W.H.O. estimates that CVD was responsible for nearly 18 million deaths in 2019, which represents 32% of all global deaths, of which 85% were due to heart attacks and strokes. According to the CDC heart disease is the leading cause of death for all people of most racial and ethnic groups, with one person having a heart attack every 40 seconds and one person dying from CVD every 33 seconds, costing around $239.9 billion annually.
Previous research has focused on Western Countries and diets that combined unhealthy and harmful ultra-processed foods with nutrient-dense foods. This project was global in scope and focussed on foods that are commonly considered to be healthy, protective, or natural rather than unhealthy, deriving a diet score from PHRI’s ongoing and large-scale global PURE Study, then replicated that in five independent studies to measure health outcomes in different World regions and in people with and without prior CVD diagnosis.
“Previous diet scores – including the EAT-Lancet Planetary Diet and the Mediterranean Diet tested the relationship of diet to CVD and death mainly in Western countries. The PURE Healthy Diet Score included a good representation of high, middle, and low-income countries,” said Salim Yusuf, senior author and principal investigator of the Prospective Urban and Rural Epidemiological (PURE) Study.
“We were unique in that focus. The other diet scores combined foods considered to be harmful – such as processed and ultra-processed foods – with foods and nutrients believed to be protective of one’s health,” said first author Andrew Mente, PHRI scientist and assistant professor at McMaster’s Department of Health Research Methods, Evidence, and Impact.
“There is a recent increased focus on higher consumption of protective foods for disease prevention. Outside of larger amounts of fruits, vegetables, nuts, and legumes, the researchers showed that moderation is key in the consumption of natural foods,” he said.
“Moderate amounts of fish and whole-fat dairy are associated with a lower risk of CVD and mortality. The same health outcomes can be achieved with moderate consumption of grains and meats – as long as they are unrefined whole grains and unprocessed meats.”
The researchers report that the PURE Healthy Diet Score recommends an average daily intake of: 2-3 servings of fruit; 2-3 servings of vegetables; one serving of nuts; and two servings of whole-fat dairy. The PURE Healthy Diet Scores also includes 3-4 weekly servings of legumes; 2-3 weekly servings of fish, with possible substitutions including whole grains at one daily serving, and lean cuts of unprocessed red meat or poultry at one serving per day.
Structured Graphical Abstract Caption: In a combined analysis of data from six international studies involving 245,000 people from 80 countries, a diet comprised of higher amounts of fruit, vegetables, nuts, legumes, fish, and dairy foods is associated with a lower risk of cardiovascular disease and mortality in all world regions, especially in lower-income countries. Credit: PURE, Prospective Urban Rural Epidemiology Study. Paper:” Diet, cardiovascular disease and mortality in 80 countries” by Mente, Andrew; Dehghan, Manshid, Oxford University Press, European Heart Journal.
