Eating fruits, vegetables, legumes, nuts, fish and full-fat dairy products is an important factor in reducing the risk of cardiovascular disease, the World Health Organization estimates that CVD deaths in 2019 represent 32 percent of all deaths worldwide. 85 percent of these deaths were due to heart attacks and strokes.

A global survey

McMaster University researchers, Population Health Research Institute (PHRI) Hamilton Health Sciences researchers, and their collaborators from around the world conducted a recent study that analyzed data from multiple surveys of 245,000 people in 80 countries. The results were published this year in the European Heart Journal on July 6, 2023. It shows that not eating enough of 6 key foods is associated with an increased risk of cardiovascular disease (CVD) in adults.

Saudi participation in the study

Dr. Khaled bin Fayez Al-Habib, consultant in adult cardiology and cardiology catheterization, King Fahd Cardiology and Cardiac Surgery Center, College of Medicine, King Saud University and President of the Association Against Heart Disease (NABADAT) Dr. Khaled bin Fayez Al-Habib, in his capacity as a researcher, is one of the researchers in a major and global study in Saudi Arabia to shed more light on this study.

Dr. Al-Habib explained that previous research and similar research focused on Western countries and diets that combine harmful, ultra-processed foods with nutrient-dense foods. In general, this includes eating fruits and vegetables, legumes, nuts, fish, and full-fat dairy products, which are key factors in reducing the risk of cardiovascular disease, including heart attack and stroke.

The study also found that a healthy diet can be achieved in a variety of ways, including moderate amounts of whole grains or unprocessed meats.

Professor Khaled Al-Habib added that the researchers extracted the dietary score from the current, large-scale PHRI Future Urban and Rural Epidemiology (PURI) study, and then replicated it in 5 independent studies, to measure health outcomes in different areas. World and in those with heart disease, previous vascular, or not affected.

Previous dietary studies, including the EAT-Lancet Planetary Diet and the Mediterranean Diet, have examined the relationship between diet and cardiovascular disease and mortality, mainly in Western countries.

Dr. Al-Habib added that increasing the consumption of preventive foods to prevent disease has recently received more attention. Researchers have shown that a moderate diet of natural foods is important, as well as moderate amounts of fish and full-fat dairy products. Associated with a lower risk of cardiovascular disease and death. The same health results can be achieved with moderate consumption of grains and meats; As long as it’s whole, unrefined grains and unprocessed meat.

Facts about the study

Professor Khalid Al-Habib confirmed that the study was the most diverse study of nutrition and health outcomes in the world and the only study with sufficient numbers, with representation from high-, middle- and low-income countries. the world

Current recommendations for a high-quality diet to prevent cardiovascular disease (CVD) were based on studies decades ago, in high-income countries, with limited information on what people around the world eat today.

Dietary patterns vary considerably among regions of the world, so it is not known whether conclusions about dietary patterns drawn from studies in high-income countries and Western countries (where overeating of certain staple foods is a major problem) apply to low-income countries. Medium (missing some key foods is a major concern).

Key Findings

The main findings we focus on here are four, namely:

> A higher score on a healthy clean diet means foods that are part of other food scores (ie, high amounts of fruits, vegetables, nuts, legumes, and fish) but an item not included in other food scores (full-fat milk) are associated with lower global mortality, heart disease, heart attacks, and Associated with a lower risk of stroke.

> A 20 percent improvement in dietary quality in the population is likely to be associated with an 8 percent reduction in mortality and a 6 percent reduction in cardiovascular disease.

> The PURE score performs slightly better than many popular diet quality scores, such as the Mediterranean Diet Score, the Healthy Eating Index, and the Diet to Stop Hypertension (DASH) score, but it is much better than the Planetary Diet Score. Planet Food Score). Importantly, unlike previous diet scores, the PURE Diet Score has been developed and replicated among populations from many parts of the world.

