Poor dietary habits, specifically high sodium intake and a lack of fruits and whole grains, were linked to nearly six million cardiovascular deaths worldwide in 2023, research suggests.
Men experience a significantly higher burden of diet-related heart disease than women, with the highest total death counts occurring in China and India.
While better health care is lowering individual mortality rates, total deaths are rising due to aging populations and a shift to processed foods in regions like the Pacific Islands.
Dietary risk factors were associated with 5.91 million cardiovascular deaths in 2023 in a new study of 204 countries and territories. The researchers are calling for more population-specific contextualized dietary strategies, such as low-sodium reformulation initiatives in China and prioritizing nutritious food affordability in Pacific Island nations.
The paper authors warn that while diet remains the leading modifiable cause of cardiovascular disease globally, mortality and disease risks are still being driven up by a top-three list of “dietary villains”: high sodium intake, low fruit consumption, and the lack of whole grains.
Other key dietary factors linked to disease risk and mortality include low intake of nuts and seeds, vegetables, and omega-3 and omega-6 fatty acids.
The researchers stress that while medical advances have helped lower per-capita death rates, the absolute number of lives lost continues to rise.
“Our findings underscore that improving dietary quality must remain a central pillar of global heart disease prevention,” says corresponding author Guoshuang Feng from the Big Data Center at Beijing Children’s Hospital, China.
“While we are seeing a decline in age-standardized mortality rates due to better health care, the total absolute burden is staggering. We are essentially in a race against an aging population that is increasingly vulnerable to the harms of high-salt and low-nutrient diets.”
Primary health impacts of poor diet
The research team reviewed data from the Global Burden of Disease (GBD) Study 2023, evaluating 13 different dietary risk factors over a 33-year period, between 1990 and 2023. Their paper measures the impact of diet-related cardiovascular disease across global, regional, and national levels.
They calculated the total number of deaths and years of healthy life lost, adjusted for age to ensure fair comparisons across different populations.
The findings estimated that ischemic heart disease and stroke are the primary outcomes of these poor dietary habits. The study also highlighted a sharp gender divide, with males consistently experiencing a higher diet-attributable burden than females across nearly all regions.
Geographical disparities were noticeable in the findings. According to the paper, China faced the highest absolute number of diet-related cardiovascular deaths at 1.36 million, followed by India at 1.11 million.
However, when looking at mortality rates proportional to population size, the researchers found that Pacific Island nations like the Solomon Islands and Nauru faced the heaviest burden. They attribute this to a “nutrition transition” in these islands, where fresh local produce is being replaced by imports of highly processed foods.
Key considerations
The study authors stress that certain limitations should be considered. Firstly, GBD 2023 estimates include multiple data sources with variable coverage and quality that vary across countries, which may have influenced the reliability of the findings.
“Meanwhile, dietary exposure data in particular may rely partly on modeled estimates and, in some settings, on population-level availability rather than individual consumption, which can introduce measurement error and increase uncertainty,” they add.
Another concern is that much of the evidence comes from studies that observe habits rather than controlled experiments. Additionally, because dietary habits are interconnected, the authors acknowledge the difficulty in separating the effect of one specific food from another, which can make individual risks seem larger than they actually are.
In their conclusion, the researchers also call for more targeted, context-specific policy interventions for healthier dietary guidance tailored to each country. For high-population nations like China, structural measures such as mandatory front-of-pack sodium labeling and food reformulation are essential.
In smaller, vulnerable island economies, they say the focus must shift toward food sovereignty and increasing the availability of affordable, fresh fruits and vegetables. Previous research found that children aged two to eight years across the US-affiliated Pacific region are not meeting daily recommended intakes for key micronutrients and are either consuming too much or too little.