PURE: Findings Could Have Implications For Global Dietary Guidelines

Separate findings from the PURE study suggesting an association between cardiovascular disease and mortality and fruit, vegetables and legume intake, as well as intake of fats and carbohydrates, could have an impact on global dietary guidelines, according to researchers presenting at ESC Congress 2017 in Barcelona.

All three studies, which were published in The Lancet, are based off the large, epidemiological PURE study involving 135,335 individuals aged 35-70 years across 18 countries and five continents between January 2003 and March 2013. Researchers used country-specific food frequency questionnaires at baseline and collected demographic, socioeconomic, lifestyle, family history and individual health history and medication information. The primary clinical outcomes were major cardiovascular disease, fatal and non-fatal myocardial infarction (MI), fatal and non-fatal stroke, cardiovascular mortality, non-cardiovascular mortality and total mortality. During a median 7.4 years (5.5-9.3) there were 4,784 major cardiovascular disease events, 1,649 cardiovascular deaths and 5,796 total deaths.

In an analysis of fruit, vegetable and legume intake, researchers found higher consumption of these was associated with a lower risk of non-cardiovascular and total mortality. Three to four servings per day (equivalent to 375-500 g/day) appeared to provide the maximum benefits for both non-cardiovascular mortality and total mortality. When looked at separately, researchers noted fruit intake was associated with lower risk of cardiovascular, non-cardiovascular and total mortality, while legume intake was inversely associated with non-cardiovascular death and total mortality. Raw vegetable intake was strongly associated with a lower risk of total mortality, while cooked vegetables were associated with a modest benefit against mortality.  

A separate analysis of nutrient intake (carbohydrate, fats and protein) found high carbohydrate intake was associated with higher risk of total mortality, but not with the risk of cardiovascular disease or cardiovascular disease mortality. Total fat and individual types of fat were associated with lower risk of total mortality, but were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality. Higher saturated fat intake was associated with lower risk of stroke.

A third analysis (not presented at ESC Congress 2017), used multilevel modeling to assess the effect of dietary nutrients on blood lipids and blood pressure in 125,287 PURE participants. Intake of total fat and each type of fat was associated with not only higher concentrations of total cholesterol and LDL cholesterol, but with higher HDL cholesterol and apolipoprotein A1 (ApoA1), and lower triglycerides, ratio of total cholesterol to HDL cholesterol, ratio of triglycerides to HDL cholesterol, and ratio of apolipoprotein B (ApoB) to ApoA1. Higher carbohydrate intake was associated with lower total cholesterol, LDL cholesterol and ApoB, but also with lower HDL cholesterol and ApoA1, and higher triglycerides, ratio of total cholesterol to HDL cholesterol, ratio of triglycerides to HDL cholesterol, and ApoB-to-ApoA1. Higher intakes of total fat, saturated fatty acids and carbohydrates were also associated with higher blood pressure, whereas higher protein intake was associated with lower blood pressure. Replacement of saturated fatty acids with carbohydrates was associated with the most adverse effects on lipids, according to researchers.  While replacement of saturated fatty acids with unsaturated fats improved some risk markers (LDL cholesterol and blood pressure), it seemed to worsen others (HDL cholesterol and triglycerides).

Researchers said their findings “are at odds with current recommendations to reduce total fat and saturated fats” and suggested global dietary guidelines be reconsidered. 

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet

Keywords: ESC Congress, ESC2017, Cholesterol, HDL, Cholesterol, LDL, Apolipoprotein A-I, Vegetables, Triglycerides, Apolipoproteins B, Lipids, Blood Pressure, Fruit, Fatty Acids, Fats, Unsaturated, Fabaceae, Energy Intake, Diet, Apolipoprotein B-100, Nutrition Policy, Myocardial Infarction, Stroke, Cardiovascular Diseases, Life Style, Carbohydrates, Demography, Epidemiologic Studies


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