# The burden of chronic kidney disease attributable to diet low in whole grains from 1990 to 2021: a global, regional and national analysis

## TL;DR

This study shows that low whole-grain diets have significantly increased chronic kidney disease burden globally, especially in regions with lower development indices.

## Contribution

The paper provides the first global, regional, and national analysis of CKD burden linked to low whole-grain intake using standardized metrics.

## Key findings

- In 2021, 21,992.9 deaths and 549,741 DALYs were attributed to low whole-grain diets for CKD.
- The low SDI region had the highest age-standardized rates, while East Asia had the heaviest overall burden.
- ARIMA projections suggest rising CKD mortality and DALYs due to low whole-grain diets by 2050.

## Abstract

Chronic kidney disease (CKD) is a major global health issue with a growing disease burden. Dietary factors play a significant role in the onset and progression of CKD. Currently, there is a lack of comprehensive assessment on the global CKD burden attributable to diet low in whole grains, highlighting an urgent need to analyze its cross-regional and temporal distribution characteristics and trends based on standardized metrics.

Using Global Burden of Disease (GBD) 2021 data, we analyzed CKD deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR) attributable to low whole-grain intake across 204 countries (1990–2021). Temporal trends were quantified via estimated annual percentage change (EAPC); autoregressive integrated moving average (ARIMA) modeling projected burdens to 2050.

In 2021, global deaths and DALYs from CKD attributable to diet low in whole grains were 21,992.9 and 549,741, respectively, increasing by 183 and 146% compared with 1990. Both the ASMR and ASDR showed upward trends. At the regional level, in 2021, the middle SDI region had the highest deaths and DALYs, while the low SDI region had the highest ASMR and ASDR; the East Asia region carried the heaviest burden overall. At the national level, China ranked first in both the number of deaths and DALYs, whereas American Samoa had the highest ASMR and ASDR. In 2021, the EAPC of ASMR for CKD due to diet low in whole grains was negatively correlated with the SDI (R = −0.517, p < 0.001), as did ASDR. ARIMA predicted rising deaths, DALYs, and ASMR by 2050. ASDR will stabilize overall but rise in women.

Over the past three decades, the global burden of CKD attributable to diet low in whole grains has increased and remains at a high level, with significant regional disparities. Policymakers must implement targeted measures to enhance public awareness and intake of whole grains.