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Dietary Factors & Cardiometabolic Mortality in the US

JAMA; 2017 Mar 7; Micha, Peñalvo, et al

A substantial proportion of deaths from heart disease, stroke, and type 2 diabetes among US adults is associated with dietary factors, a recent study estimated. The comparative risk assessment incorporated data and corresponding uncertainty on population demographics and dietary habits from National Health and Nutrition Examination Surveys (1999-2002: n=8,104; 2009-2012: n=8,516) and estimated associations of diet and disease from meta-analysis of prospective studies and clinical trials. Exposures included consumption of 10 foods/nutrients associated with cardiometabolic diseases: fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), polyunsaturated fats, seafood omega-3 fats, and sodium. Researchers found:

  • In 2012, suboptimal intake of dietary factors was associated with an estimated 318,656 cardiometabolic deaths, representing 45.4% of cardiometabolic deaths.
  • The largest numbers of estimated diet-related cardiometabolic deaths were related to high sodium (66,508 deaths in 2012; 9.5% of all cardiometabolic deaths), low nuts/seeds (59,374; 8.5%), high processed meats (57,766; 8.2%), low seafood omega-3 fats (54,626; 7.8%), low vegetables (53,410; 7.6%), low fruits (52,547; 7.5%), and high SSBs (51,694; 7.4%).
  • By age, SSBs were the leading estimated factor associated with cardiometabolic mortality between ages 25-64 years and sodium at age 65 years or older.
  • Between 2002 and 2012, population-adjusted US cardiometabolic deaths per year decreased by 26.5%.


Micha R, Peñalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA. 2017;317(9):912-924. doi:10.1001/jama.2017.0947.


Almost half of all cardiometabolic deaths in the US are due to suboptimal intakes of 10 dietary factors. It is interesting to note that some cardiometabolic deaths are due to eating too much unhealthy food, including too much salt, soda, and processed meats, but almost half of the estimated deaths are due to inadequate consumption of healthy foods such as vegetables, fruits, seafood, and nuts/seeds. If the current obesity epidemic (which leads to an increase in diabetes, heart disease, and stroke) is to be turned around, an approach that emphasizes healthy eating and exercise is the only real answer. —Neil Skolnik, MD