Cardiometabolic Disease: How Much Does Diet Matter?

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A recent report by The Journal of the American Medical Association (JAMA) looks at the relationship between dietary factors and heart disease, stroke, and diabetes-related deaths in the United States

Heart disease, stroke, and type 2 diabetes collectively caused 702,308 deaths in the United States in 2012.[1] Each of these conditions has been demonstrated to have associations with dietary intake, but a larger assessment of this effect had not been undertaken – until now. In a recent study published by JAMA, the consumption of 10 different dietary components was analyzed to determine which foods and nutrients were associated with an increased risk of death from cardiometabolic conditions.

From this undertaking, it was found that almost half of the deaths were associated either with overconsumption of sodium or sugar, or with low intakes of nutritious foods, such as those providing vitamins or omega-3 fatty acids. Within the 10 categories, the largest numbers of diet-related cardiometabolic deaths were related to high sodium, low nuts/seeds, high processed meats, low seafood omega-3 fats, low vegetables, low fruits, and high sugar-sweetened beverage consumption, in that order. Typically, these diet changes occur in tandem, with “junk” foods replacing more nutritious alternatives. Notably, almost two-thirds of the cardiometabolic deaths at young ages (25 – 34 years) were related to suboptimal dietary intakes across all food categories. With the incidence of juvenile diabetes and non-alcoholic fatty liver disease also on the rise,[2],[3] these statistics are seriously concerning.

On the good news side, the number of population-adjusted cardiometabolic deaths decreased by 26.5% from 2002 to 2012. In that same period, improvements in dietary quality were seen, including increased consumption of polyunsaturated fats, nuts and seeds, whole grains, and fruit. Excess intake of sugar-sweetened beverages – which was the third leading dietary-related risk factor of cardiometabolic death in 2002 – also dropped over the 10-year period. The trends suggest that the cries of health professionals concerning diet quality are being heard.

What’s holding us back? A look at the cost of a healthy diet

Many factors contribute to dietary selections including time, availability, and personal preferences, but one often-cited factor is cost. However, an assessment of the cost of eating healthy at a single meal shows that cost is not always a valid argument.[4] Findings from this study were that the cost of a home-prepared meal containing baked chicken breast, sweet potato, and vegetables from a variety of phytonutrient color groups ($3.00) was less than half the cost of a fast food meal containing a burger, fries, soda, and dessert ($6.28). The nutritional content of the home-prepared meal is far more complete, and although food preparation takes more time, the cost was far lower.

The cost of a home-prepared meal containing chicken, sweet potato, and vegetables from a variety of phytonutrient color groups ($3.00) was less than half the cost of a fast food meal containing a burger, fries, soda, and dessert ($6.28)

A short documentary titled Food Stamped also surveys the cost of eating healthy, and is worth viewing if access can be obtained (available by video and Netflix).[5] The documentary follows a couple who take on the challenge of eating healthy on a government-subsidized, food-stamp budget (approximately $1.00 – $1.50 per meal). Considering the cost of the meal prepared in the previous example, this amount of funding is not adequate for making the chicken paired with vegetables and sweet potato unless the cost of the other daily meals was dramatically reduced.

On a food-stamp budget it becomes necessary to buy in bulk and rely on cheaper protein sources such as beans and legumes. Moreover, unless one has access to a garden plot, there often is less natural color and lower phytonutrients in the diet. The analysis sheds light on why socioeconomic factors still influence health: the finances necessary to purchase healthy foods are sometimes not available.

Summary

Although diet quality has improved in recent decades, a large number of cardiometabolic deaths are still attributable to poor diet. In individuals with a suboptimal diet, disease risks can be reduced by increasing one’s consumption of nuts and seeds, fruits, vegetables, and seafood omega-3 fats, while decreasing the intake of salty foods (sodium) and sugar-sweetened beverages. The nutritional quality of home-prepared meals is typically more complete than fast foods or restaurant meals, and the cost – and calorie count – is far lower.

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