The study, led by Dr Carolyn Scrafford, senior managing scientist at scientific consulting firm Exponent, is reported to be the first to comprehensively analyze the potential cost implications of improved adherence to healthy dietary patterns among US adults across major chronic disease types.
“We found that increasing adherence to healthy dietary patterns by even 20 percent at a population level has the potential to save more than $20 billion in both direct and indirect costs associated with 10 major health outcomes,” said Dr Scrafford. “That's a significant saving from what we believe is a realistic shift in diet quality.”
A broad view
Speaking with FoodNavigator-USA at Nutrition 2018, Dr Scrafford, told us: “A couple things were new with this [study, compared to other economic evaluations]: First of all we did a very broad search of health outcomes. So, a lot of the health economic evaluations will look at a certain outcome, will focus on something like just cancer, just cardiovascular disease.
“Here we wanted to look at really a net change in healthcare cost savings, so we wanted to look at all of the benefits that you might imagine with a higher diet quality. As well as if there’s anything out there that maybe shows an adverse effect.
“It was a broad view, we wanted to capture every type of health outcome that has been looked at with these dietary patterns, in this case the HEI and the Mediterranean diet,” added Dr Scrafford.
The HEI is used frequently to evaluate a US-style diet and reflects adherence with the 2015-2020 Dietary Guidelines for Americans. The MED is used to describe the diet of countries in the Mediterranean region and emphasizes components such as fish, nuts, fruits, and olive oil.
The researchers assessed the impact of a healthy dietary pattern, as measured by the Healthy Eating Index (HEI) and the Mediterranean-style diet (MED) score. Two scenarios were studied: a conservative scenario, which looked at improving adherence by 20%; and a more ambitious scenario, which looked at improving adherence by 80%.
According to the data, the average American adult currently shows about 60% adherence to the HEI. If adherence increased to 72% (a relative increase of 20%), then the US could save $30-47 billion in health-related costs annually. Under the more ambitious scenario, if the average US adult increased their adherence to 80% of the HEI, the researchers project an annual savings of $52-82 billion.
Almost 50% of these savings result from a reduction in costs associated with heart disease, with additional savings from reductions in costs associated with type 2 diabetes and cancer.
The average American adult currently scores 3.5 out of 9 possible points on the MED score used to assess adherence to the Mediterranean-style diet, said the researchers. If this adherence increased by 20%, the annual savings would be $21-26 billion, they predicted. Increasing adherence by 80% would result in annual savings of $112-135 billion.
“Our results suggest that it's worthwhile to educate Americans on these dietary patterns and their components, to encourage them to make little changes to improve their diet quality,” said Scrafford.
Providing a reference point
It is unlikely that Americans could change their dietary patterns overnight or that the projected health improvements would immediately reduce health-related costs, explained Scrafford, but the numbers provide a reference point for understanding the potential benefits of adopting a healthier diet.
Dr Scrafford added that the team did not want to necessarily comment on policy, or what should be done. “I think our goal here was to look at two dietary patterns that are part of the dietary guidelines, so a healthy US style, a healthy Mediterranean style,” she said.
“We looked at the evidence that was out there for their association with various health outcomes. And we just wanted to see—you know this is a hypothetical, this is a model to look at what the potential impact could be on cost savings, health care cost savings.
“This would really be a data point for perhaps a policy maker to use in any type of advocacy or discussion of public health interventions improving diet quality in a US population.”
"The findings are not unexpected"
Commenting on the study's findings, Dr Greg Miller, Chief Global Science Officer at National Dairy Council, which funded the study, told FoodNavigator-USA: “The great news around this study indicates if Americans made minor changes to their diets and followed the 2015-2020 Dietary Guidelines, not only would they improve their health, they would save money in healthcare costs, which is particularly important at a time when healthcare costs are rising.
"The findings show that following recommended eating patterns would offer billions of dollars in potential savings to the economy, while also improving the health and wellbeing of our country. Dairy foods, like low-fat and fat-free milk, yogurt and cheese are part of both of the healthy eating patterns outlined in the Dietary Guidelines and used in this study. The findings are not unexpected, because research already points to an association among eating dairy foods and reduced risk for cardiovascular disease and type 2 diabetes.”
To estimate healthcare costs, Scrafford and her co-workers used data from the American Heart Association, American Diabetes Association and National Cancer Institute of the National Institutes of Health, along with case reports tracking costs associated with hip fractures and Alzheimer's disease.
Cost estimates included both direct costs--such as medical fees, devices and drugs--and indirect costs, such as lost wages and caregiver burden, where available.
Additional reporting by Adi Menayang