Bravo to the EAT-Lancet Commission for catapulting the global nutrition crisis to center stage as one of a handful of our most critical global challenges. The Commission’s work crests a wave that has been building since the first Nutrition for Growth Summit in 2013. In the years since, there have been four Global Nutrition Reports, 194 governments have adopted the most ambitious set of nutrition-related national goals, and the UN General Assembly has proclaimed 2016 to 2025, the “Decade of Action on Nutrition.”

Over the same period, there have been a plethora of nutrition initiatives, including the Scaling Up Nutrition (SUN) movement and business network, the Power of Nutrition Fund and Food Reform for Sustainability and Health (FReSH), Standing Together for Nutrition, to name a few. USCIB, leading business alliance, and NGO GAIN joined forces to produce a set of “Principles of Engagement” to encourage the public and private sectors to work together to address one of the greatest barriers to progress – the reticence of governments, businesses, UN agencies and NGOs to work with, rather than against, each other on nutrition.

But what now? How to take all of this activity and turn it into real action that reduces nutrition-related deaths and disabilities?

First, we need to know what is causing the most nutrition-related deaths to understand where immediate action can have the greatest impact on human health. Second, we need to identify the largest populations at greatest risk of nutrition-related death, by age and gender to know which populations to target. And third, we need a  list of the countries where nutrition-related deaths are concentrated in order to fully engage the right set of governments and non-state actors. This information will help prioritize the right issues, populations, and actors so that investments have the greatest possible impact on the global nutrition crisis and the achievement of the Sustainable Development Goals (SDGs).

Who is vulnerable to nutrition-related deaths?

The vast majority (92%) of the 7.9 million diet-related deaths occur among adults aged over 50. In contrast, the majority (97%) of the 2.9 million child and malnutrition-related deaths occur among children under five. Direct deaths from nutritional deficiencies are more evenly spread across the life-cycle, with 39% occurring among children under five and 50% among adults over 50. Males are more vulnerable to diet-related (57% of all deaths) and child malnutrition-related (55% of all deaths). Twice as many men as women die from causes related to diets high in red meat, processed meat, and sugar-sweetened beverages, and low in whole grains. More males than females also die from low birth weight, child stunting, low breastfeeding, zinc and vitamin A deficiencies.

In contrast, females make up 55% of direct deaths from malnutrition, due to the larger numbers of young girls and elderly women who die from protein-energy malnutrition. In fact, 73% of direct deaths from this form of malnutrition are concentrated among women and children. The one area where the burden of nutrition-related deaths falls exclusively on females is iron deficiency. In addition to contributing to the deaths of an estimated 42,000 women, iron deficiency is a major cause of Disability Adjusted Life Years (DALYs) for women. Only unsafe sex is a higher behavioral risk for women aged 15-49 years, according to the GBD.

Where are the most nutrition-related deaths?

The majority of nutrition-related deaths occur in a subset of twenty countries which fall into three groups. First there are the countries where more than 80% of nutrition-related deaths are due to dietary risks, including China, Russia, USA, Ukraine, Japan, Germany, Viet Nam, Egypt, and Italy. Second are the countries where between 50 and 80% of deaths are due to dietary risks, including India, Pakistan, Indonesia, Brazil, Bangladesh, Philippines, and Mexico. Finally there are the countries where less than 50% of deaths are due to dietary risks. Instead child and material malnutrition dominates, including Nigeria, Ethiopia, Democratic Republic of Congo, and Tanzania – all in Africa.

Countries from almost every region of the world are on this list indicating the wide spread of nutrition-related deaths. However, most diet-related deaths are in middle- and high-income countries while most child and malnutrition-related deaths and deaths from nutritional deficiencies are in low- and middle-income countries across South Asia and Sub-Saharan Africa, due to the heavy burdens in India, Pakistan, Nigeria, and others. It is important to note that five countries are struggling with high numbers of nutrition-related deaths across all three categories – dietary risks, child and maternal malnutrition, and nutritional deficiencies – including India, China, Indonesia, Pakistan, and Bangladesh, which is a reflection of the double-burden of malnutrition across Asia.