Results from a recently released, long awaited dietary study will put supporters of low-fat diets into a carbohydrate-fueled tailspin. According to the large cohort Prospective Urban Rural Epidemiology PURE study, higher fat diets that include both saturated and unsaturated fats are associated with a lower risk of mortality. And replacing said fats with high carbohydrate intakes (above 60% energy) is associated with higher risk mortality.
The news, presented in Barcelona at the European Cardiology Congress and published in Lancet, shows the world has a significant health problem: too many people consume too many simple carbohydrates and too few fats. Why? Many take advice from European and North American health advisories, which may not be relevant to moderate and low-income populations.
The study included people aged 35-70 years old from 18 countries across various regions including the Middle East, South America, Africa, China, North America and Europe, and South Asia and looked at the links between diet, cardiovascular disease and death. Participants’ completed follow-up visits with the researchers every three years to record information on cardiovascular disease (ie, fatal and non-fatal heart attacks, stroke and heart failure) and death for 7.4 years. The team analysed rates of cardiovascular events (for example, heart attack, stroke, heart failure), cardiovascular deaths and and non-cardiovascular deaths.
PURE Study Points to Fewer Carbs and Greater Fat Intake
The study found that on average, globally, people’s diets consisted of over 60% energy from carbohydrates and 24% energy from fats, suggesting that rather than focusing on reducing fat intake, dietary guidelines should instead focus on reducing carbohydrate consumption, particularly in low- and middle-income countries where carbohydrate intake was highest.
Additionally, while current guidelines recommend reducing saturated fat intake to below 10%, the study found that very low intake of saturated fats (below 3%) was associated with a higher risk of mortality, compared to diets with a higher intake of saturated fats of up to 13%.
“For the first time, our study provides a global look at the realities of people’s diets in many countries and gives a clearer picture of people’s fat and carbohydrate intake,” says lead author Dr. Mahshid Dehghan, McMaster University, Canada. “The current focus on promoting low-fat diets ignores the fact that most people’s diets in low and middle income countries are very high in carbohydrates, which seem to be linked to worse health outcomes. In low- and middle-income countries, where diets sometimes consist of more than 65% of energy from carbohydrates, guidelines should refocus their attention towards reducing carbohydrate intake, instead of focusing on reducing fats.”
The best diets will include a balance of carbohydrates and fats – approximately 50-55% carbohydrates and around 35% total fat, including both saturated and unsaturated fats. Our study did not look at trans fats, typically from processed foods, and the evidence is clear that these are unhealthy,” says Dehghan.
Critical Findings of PURE Study
Globally, the average diet consisted of 61.2% carbohydrates, 23.5% fat (including 8% saturated fats, 8.1% monounsaturated fats, and 5.3% polyunsaturated fats), and 15.2% protein.
However, this balance varied by region: on average, carbohydrate intake was highest in China (67%), South Asia (65.4%) and Africa (63.3%); total fat intake was highest in North America and Europe (30.5%), Middle East (30.3%), and Southeast Asia (29.2%).
High carbohydrate diets were common, with more than half of the people in the study eating a high carbohydrate diet (at least 60% of energy from carbohydrates), and about a quarter deriving 70% of their daily calories from carbohydrates.
Half of the people involved derived less than 7% of their energy from saturated fats, and three-quarters (75%) ate less than 10% from saturated fats.
Cardiovascular Disease Outcomes
During the study, 5,796 people died (including 1,649 from cardiovascular disease and 3,809 from non-cardiovascular disease) and 4,784 had a major cardiovascular disease event (2,143 heart attacks and 2,234 strokes).
Diets high in carbohydrates (average of 77% energy from carbohydrates) were associated with a 28% higher risk of death, compared with low carbohydrate diets (46% energy from carbohydrates). Rates of major cardiovascular events remained similar for low and high carbohydrate diets.
Comparatively, diets with high total fat intake (35.3% energy from fat) were associated with a 23% lower risk of death, compared with low fat diets (11.0% energy from fat).
Rates of major cardiovascular events remained similar for low and high fat diets.
The trends were similar when looking at saturated fats, with very low intake (below 3%) associated with a higher risk of mortality, compared to diets with a higher intake of saturated fats of up to 13%.