Table 2.
Cardiometabolic Deaths Among US Adults Aged ≥25 Years Associated With Suboptimal Dietary Habits in 2012
| Cardiometabolic Disease by Dietary Factor (Suboptimal Intake Level)a | Associated Deaths/y, No. (95% UI)b | Total Disease-Specific Deaths/y, %b |
|---|---|---|
| Overall Suboptimal Dietc | ||
| Heart disease | 223 960 (211 689–234 444) | 44.3 (41.8–46.3) |
| CHD | 197 981 (187 580–207 070) | 53.3 (50.5–55.8) |
| Hypertensive heart disease | 7958 (7158–8792) | 22.7 (20.4–25.1) |
| Other CVDd | 7449 (6858–8109) | 7.5 (6.9–8.1) |
| Stroke | 66 547 (62 799–69 915) | 51.9 (48.9–54.5) |
| Ischemic | 7170 (6412–7779) | 44.5 (39.8–48.2) |
| Hemorrhagic | 19 863 (18 301–21 265) | 60.9 (56.2–65.2) |
| Other | 39 289 (35 902–42 399) | 49.4 (45.1–53.3) |
| Diabetes | 32 732 (30 803–34 568) | 48.2 (45.4–50.9) |
| Total cardiometabolic disease | 318 656 (306 064–329 755) | 45.4 (43.6–47) |
| Fruits (<300 g/d) | ||
| CHD | 23 865 (18 658–28 884) | 6.4 (5.0–7.8) |
| Stroke | 28 741 (25 609–31 682) | 22.4 (20–24.7) |
| Ischemic | 1920 (1602–2267) | 11.9 (9.9–14.1) |
| Hemorrhagic | 10 317 (8661–11 823) | 31.7 (26.6–36.3) |
| Other | 16 470 (13 671–19 119) | 20.7 (17.2–24) |
| Total cardiometabolic disease | 52 547 (46 557–58 706) | 7.5 (6.6–8.4) |
| Vegetables (<400 g/d) | ||
| CHD | 25 443 (20 252–30 895) | 6.9 (5.5–8.3) |
| Stroke | 28 039 (23 525–31 941) | 21.9 (18.3–24.9) |
| Ischemic | 3466 (2567–4208) | 21.5 (15.9–26.1) |
| Hemorrhagic | 8041 (5987–9897) | 24.7 (18.4–30.4) |
| Other | 16 584 (12 721–20 123) | 20.8 (16–25.3) |
| Total cardiometabolic disease | 53 410 (46 290–60 398) | 7.6 (6.6–8.6) |
| Nuts/Seeds (<20.2 g/d) | ||
| CHD | 54 591 (46 447–63 554) | 14.7 (12.5–17.1) |
| Diabetes | 4732 (3763–5715) | 7.0 (5.5–8.4) |
| Total cardiometabolic disease | 59 374 (51 211–68 422) | 8.5 (7.3–9.7) |
| Whole Grains (<125 g/d) | ||
| CHD | 16 169 (11 749–20 833) | 4.4 (3.2–5.6) |
| Stroke | 13 449 (11 539–15 160) | 10.5 (9–11.8) |
| Ischemic | 1618 (1205–2072) | 10 (7.5–12.8) |
| Hemorrhagic | 4024 (3172–4810) | 12.3 (9.7–14.8) |
| Other | 7774 (6211–9233) | 9.8 (7.8–11.6) |
| Diabetes | 11 639 (10 102–13 143) | 17.1 (14.9–19.4) |
| Total cardiometabolic disease | 41 311 (36 141–46 360) | 5.9 (5.1–6.6) |
| Red Meats, Unprocessed (>14.3 g/d) | ||
| Diabetes | 2869 (2091–3694) | 4.2 (3.1–5.4) |
| Total cardiometabolic disease | 2869 (2091–3694) | 0.4 (0.3–0.5) |
| Processed Meats (>0 g/d) | ||
| CHD | 45 637 (35 048–56 391) | 12.3 (9.4–15.2) |
| Diabetes | 11 900 (10 070–13 833) | 17.5 (14.8–20.4) |
| Total cardiometabolic disease | 57 766 (47 220–68 866) | 8.2 (6.7–9.8) |
| Sugar-Sweetened Beverages (>0 g/d) | ||
| Heart disease | 40 552 (35 643–45 841) | 8.0 (7.0–9.1) |
| CHD | 39 937 (34 992–45 204) | 10.8 (9.4–12.2) |
| Hypertensive heart disease | 616 (433–830) | 1.8 (1.2–2.4) |
| Stroke | 916 (809–1028) | 0.7 (0.6–0.8) |
| Ischemic | 82 (69–98) | 0.5 (0.4–0.6) |
| Hemorrhagic | 405 (342–479) | 1.2 (1.1–1.5) |
| Other | 426 (345–512) | 0.5 (0.4–0.6) |
| Diabetes | 10 043 (8419–11 979) | 14.8 (12.4–17.6) |
| Total cardiometabolic disease | 51 694 (46 363–57 156) | 7.4 (6.6–8.1) |
| PUFAs Replacing Carbohydrates or Saturated Fats (<11% Energy/d)e | ||
| CHD | 16 025 (13 280–18 925) | 4.3 (3.6–5.1) |
| Total cardiometabolic disease | 16 025 (13 280–18 925) | 2.3 (1.9–2.7) |
| Seafood omega-3 Fats (<250 mg/d) | ||
| CHD | 54 626 (45 541–65 053) | 14.7 (12.3–17.5) |
