back to whole grains, for example, is going to require a complete change in the economics of food production and distribution, she said.
“Refining grains is highly profitable,” Hawkes said. “Take corn, for example. You can refine it into different ingredients: animal feed, refined flours and high-fructose corn syrup to name three. So manufacturers are generating multiple value streams from this refining process.
“If we then say, ‘I’m producing corn to make one product,’ then we need to have dialogues with the industry to ask about where public investment is needed and how we can shift the system, because it’s going to be a big deal. It’s a big, big shift.”
But Hawkes is hopeful. Twenty years ago, she said, when she entered a room of global health policymakers and mentioned the importance of diet, she was seen as “sort of a fringe person. Now, when I enter a room and say that, it’s taken seriously.”
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At least 15 states have identified more than 120 cases of lung disease or injury that could be linked to vaping, a CNN survey of state health departments has found.
States with the most cases include Wisconsin, with 15 confirmed cases and 15 more under investigation. Illinois has 10 confirmed cases, while 12 more are under investigation. California is looking into 19 such cases. The New York State Department of Health said Friday it was “actively investigating” 11 cases. Indiana and New Jersey both reported nine cases, of which Indiana has confirmed six.
Health officials in Connecticut, Florida, Iowa, Michigan, Minnesota, North Carolina, Pennsylvania, Texas and Utah also said they were aware of confirmed or potential cases. A total of 42 states and Washington, DC, provided CNN with a response.
“These latest reports of pulmonary disease in people using vaping products in New York and other states are proof that more study is needed on the long-term health effects of these products,” Dr. Howard Zucker, health commissioner for New York State, said in a statement Friday.
Health officials in multiple states said it is still unclear whether there’s a connection between the cases or whether vaping definitively caused these illnesses — which led to multiple people being hospitalized.
In an email Friday, the US Centers for Disease Control and Prevention urged doctors to collect information and samples of what similar patients might have been vaping. The agency said it was working with some of these states to share information and facilitate testing.
“There are still many unanswered questions, but the health harms emerging from the current epidemic of youth vaping in Minnesota continue to increase,” Dr. Ruth Lynfield, the Minnesota Department of Health’s medical director and state epidemiologist, said in a statement Tuesday. “We are encouraging providers and parents to be on the look-out for vaping as a cause for unexplained breathing problems and lung injury and disease.”
A tough condition to track
The Minnesota Department of Health reported this week that some patients were hospitalized for “multiple weeks,” in some cases ending up in the intensive care unit. They came in with symptoms including shortness of breath, fever, cough, vomiting, diarrhea, headache, dizziness and chest pain.
Dr. Emily Chapman, chief medical officer at Children’s Minnesota, which reported four cases, said in a statement that these illnesses are tricky to diagnose because they can start off looking like a common infection before leading to more serious complications.
They are also tricky to track, experts say, because vaping-related lung disease is not a condition that’s mandatory to report. Some health departments said they don’t track this data.
Still, states are putting out notices in hopes that doctors will notice the clues and ask the right questions. In Colorado, Georgia and Kansas, health officials have tried to look for cases by analyzing data from emergency departments.
“There is no diagnostic code … for lung diseases related to vaping. So it’ll be hard to follow and track,” said Dr. Humberto Choi, a pulmonologist and critical care specialist at the Cleveland Clinic.
Choi said he has seen three cases himself over the last several months — and he suspects there were others who didn’t think of vaping as a potential cause.
“People had the impression that vaping was something safe,” Choi said. “They don’t connect new symptoms with vaping.”
Choi’s state of Ohio, however, is not one of the states where health departments are currently reporting cases, according to the state’s health department.
“It’s hard to tell what to expect in these cases because it’s something new,” Choi said.
No clear culprit
Thomas Haupt, a respiratory disease epidemiologist with Wisconsin’s Department of Health Services, told CNN earlier this month that the cases in his state were young people who were “otherwise normally healthy, and they were coming in with severe respiratory illnesses, and in some cases, they actually had to go to the intensive care unit and were placed on ventilators.”
The lung disease initially looked like it was caused by an infection, “but every test has come back completely negative,” he added.
Wisconsin’s cases were largely in the southeastern part of the state, Haupt said. This borders the northeastern part of Illinois, where that state’s initial patients were hospitalized.
While officials are still trying to determine which products patients used, some states — including Wisconsin, Minnesota and New York — said the use of both nicotine and marijuana products had been reported.
In Wisconsin, “all patients reported vaping prior to their hospitalization, but we don’t know all the products they used at this time,” Andrea Palm, the state’s Department of Health Services secretary-designee, said in a statement last week. “The products used could include a number of substances, including nicotine, THC, synthetic cannabinoids, or a combination of these.”
Health experts have pointed to a variety substances in e-liquids they worry may harm cells or contain “dangerous chemicals,” but the full extent of e-cigarettes’ short- and long-term risks are yet unclear. A number of counterfeit and adulterated products have also hit the market, which may have other additives or ingredients. It is unclear whether that plays a role across these cases.
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London and Moscow (CNN) – An explosion. An abruptly-canceled village evacuation. Five dead nuclear experts. And a few traces of radioactive iodine in the air over the northern Norwegian coastline.
These are the fingerprints of what appears to have been Russia’s latest failed bid to test its Burevestnik missile, also known as Skyfall.
It’s claimed by its owner, Russian President Vladimir Putin, to have unlimited range and be able to outflank all US air defenses. But this month, it proved, for a Kremlin keen to emphasize its growing military muscle, yet another high-profile hiccup.
It wouldn’t be the first time that a test of the missile wasn’t entirely successful, according to US officials.
