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

The PURE (Prospective Urban Rural Epidemiology) study is an ongoing large population study that stands out from other similar studies due to its global reach. It embraces a wide demographic, covering different incomes and regions, which enables the capturing of a diversified, all-encompassing picture of health and dietary habits worldwide.

The latest published paper from the PURE study developed a unique healthy diet score based on six foods, a central focus of the study, tested extensively for its relevance and effectiveness. This PURE diet score notably includes whole-fat dairy as a constituent of its healthy foods - a diversion from other diet scores.

Interestingly, the PURE diet score refrained from categorising meat, leaving it un-scored, unlike most dietary index systems. The PURE diet score was compared in the paper with other commonly used diet scores. These included the Mediterranean diet, the DASH (Dietary Approaches to Stop Hypertension) score, the Healthy Eating Index, and the Planetary diet score.

The PURE diet score performed well against other scores. It was associated with a lower rate of mortality and reduced incidence of cardiovascular disease (CVD). Moreover, the PURE score was found to be widely applicable - including to individuals from high, middle, and low-income countries across the world, and to those with or without cardiovascular disease.

On the other hand, the Planetary diet score, based on the EAT Lancet diet from 2019, did not show any significant association with total mortality or significant CVD events, thereby deeming it somewhat inadequate as a health-outcome indicator.

The study's findings have implications. It suggests that whole dairy can and should be part of a healthy diet, a proposition often contradicted in traditional dietary guidelines. Similarly, it posits meat as neutral, a finding that overturns years of research that have often classified meat as detrimental.

Despite these findings, the key debate remains: does healthy food result in healthy individuals, or do inherently healthy individuals incline towards healthy foods?

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