Cardiovascular disease has been linked to inadequate consumption fruits, vegetables, legumes, nuts, fish, and whole-fat dairy
A diet score derived from the ongoing, extensive global Prospective Urban and Rural Epidemiological (PURE) study was used in a study conducted by researchers from McMaster University and Hamilton Health Sciences at the Population Research Health Institute (PHRI). This study has revealed that insufficient intake of a combination of six key foods is linked to a heightened risk of cardiovascular disease (CVD) among adults.
The consumption of fruits, vegetables, legumes, nuts, fish, and whole-fat dairy products plays a crucial role in decreasing the risk of CVD, which includes heart attacks and strokes. Additionally, the study indicates that achieving a healthy diet can be accomplished through various approaches, such as incorporating moderate amounts of whole grains or unprocessed meats.
This research takes a global perspective on diet and health, differing from previous similar studies that concentrated on Western countries and diets blending harmful, ultra-processed foods with nutrient-dense options. Instead, this study focused on foods commonly acknowledged as healthy.
According to the World Health Organization (WHO), approximately 18 million people succumbed to CVD in 2019, accounting for 32 percent of all global deaths. Among these fatalities, 85 percent were attributed to heart attacks and strokes. Researchers from PHRI, along with their global collaborators, scrutinized data from 245,000 individuals across 80 countries from multiple studies. The findings of this research were published in the European Heart Journal.
A novel method for assessing diets was developed by researchers using PHRI’s ongoing, extensive global Prospective Urban and Rural Epidemiological (PURE) study. This approach was replicated in five independent studies to evaluate health outcomes across various regions worldwide, involving individuals both with and without previous cardiovascular disease (CVD).
Salim Yusuf, the senior author and principal investigator of PURE, highlighted that unlike previous diet scores, such as the EAT-Lancet Planetary Diet and the Mediterranean Diet, which mainly examined the diet-CVD relationship in Western nations, the PURE Healthy Diet Score encompassed a diverse representation of countries with different income levels, spanning high, middle, and low-income countries.
In addition to its global scope, the PURE Healthy Diet Score centers on foods that are exclusively protective or natural. This innovative approach aims to analyze the relationship between diet and health outcomes in a comprehensive and diverse manner.
An emphasis on foods with protective qualities was a unique focal point of our approach. Unlike other diet scoring methods that amalgamated harmful processed and ultra-processed foods with those considered beneficial for health, our study concentrated solely on the latter category, as articulated by first author Andrew Mente, a PHRI scientist and assistant professor at McMaster’s Department of Health Research Methods, Evidence, and Impact.
Mente emphasized the recent surge in attention towards consuming larger quantities of protective foods for disease prevention. Apart from advocating higher intake of fruits, vegetables, nuts, and legumes, the research highlighted the significance of moderation in the consumption of natural foods.
The study revealed that moderate consumption of fish and whole-fat dairy is linked to a decreased risk of cardiovascular disease (CVD) and mortality. Similarly, the study found that health benefits can be achieved through moderate intake of grains and meats, specifically unrefined whole grains and unprocessed meats.
The recommendations outlined by the PURE Healthy Diet Score suggest an average daily consumption of fruits (two to three servings), vegetables (two to three servings), nuts (one serving), and dairy (two servings). Additionally, the score suggests three to four weekly servings of legumes and two to three weekly servings of fish. Alternatives include one daily serving of whole grains and unprocessed red meat or poultry.
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.