New research is making claims contradictory to existing diet advice, suggesting that a diet including whole-fat dairy is healthy and lowers the risk of cardiovascular disease (CVD) and death.

The study, which took place in 80 countries across the globe, states that a healthy diet does not need to involve unprocessed red meat and whole grains.

According to the study, “a diet comprised of higher amounts of fruit, vegetables, nuts, legumes, fish, and whole-fat dairy is associated with lower CVD and mortality” throughout the world. Eating unprocessed red meat and whole grains had little effect on the results.

Study author, Dr Andrew Mente of the Population Health Research Institute, McMaster University, in Hamilton, Canada, explained: “Low-fat foods have taken centre stage with the public, food industry and policymakers, with nutrition labels focused on reducing fat and saturated fat.

“Our findings suggest that the priority should be increasing protective foods such as nuts (often avoided as too energy dense), fish and dairy, rather than restricting dairy (especially whole-fat) to very low amounts.”

He continued: “Our results show that up to two servings a day of dairy, mainly whole-fat, can be included in a healthy diet. This is in keeping with modern nutrition science showing that dairy, particularly whole-fat, may protect against high blood pressure and metabolic syndrome.”

Researchers examined the association between a new diet score and the health of people throughout the globe. They generated a diet score based on six foods included in the PURE diet: two to three servings of fruit per day, two to three servings of vegetables per day, two to four servings of legumes per week, seven servings of nuts per week, two to three servings of fish per week and 14 servings of mainly whole fat dairy products (excluding butter or whipped cream) per week.

For each category, if an individual consumed above the median in the group, they received the healthy score of 1 and if an individual consumed the median in the group or below, they received the unhealthy score of 0.

“Participants in the top 50% of the population – an achievable level – on each of the six food components attained the maximum diet score of six,” added Dr Mente.

The PURE study involved 147,642 people from 21 countries and examined the link between the score and mortality, myocardial infarction, stroke and total CVD. Researchers accounted for factors which could sway the results such as age, sex, education level, urban or rural location, smoking status, diabetes and physical activity.

The average score was 2.95. During a median follow up of 9.3 years, 15,707 people had died and there had been 40,764 cardiovascular events.

The results revealed that those who had the healthiest diets, with a score of at least 5, had a 30% lower risk of death, 18% lower risk of CVD, 14% lower risk of myocardial infarction and 19% lower risk of stroke when compared to individuals with the unhealthiest scores of 1 or less.

Five independent studies which involved a total of 96,955 patients with CVD across 70 countries observed the link between diet scores and health outcomes.

“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,” said Dr Mente. “The connection between the PURE diet and health outcomes was found in generally healthy people, patients with CVD, patients with diabetes, and across economies.”

Professor Salim Yusuf, senior author and principal investigator of PURE, said: “The associations were strongest in areas with the poorest quality diet, including South Asia, China and Africa, where calorie intake was low and dominated by refined carbohydrates.

“This suggests that a large proportion of deaths and CVD in adults around the world may be due to undernutrition, that is, low intakes of energy and protective foods, rather than overnutrition. This challenges current beliefs.”

Dr Dariush Mozaffarian of the Friedman School of Nutrition Science and Policy, Tufts University, in Boston, stated: “The new results in PURE, in combination with prior reports, call for a re-evaluation of unrelenting guidelines to avoid whole-fat dairy products.

“Investigations such as the one by Mente and colleagues remind us of the continuing and devastating rise in diet-related chronic diseases globally, and of the power of protective foods to help address these burdens.”

Dr Mozaffarin concluded: “It is time for national nutrition guidelines, private sector innovations, government tax policy and agricultural incentives, food procurement policies, labelling and other regulatory priorities, and food-based healthcare interventions to catch up to the science. Millions of lives depend on it.”

The study was published in the in European Society of Cardiology (ESC) journal, European Heart Journal.

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