Diet score derived from the large-scale global prospective urban and rural epidemiological (PURE) study
McMaster University
Summary : Previous and similar research has focused on Western countries and diets that combine harmful ultra-processed foods with nutrient-dense foods. This research was global in scope and focused on foods commonly considered healthy . Researchers obtained a diet score from PHRI’s ongoing large-scale global prospective urban and rural epidemiology (PURE) study, and then replicated it in five independent studies to measure health outcomes in different regions of the world and in people. with and without previous CVD. A study led by researchers from McMaster University and Hamilton Health Sciences at the Population Health Research Institute (PHRI) found that not eating enough of six key foods combined is associated with an increased risk of cardiovascular disease (CVD) in adults. |
Unhealthy diets have been classified as a major contributor to death and cardiovascular disease (CVD) globally. Contemporary nutritional recommendations are based on the associations of individual foods, nutrients, and dietary patterns with CVD in many ancient and contemporary prospective cohort studies conducted primarily in North America, Europe, and East Asia; numerous short-term randomized intervention trials of physiological risk factors; and some randomized clinical trials of dietary patterns on clinical outcomes, but conducted mainly in Western countries.
Previous dietary pattern scores have been described [ Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Healthy Eating Index (HEI) and, more recently, the EAT-Lancet Planetary diet] and their relationship with CVD and mortality has been described. Tested mainly in Western countries. These diet scores combine consumption of foods thought to be protective with foods (or nutrients) considered harmful , so no diet score focuses exclusively on protective foods despite a recent increased focus on increased intake of protective foods. . Foods for disease prevention. Additionally, all of these diet scores above have in common an emphasis on increasing fruits, vegetables, legumes, nuts and fish, with some differences in their focus on different types of fats and consumption of dairy or red meat.
Recent data from cohort studies have challenged conventional recommendations about which dietary components are protective or harmful . Dietary exposures (such as full-fat dairy products) that were previously thought to increase cardiovascular disease have recently been shown to be neutral or protective in large cohort studies. This new information has not been incorporated into nutrition guides. Furthermore, it is not known whether the conclusions drawn from diet scoring studies conducted predominantly in the US patterns differ markedly (Africa and South Asia).
Our objectives were to (i) develop a healthy diet score from the large Prospective Urban Rural Epidemiology (PURE) cohort study involving 147,642 people from 21 countries on 5 continents ; (ii) examine the consistency of associations of the PURE healthy diet score with events in three independent prospective studies (n = 43,834 in 50 countries) and 2 case-control studies of myocardial infarction (MI) (n = 26 191 in 52 countries) or stroke (n= 26,930 in 33 countries); (iii) evaluate whether the PURE healthy diet score is applicable to people from high-, middle-, and low-income countries, from various regions of the world, and to people with and without prior CVD; and (iv) compare the performance of the PURE Healthy Diet Score with that of other commonly used diet scores (Mediterranean Diet, HEI-2010 and 2015, DASH, and Planetary Diet Scores).
Comments
Consuming fruits, vegetables, legumes, nuts, fish and full-fat dairy products is key to reducing the risk of cardiovascular diseases, including heart attacks and strokes. The study also found that a healthy diet can be achieved in several ways, such as including moderate amounts of whole grains or unprocessed meats.
Previous and similar research has focused on Western countries and diets that combine harmful ultra-processed foods with nutrient-dense foods. This research was global in scope and focused on foods commonly considered healthy.
The World Health Organization estimates that nearly 18 million people died from CVD in 2019, accounting for 32 percent of all deaths worldwide. Of these deaths, 85 percent were due to heart attacks and strokes. PHRI researchers and their global collaborators analyzed data from 245,000 people in 80 countries from multiple studies. The results were published in the European Heart Journal .
Researchers obtained a diet score from PHRI’s ongoing large-scale global prospective urban and rural epidemiology (PURE) study, and then replicated it in five independent studies to measure health outcomes in different regions of the world and in people. with and without previous CVD.
"Previous diet scores, including the EAT-Lancet Planetary Diet and the Mediterranean Diet , tested the relationship of diet to cardiovascular disease and death primarily in Western countries. The PURE Healthy Diet Score included a good representation of countries from high, middle and low income,” said Salim Yusuf, lead author and principal investigator of PURE.
In addition to being truly global, the PURE Healthy Diet Score focused on exclusively protective or natural foods.
"We were unique in that approach. The other diet combines foods considered harmful, such as processed and ultra-processed foods, with foods and nutrients thought to be health-protective," said first author Andrew Mente, a scientist and assistant professor in the Department of McMaster Health Research Methods, Evidence and Impact.
"Recently there is an increased focus on increased consumption of protective foods for disease prevention. Aside from increased amounts of fruits, vegetables, nuts and legumes, researchers have shown that moderation is key in the consumption of natural foods," he said .
"Moderate amounts of fish and full-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 PURE Healthy Diet Score recommends an average daily intake of: Fruits in two to three servings; vegetables in two or three servings; walnuts in one serving; and dairy in two servings. The score also includes three to four weekly servings of legumes and two to three weekly servings of fish. Possible substitutes included whole grains in one daily serving and unprocessed red meat or poultry in one daily serving.
Conclusions Consumption of a diet composed of higher amounts of fruits, vegetables, nuts, legumes, and a moderate amount of fish and full-fat dairy products is associated with a lower risk of CVD and mortality in all regions of the world, but especially in countries with higher incomes. lows where the consumption of these natural foods is low. Similar associations were found with the inclusion of meat or whole grain consumption in the diet score (in the common ranges across all six included studies). Our findings indicate that the risks of death and vascular events in adults worldwide are higher with inadequate intake of protective foods . |
There was no specific funding for this analysis, although each study that contributed data was funded separately and was carried out over a 25-year period.
