[Nutrition in cardiovascular prevention: should we change our approach after the PURE study?]

PURE (Prospective Urban Rural Epidemiology) is a large ongoing observational study, performed in a number of variously developed countries (mostly Asian urban or rural cohorts). In a recent publication, authors were unable to identify, in the PURE cohort, any unfavorable correlation between the dietary intake of total fat or saturated fats and the risk of cardiovascular events or all-cause death. These data are in substantial agreement with information obtained from European cohorts (e.g. the PREDIMED or EPIC studies), and with the results of two recent meta-analyses, but at odd with most of data collected in US cohorts, in which saturated fat intake still represents a significant risk factor for cardiovascular events. In order to try to understand the possible reason(s) of these discrepancies, this review takes into consideration the different sources of saturate fats in US (meats) and Europe (milk and dairy), and suggests that the direct effect of saturated fats on cardiovascular risk is most likely very small or negligible; future dietary recommendation will need to take into greater consideration foods rather than nutrients.