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Introduction: Despite the clear association between poor diet and cardiometabolic diseases (CMD) and the overall economic burden of such conditions, the costs of an unhealthy diet pattern have not been assessed for the US population.Aim: Estimate the costs of CMD related to suboptimal intakes of 10 specific dietary factors in the US adult population.Methods: A validated microsimulation model (CVD PREDICT) was populated by weighted sampling (with replacement) of individuals aged 35–85y from the 2009-2010 and 2011-2012 National Health and Nutrition Examination Surveys (NHANES), in order to create an US representative model population. Consumption of 10 foods/nutrients associated with CMD were assessed: fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages, polyunsaturated fats, seafood omega-3 fats, and sodium. Cardiovascular disease progression and events were simulated and annual healthcare costs estimations were calculated. The model compared reported consumption of the 10 food/nutrients in the NHANES surveys to a hypothetical situation in which the consumption level of these nutrients were optimal. Each food/nutrient was assessed individually and combined. Estimates were stratified by gender, age, race and insurance.Results: The 2012 annual cost of an unhealthy diet was $USD 280 (Acute $USD 236, Chronic $USD 40 and Drug $USD 4) per adult. Individually the food/nutrient consumed below optimal levels that imposed the highest CMD economic burden was nuts/seeds ($USD 75) while non-optimal red meat consumption was associated with the lowest cost per person ($USD 3). Unhealthy diet costs of CMD by gender, age group, race and insurance are provided in table 1. The annual unhealthy diet cost of CMD in the US was $USD 44.9bn in 2012. Acute care costs represent 84.3% of this total ($USD 37.9bn).Conclusions: Suboptimal diet accounts for substantial CMD costs in the US, highlighting the need for timely implementation of diet policies to address these burdens.