# The global epidemiology of gastrointestinal cancer burden attributable to dietary risks: a systematic analysis of the Global Burden of Disease Study 2021

## TL;DR

This study examines how diet-related risks contribute to gastrointestinal cancer deaths and disability worldwide, highlighting regional disparities and trends from 1990 to 2021.

## Contribution

The study provides a global analysis of dietary risk-attributable GI cancer burden using the latest Global Burden of Disease data and future projections.

## Key findings

- Colorectal cancer mortality and disability rates attributable to diet declined by about 0.87% annually between 1990 and 2021.
- Esophageal cancer rates dropped more than 3% annually, with low SDI regions bearing the highest burden.
- Stomach cancer rates decreased by over 2% annually, but remain high in East Asia and Sub-Saharan Africa.

## Abstract

Gastrointestinal (GI) cancers collectively account for over 30% of global cancer-related mortality, with diet and nutrition playing crucial roles in their development. We investigated the burden, trends and disparities of GI cancers attributable to dietary risks.

Data was collected from the Global Burden of Disease Study 2021. Disease burden was measured by deaths and disability-adjusted life years (DALYs), along with age-standardized rates (ASRs). Joinpoint regression, with average annual percent changes (AAPCs) were used to assess temporal trends. ARIMA models were employed to project the ASRs till 2040.

Between 1990 and 2021, the AAPC of the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) of colorectal cancer (CRC) attributable to dietary risks were −0.87 (95% CI: −0.89, −0.84) and −0.88 (95% CI: −0.90, −0.86). Esophageal cancer showed the greatest declining rate, with ASRs declining more than 3% annually. The ASRs of stomach cancer decreased by more than 2% per year. The burden of stomach cancer and esophageal cancer were highest among low and low-middle SDI countries and regions, particularly East Asia and Sub-Saharan Africa, respectively. High-SDI countries and regions showed the highest burden of CRC but the greatest declining rates. Future projections suggest constant decreasing burden for stomach cancer and CRC, but stable trends for esophageal cancer.

Diet-attributed GI cancer remains a significant public health challenge globally, especially among low SDI and lower-middle SDI countries. Given the disparity of risk exposures and disease burden, we recommend promoting screening practices and improving healthcare accessibility in low SDI countries, while emphasizing lifestyle modifications in higher SDI countries to combat this pressing issue.