Not eating enough of these six healthy foods is associated with higher cardiovascular disease and deaths globally

Andrea Mind

image: Andrew Mente, Population Research Health Institute scientist and assistant professor in the McMasters Department of Health Research Methods, Evidence, and Impact.
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Credit: Health Institute for Population Research

HAMILTON, ON (July 6, 2023) — A study by McMaster University and Hamilton Health Sciences researchers at the Population Research Health Institute (PHRI) found that not eating enough of six key foods in combination is associated with a higher risk of cardiovascular disease (CVD) disease in adults.

Consuming fruits, vegetables, legumes, nuts, fish and whole-grain dairy products is essential for reducing the risk of cardiovascular disease, including heart attacks and strokes. The study also found that a healthy diet can be achieved in a variety of ways, such as including moderate amounts of whole grains or unprocessed meats.

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Previous research and the like have focused on Western countries and diets that combined unhealthy, ultra-processed foods with nutrient-dense foods. This research was global in scope and focused on foods commonly considered healthy.

The World Health Organization estimates that nearly 18 million people died from CVD in 2019, accounting for 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke. PHRI researchers and their global collaborators analyzed data on 245,000 people in 80 countries from multiple studies. The results were published in European Heart Journal on July 6th.

The researchers derived a diet score from PHRI’s ongoing large-scale Prospective Urban and Rural (PURE) Global Study, then replicated it in five independent studies to measure health outcomes in different regions of the world and in people with and without previous CVDs.

“Previous diet scores, including the EAT-Lancet Planetary Diet and the Mediterranean Diet, have tested the relationship between diet, CVD, and death primarily in Western countries. The PURE Healthy Diet Score included good representation from high-, middle-, and low-income countries,» said Salim Yusuf, PURE senior author and principal investigator.

In addition to being truly global, the PURE Healthy Diet Score focused solely on protective or natural foods.

“We were unique in this focus. The other diet scores combined foods considered harmful — such as processed and ultra-processed foods — with foods and nutrients thought to be protective of health,” said first author Andrew Mente, PHRI scientist and assistant professor in the Department of Health Research at McMaster. Methods, evidence and impact.

“There is recent increased attention for increased consumption of protective foods for disease prevention. Outside of large amounts of fruits, vegetables, nuts and legumes, researchers have shown that moderation is key in eating whole foods,” she said.

“Moderate amounts of whole fish and dairy products are associated with a lower risk of cardiovascular disease and mortality. The same health results can be achieved with moderate consumption of grains and meats, as long as they are unrefined whole grains and unprocessed meats.

The PURE Healthy Diet Score recommends an average daily intake of: two to three servings of fruit; vegetables in two or three servings; nuts in one serving; and two-serving dairy products. The score also includes three to four weekly servings of legumes and two to three weekly servings of fish. Possible substitutes included whole grains in one serving per day and unprocessed red meat or poultry in one serving per day.

There was no specific funding for this analysis, although each study providing data was separately funded and conducted over a 25-year period.


A photo by Andrew Mente can be found at:

For more information, or to schedule an interview, please contact:

Andrea Mind
Population Health Research Institute (PHRI)
[email protected]


Veronica McGuire
Media relations
McMaster University
905-525-9140, extn. 22169
[email protected]

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