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Unhealthy diets are a contributing factor for death and cardiovascular disease globally. Research continually looks at how diet can influence our CVD risk and overall mortality, but mostly in the western world.

A recent team of researchers decided to look at this from a global perspective and set out to develop a healthy diet score using a cohort of 147,642 people aged 35-70 years, from 21 countries and 5 continents, known as the PURE study.

In the PURE study, a globally applicable diet score based on six food categories, each of which are associated with lower risk of mortality was developed. Specifically, fruit, veggies, legumes, nuts, dairy and fish.

The PURE Diet framework:
2-3 servings fruit daily (1 serve = 1 medium apple, banana or pear)
2-3 servings veggies daily (1 serve = 1 cup leafy vegs, ½ cup other veg)
3-4 servings legumes weekly (1 serve = ½ cup beans or lentils)
7 servings nuts weekly (1 serve = 30g)
2-3 servings fish weekly (1 serve = 85g cooked)
14 servings dairy (whole fat, excluding butter and cream) weekly (1 serve = 1 cup milk or yoghurt, 40g cheese)


  • Wholegrains 1 serve daily can be part of a healthy diet (1 serve = 40g slice bread, ½ cup cooked rice, barley, buckwheat, quinoa or bulgur)
  • Unprocessed meats 1 serving daily (1 serve = 85g cooked red meat or poultry)


A score of 1 (healthy) was assigned for intake above the median in the group and a score of 0 (unhealthy) for intake at or below the median, for a total of 0 to 6.

The average diet score was 2.95.

Compared with the least healthy diet (score of 1 or less), the healthiest diet (score of 5 or more) was linked with a 30% lower risk of death, 18% lower likelihood of CVD, 14% lower risk of myocardial infarction and 19% lower risk of stroke.

Overall, it was found that consuming a diet 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 CVD and mortality in all world regions, but especially in countries with lower income where consumption of these natural foods is low.

Similar associations were found with the inclusion of meat or whole grain consumption in the diet score (in the quantities outlined above).

As I have spoken about previously, a Mediterranean diet pattern is associated with decreased risk of CVD and all-cause mortality. The 6 food types in the PURE study are also regularly consumed as part of a Mediterranean diet pattern, expect there is less emphasis on wholegrains.

Again, what this tells us is a diet high in plant food, lean protein in the form of fish and good quality dairy is protective of heart health and may help to reduce all-cause mortality.


Study reference: Diet, cardiovascular disease, and mortality in 80 countries, European Heart Journal, 2023.