In 2012, more than 45 percent of cardiometabolic deaths in the U.S. were associated with suboptimal intakes of 10 dietary factors, according to a comparative risk assessment model.

Men, younger patients, blacks, Hispanics and people with lower education levels were more likely to have a larger diet-related mortality.

Lead researcher Renata Micha, RD, PhD, of the Tufts Friedman School of Nutrition Science and Policy in Boston, and colleagues published their results online in JAMA on March 7.

The researchers developed the model by using population demographics and dietary habits from the National Health and Nutrition Examination Surveys, the National Center for Health Statistics and meta-analyses of prospective studies and clinical trials.

They considered the following 10 dietary factors: fruits excluding fruit juices, vegetables including legumes, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages, polyunsaturated fats, seafood omega-3 fats and sodium.

In 2002 and 2012, national intakes of each of the dietary factors were suboptimal, according to the researchers. They added that in 2012, there were 702,308 cardiometabolic deaths in U.S. adults, including 506,100 due to heart disease, 128,294 from stroke and 67,914 from type 2 diabetes.

The model estimated that the 10 dietary factors were associated with 45.4 percent of the cardiometabolic deaths in the U.S. in 2012. The largest numbers of estimated diet-related cardiometabolic deaths were related to high sodium (9.5 percent of all cardiometabolic deaths), low nuts/seeds (8.5 percent), high processed meats (8.2 percent), low seafood omega-3 fats (7.8 percent), low vegetables (7.6 percent), low fruits (7.5 percent), and high sugar-sweetened beverages (7.4 percent). The lowest estimated mortality burdens were associated with low polyunsaturated fats (2.3 percent od all cardiometabolic deaths) and high unprocessed red meats (0.4 percent).

Between 2002 and 2012, the number of population-adjusted cardiometabolic deaths per year in the U.S. decreased by 26.5 percent and the number of diet-related cardiometabolic deaths decreased for all dietary factors, according to the researchers.

The researchers acknowledged a few potential limitations, including that the model did not prove that changes in dietary habits reduce the disease risk. They also said measurement error could limit the estimated relative risk of each dietary factor. In addition, they measured dietary habits via self-reported 24-hour recalls, which could be subject to recall error.

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