Healthy diet including full-fat dairy lowers risk for heart disease, death worldwide
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Key takeaways:
- Lower consumption of healthy foods, including full-fat dairy, may increase cardiovascular risk globally.
- Findings were consistent in adults with and without vascular disease.
Researchers reported that 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.
In an analysis of data from four large, international prospective cohort studies from 80 countries and two case-control studies from 62 countries, researchers found that a 20% higher PURE healthy diet score was associated with a 6% lower risk for major CV events and an 8% lower risk for mortality. The score includes foods that are part of other diet scores, such as fruit, vegetables, legumes, nuts and fish, but also an element that previous scores do not include — whole-fat dairy.
“Eat plenty of fruits, vegetables, nuts, legumes and moderate amounts of fish and whole-fat dairy to lower risk of CVD and mortality, in all world regions,” Andrew Mente, MSc, PhD, associate professor and principal investigator for the epidemiology program at the Population Health Research Institute, McMaster University, Hamilton, Canada, told Healio. “In poorer world regions where intake of these natural foods is lowest, improving intake in even three or four of these foods would produce a marked protection. On this basis, current advice to restrict dairy — especially whole fat dairy — to very low amounts in populations globally is not necessary or appropriate. Bottom line: Our findings indicate that the risks of deaths and vascular events in adults globally is higher with inadequate intake of protective foods.”
Examining diets across countries
Mente and colleagues developed a healthy diet score for 147,642 people with complete diet information from 21 countries across five continents who participated in the PURE study, an ongoing, large-scale epidemiological cohort. Researchers examined the consistency of the associations of the score with events 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 for mortality: fruits, vegetables, nuts, legumes, fish and dairy (mainly whole-fat). Scores ranged from 0 to 6.
The main outcomes were all-cause mortality and major CV events.
The findings were published in the European Heart Journal.
The mean PURE Healthy Diet Score was 2.95. A higher healthy diet score was associated with higher per capita gross national income (P for trend < .0001). The highest median diet scores and intake of food components in the diet score were found in North America and Europe, the Middle East and South America.
During a median follow-up of 9.3 years in PURE, compared with a diet score of 1 or fewer points, a diet score of 5 or more points was associated with a lower risk for mortality (HR = 0.7; 95% CI, 0.63-0.77), CVD (HR = 0.82; 95% CI, 0.75-0.91), MI (HR = 0.86; 95% CI, 0.75-0.99), and stroke (HR = 0.81; 95% CI, 0.71-0.93).
For three independent prospective studies with 43,834 participants with vascular disease, researchers similarly observed that a higher diet score was associated with lower mortality (HR = 0.73; 95% CI, 0.66-0.81), CVD (HR = 0.79; 95% CI, 0.72-0.87) and MI (HR = 0.85; 95% CI, 0.71-0.99).
For two case-control studies assessing MI (n = 26,191) and stroke (n = 26,930), a higher diet score was associated with lower risk for first MI (OR = 0.72; 95% CI, 0.65-0.8) and stroke (OR = 0.57; 95% CI, 0.5-0.65). Additionally, a higher diet score was associated with lower risk for death or CVD in regions with lower vs. higher gross national incomes (P for heterogeneity < .0001).
The PURE score was more closely associated with CVD and death risk than other scores (P for each comparison < .001), according to the researchers.
Mente added that the study did not examine specific bioactive compounds in foods that may be most protective.
“For example, recent evidence suggests that polyphenols, which are found in certain fruit or vegetables like berries, spinach and beans, may be especially protective against CVD,” Mente told Healio. “More research is needed to sort out what proportion of fruit and vegetable-related health benefits are driven by delivering dietary polyphenols or other nutrients.”
“This was by far the most diverse study of nutrition and health outcomes in the world and the only one with sufficient representation from high-, middle- and low-income countries,” Mente said in a press release. “The connection between the PURE diet and health outcomes was found in generally healthy people, patients with CVD, patients with diabetes, and across economies.”
Data show ‘power of protective foods’
In a related editorial, Dariush Mozaffarian, MD, DrPH, Jean Mayer Professor of Nutrition and a professor of medicine at Tufts School of Medicine and in the division of cardiology at Tufts Medical Center, wrote that the data are important as there is a “devastating rise” in diet-related chronic diseases globally, noting that the “power of protective foods” can help address these burdens.
“This new report from the PURE study provides valuable confirmatory evidence from diverse nations on the importance of health-protecting foods such as fruits, whole grains, vegetables, legumes, nuts/seeds and dairy,” Mozaffarian wrote. “These results are highly consistent with most dietary guidelines around the world (except for current guidelines often emphasizing low-fat, rather than any fat, dairy). Notably, the findings do not support the authors’ conclusion that ‘the key to a healthy diet is probably one that includes diverse natural foods in moderation,’ or ‘the ideal diet for each population is likely one of variety and moderation.’ Rather, the findings support targeting specific foods, including higher levels of fruits and vegetables (in the top quintile of the PURE score, 5 servings/day), dairy (2 servings/day), and nuts (1.2 servings/ day), and at least moderate levels of legumes (0.5 servings/day) and fish (0.3 servings/day).”
Mozaffarian also wrote that the findings provide no support for major health benefits of including a “variety and moderation” of other natural foods such as red meat, poultry or butter.
Reference:
For more information:
Andrew Mente, MSc, PhD, can be reached at andrew.mente@phri.ca; Twitter: @toyourhealth101.
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