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. 2019 Dec 17;16(12):e1002981.
doi: 10.1371/journal.pmed.1002981. eCollection 2019 Dec.

Cardiometabolic disease costs associated with suboptimal diet in the United States: A cost analysis based on a microsimulation model

Thiago Veiga Jardim  1   2 , Dariush Mozaffarian  3 , Shafika Abrahams-Gessel  2 , Stephen Sy  2 , Yujin Lee  3 , Junxiu Liu  3 , Yue Huang  3 , Colin Rehm  4 , Parke Wilde  3 , Renata Micha  3 , Thomas A Gaziano  1   2
Affiliations

Cardiometabolic disease costs associated with suboptimal diet in the United States: A cost analysis based on a microsimulation model

Thiago Veiga Jardim et al. PLoS Med. .

Abstract

Background: Poor diet is a leading risk factor for cardiometabolic disease (CMD) in the United States, but its economic costs are unknown. We sought to estimate the cost associated with suboptimal diet in the US.

Methods and findings: A validated microsimulation model (Cardiovascular Disease Policy Model for Risk, Events, Detection, Interventions, Costs, and Trends [CVD PREDICT]) was used to estimate annual cardiovascular disease (fatal and nonfatal myocardial infarction, angina, and stroke) and type 2 diabetes costs associated with suboptimal intake of 10 food groups (fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages, polyunsaturated fats, seafood omega-3 fats, sodium). A representative US population sample of individuals aged 35-85 years was created using weighted sampling from National Health And Nutrition Examination Surveys (NHANES) 2009-2012 cycles. Estimates were stratified by cost type (acute, chronic, drug), sex, age, race, education, BMI, and health insurance. Annual diet-related CMD costs were $301/person (95% CI $287-$316). This translates to $50.4 billion in CMD costs (18.2% of total) for the whole population, of which 84.3% are attributed to acute care ($42.6 billion). The largest annual per capita costs are attributed to low consumption of nuts/seeds ($81; 95% CI $74-$86) and seafood omega-3 fats ($76; 95% CI $70-$83), and the lowest are attributed to high consumption of red meat ($3; 95% CI $2.8-$3.5) and polyunsaturated fats ($20; 95% CI $19-$22). Individual costs are highest for men ($380), those aged ≥65 years ($408), blacks ($320), the less educated ($392), and those with Medicare ($481) or dual-eligible ($536) insurance coverage. A limitation of our study is that dietary intake data were assessed from 24-hour dietary recall, which may not fully capture a diet over a person's life span and is subject to measurement errors.

Conclusions: Suboptimal diet of 10 dietary factors accounts for 18.2% of all ischemic heart disease, stroke, and type 2 diabetes costs in the US, highlighting that timely implementation of diet policies could address these health and economic burdens.

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Conflict of interest statement

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.

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