Dietary Risks and Cardiometabolic Disease Burden Across the United States: Geographic Inequalities, Age-Period-Cohort Patterns, and Projections to 2045.

Diet and nutrition remain significant but modifiable drivers of cardiometabolic diseases (CMDs), yet the contemporary burden and future impact of diet-attributable CMDs in the United States remain incompletely characterized. We obtained data from the Global Burden of Disease (GBD) 2023. Deaths and disability-adjusted life years (DALYs) of CMDs attributable to dietary risks were estimated through a comparative risk assessment framework. Temporal patterns were assessed with estimated annual percent changes (EAPCs) and age-period-cohort models. Time-series forecasting models projected burden through 2045 under a reference scenario and a counterfactual scenario assuming a 1% annual decline in overall dietary risk exposure. In 2023, dietary risks accounted for more than 300,000 deaths and approximately 8 million DALYs of CMDs in the United States. Although the age-standardized death and DALY rates of diet-attributable cardiovascular disease declined, diabetes and chronic kidney disease (CKD) followed less favorable trajectories, with CKD increasing most rapidly. Diet-associated CMD burden were disproportionately concentrated in Southern and Appalachian states, with persistent geographic inequities. Leading dietary contributors were broadly consistent across states, including low intake of fruits, vegetables, and whole grains and high intake of processed meat, sodium, and sugar-sweetened beverages. Projection analyses suggested that modest, sustained improvements in population-level diet quality could yield substantial health gains through 2045. Dietary risks continue to impose a substantial and uneven cardiometabolic disease burden across the United States. Divergent trends by disease and persistent geographic disparities highlight the need for targeted nutrition policies and population-wide strategies to promote healthier dietary patterns.