A diet high in salt, low in fruit and lacking wholegrains is now the leading modifiable cause of heart disease in the Western world, worrying research has revealed.
Ultra-processed foods, typically high in saturated fat, salt and added sugars have long been known to increase the risk of heart attack, stroke and premature death.
But now experts say the number of lives lost to heart disease is being driven by a new top three list of dietary villains – responsible for more than 5 million deaths in 2023.
In 2021, heart disease accounted for more than a quarter of all deaths worldwide.
‘Our findings underscore that improving dietary quality must remain a central pillar of global heart disease prevention,’ Professor Guoshuang Feng, an expert in medical data from Beijing Children’s Hospital, and study lead author said.
‘While we are seeing a decline in mortality rates due to better healthcare, 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.’
The research – published in the journal Innovation Press – analysed data from the Global Burden of Disease Study, tracking 13 dietary risk factors over 33 years.
A diet high in salt and low in fruit and wholegrains is now the leading cause of preventable heart disease deaths worldwide
Dietary risks were defined as imbalances in food and nutrient intake, including excessive consumption of unhealthy components or insufficient intake of protective foods.
These included diets low in fruits, vegetables, whole grains, nuts and seeds, legumes, fibre, fish, and omega-6 fatty acids, as well as diets high in sodium, trans fatty acids, processed meat, sugar-sweetened beverages, and red meat.
Analysis revealed that these dietary patterns significantly contributed to coronary heart disease – which occurs when the heart cannot get enough oxygen-rich blood due to fatty plaque building up in the arteries – and stroke.
The study also highlighted a stark gender divide, with men significantly more likely to develop heart disease as a result of poor diet across nearly all 204 countries studied.
Researchers put this down to men typically engaging in more risky behaviours – such as smoking or drinking alcohol, than women that may interact with diet to increase overall burden.
Geographical disparities were also particularly pronounced, with China contributing the largest number of cardiovascular disease-related deaths at 1.36million, followed by India at 1.11million.
However, when looking at mortality rates proportional to population size, Pacific Island nations such as the Solomon Islands faced the heaviest burden.
Experts said this was likely due to ‘nutrition transition’ – where fresh local produce is being replaced by imported, heavily processed alternatives.
Additionally, under-resourced healthcare services and economic inequalities are also likely to factor, limiting both prevention and treatment of heart diseases.
‘Collectively, these findings underscore that improving dietary quality should remain a central pillar of global CVD prevention,’ Prof Feng said.
He added that the findings suggest that even as age-related death rates improve, this may not translate into fewer deaths if additional risk factors such as diet are not addressed from a young age.
It is well-known that diets high in salt can increase the risk of heart problems – with some studies suggesting it more than doubles the risk.
As such the World Health Organisation (WHO) recommends eating no more than 5g salt per day.
This is because excess sodium can push up blood pressure levels, which is a risk factor for coronary heart disease and stroke.
In the current study, diets high in salt were found to be prominent across all socio-demographics, reflecting a wide-reaching reliance on processed foods and high-salt cooking practices.
In China specifically, sodium intake has been reported to exceed twice the WHO recommendations – which researchers say may help explain why there are so many diet-related cardiovascular disease deaths in China.
Fibre, on the other hand, found in foods such as fruit, vegetables and wholegrains, has been shown to have a heart-protective effect.
This is because it can help lower levels of so-called bad cholesterol – by reducing the amount of cholesterol absorbed in the gut – as well as helping maintain weight loss and controlling blood sugar levels which can cut the risk of type 2 diabetes.
Prof Feng continued: ‘From a public health perspective, these “protective food deficits” often reflect affordability, availability, and food-environment constraints – especially in low and middle socio-demographic settings –rather than preference alone.
‘Thus, effective strategies likely require both demand-side interventions (nutrition education, clinical dietary counseling) and supply-side actions (improving access, pricing, and distribution of healthier foods).’
In the UK, government guidelines recommend adults eat around 30g of fibre a day. But most of us fall short, averaging around just 17g.
The researchers concluded: ‘Diet-attributable CVD burden remains substantial and unequally distributed across populations, with high sodium intake and low consumption of whole grains and fruits consistently contributing the largest shares.
‘Strengthening diet quality should remain central to CVD prevention, and public health policies and clinical guidance should prioritise scalable interventions addressing the leading dietary risk factors to reduce premature CVD mortality and disability worldwide.’
