Suboptimal diet and cardiometabolic disease healthcare costs in the US

December 17, 2019

Approximately $50 billion dollars of the annual healthcare cost of cardiometabolic disease in the US population could be associated with poor diet, according to a research article published this week in the open access journal PLOS Medicine. The results of the study, conducted by Renata Micha and Thomas Gaziano of Tufts University and the Brigham and Women's Hospital, Boston, United States and colleagues, suggest that the highest costs associated with cardiometabolic disease may be attributable to suboptimal consumption of foods such as nuts and seeds, and seafood-derived omega-3 fats.

While unhealthy diet contributes to the risk of developing diseases such as type 2 diabetes, stroke, and coronary heart disease, the related healthcare costs are unknown. In the new study, which was part of the National Institutes of Health- funded Food-PRICE (Policy Review and Intervention Cost Effectiveness) Project to improve diet-related health in the US population, Micha, Gaziano and colleagues used a microsimulation modeling approach to estimate cardiometabolic disease costs associated with suboptimal consumption of ten food groups in US adults between 35 and 85 years of age. In their model, the authors incorporated dietary intake and cardiovascular disease risk factor data from the 2009-2012 National Health and Nutrition Examination Survey (NHANES), a program of studies assessing health and nutrition in the US.

The study estimated that the annual cardiometabolic disease cost associated with suboptimal diet is $301 per person, and $50.4 billion for the US population, corresponding to 18.2% of the total cardiometabolic disease cost. Further, the results suggest that the largest estimated annual costs per person are associated with lower than recommended consumption of foods such as nuts and seeds ($81), and omega-3 fats derived from seafood ($76). It is important to note that the study diet data are derived from individuals' recollections of recent food consumption, and could be subject to recall errors, or may not reflect an individual's long-term dietary habits.

These results suggest that improvements in diet may help to reduce the cost burden associated with cardiometabolic diseases in the US. The authors explain that the high costs attributable to specific dietary groups in this study, such as nuts and seeds, are in part related to the fact that individual consumption of these food components is relatively low, noting that "...from the economic perspective, intervention policies focused not just on the benefit or harm of dietary factors, but also focused on how far the population is from achieving ideal consumption are more likely to have economic benefit."
Research Article


This research was supported by the National Institutes of Health, National Heart, Lung, and Blood Institute [R01 HL130735 (RM)]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

I have read the journal's policy and the authors of this manuscript have the following competing interests: YH, JL, YL, PW, TAG, DM, and RM report grants from NIH during the conduct of the study. RM is PI of a research grant from Unilever on an investigator-initiated project to assess the effects of omega-6 fatty acid biomarkers on diabetes and heart disease. TAG reports research funding from Novartis unrelated to the submitted work; and all outside the submitted work, personal fees for consulting from the World Health Organization and Amgen. CR has consulted for the Dairy Management Institute, Unilever, Nestle, PepsiCo, and the Bell Institute (General Mills), all outside of the submitted work. In addition, RM reports personal fees from the World Bank and Bunge, and DM reports research funding from the National Institutes of Health and the Gates Foundation; and, all outside the submitted work, personal fees for ad hoc consulting from GOED, Nutrition Impact, Bunge, Indigo Agriculture, Amarin, Acasti Pharma, Cleveland Clinic Foundation, America's Test Kitchen, and Danone; scientific advisory board, DayTwo, Elysium Health, Filtricine, and Omada Health; and chapter royalties from UpToDate. This work was performed this investigation as part of the Food Policy Review and Intervention Cost Effectiveness (Food-PRICE) Study.


Jardim TV, Mozaffarian D, Abrahams-Gessel S, Sy S, Lee Y, Liu J, et al. (2019) Cardiometabolic disease costs associated with suboptimal diet in the United States: A cost analysis based on a microsimulation model. PLoS Med 16(12): e1002981.

Image Credit: marijana1, Pixabay

Author Affiliations:

Department of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
Office of Community and Population Health, Montefiore Medical Center, Bronx, New York, United States of America

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