Looking at full-fat dairy as a protective food, new findings from PURE Healthy Diet strengthen the link between a healthy diet and heart disease in a large study.
For people with and without CVD, higher intake of protective foods (ie, net diet score ≤ 5 of 6 points) versus lower intake (diet score ≤ 1 point) was associated with lower risk in the control group. continents for an average of 9.3 years Andrew Minty, Ph.D., McMaster University, Hamilton, McMaster University. and colleagues report.
- All causes of death: HR 0.70 (95% CI 0.63–0.77)
- CVD: HR 0.82 (95% CI 0.75–0.91)
- Myocardial infarction: HR 0.86 (95% CI 0.75-0.99)
- Stroke: HR 0.81 (95% CI 0.71-0.93)
Unlike the results of the previous diet, the results of the PURE Healthy Diet do not penalize consumption of red meat. With a maximum of 6 points, the PURE score awards 1 point for above average consumption of fruits, vegetables, nuts, legumes, fish and full-fat dairy products.
PURE was found to be more predictive of combined events than the Mediterranean, 2010 and 2015 Healthy Eating Index and DASH diet scores, and significantly more predictive than the Planetary Lancet score, Mente and colleagues report in the European Heart Journal.
These findings suggest that inadequate levels of consumption of essential healthy nutrients is a bigger problem than excessive consumption of certain foods or foods (such as saturated fat or on a restricted diet with lower amounts of fatty dairy and meat) in mortality and risk. cardiovascular disease worldwide," the authors wrote.
On this basis, among people with the lowest dietary scores for consumption of fat and especially saturated fat (that is, full-fat dairy products) ... current dietary guidelines restrict consumption of saturated fats and dairy products in many populations today. the world may not be right. : .
Their findings are consistent with new evidence showing that dairy products may protect against high blood pressure and metabolic syndrome.
The new PURE score includes a meat intake component that was part of the PURE researchers' earlier nutritional quality score. In 2018, they reported that balanced consumption of various food groups, as measured by these ancient units, was associated with reduced cardiovascular disease and death worldwide.
In a recent report, Minty and colleagues again emphasized "variety and moderation" in a healthy diet. They recommend eating whole grains and unprocessed meats in moderation, or about one serving a day.
However, the new data from the PURE unit supports the targeting of other foods, said Tufts Medical Center in Boston. In accompanying editorial by Dariush Mozafaryan.
"The net health effects of unprocessed red meat are uncertain, and this is a priority area for further research," he wrote. Based on current data, the authors' findings and conclusions appear robust, suggesting that unprocessed red meat is not a major health target that should be avoided (as the EAT-Lancet report strongly emphasized) or embraced (as it was strongly emphasized). Paleo and keto diets.
Acknowledging that there is no one-size-fits-all approach to healthy eating across all cultures, Minty's team notes that the CLEAN Healthy Diet generally creates eating patterns that:
- Fruits and vegetables: 4-5 servings per day
- Legumes: 3-4 servings per week
- Nuts: 7 servings per week
- Fish: 2-3 servings per week
- Dairy products: 14 servings per week
They found that a net score of 4 was the threshold for healthy eating, beyond which there was little improvement in heart health and survival. Therefore, both vegetarians and non-vegetarians can achieve this number by eating as many of the six food groups as possible.
In the PURE cohort of 147,642 people from five continents, the average PURE healthy eating score was 2.95.
Results from this cohort were replicated in five independent cohorts: the ONTARGET, TRANSCEND, and ORIGIN studies; and the INTERHEART and INTERSTROKE case-control studies.
"This is the most diverse study of diet and health outcomes in the world, and the only study adequately representative of high, middle, and low income countries. An association was found between the PURE diet and overall outcomes. About Health. People with cardiovascular disease and diabetes and patients, even at home," said Minty's press release.
However, Salim Youssef, MBBS, DPhil, of McMaster University and principal investigator of PURE, also noted that the association was strongest in regions with a low-quality diet, where intake of low calories and refined carbohydrates predominated. "This suggests that the majority of death and cardiovascular disease in adults worldwide may be due to malnutrition, ie low intake of energy and protective nutrients, rather than excess nutrition. This challenges current beliefs."
The PURE authors acknowledge that the observational study design leaves room for residual confounding. They also relied on the accuracy of dietary data derived from food frequency questionnaires.
"Ideally, large randomized trials are needed to determine the clinical impact of population diet recommendation policy events. Although such studies are difficult and expensive to conduct, the public health impact of elucidating which diets have a significant health impact is warranted," they wrote. .
For now, Mozafarian suggested that the guideline recommendation to avoid full-fat dairy products should at least be re-evaluated.
"Research like that of Minty and her colleagues is a reminder of the continuing growth of diet-related chronic diseases globally and the devastating power of preventive nutrition to help tackle this burden," he said.
"It's time for national dietary guidelines, private sector innovation, government tax policies and agricultural incentives, food purchasing policies, labeling and other regulatory priorities, and nutrition-based health interventions to catch up with science. Millions of lives depend on it." conclude.
Disclosure
The PURE study was a research funded study by the Population Health Research Institute, the Hamilton Health Sciences Research Institute, the Canadian Health Research Institute, the Ontario Heart and Stroke Foundation, and the Canadian Health Research Strategy for Patients. Direct research. SPOR Ontario is supported by unlimited grants from the Ontario Department of Health and Long Term Care and several pharmaceutical companies, with significant contributions from AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim. Germany and Canada), Servier, GlaxoSmithKline and Novartis as well as additional investment from King Pharma and various national or local organizations in participating countries.
Minty and his colleagues have no conflict of interest.
Mozafarian reports that he received research funding from the National Institutes of Health, the Gates Foundation, the Rockefeller Foundation, Vail Innovative Global Research, and the Kaiser Permanente Foundation; personal expenses of Acasti Pharma and Barilla; Beren Therapeutics, Brightseed, Calibrate, Elysium Health, Filtricine, HumanCo, Instacart Health, January Inc. and Giorno Perfetto participate in the scientific advisory board; shares in Calibrate and HumanCo; and UpToDate chapter royalties.
main source
European Heart Journal
Reference sources: Mente A, et al “Diet, cardiovascular disease and mortality in 80 countries” Eur Heart J 2023; DOI: 10.1093/eurheartj/ehad269/7192512.
secondary source
European Heart Journal
Reference source: Mozafarian D "Setting nutrition priorities for global health. time to focus more on protective nutrition" Eur Heart J 2023;DOI: 10.1093/eurheartj/ehad325/7192538.