Association Between Diet and Cardiometabolic Mortality

Study Questions:

Are specific dietary factors associated with risk for cardiometabolic mortality?


Data from the National Health and Nutrition Examination Surveys (NHANES) (1999-2002 and 2009-2012) were used for the present analysis. Comparative risk assessment models, which included population demographics and dietary habits, were used to estimate the associations between diet and cardiometabolic disease. A meta-analysis of prospective studies and clinical trials was also used to estimate associations between diet and disease. Disease-specific national mortality rates were collected from the National Center for Health Statistics, as well as from a meta-analysis of prospective studies. Dietary factors included the consumption of 10 foods/nutrients associated with cardiometabolic diseases: fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages, polyunsaturated fats, seafood omega-3 fats, and sodium. The primary outcomes were estimated absolute and percentage mortality due to heart disease, stroke, and type 2 diabetes in 2012. Disease-specific and demographic-specific (age, sex, race, and education) mortality and trends between 2002 and 2012 were also evaluated.


A total of 8,104 adults from NHANES (1999-2002) and 8,516 from NHANES (2009-2012) were included in this analysis. In 2012, 702,308 cardiometabolic deaths occurred in US adults, including 506,100 from heart disease (371,266 coronary heart disease, 35,019 hypertensive heart disease, and 99,815 other cardiovascular disease), 128,294 from stroke (16,125 ischemic, 32,591 hemorrhagic, and 79,578 other), and 67,914 from type 2 diabetes. Of these, an estimated 318,656 (95% uncertainty interval, 306,064–329,755; 45.4%) cardiometabolic deaths per year were associated with suboptimal intakes, including 48.6% of cardiometabolic deaths in men and 41.8% in women. Younger ages (25-34 years) had higher cardiometabolic mortality rates (associated with surgery-sweetened beverages and processed meats) than older adults. Blacks (53.1%) and Hispanics (51.6%) had approximately 503% mortality rates, while whites had lower rates (42.8%). The largest numbers of estimated diet-related cardiometabolic deaths were related to high sodium (9.5% of all cardiometabolic deaths), low nuts/seeds (8.5%), high processed meats (8.2%), low seafood omega-3 fats (7.8%), low vegetables (7.6%), low fruits (7.5%), and high sugar-sweetened beverages (7.4%). Between 2002 and 2012, population-adjusted US cardiometabolic deaths per year decreased by 26.5%. After accounting for declines in total cardiometabolic mortality, reductions in diet-associated mortality were related to improvements in sugary-beverage intake and insufficient polyunsaturated fats.


The authors concluded that dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.


These data suggest that continued improvement in diet, including reducing sodium and sugary beverage intake, would result in significant improvements in cardiometabolic mortality.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet, Hypertension

Keywords: Coronary Disease, Diabetes Mellitus, Type 2, Diet, Fatty Acids, Omega-3, Fruit, Heart Diseases, Hypertension, Ischemia, Intracranial Hemorrhages, Metabolic Syndrome X, Mortality, Nuts, Primary Prevention, Risk Assessment, Sodium, Stroke, Sweetening Agents, Vegetables

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