36-fold higher estimate of deaths attributable to red meat intake in GBD 2019: is this reliable?

摘要

Author's reply: Alice Stanton and colleagues raise concerns about the large increase in estimated deaths due to red meat intake in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 results compared with the GBD 2017 results. As they note, the reasons for the change were estimation of new risk functions, updated systematic reviews, and a change in the theoretical minimum risk exposure level (TMREL). Ioannidis has raised doubts about the credibility of much of the published literature on diet risk-outcome pairs that are based primarily on observational data. The GBD estimates reflect uncertainty from the estimated risk functions, uncertainty in risk exposure, and uncertainty in the TMREL. But many commentators have noted that their concern about the diet risk-outcome pairs extends beyond uncertainty intervals and is about the potential for residual confounding in observational studies on diet. These doubts have been echoed by the Independent Advisory Committee for the GBD, an oversight body that reviews the work of the GBD every 6 months. Based on these concerns, we embarked on a major revision to our approach to all risk-outcome pairs beginning in 2017; these revisions influenced the GBD 2019 results but will be more fully reflected in the forthcoming GBD 2020 revisions.