10 foods that may impact your risk of dying from heart disease, stroke, and type 2 diabetes

Could just 10 foods substantially impact your risk of dying from a cardiometabolic disease (CMD) like type 2 diabetes, heart disease, or stroke? Maybe.

A study published in JAMA provides some insight into the degree to which 10 specific foods and nutrients affect the risk of dying from CMD. The study found that in 2012, eating suboptimal levels of 10 foods or nutrients — too much of some and not enough of others — was associated with more than 45% of deaths due to type 2 diabetes, heart disease, and stroke.

10 foods associated with nearly half of CMD deaths

The researchers developed a risk assessment model that combined and analyzed data from three sources. They estimated dietary intakes of foods and nutrients using self-reported data from the National Health and Nutrition Examination Survey (NHANES); they used studies and clinical trials to estimate associations of the 10 dietary factors with CMD; and they estimated deaths due to CMD in 2012 from the National Center for Health Statistics.

Optimal consumption levels for the dietary factors were consistent with the lowest disease risk in research trials and with major dietary guidelines.

In 2012, 702,308 CMD deaths occurred in the United States. The researchers estimated that 45.4% of these deaths were associated with suboptimal intakes of the 10 foods and nutrients they had studied.

Too much, not enough, or just right?

Not eating enough of the following foods and nutrients was estimated to contribute to the corresponding percentage of CMD deaths:

  • nuts and seeds (8.5%)
  • seafood-based omega-3 fats (7.8%)
  • vegetables (7.6%)
  • fruits (7.5%)
  • whole grains (5.9%)
  • polyunsaturated fats in place of saturated fat or carbohydrates (2.3%).

Eating too much of the following foods and nutrients was estimated to contribute to the corresponding percentage of CMD deaths:

  • sodium (9.5%)
  • processed meat (8.2%)
  • sugar sweetened beverages (7.4%)
  • unprocessed red meat (0.4%).

A word of caution

As with any study, there are some limitations. The comparative risk model is not a cause-and-effect model, and it does not prove that changing intakes of these foods and nutrients would reduce CMD disease risk.

In addition, the particular health effect of each food or nutrient on any individual could be affected by a number of factors including other dietary habits, age, sex, level of physical activity, and genetics.

Still, it’s safe to say that everyone has some room for improvement in their diet.

Eat more of these foods and nutrients

Nuts and seeds: Goal = 1 ounce (1/4 cup) per day. Add to oatmeal, whole grain cereal, or salads. Try 1/4 cup as an afternoon snack.

Seafood: Goal = 12 ounces per week. Make a sardine or tuna sandwich during the week. Grill or broil seafood kabobs for dinner. Order fish when you eat out.

Vegetables: Goal = 5 servings per day (1 serving = 1 cup raw or 1/2 cup cooked veggies). Steam, grill or stir-fry vegetables to preserve all their nutrients, or eat them raw. Fill at least half your plate with vegetables.

Fruits: Goal = 4 servings per day (1 serving = 1 medium fresh fruit). Try to have fruit at each meal or between meals. Frozen fruit is also a good option.

Whole grains: Goal = 4 servings per day (1 serving = 1 slice whole grain bread or 1/2 cup cooked whole grains). Try a variety of whole grains such as barley, millet, quinoa, bulgur, brown rice, or farro. Make ahead, keep refrigerated, and heat for a warm side or add cold to a salad.

Polyunsaturated fats in place of saturated fat or carbohydrates: Goal = replace at least 11% of calories from saturated fat or carbohydrates with calories from polyunsaturated fats (the equivalent of about two tablespoons of a healthy oil for someone consuming 1,800 calories per day). Try heathy oils such as canola or olive oil in place of butter. Eat a small spoonful of nut butter instead of a piece of white toast for a midmorning snack.

Eat less of these foods and nutrients

Sodium: Goal = less than 2,000 milligrams per day. Limit intake of processed, packaged, and fast foods, as well as condiments such as soy sauce, bottled salad dressings, and barbecue sauce. Cut back on the American Heart Association’s Salty Six: breads and rolls, pizza, sandwiches, cold cuts and cured meats, soups, and burritos and tacos.

Processed meats: Goal = 0 servings per day. Put chicken or tuna in your sandwiches instead of bologna, ham, salami, or hot dogs. Or try plant-based fillings like beans or nut butters.

Sugar sweetened beverages: Goal = 0 servings per day. Instead of sports drinks, sugar-sweetened coffees and teas, or soda, infuse a large pitcher of water with slices of oranges, lemon, lime, or berries. Plain tea, coffee, and seltzer water are also great substitutes.

Red meat: Goal = less than 4 ounces per week. Use red meat more as a side and not as the main attraction (a small amount of lean meat in a veggie-heavy stir fry, for example). Go meatless one night per week.


  1. Lisa Chierici

    What do those numbers mean? What is “not enough” or “too much”? .4% increased risk? I know that .4% means 4 out of 1,000, so how does that correlate to risk? 4 of 1,000 people who eat “too much” red meat will die from CMD? If so, then 996 people who eat too much red meat won’t die from CMD?

    I believe moderation and variety are key. Try to make sure most of what you eat has some nutritional value and eat fresh whenever possible. Extreme diets, eg. all-meat diets, all processed food diets, all raw food diets, no fat diets, no sugar diets, – are all ridiculous.

    • Eliza Mbamba

      My understanding is that the number means the contribution to the total risk of dying from CMD. That is if the risk of dying from CMD is increased by 100%, ‘not eating nuts’ contributes 0.4% to that risk.

