The PURE study – diet, CVD & mortality in 80 countries

Executive summary

* The PURE study is an ongoing large population study, which differs from other population studies because of its global reach.

* The latest paper from the PURE study had several aims. Central to these was the development of a simple healthy diet score (based on six foods). The PURE diet score was tested for its relevance in many different ways in this paper.

* The inclusion of whole-fat dairy, as one of the six healthy foods, differentiated this healthy diet index from others. Meat was not scored (as healthy or unhealthy).

* The PURE diet score was compared with other commonly used diet scores (Mediterranean, DASH, Healthy Eating Index and the Planetary diet score).

* The PURE diet score performed well. It was associated with lower mortality and cardiovascular disease (CVD).

* The PURE diet score was found to be applicable to people from high, middle and low income countries from various regions of the world and to those without CVD.

* The planetary diet score (based on the EAT Lancet diet from 2019) was not associated with total mortality or major CVD events. It turned out to be a useless indicator of these health outcomes.

* There are a number of implications of this study. Whole dairy can be part of a healthy diet. Meat has been established as neutral in this study (most studies previously have positioned or scored meat as harmful).

* The main population study debate remains – does healthy food make people healthy or do healthy people eat healthy food? I have a view.