> PURE’s findings are replicated in 5 studies of different designs and cohorts worldwide, in people with and without vascular disease or diabetes, in all parts of the world, but in poorer parts of the world (eg: South Asia, China, Africa); Where PURE Diet scores low. These findings raise the idea that under-consumption of key natural foods (and possibly under-nutrition) rather than over-consumption or over-nutrition may be the main problem of diet in terms of mortality and cardiovascular disease worldwide. It challenges current beliefs.

Global Diet

This research has profound implications for food systems around the world. Globally, the greatest gains in avoided cardiovascular disease and premature death are expected to come from moderate consumption of healthy foods; Especially in the poorest parts of the world. On this basis, the current advice to restrict dairy products (particularly full-fat milk) to very low levels in the population worldwide is neither necessary nor appropriate. A modest increase in their consumption in low- and middle-income countries would be beneficial. The ideal diet for each population group is likely to be varied and moderate, which are characteristics of a pure diet.

PURE is recommended at the global population level and can be used as a basis for recommendations for what constitutes a healthy diet globally, then adapted for each region based on the specific types of food available and affordable in each region. It could also address the continuing significant problem of malnutrition in many countries or the poor in high-income countries.

> How to achieve healthy food in places where maximum food quality is difficult to achieve?

Professor Al-Habib responded that a small improvement in food quality is expected to have a significant impact on people’s health, especially in poor countries. In fact, the greatest gains in health were seen when a diet score of 4 was achieved, with moderate additional health gains with diet scores above 4.

This diet score can be achieved in a variety of ways to suit personality or culture and preferences, and does not necessarily include or exclude animal foods from the diet. For example, a vegetarian can achieve a score of 4 on a diet by eating more fruits, vegetables, legumes, nuts, whole grains, and dairy products. Conversely, non-vegetarians can achieve the same effect by consuming more fruits, vegetables, and legumes, along with dairy products or fish, or even moderate amounts of red meat or poultry.

> To what extent are the results of this study consistent or inconsistent with the current adoption of the Mediterranean diet?

Professor Al-Habib explained that the healthy diet findings are similar to other popular dietary findings, with some differences in the emphasis on different types of fat, including the Mediterranean diet, which focuses on increasing fruits, vegetables, legumes, nuts and fish. and consumption of dairy products or red meat.

Our findings show that a similar dietary pattern, but including dairy foods consumed mainly as full-fat dairy products, may have positive associations with health outcomes in the global population.

The Mediterranean diet is similar, except that it includes whole dairy products. Some other dietary markers include whole grains, including the Mediterranean, which has been shown to be positively associated with lower CVD events in several cohort studies. In our study, whole grains did not contribute to the benefit of the Diet Score in predicting cardiovascular disease risk or mortality. Therefore, moderate amounts of whole grains are recommended for a healthy diet.

Finally, Professor Khaled Al-Habib sent a message to the general public and policy makers, recommending eating lots of fruits, vegetables, nuts and legumes and moderate amounts of fish and full-fat dairy products to reduce risk. Cardiovascular morbidity and mortality in all regions of the world.

For the poorest parts of the world; If intake of these natural foods is very low, improving 3 or 4 of these foods can provide significant protection, he said. He reiterated that his findings indicate that, globally, the risks of death and vascular events are higher in adults with adequate intake of protective foods.

Dietary Study Recommendations

The Pure Healthy Diet Score recommends an average daily intake of: two to three servings of fruit; Two to three servings of vegetables; Nuts 1 serving; Two servings of dairy products; Legumes for three to four weeks; and serve fish for 2 to 3 weeks. Possible substitutions include one serving of whole grains per day, and one serving per day of unprocessed red meat or poultry.

He expressed his gratitude and appreciation to the sponsors of the study, the Saudi Heart Association, Sheikh Saleh Serafi Chair for Coronary Artery Disease Research and Dr. Muhammad Al-Faqih Hospital.* Consultant in Community Medicine.