July 11, 2023 – In the seesaw world of trying to maintain a healthy diet, researchers have good news for dairy lovers: Whole-fat foods, particularly dairy, can and should be included in a nutritious diet.
The finding flies in the face of U.S. and other dietary guidelines that recommend restricting whole-fat foods in favor of low-fat products.
The PURE diet recommends 2-3 daily servings of fruit; 2-3 daily servings of vegetables; 3-4 weekly servings of legumes; 7 weekly servings of nuts; 2-3 weekly servings of fish; and 14 weekly servings of dairy products (mainly whole fat).
The researchers developed the PURE healthy diet score for the current study, published online July 7 in in the European Heart Journal, based on an analysis of 245,000 people in 80 countries around the world.
Lead study author Andrew Mente, PhD, of McMaster University in Hamilton, Canada, said for too long the focus for healthy diets has been on low-fat foods.
“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,” Mente said.
More than 145,000 from 21 countries took part in the study, which uses healthy diet scores that range from 0 (least healthy) to 6 (most healthy). The average score among participants was 2.95.
An earlier version of the PURE diet penalized participants for things like red meat. This time, however, researchers said “unprocessed” red meat had little impact on outcomes. Unprocessed meat in general refers to cuts of meat that have not been otherwise processed, like steaks, loins, and chops. Processed meat includes bacon, sausage, and ham.
During an average follow-up of 9.3 years in the latest study, the healthiest diet (score of 5 or more) was linked with a 30% lower risk of death, 18% lower likelihood of heart disease, 14% lower risk of heart attack, and 19% lower risk of stroke compared with the least healthy diet (score of 1 or less).
The researchers also calculated scores for popular diets such as the DASH and Mediterranean diets. Links between heart health and diet were slightly stronger for the PURE score.
In addition, the findings were consistent in healthy adults as well as those with heart disease or diabetes at the beginning of the study.
The take-home message for everyone “is to eat plenty of fruits, vegetables, nuts, legumes, and a moderate amount of fish and whole-fat dairy to lower your risk of heart disease and death,” Mente said. “Guidelines and policies need to be updated with this newer evidence.”
Many other diets also do a great job in predicting disease risk, countered Howard D. Sesso, ScD, MPH, of Brigham and Women’s Hospital and Harvard Medical School. “Is PURE that much better? Maybe, maybe not. But not enough to dismiss other diets that are already the basis of recommendations in the U.S., Europe, and worldwide.”
“I do not believe guidelines should be changed based on this single study,” Sesso said, “but I welcome the scientific dialogue that should come out of any study that challenges what we think we know.”
Meanwhile, he said, “people should follow the healthy dietary pattern that works best for them.”