What you choose to eat every day has a major impact on your cardiovascular health. But did you know that your dietary choices – combined with those of everyone else in this country – also have a big impact on our nation’s economic health?
”About 45% of the cost associated with heart disease, stroke, and diabetes – what we call cardiometabolic disease – is related to an unhealthy diet,” says cardiologist Dr. Thomas A. Gaziano, associate professor of medicine at Harvard Medical School. Here’s the key thing to know about an unhealthy diet: what you’re not eating may be just as important as what you’re eating.
That’s what he and colleagues discovered when they analyzed the effect of 10 types of food (including fruits, vegetables, nuts, sugary drinks, and processed meats) to estimate the annual cost of cardiometabolic diseases linked to consuming less-than-optimal diets. They chose foods and nutrients known to have either positive or negative effects on risk factors linked to heart disease, based on the best available evidence.
”Food affects things like blood pressure, blood sugar, and obesity. We wanted to know what benefits people would get by eating the right amount of specific foods,” Dr. Gaziano. (See ”A heart-healthy diet: Which foods and how much?”)
A heart-healthy diet: Which foods and how much?
Foods highlighted in blue are the minimum amounts considered to be healthy; eat at least the suggested amounts. Foods highlighted in red are the maximum amounts considered to be healthy; eat no more than the suggested amounts. (Polyunsaturated fats are a special case; see note.)
Suggested daily amount
Number of servings
Nuts and seeds
20 grams (0.7 ounces)
One a day
2 tablespoons of mixed nuts (walnuts, pecans, peanuts, cashews) or seeds (sesame, flax, sunflower, pumpkin)
Seafood omega-3 fatty acids
One to two servings a week
3 to 4 ounces of fatty fish such as salmon, mackerel, herring; canned tuna *
400 grams (14 ounces)
About five a day
1 cup dark green leafy vegetables (kale, spinach, broccoli); ½ cup chopped cucumber, peppers, squash
300 grams (10.6 ounces)
About four a day
1 medium orange, apple, pear; 1/2 cup of berries, grapes, cubed melon
125 grams (4.4 ounces)
One a day
1/2 cup brown rice or oatmeal; slice of whole-grain bread
Polyunsaturated fats **
11% of total calories
About 2 tablespoons
Canola, soybean, and sunflower oil
14.3 grams (0.5 ounces)
One to two servings a week
Lean beef, lamb, or pork
Bologna, salami, bacon, hot dogs
Savory processed foods and snacks contain the most; check the Nutrition Facts panel
Sodas, sports drinks, lemonade, bottled iced tea, coffee drinks
* See main story for vegetarian alternatives.
** In addition to the oils listed, nuts, seeds, avocados, and some fish are also high in polyunsaturated fats. These fats help lower harmful LDL cholesterol and other risks of cardiometabolic disease when eaten in place of saturated fat or carbohydrates.
Diet and cost analysis
The researchers relied on data from the National Health and Nutrition Examination Survey (NHANES) to create a representative sample of adults ages 35 to 85 living in the United States. Based on the respondents’ eating habits, they analyzed their risk of cardio-metabolic diseases and calculated the associated costs, using a model they developed called CVD PREDICT. Then they recalculated the costs, assuming that people instead ate the healthiest amounts of the 10 foods and nutrients. The conclusion: Each year, unhealthy diets cost the United States an average of about $ 300 per person in medical costs for cardiometabolic disease. That translates to more than $ 50 billion nationwide. By far, the greatest costs (about 84%) are for acute care – that is, the price of treating heart attacks and strokes, including paying for all of the staff, testing, and procedures in emergency departments and hospitals. The study was published last year in PLOS Medicine .
Which dietary habits matter most? A less-than-optimal intake of nuts, seeds, and seafood omega-3 fatty acids, all of which are rich in heart-healthy fats. Nuts and seeds are also good sources of fiber as well as vitamins and minerals. Fatty fish such as salmon and mackerel are the richest sources of omega-3s. But for people who don’t eat fish, many experts say that plant-based sources (such as flaxseed, walnuts, pumpkin seeds, and soybean or canola oil) are just as good. No surprise: eating plenty of vegetables and fruits was also linked to lower costs, as was a daily serving of whole grains.
As for foods to avoid, the two biggest contributors to higher costs were sugar-sweetened beverages (such as sodas, fruit drinks, and sweetened teas) and processed meats (such as hot dogs, bacon, salami, ham, and sausages).
From a purely economic viewpoint, the three other dietary components under study – red meat, sodium, and polyunsaturated fats – didn’t make much of a difference. But from a personal health perspective, aiming for the optimal amounts is a good idea, according to most nutrition experts.
”If you really want to optimize your cardiovascular health, you could aim for ideal amounts in all 10 categories,” Dr. Gaziano. Or you could pick one or two categories where you’re furthest from the ideal and focus on them, he says. Think buying healthy foods (especially salmon, but also nuts and fresh produce) is too expensive? Don’t forget that you can save money by keeping processed meats and sodas out of your shopping cart.
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