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Are High-Fat Dairy Products on the Table Again?

Recent studies present a fresh perspective challenging the conventional wisdom surrounding the restriction of high-fat dairy products.

A recent study published in the European Heart Journal, affiliated with the European Society of Cardiology (ESC), suggests that whether we include or exclude red meat and whole grains from a healthy diet might not significantly impact overall health outcomes. This extensive research covered 80 countries across all inhabited continents and found that diets emphasizing fruits, vegetables, full-fat dairy, nuts, legumes, and fish were linked to lower risks of cardiovascular disease (CVD) and premature mortality worldwide. Interestingly, the presence or absence of unprocessed red meat and whole grains didn’t notably change these observed health benefits.

A statement from Dr. Andrew Mente, from McMaster University’s Population Health Research Institute in Hamilton, Canada, sheds light on the spotlight placed on low-fat foods by the public, food industry, and policymakers. He suggests a shift in focus towards incorporating protective foods like nuts (often disregarded due to their high energy content), fish, and dairy, instead of severely limiting dairy consumption, especially whole-fat varieties. The study’s findings indicate that including up to two servings of dairy per day, primarily whole-fat, can be part of a healthy diet. Modern nutrition science also suggests that whole-fat dairy might have a shielding effect against conditions like high blood pressure and metabolic syndrome.

This research delved into the correlation between a novel diet score and health outcomes across a global population. The PURE diet score was constructed based on six foods associated with enhanced longevity. It recommended 2-3 daily servings of fruits and vegetables, 3-4 servings of legumes weekly, 7 servings of nuts weekly, 2-3 servings of fish weekly, and 14 servings of dairy products weekly (primarily whole fat, excluding butter or whipped cream).

Participants scoring above the median intake were given a healthy score of 1, while those at or below the median intake were marked as unhealthy with a score of 0, ranging from 0 to 6 in total. Dr. Mente clarified that individuals achieving the highest diet score, set at six, were those in the top 50% of the population for each of the six food components – a realistically achievable benchmark.

In the extensive PURE study involving 147,642 individuals from 21 countries, researchers explored the relationship between a diet score and various health markers such as mortality, heart attacks, strokes, and overall cardiovascular disease (comprising fatal CVD, non-fatal heart attacks, strokes, and heart failure). To ensure accuracy, the analyses were adjusted for multiple influencing factors including age, sex, waist-to-hip ratio, education, income, urban or rural residence, physical activity, smoking habits, diabetes, use of statins or high blood pressure medications, and total energy intake.

The average diet score among participants stood at 2.95. Throughout a median tracking period of 9.3 years, there were 15,707 recorded deaths and 40,764 cardiovascular events. Comparing the healthiest diets (score of 5 or higher) to the least healthy diets (score of 1 or lower), findings revealed a 30% reduced risk of death, an 18% lowered chance of CVD, a 14% decreased risk of heart attacks, and a 19% reduced likelihood of strokes. These associations between the diet score and health outcomes were consistently observed across five separate studies involving 96,955 cardiovascular disease patients in 70 different countries.

“This study stands out as the most diverse examination of nutrition’s impact on health outcomes globally. It uniquely included representation from high-, middle-, and low-income nations. The link between the PURE diet and health outcomes remained evident across various groups, encompassing healthy individuals, those with cardiovascular disease, patients with diabetes, and across different economic landscapes.”

Dr. Andrew Mente

“The strongest correlations were observed in regions with the least nutritious diets, encompassing South Asia, China, and Africa. These areas exhibited low calorie intake primarily reliant on refined carbohydrates. This implies that a significant portion of deaths and cardiovascular disease in adults globally might stem from undernutrition, characterized by insufficient energy intake and a lack of protective foods, rather than overnutrition. This challenges prevailing beliefs.”

Professor Salim Yusuf, the senior author and lead investigator of PURE

“The fresh findings from PURE, coupled with previous reports, prompt a reconsideration of steadfast guidelines advocating the avoidance of whole-fat dairy products. Studies like the one conducted by Mente and colleagues serve as a reminder of the ongoing and severe increase in diet-related chronic ailments worldwide, emphasizing the potential of protective foods in addressing these challenges. It’s high time for national nutrition guidelines, corporate innovations, governmental tax policies, agricultural incentives, food procurement strategies, labeling regulations, and other regulatory priorities in the food industry and healthcare interventions to align with current scientific knowledge. The lives of millions hinge on this alignment.”

Dr. Dariush Mozaffarian from the Friedman School of Nutrition Science and Policy at Tufts University in Boston, US



To develop a healthy diet score that is associated with health outcomes and is globally applicable using data from the Prospective Urban Rural Epidemiology (PURE) study and replicate it in five independent studies on a total of 245 000 people from 80 countries.

Methods and results

A healthy diet score was developed in 147 642 people from the general population, from 21 countries in the PURE study, and the consistency of the associations of the score with events was examined in five large independent studies from 70 countries. The healthy diet score was developed based on six foods each of which has been associated with a significantly lower risk of mortality [i.e. fruit, vegetables, nuts, legumes, fish, and dairy (mainly whole-fat); range of scores, 0–6]. The main outcome measures were all-cause mortality and major cardiovascular events [cardiovascular disease (CVD)]. During a median follow-up of 9.3 years in PURE, compared with a diet score of ≤1 points, a diet score of ≥5 points was associated with a lower risk of mortality [hazard ratio (HR) 0.70; 95% confidence interval (CI) 0.63–0.77)], CVD (HR 0.82; 0.75–0.91), myocardial infarction (HR 0.86; 0.75–0.99), and stroke (HR 0.81; 0.71–0.93). In three independent studies in vascular patients, similar results were found, with a higher diet score being associated with lower mortality (HR 0.73; 0.66–0.81), CVD (HR 0.79; 0.72–0.87), myocardial infarction (HR 0.85; 0.71–0.99), and a non-statistically significant lower risk of stroke (HR 0.87; 0.73–1.03). Additionally, in two case-control studies, a higher diet score was associated with lower first myocardial infarction [odds ratio (OR) 0.72; 0.65–0.80] and stroke (OR 0.57; 0.50–0.65). A higher diet score was associated with a significantly lower risk of death or CVD in regions with lower than with higher gross national incomes (P for heterogeneity <0.0001). The PURE score showed slightly stronger associations with death or CVD than several other common diet scores (P < 0.001 for each comparison).


A diet comprised of higher amounts of fruit, vegetables, nuts, legumes, fish, and whole-fat dairy is associated with lower CVD and mortality in all world regions, especially in countries with lower income where consumption of these foods is low.

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