Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in the United States.
Level 3 - non-randomized controlled study
Comparative risk assessment modeling study combining national survey data with meta-analyses of cohorts and trials (design analogy).
PubMed 28267855 · doi:10.1001/jama.2017.0947
What was done
A comparative risk assessment model evaluated the proportion and absolute number of US cardiometabolic deaths (heart disease, stroke, type 2 diabetes) attributable to 10 dietary factors in 2012, along with trends from 2002 to 2012. Population demographics and dietary habits were drawn from NHANES (1999–2002: n = 8,104; 2009–2012: n = 8,516). Relative risk estimates for diet-disease pairs were derived from meta-analyses of prospective cohort studies and clinical trials. Mortality data were obtained from the National Center for Health Statistics. The 10 factors were fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), polyunsaturated fats, seafood omega-3 fats, and sodium.
What was found
In 2012, 702,308 cardiometabolic deaths occurred in US adults (506,100 from heart disease, 128,294 from stroke, and 67,914 from type 2 diabetes). An estimated 318,656 (95% UI, 306,064–329,755; 45.4%) of these deaths per year were associated with suboptimal intake of the 10 dietary factors. Diet-attributable mortality was higher in men (48.6%) than women (41.8%), at younger ages (64.2% at 25–34 years vs 35.7% at ≥75 years), among Black (53.1%) and Hispanic (50.0%) vs white individuals (42.8%), and among low-education (46.8%) vs high-education individuals (39.1%). The largest estimated mortality burdens were from high sodium (66,508 deaths; 9.5% of 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%). Between 2002 and 2012, overall cardiometabolic deaths decreased by 26.5%, with the greatest dietary-associated declines for polyunsaturated fat deficiency (-20.8%) and nuts/seeds (-18.0%), while mortality associated with unprocessed red meat increased (+14.4%).
Why it matters
This study provides national estimates showing that nearly half of US cardiometabolic deaths in 2012 were attributable to suboptimal dietary habits, highlighting specific targets for intervention and substantial demographic disparities.
Limits
The findings rely on comparative risk assessment modeling rather than direct prospective intervention, assuming causal relationships from meta-analyses of mostly observational studies. Dietary intake data depended on self-reported 24-hour recalls in NHANES, which are prone to measurement error and recall bias. Only 10 specific dietary components were evaluated.
Cited by
- contradicts Food- and diet-related chronic disease kills over one million people annually in the United States.