ESC: Huge Diet Study Shows Carbs, Not Fats Are the Problem —-But PURE also challenges belief that more is better for fruits and vegetables

by Larry Husten, CardioBrief August 29, 2017, MedPage Today & American College of Cardiology

BARCELONA — An enormous prospective study of food intake in adults, reported here, challenges several staunchly held beliefs about dietary components and their association with health risks: finding, for example that diets rich in fats, including saturated fats, don’t increase mortality risk, but high-carbohydrate diets do.

And the study, called PURE (Prospective Urban Rural Epidemiology), also found that the benefits of fruits, vegetables, and legumes top out at just three to four total servings per day.

In sum, the results suggest that nutritional guidelines and conventional wisdom regarding these basic dietary elements may be seriously mistaken.

PURE investigators recorded food intake using questionnaires in 135,000 people in 18 countries, including high-, medium- and low-income nations. The latest findings from the ongoing study, with median follow-up of 7.4 years, were outlined in two separate presentations at the European Society of Cardiology meeting here, which were accompanied by simultaneous publications in The Lancet and in Lancet: Diabetes & Endocrinology.

Carbohydrates and Fats: Unexpected Findings

One presentation and Lancet paper led by Mahshid Dehghan, PhD, of McMaster University in Hamilton, Ontario, focused on the association of fats and carbohydrate intake with cardiovascular disease and mortality.

Defying expectations, PURE found that high carbohydrate intake was associated with a significant increase in the risk of death, while both total fat and saturated and unsaturated fats were associated with a decreased risk of death. However, fat consumption was not associated with cardiovascular disease or cardiovascular mortality, though saturated fat had an inverse association with stroke.

“Global dietary guidelines should be reconsidered in light of these findings,” Dehghan concluded.

These findings may be partly explained by the paper in Lancet: Diabetes & Endocrinology, which looked at the effect of dietary nutrients on lipids and blood pressure. The authors found that high intake of carbohydrates had “the most adverse impact on cardiovascular risk factors” while monounsaturated fats had a beneficial effect and saturated fat had a neutral effect.

“Reducing saturated fatty acids and replacing them with carbohydrates might have an adverse effect on cardiovascular disease risk,” they concluded. “Current recommendations to reduce total fat and saturated fatty acids in all populations, which de facto increases carbohydrate intake, are not supported by our data.”

Fruits, Vegetables, Legumes: Benefits Limited

The second presentation and Lancet paper, by Andrew Mente, PhD, also of McMaster University, challenges the widely held and nearly religious belief that more is always better when it comes to fruits, vegetables, and legumes.

The study did confirm that fruits and veggies (and legumes) in moderation are good for you, but it did not show that the benefits keep growing with increased consumption. Instead, the PURE researchers found that the maximum benefit was achieved with three to four serving per day. Current guidelines recommend that people consume five servings a day. The authors note that many people in lower income countries are unable to afford this high level of consumption.

“Optimal health benefits can be achieved with a more modest level of consumption, an approach that is likely to be much more affordable,” write the PURE investigators.

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