Using data from an ongoing, large-scale study, researchers found that a diet low in six specific heart-healthy foods increases an individual's risk of cardiovascular disease, heart attack, and stroke.
Previous research investigating which foods may raise or lower the risk of cardiovascular disease has primarily focused on people living in Western countries. Moreover, diet scores researchers used to identify links between diet and heart health mainly include a combination of heart-healthy and potentially harmful ultra-processed foods.
However, in a new study published on July 6 in European Heart Journal, researchers from the Population Research Health Institute (PHRI) developed a new healthy diet score — called the PURE Healthy Diet Score — using data from participants from around the world, including those in low, middle, and high-income countries. In addition, it focused on foods known to be beneficial for cardiovascular health.
The data came from the institute's ongoing, large-scale Prospective Urban and Rural Epidemiological (PURE) study involving 147,642 people from 21 countries.
When the scientists applied the PURE Healthy Diet Score to five independent studies to measure health outcomes — a total of 244,597 people — they found that healthy people and those with vascular disease who scored higher by consuming higher amounts of fruits, vegetables, nuts, legumes, and moderate amounts of fish, and whole-fat dairy had a lower risk of cardiovascular disease and mortality.
The researchers found this to be especially true in lower-income countries where the consumption of these foods is typically low.
Moreover, the team found similar associations when they included moderate amounts of unprocessed meat and whole grains.
Specifically, people with a 20% higher PURE Healthy Diet score had a 6% lower risk of major cardiovascular events and an 8% lower risk of death.
The study authors suggest that worldwide, the key to a healthy diet is likely one that includes diverse natural foods in moderation rather than restricting intake to a small number of food categories.
"These findings suggest that an inadequate level of consumption of key healthy foods is a larger problem than over-consumption of some nutrients or foods (such as saturated fats or whole-fat dairy and meats—all of which are consumed in lower amounts with a lower diet score) for mortality and [cardiovascular disease] risk around the world," the study authors wrote.
"On this basis, given the low intake of fats and especially saturated fat (i.e., whole-fat dairy) among people with the lowest diet score […], current targeted dietary guidance limiting the consumption of saturated fat and dairy in many populations of the world may not be warranted," they add.
Moreover, the authors say moderate consumption of unprocessed red meat may not negatively impact heart health as once thought.
According to the study authors, the optimal average daily or weekly intake of the six foods included in the PURE Healthy Diet Score are:
- Two to three servings of fruit per day
- Two to three servings of vegetables per day
- One serving of nuts per day
- Two servings of dairy per day
- Three to four servings of legumes per week
- Two to three servings of fish per week
In addition, one serving daily of whole grains, unprocessed red meat, or poultry are possible substitutes for some of the foods listed.
Limitations to the study included the participants' self-reported what they ate, which could have impacted the results. In addition, the researchers did not look at the health effects of individual types of fruits and vegetables.
However, because the study included nearly 245,000 people from 80 countries with different economic levels, the authors suggest that these findings can be applied to most people worldwide, and individuals can adapt the diet recommendations based on available foods and cultural preferences.
For example, the scientists say vegetarians can reach an adequate diet score by consuming plenty of fruits, vegetables, nuts, legumes, whole grains, and dairy. Moreover, non-vegetarians can achieve the same score by eating plenty of fruits, vegetables, and legumes along with either dairy or fish or moderate amounts of red meat or poultry.
- European Heart Journal. Diet, cardiovascular disease, and mortality in 80 countries.