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Diet, cardiovascular disease, and mortality in 80 countries

Mente A 1 , Dehghan M 1 , Rangarajan S 1 , O'Donnell M 2 , Hu W 1 , Dagenais G 3 Show all authors , Wielgosz A 4 , A Lear S 5 , Wei L 6 , Diaz R 7 , Avezum A 8 , Lopez-Jaramillo P 9 , Lanas F 10 , Swaminathan S 11 , Kaur M 12 , Vijayakumar K 13 , Mohan V 14 , Gupta R 15 , Szuba A 16 , Iqbal R 17 , Yusuf R 18 , Mohammadifard N 19 , Khatib R 20 , Nasir NM 21 , Karsidag K 22 , Rosengren A 23 , Yusufali A 24 , Wentzel-Viljoen E 25 , Chifamba J 26 , Dans A 27 , Alhabib KF 28 , Yeates K 29 , Teo K 1 , Gerstein HC 1 , Yusuf S 1

Affiliations 

  • 1 Population Health Research Institute, Hamilton Health Sciences and McMaster University, 2nd Floor, Room C2-105, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
  • 2 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  • 3 Department of Medicine, Université Laval Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City G1V 4G5, Canada
  • 4 Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  • 5 Faculty of Health Sciences, and Department of Biomedical Physiology & Kinesiology, Simon Fraser University Vancouver, Burnaby, British Columbia, Canada
  • 6 State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, Xicheng District, China
  • 7 Estudios Clinicos Latinoamerica ECLA, Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
  • 8 International Research Center, Hospital Alemão Oswaldo Cruz & UNISA, Sao Paulo, São Paulo estado, SP Brazil
  • 9 Masira Research Institute, Medical School, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia
  • 10 Francisco Salazar, Universidad de La Frontera, Temuco, Araucanía, Chile
  • 11 Division of Nutrition, St John's Research Institute, Koramangala, Bangalore, Karnataka, India
  • 12 Postgraduate Institute of Medical Education and Research, School of Public Health, Chandigarh, Punjab and Haryana, India
  • 13 Health Action by People, Amrita Institute of Medical Sciences, Trivandrum, Kerala, India
  • 14 Director and Chief of Diabetes Research, Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
  • 15 Eternal Heart Care Centre and Research Institute, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India
  • 16 Department of Internal Medicine, Wroclaw Medical University, 4th Military Hospital, Wroclaw, Lower Silesian Voivodeship, Poland
  • 17 Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Sindh, Pakistan
  • 18 Department of Life Sciences, Independent University, Bangladesh, Bashundhara, Dhaka, Dhaka District, Bangladesh
  • 19 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Isfahan Province, Iran
  • 20 Departments of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  • 21 Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, Selangor, Malaysia
  • 22 Department of Internal Medicine, Division of Endocrinology, Medical Faculty of Istanbul University, Istanbul, Istanbul Province, Turkey
  • 23 Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Västergötland, Sweden
  • 24 Hatta Hospital, Dubai Health Authority, Dubai Medical University, Dubai, United Arab Emirates
  • 25 Faculty of Health Sciences, Centre of Excellence for Nutrition, Potchefstroom, North West Province, South Africa
  • 26 College of Health Sciences, Physiology Department, University of Zimbabwe, Harare, Harare Metropolitan Province, Zimbabwe
  • 27 Department of Medicine, University of the Philippines, Ermita, Manila, Metro Manila, Philippines
  • 28 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Riyadh Province, Saudi Arabia
  • 29 Department of Medicine, Queen's University, 94 Stuart Street, Etherington Hall, Kingston, Ontario, Canada
Eur Heart J, 2023 Jul 21;44(28):2560-2579.
PMID: 37414411 DOI: 10.1093/eurheartj/ehad269

Abstract

AIMS: To develop a healthy diet score that is associated with health outcomes and is globally applicable using data from the Prospective Urban Rural Epidemiology (PURE) study and replicate it in five independent studies on a total of 245 000 people from 80 countries.

METHODS AND RESULTS: A healthy diet score was developed in 147 642 people from the general population, from 21 countries in the PURE study, and the consistency of the associations of the score with events was examined in five large independent studies from 70 countries. The healthy diet score was developed based on six foods each of which has been associated with a significantly lower risk of mortality [i.e. fruit, vegetables, nuts, legumes, fish, and dairy (mainly whole-fat); range of scores, 0-6]. The main outcome measures were all-cause mortality and major cardiovascular events [cardiovascular disease (CVD)]. During a median follow-up of 9.3 years in PURE, compared with a diet score of ≤1 points, a diet score of ≥5 points was associated with a lower risk of mortality [hazard ratio (HR) 0.70; 95% confidence interval (CI) 0.63-0.77)], CVD (HR 0.82; 0.75-0.91), myocardial infarction (HR 0.86; 0.75-0.99), and stroke (HR 0.81; 0.71-0.93). In three independent studies in vascular patients, similar results were found, with a higher diet score being associated with lower mortality (HR 0.73; 0.66-0.81), CVD (HR 0.79; 0.72-0.87), myocardial infarction (HR 0.85; 0.71-0.99), and a non-statistically significant lower risk of stroke (HR 0.87; 0.73-1.03). Additionally, in two case-control studies, a higher diet score was associated with lower first myocardial infarction [odds ratio (OR) 0.72; 0.65-0.80] and stroke (OR 0.57; 0.50-0.65). A higher diet score was associated with a significantly lower risk of death or CVD in regions with lower than with higher gross national incomes (P for heterogeneity <0.0001). The PURE score showed slightly stronger associations with death or CVD than several other common diet scores (P < 0.001 for each comparison).

CONCLUSION: A diet comprised of higher amounts of fruit, vegetables, nuts, legumes, fish, and whole-fat dairy is associated with lower CVD and mortality in all world regions, especially in countries with lower income where consumption of these foods is low.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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