Which risk factor is responsible for more deaths around the world than any other? Not smoking. Not even high blood pressure. It's a poor diet.

"In many countries, poor diet now causes more deaths than tobacco smoking and high blood pressure," said Ashkan Afshin, an assistant professor at the Institute for Health Metrics and Evaluation at the University of Washington.

And it's not just that people are choosing unhealthy options such as red meat and sugary sodas. Just as critical, said Afshin, the lead author of a 27-year global diet analysis published Wednesday in the journal the Lancet, is the lack of healthy foods in our diets, along with high levels of salt.

"While traditionally all the conversation about healthy diet has been focused on lowering the intake of unhealthy food, in this study, we have shown that, at the population level, a low intake of healthy foods is the more important factor, rather than the high intake of unhealthy foods," he said.

One in five deaths globally -- that's about 11 million people -- in 2017 occurred because of too much sodium and a lack of whole grains, fruit and nuts and seeds, the study found, rather than from diets packed with trans fats, sugar-sweetened drinks and high levels of red and processed meats.

The large study size means these findings are relevant to everyone, no matter where they live, said Andrew Reynolds, a postdoctoral research fellow at the University of Otago in New Zealand, who was not involved in the study.

"The findings of the paper will inform policy decisions that shape what food is available in Western countries, how it is marketed and potentially what it costs in the coming years," Reynolds said.

15 dietary risk factors

In the analysis, funded by the Bill & Melinda Gates Foundation, Afshin and his colleagues looked at 15 dietary risk factors and their impact on death and disability. High levels of unhealthy red and processed meats, sugar-sweetened beverages, trans fatty acids and salt -- all known to be health risks -- were compared with the effects of a diet low in many healthy foods. Those healthy items included fruits, vegetables, whole grains, milk, calcium, nuts and seeds, fiber, legumes or beans, omega-3 fatty acids from seafood, and polyunsaturated fats, the good-for-you fats found in salmon, vegetable oils and some nuts and seeds.

Except salt, which was a key risk factor in most countries, the study found red and processed meats, trans fats and sugary drinks toward the bottom of the risk chart for most countries.

In fact, more than half of all global diet-related deaths in 2017 were due to just three risk factors: eating too much salt, not enough whole grains and not enough fruit. Those risks held true regardless of socioeconomic level of most nations, Afshin said.

For the United States, India, Brazil, Pakistan, Nigeria, Russia, Egypt, Germany, Iran and Turkey, a lack of whole grains was the greatest risk factor; for many more countries, that came in second or third. That doesn't mean people in these countries ate no grains but rather that they ate processed grains, with little nutritional value and the potential for high calorie counts.

Reynolds, who published a study in The Lancet on the effect of whole grains this year, cautions that many of the products sold to consumers today as "whole grain" often aren't.

"Whole grains are being included in ultraprocessed products that may be finely milled down and have added sodium, added free sugars and added saturated fats," Reynolds said. "I think we all need to be aware of this and not confuse the benefits from the more intact, minimally processed whole grains with what is often advertised as whole-grain products available today."

A whole grain is defined as the use of the entire seed of a plant: the bran, the germ and the endosperm. The Whole Grains Council provides a stamp, available in 54 countries, that consumers can look for that certifies the degree of whole grains in the product. (CNN)

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