A systematic review and meta-analysis found that increased risk for coronary heart disease, stroke, and diabetes was associated with 10 foods, 3 beverages, and 12 nutrients. These findings were published in JAMA Network Open.

Investigators at Tufts University searched publication databases between May 2015 and February 2021, for meta-analyses about of the effect of nutritional components on cardiometabolic diseases. This study focused on 43 food, beverage, or nutrient groups. A total of 28 meta-analyses interrogating 62 relationships met the inclusion criteria.

Most relationships were protective. The protective relationships were observed for fruits, vegetables, nuts or seeds, whole grains, fish or seafood, yogurt, chocolate, milk, tea, dietary fiber, cereal fiber, fruit fiber, vegetable fiber, polyunsaturated fatty acid (PUFA) replacing carbohydrate, PUFA replacing saturated fatty acid, and potassium. Harmful associations were observed for potatoes, unprocessed red meats, processed meats, sugar-sweetened beverages, glycemic index, glycemic load, trans-fatty acids, total protein, animal protein, and sodium.

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There were 14 associations between dietary components and coronary heart disease, 13 for stroke, and 10 for cardiovascular disease. Most relative risks (RRs) ranged between 0.87 and 0.96 per daily serving change for protective effects and between 1.06 and 1.15 per daily serving change for harmful effects.

The most protective effects were fiber for cardiovascular disease (RR, 0.54; 95% CI, 0.38-0.77 per 20 g/d) and fiber (RR, 0.59; 95% CI, 0.46-0.77 per 20 g/d) and nuts or seeds (RR, 0.71; 95% CI, 0.63-0.80 per 28 g/d) for coronary heart disease. The most harmful effects were for glycemic load (RR, 1.57; 95% CI, 1.32-1.85 per 80 g/d/2000 kcal), glycemic index (RR, 1.24; 95% CI, 1.12-1.38 per 10 units), and trans-fatty acids (RR, 1.23; 95% CI, 1.11-1.37 per 2% E/d) for coronary heart disease.

For diabetes, there were 13 associations, 5 of which were protective (whole grains, yogurt, fiber, cereal fiber, and PUFA replacing carbohydrate) and 8 were harmful (potatoes, unprocessed red meat, processed meat, sugar-sweetened beverages, glycemic index, glycemic load, protein, and animal protein). The greatest protection was for yogurt (RR, 0.74; 95% CI, 0.60-0.86 per 244 g/d) and most harmful effects were glycemic load (RR, 1.26; 95% CI, 1.15-1.37 per 80 g/d/2000 kcal) and sugar-sweetened beverages (RR, 1.19; 95% CI, 1.13-1.24 per 244 g/d).

This analysis did not evaluate the quality of individual studies included in the underlying meta-analyses.

“This systematic review summarized the quality of current evidence of the associations of specific dietary factors with CHD, stroke, and diabetes,” the researchers noted. “These findings may inform dietary guidance, provide risk estimates and uncertainty to identify the disease burden for specific populations, help with policy setting to reduce the burden of diet-related CMD, and identify gaps in the literature to guide future research.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Miller V, Micha R, Choi E, Karageorgou D, Webb P, Mozaffarian D. Evaluation of the quality of evidence of the association of foods and nutrients with cardiovascular disease and diabetes: A systematic review. JAMA Netw Open. Published online February 2, 2022. doi:10.1001/jamanetworkopen.2021.46705