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

By: Katherine D. McManus, MS, RD, LDN, Contributor

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.