Categorized dietary risks factors (sex, age)

Men risks:
- Excess processed meats (38 632 deaths [10.8% of all cardiometabolic deaths])
- Sodium (35 777 [10.0%]), SSBs (33 314 [9.3%]);
- Insufficient nuts/seeds (31 587 [8.8%])
- Insufficient Seafood omega-3 fats (31 545 [8.8%]).

Women risks
- Excess sodium (30 281 [8.8%])
- Insufficient nuts/seeds (27 721 [8.1%])
- Insufficient vegetables (25 592 [7.4%])
- Insufficient fruits (24 449 [7.1%])
- Insufficient omega-3 fats (23 032 [6.7%]).
By age, in 25- to 64-year-olds, excess SSBs and processed meats were the top estimated diet factors associated with cardiometabolic mortality; in 65-year-olds and older, these were excess sodium and insufficient nuts/seeds and vegetables
The highest estimated proportional deaths at youngest ages (<44 years) were associated with Sugar-sweetened beverages (SSBs) followed by processed meat, fruits, nuts/seeds, and vegetables;
At middle age (45-54 years), with SSBs, processed meat, nuts/seeds, and seafood omega-3 fats; and at oldest age (≥65 years), with sodium.
By race/ethnicity, estimated proportional diet-related mortality was higher among blacks or Hispanics for most dietary factors assessed (Figure 2; eFigure 3, eFigure 5, eFigure 6, and eTable 14 in the Supplement). For example, estimated cardiometabolic mortality associated with SSBs was nearly twice as high in blacks (12.6%; the leading factor) vs whites (6.4%), and from low nuts/seeds, higher in Hispanics (11.7%; the leading factor) vs whites (7.9%). One exception was omega-3 fat–associated proportional mortality, which was higher in whites (8.0%). Relative rankings of cardiometabolic mortality related to different dietary factors were otherwise generally similar by race/ethnicity. Overall, suboptimal diet was associated with 53.1% of total estimated cardiometabolic deaths among blacks, 50.0% among Hispanics, and 42.8% among whites (absolute differences, +10.5% [95% UI, 8.0%-12.7%] for blacks vs whites and +7.2% [95% UI, 4.8%-9.8%] for Hispanics vs whites).

Estimated proportional diet-related cardiometabolic mortality was generally higher among individuals with low or medium education compared with high education (Figure 2; eFigure 4, eFigure 5, eFigure 7, and eTable 14 in the Supplement). This was most notable for nuts/seeds (in low vs high education, 10.7% vs 6.2% of cardiometabolic deaths), SSBs (8.4% vs 4.5%), and fruits (8.5% vs 6.4%). Overall, suboptimal diet was associated with 46.8% of cardiometabolic deaths for lower-, 45.7% for medium-, and 39.1% for higher-educated adults (absolute differences, +7.7% [95% UI, 4.9%-10.4%] for low vs high and +6.7% [95% UI, 4.1%-9.0%] for medium vs high).
Relying on evidence from observational studies...carries the potential limitation of confounding bias


The editorial raises the possibility that the effect of confounding factors such as socioeconomic status and physical activity could be substantial. "For instance, it's possible that processed meat consumption merely reflects a Westernized dietary pattern.
This means that a single 200-calorie sugary drink may be OK for a person who typically consumes a 2,000 calorie-per-day diet.