Cardiovascular Health

Nutritional Pearls: Dining Out May Lead to Health Issues

  • We know that people who eat out at restaurants frequently are more likely to develop obesity, diabetes, and other chronic health conditions, likely because food from restaurants and fast food places tends to be more calorie-dense, nutrient-poor, and higher in fat and sodium than what you might make at home. So, it might seem obvious to conclude that those who eat out a lot are more likely to die of a heart attack or develop cancer.

    However, medicine is not math, and the transitive property of equality does not necessarily apply. Today's article tries to connect those dots.

    The Research

    The authors analyzed data gathered from 1999 to 2000 and from 2013 to 2014 as part of the National Health and Nutritional Examination Survey (NHANES), an ongoing, large-scale, long-term study of Americans living all over the United States.1 For the purposes of the article, the authors included participants who were at least aged at least 20 years in 1999 or 2000 and did not have cardiovascular disease or cancer, which was more than 35,000 people.

    During the extensive interviews conducted as part of the survey, the participants were asked how many times in the last 7 days they had a meal that was "prepared away from home in places such as restaurants, fast food places, food stands, grocery stores, or from vending machines." That frequency was then classified into 5 increasing levels ranging from less than 1 meal per week (on average) to 2 meals or more per day.

    As part of the survey, the participants received a physical examination from a physician and responded to detailed questionnaires assessing their health, demographic information, and dietary factors. The assessment allowed the authors to consider the quality of the participants' overall diet, as well as factors including race/ethnicity,  smoking status, physical activity, and body mass index.

    The study compared the frequency of dining out for those participants who died during the study period with those who did not. The authors were able to ascertain the cause of death through NHANES' link to the National Death Index.

    In particular, the researchers were interested in all-cause mortality, cardiovascular mortality, and cancer mortality.

    The Results

    The results are predictable but still surprising. Compared with those who ate out the least, those who ate out 2 times per day or more were 49% more likely to die of any cause, 18% more likely to die of a heart attack or other cardiovascular event, and 67% more likely to die of cancer.

    This was after considering not only demographic and health factors but also what the participants ate.

    What’s the Take Home?

    I would like to think that most people do not eat out every day, but the fact is that it is not that unusual. I have patients who eat out at every meal. My goal has always been to get people cooking at home more often, for their health as well as their wallet.



    1. Du Y, Rong S, Sun Y, et al. Association between frequency of eating away-from-home meals and risk of all-cause and cause-specific mortality. J Acad Nutr Dietetics. 2021;121(9):1741-1749. doi:10.1016/j.jad.2021.01.012

    Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients with evidence-based resources including special diets for coumadin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low sodium diets (1500 mg/d), and lactose intolerance. 

    Timothy S. Harlan, MD, is a board-certified internist and professional chef who translates the Mediterranean diet for the American kitchen with familiar, healthy recipes. He is an assistant dean for clinical services, executive director of The Goldring Center for Culinary Medicine and associate professor of medicine at Tulane University in New Orleans.