But what is Skyfall? In truth, analysts don’t really know, but their guesswork leads them to believe it’s a form of cruise missile designed around a nuclear reactor.
The spiking of radiation levels in the area, potentially reaching as far away as Norway, lends credibility to the theories.
Putin’s spokesman, Dmitry Peskov, declined to confirm widespread international speculation that the accident involved a nuclear-powered cruise missile, but said the mishap would not set back Russian efforts to develop advanced military capabilities.
Peskov said that only experts could speak with authority on such matters, but added: “Accidents, unfortunately, happen. They are tragedies. But in this particular case, it is important for us to remember those heroes who lost their lives in this accident.”
Jon Hawkes, associate director of land warfare at Jane’s IHS Markit, said the system could work one of two ways. It could be an “air-breathing engine employing a small nuclear reactor core to heat incoming air that is expelled to generate thrust.”
Or it could be a “nuclear thermal rocket engine, where the nuclear core is used to heat a liquid fuel such as hydrogen before expelling it through a nozzle to produce thrust.”
Yet he added, “given the Russians are claiming unlimited range, then one would assume it has to be along the lines of the first option, as the hydrogen fuel device would have a limit to its range.”
The major problem with the 9M370, or SSC-X-9 Skyfall (as NATO calls it), is the exhaust. You can’t use a nuclear reactor to power a rocket without likely creating a form of dirty bomb on wings.
“This is a doomsday weapon really,” said Dr Mark Galeotti, from Royal United Services Institute for Defence and Security Studies.
“It’s not something that could be deployed in anything other than a full-scale nuclear war. It is a cruise missile that can stay in the air for a long time, but it is belching out radioactive plumes behind it.”
The US indeed had a similar program in the 1960s, called Project Pluto, which was abandoned as they concluded it was too dangerous at the time.
When Putin launched the missile with great fanfare in March 2018 he extolled its unlimited range — that it could circle the globe many times and then fire itself at its target from an unexpected angle, perhaps even days after launch.
Is Putin bothered that it doesn’t appear so far to have worked that well? Not really, said Galeotti.
“Vladimir Putin’s Russia is basically trying to puff itself up,” he said. “It is trying to look more militarily formidable than it is. Although they don’t like the fact that this failed, the fact that we are talking about the latest Russian military technology is definitely something of a plus.”
US officials told CNN it’s been tested a few times, but never fully successfully. How far along the project is, and how big a setback this, is is anyone’s guess.
A bad summer
But the Kremlin has had a number of incidents to brush off in the past month.
In early July, the AS-31, or Losharik, super-deep, super-secret spy submarine, ran into trouble off the northern coast. State media said 14 sailors on board died of smoke inhalation, and the Kremlin insisted its nuclear reactor was intact when it was returned to port.
The Losharik — named after a Soviet-era cartoon horse because of the compartmentalized components that enable it to dive to the bottom of the ocean floor — was meant to plunge to depths that nuclear and attack submarines could not.
Again, Putin found himself being briefed on a clean-up operation.
Weeks later, a munitions dump in Achinsk suffered a series of explosions over five hours, some causing devastating shockwaves and debris to be scattered over the area. A week later, local officials admitted forty people were injured.
These three incidents amount to a bad summer for the Russian military, who after the invasion of Ukraine, and their intervention into Syria, had benefited from a short-term lift in their domestic prestige.
Could over-reach be behind this recent spate of problems?
Andrey Kortunov, Director General of the Russian International Affairs Council, said, “if you look at the current defense budget of the Russian Federation, it reached its peak in 2016.”
He added it had decreased since.
“So basically, the military and the defense sector are asked to do more for less,” he added, “and that might be a stretch. Maybe some of these accidents are a part of the price that the military has to pay from this relatively modest budget but the [substantial] ambitions behind this budget.”
A turbulent month of unexpected blasts and leaks that begs the question as to whether the Kremlin’s race to the bottom of the sea, or top of the heavens, will scorch too much in its wake.
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Dozens of Android adware apps disguised as photo-editing apps and games have been caught serving ads that would take over users’ screens as part of a fraudulent money-making scheme.
Security firm Trend Micro said it found 85 individual apps downloaded more than eight million times from Google Play — all of which have since been removed from the app store.
More often than not adware apps will run on a user’s device and will silently serve and click ads in the background and without the user’s knowledge to generate ad revenue. But these apps were particularly brazen and sneaky, one of the researchers said.
“It isn’t your run-of-the-mill adware family,” said Ecular Xu, a mobile threat response engineer at Trend Micro. “Apart from displaying advertisements that are difficult to close, it employs unique techniques to evade detection through user behavior and time-based triggers.”
When it comes to the effect manmade materials have on the environment, you need look no further than, well, every corner of the globe, apparently. Microplastics, or tiny pieces of plastic that pollute the environment, have now officially been found as far away as the northernmost parts of the earth. Now, according to a new study, it appears microplastics have been found as far away as the Alps and even the Arctic Ocean, where most humans rarely tread.
Ecologist Melanie Bergmann and her colleagues at the Alfred Wegener Institute in Germany published a study in Science Advances that examined how these microplastics spread, the mechanics of which aren’t yet fully understood by researchers. The tiny bits of plastic debris, which can be up to the size of a single sesame seed or smaller, are present just about everywhere now, it seems. Bergmann and her team set out to examine whether or not microplastics can gather in the air, and they pulled samples from snow in the Alps and even sea ice from the Arctic Ocean to do so. Snow was chosen because it tends to capture particles from the air more readily than other surfaces, so if there were any to find, the team would find it there. And find microplastics in these locations they did. Shocking numbers of them, in fact, which surprised Bergmann and her team.