An analysis of data from international studies indicated that diets comprised of higher amounts of fruits, vegetables, nuts, legumes, and a moderate amount of fish and whole-fat dairy is associated with a lower risk of cardiovascular disease (CVD) and mortality in all world regions, especially in countries with lower income where consumption of these protective foods is low. Based on six foods each of which has been associated with a significantly lower risk of mortality, i.e. fruit, vegetables, nuts, legumes, fish, and dairy (mainly whole-fat), a healthy diet score (the unweighted sum of the 6 component scores; 1 point was given for intake levels above the median in the study cohort for each component) was developed in 147 642 people from the general population in 21 countries, and then examined in five independent studies from 70 countries. During a median follow-up of 9.3 years, compared with a diet score of ≤1 points, a diet score of ≥5 points was associated with a lower risk of mortality [hazard ratio (HR) 0.70], CVD (HR 0.82), myocardial infarction (MI, HR 0.86), and stroke (HR 0.81). In three independent prospective cohort studies in vascular patients, similar results were found, with a higher diet score being associated with lower mortality (HR 0.73), CVD (HR 0.79), MI (HR 0.85), and a non-statistically significant lower risk of stroke (HR 0.87). Additionally, in two case-control studies, a higher diet score was associated with lower first MI [odds ratio (OR) 0.72] and stroke (OR 0.57). The diet score was predictive of outcomes in those with and without vascular disease or diabetes and in all world regions, although the associations were significantly stronger in regions with lower than with higher gross national incomes. Similar associations were found with the inclusion of meat or whole grain consumption in the diet score. The score showed slightly stronger associations with death or CVD than several other common diet scores. The healthy diet for each population is likely one of variety and moderation. Recommendations to change intake of any given food or nutrient must consider the current level of intake of various foods in the population. Source: https://academic.oup.com/eurheartj/
