Nearly one-half of all deaths from heart disease, stroke, and type 2 diabetes are associated with suboptimal intake of dietary factors, according to a study published in JAMA.

Renata Micha, RD, PhD, from the Tufts Friedman School of Nutrition Science and Policy in Boston, and colleagues, conducted a comparative risk assessment study based on dietary habits from the National Health and Nutrition Examination Surveys (NHANES) conducted from 1999 to 2012.

Probable or convincing evidence was identified for associations of 17 dietary factors with coronary heart disease (CHD), stroke, type 2 diabetes, body mass index (BMI), or systolic blood pressure. Of these, 10 were included: fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), polyunsaturated fats, seafood omega-3 fats, and sodium. All dietary factors were adjusted for energy intake to reduce measurement error and account for potential differences in body size, lean mass, metabolic efficiency, and physical activity.

The primary outcome was 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 trends between 2002 and 2012 were also evaluated.

In 2012, 702,308 cardiometabolic deaths occurred in US adults, including 506,100 from heart disease, 128,294 from stroke, and 67,914 from type 2 diabetes. Of these, an estimated 318,656 cardiometabolic deaths per year were associated with suboptimal intakes—48.6% in men and 41.8% in women; 64.2% at younger ages (25-34 years) and 35.7% at older ages (>75 years); 53.1% among blacks, 50% among Hispanics, and 42.8% among whites; and 46.8% among lower-educated persons, 45.7% among medium-educated persons, and 39.1% among higher-educated individuals.

The largest numbers of estimated diet-related cardiometabolic deaths were related to high sodium intake (66,508 deaths in 2012), low nuts/seeds (59,374), low vegetables (53,410), low fruits (52,547), and high SSBs (51,694). Between 2002 and 2012, population-adjusted US cardiometabolic deaths per year decreased by 25.6%. The greatest decline was associated with insufficient polyunsaturated fats (-20.8% relative change), nuts/seeds (-18.0%), and excess SSBs (-14.5%). The greatest increase was associated with unprocessed red meats (+14.4%).

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


  1. Micha R, Peñalvo JL, Cudhea F, et al. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA. 7 March 2017. doi: 10.1001/jama.2017.0947