In GBD 2016, we updated our approach for estimation of the joint effects of combinations of risk factors (appendix 1 p 23). Using individual-level data from prospective cohort studies, we estimated the proportion of the effect of behavioural risks on cardiometabolic outcomes mediated through metabolic risk factors. We also estimated the proportion of the effect of each metabolic risk factor on cardiometabolic outcomes mediated through other metabolic risks. For each mediation pathway, we only included the mediators for which sufficient evidence existed for their causal relationship with the disease endpoint.