  2. Betsy Logsdon

    Every time I read the amount and the number of servings of fruits, vegetables and whole grains that are recommended per day I wonder how this is possible and who these people are who eat that much food!
    My husband and I are not big eaters perhaps that’s the explanation. Our dinner plate consists of the entree, two vegetables and a small tomato or perhaps a salad, plus a glass of milk. I choose from three breakfasts: 1/4 cup blueberries, 1/3 cup walnuts and sliced almonds and one tablespoon ground flaxseed with 1/2 cup yogurt or cottage cheese and a small fistful of bought cereal added for texture; or, two poached eggs with one slice of dark rye toast; or, one piece of buttered toasted dark rye with two tablespoons of peanut butter and a teaspoon of jelly. With breakfast I have 4 – 8 oz. glass of orange juice and a cup of tea or coffee, with one and 1/2 teaspoon of sugar.
    I eat my breakfast late morning and I have no lunch, nothing until dinner. I can’t imagine eating more. I am 83 years old, in good health, weigh 142 pounds and am 5’3.5″ tall. I am more comfortable when I weigh about five pounds less.
    What do you think? Should I really make an effort to eat more fruit or vegetables?

  3. Darrell D Birkey

    unprocessed red meat (0.4%).

    This is so low as to be insignificant.

  4. Douglas Gortner

    What doctors call research is generally count the people, count the intake, count the results. It is all correlation because they have not been rigorously trained in proper research techniques. I would be much more interested is reading about research studies done by professors of nutrition with doctorates in in biochemistry.

  5. Sylvia

    There have been important studies indicating that too little sodium, 2000mg and less as recommended by American Heart Assoc, means that a person could be consuming too litlle salt with all the problems that represents. Those studies recommend 3000mg plus just like most of us consume as we live healthy and well into our 80s and 90s. Table salt also gives us a healthy dose of chloride, which we need. Cheerio, and pass the salt.

  6. Sarah Rachel Wolf

    I am concerned with the fruit serving advice. 4 servings of fruit puts a person way over the 25 grams of sugar daily for the avarage woman and 35 grams for the avarage man. Many women would actually gain weight if eating that much fruit??

  7. Mark Headley

    Nope. Not safe to say everyone has room to improve her diet. And why despite contrary disclaimers assert these “affect the risk of dying”?

  8. TT

    I find it a little odd that eating too much unprocessed red meat is listed as a CMD contributor when it is 18.5 times less of a contributor than sugar sweetened beverages (next higher on the list). Seems like it is being unfairly categorized in the high risk behavior group.

  9. Kristin Russo

    This guide was very helpful. Thanks 🙏

  10. Andrew

    Canola Oil is a highly-refined product in which hexane is used for extraction.
    Avocado , olive or coconut are healthier choices.

  11. NEIL McCARTHY JR, Ph. D.

    If the authors of this study wish to effect dietary changes, I suggest they address the issues and data raised in G. Taubes “Good calories, Bad Calories” and various “Low Carb. conferences that contradict much of what is suggested here, ex the obviously needed reduction of sugar.

  12. Dr. Muhammad Sayed Inam

    Good post

  13. Mark

    Soon these articles will be updated inline with research that shows grains are unnecessary for a healthy diet and salt is not as evil as it is being made out when consumed in normal amounts disassociated with junk fried in vegetable oil foods. Meat is also being increasingly proven to be ok and not associated with Cardiovascular disease. You can read a book called A Fat lot of good which is medically researched advice and highlights the deficiencies in so much of the diet research that captures public awareness.

  14. Dr. Muhammad Sayed Inam

    Frozen fruit is also a good option.

    I think Fresh fruit is good

  15. Alan H. Balkany

    The article doesn’t address a few relevant concerns. Fish may have heavy-metal contaminants. It’s been alleged that Pacific-ocean fish may have radioactive elements from Fukushima, and Atlantic-ocean fish many have contaminants from Chernobyl.

    Other authors have claimed the average diet is TOO HIGH in polyunsaturated fats, and not high enough in monunsaturated fats.

    Also whole grains are also high in carbohydrates.

    A follow-up article that addresses these concerns would be informative.

  16. Anja Collette

    The recommendation to eat seafood ignores all of the harmful pollutants that are in seafood nowadays, such as heavy metals, PCB’s, and microplastics. The higher up on the food chain you eat, the more of these pollutants you ingest. There’s also the fact that our oceans are increasingly overfished, so eating seafood is not a sustainable recommendation at this point in time. Please take environmental factors into account when creating dietary recommendations.

  17. Vairavan Premakumar

    I consumed sodium indirectly through various foods. I feel that the healthiest diet patterns is important to reduce CMD. Thank you very much for your valuable informations.

  18. John Isgitt

    Why, in your opinion, are whole grains essential to good health? Can’t you get the nutrients provided by whole grains in non-grain foods?

  19. Sarah Wright

    I eat a carnivore, meat-only diet for my health.
    So your article is laughable to me.

    • Marie

      Cannot eat as much food as you are recommending. I do eat veggies and fruits everyday, just not the amounts you are telling me is healthy. Bumping into 90 years and not active enough to eat large quantities,

    • Karen Cohen MPH, RD

      Very informative blog. I liked your examples of substitutions.
      I would also advise folks who consume several of the foods contributing to CMD, to start slowing with one food at beverage change at a time.
      More likely to become a new habit that way.. Don’t get overwhelmed with changing all at once.
      Karen Cohen, MPH, RD

    • Marika

      It will be no laughing matter when that all-meat diet sends you to the ER or worse. Besides, it’s terrible for the environment (and your breath). Not sustainable. But dinosaurs didn’t know better either.

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