Comparison of Methods Used to Estimate the Global Burden of Disease Related to Undernutrition and Suboptimal Breastfeeding.

The Global Burden of Disease study (GBD) is an ambitious effort to estimate the disease burden attributable to various risk factors. The results from the GBD are used around the world to monitor the UN established Sustainable Development Goals, set health policies and research strategies, among others. The GBD along with other studies, such as those from the Maternal Child Epidemiology Estimation Group and the Lancet Breastfeeding Series Group, produce estimates of the nutrition-related global burden of disease that exhibit considerable differences. These differences are difficult to reconcile due to the estimation methods, which in recent years have substantially increased in complexity. In this paper, we give a detailed review of the methods used by GBD and other entities to estimate the global burden of disease that is attributable to undernutrition and suboptimal breastfeeding. Further, we compare the methods to determine causes for differences in estimates. We find that the main determinant of differences in estimates is what causes of death are linked to each risk factor. Methods used to estimate nutrition-related disease burden need to be more clearly documented to foster discussion and collaboration on the important assumptions required to produce estimates.