| Total cardiometabolic disease | 54 626 (45 541–65 053) | 7.8 (6.5–9.3) |
| Sodium (>2000 mg/d)f | ||
| Heart disease | 52 711 (44 681–60 826) | 10.4 (8.8–12) |
| CHD | 37 744 (29 879–45 697) | 10.2 (8.0–12.3) |
| Hypertensive heart disease | 7505 (6627–8325) | 21.4 (18.9–23.8) |
| Other CVDd | 7439 (6859–8105) | 7.5 (6.9–8.1) |
| Stroke | 13 787 (12 018–15 870) | 10.7 (9.4–12.4) |
| Ischemic | 1629 (1349–1928) | 10.1 (8.4–12) |
| Hemorrhagic | 4011 (3306–4780) | 12.3 (10.1–14.7) |
| Other | 8131 (6580–10 023) | 10.2 (8.3–12.6) |
| Total cardiometabolic disease | 66 508 (58 500–74 840) | 9.5 (8.3–10.7) |
Abbreviations: CHD, coronary heart disease; CVD, cardiovascular disease; PUFA, polyunsaturated fat; UI, uncertainty interval.
Based on the National Center for Health Statistics, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (eTable 11 in the Supplement). Cardiometabolic diseases included heart disease (the sum of CHD, hypertensive heart disease, and other CVD, including rheumatic heart disease, cardiomyopathy and myocarditis, atrial fibrillation and flutter, aortic aneurysm, peripheral vascular disease, endocarditis, and other cardiovascular and circulatory diseases), stroke (including ischemic, hemorrhagic, and other stroke [unclassified stroke or sequelae of stroke not specified as hemorrhage or infarction]), and type 2 diabetes. Diabetes deaths are those coded as proximally due to diabetes; diabetes is also separately a risk factor for CVD deaths along with other risk factors such as smoking, high blood pressure, high cholesterol, obesity, physical inactivity, etc.
Calculated from a total of 702 308 total US cardiometabolic deaths in 2012. Because each value represents central estimates from 1000 Monte Carlo simulations (see Methods section of text and eAppendix 1 in the Supplement), the subtype estimates may not sum perfectly to the total number. Deaths due to hypertensive heart disease were estimated from relationships with blood pressure (sodium) or body mass index (sugar-sweetened beverages) and deaths due to other CVD from relationships with blood pressure (sodium) (eTable 5 in the Supplement).
Based on the joint (multiplicative) population attributable fraction21 for the factors in this Table. For this, we used PUFAs replacing saturated fats rather than carbohydrates to be more conservative when estimating joint associations and excluded CHD estimates for processed meat because this relationships may be mainly driven by sodium content,22 already separately included.
For findings for subtypes of other CVD deaths, see eTable 14 in the Supplement.
Associated mortality was similar for insufficient PUFAs in place of saturated fats alone: 14 382 CHD deaths (95% UI, 11 732-17 079), representing 3.9% of CHD deaths (95% UI, 3.2%–4.6%) and 2.0% of total cardiometabolic disease deaths (95% UI, 1.7%–2.4%). In sensitivity analyses, we also modeled mortality associated with excess saturated fats (>10%) in place of PUFAs: 4244 CHD deaths (95% UI, 3366-5278), representing 1.1% of CHD deaths (95% UI, 0.9%–1.4%) and 0.6% of total cardiometabolic disease deaths (95% UI, 0.5%–0.8%).
Based on effects of sodium on systolic blood pressure in randomized trials, including by age, race, and hypertension status (eAppendix 1 and eTable 5 in the Supplement) and associations of blood pressure with heart disease and stroke by age (eTable 5 in the Supplement).7,14