Diet, cardiovascular disease, and mortality in 80 countries

Area of Science:

• Nutritional epidemiology
• Global public health
• Cardiovascular disease research

Background:

• Developing a universally applicable healthy diet score is crucial for global health research.
• Previous dietary assessment tools have limitations in global applicability and association with health outcomes.

Purpose of the Study:

• To develop and validate a healthy diet score using data from the Prospective Urban Rural Epidemiology (PURE) study.
• To assess the score's association with mortality and cardiovascular events across diverse global populations.

Main Methods:

• A healthy diet score was created based on the consumption of six food groups: fruit, vegetables, nuts, legumes, fish, and dairy.
• The score's predictive validity was tested in the PURE study (147,642 participants) and five independent studies (245,000 participants across 80 countries).
• Outcomes included all-cause mortality and major cardiovascular events (cardiovascular disease, myocardial infarction, stroke).

Main Results:

• A higher healthy diet score (≥5 points) was associated with significantly lower risks of mortality (HR 0.70) and cardiovascular disease (HR 0.82) compared to a low score (≤1 point) in the PURE study.
• Consistent associations were observed in independent studies, including vascular patients and case-control studies.
• The healthy diet score demonstrated stronger associations with reduced death or cardiovascular disease in lower-income regions.

Conclusions:

• A diet rich in fruit, vegetables, nuts, legumes, fish, and whole-fat dairy is associated with reduced cardiovascular disease and mortality worldwide.
• The developed healthy diet score is globally applicable and particularly impactful in lower-income countries.
• This score offers a valuable tool for public health initiatives aimed at improving dietary habits and reducing non-communicable disease burden globally.