MedicalResearch.com Interview with:
Ms Victoria Miller
Population Health Research Institute
DBCVS Research Institut
McMaster University, Hamilton, ON
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: PURE study is prospective urban rural epidemiology study that included aged 35 to 70 years from 26 low-income, middle-income, and high-income countries on 5 continents. Data were collected at the community, household, and individual levels. Standardized questionnaires were used to collect information about demographic factors, socio-economic status (education, income, and employment), lifestyle (smoking, physical activity, and alcohol intake), health history and medication use. Standardized case-report forms were used to record data on major cardiovascular events and mortality during follow-up, which were adjudicated centrally in each country by trained physicians using standard definitions. Participants’ habitual food intake was recorded using country-specific (or region specific in India) validated food frequency questionnaires (FFQs) at baseline. The median follow up is 7.4 years and we are aiming for follow up people at least for 15 years. During 7.4 years of follow up more than 6000 CVD and 7000 mortality recorded.
Higher fruit, vegetable and legume intake is associated with a lower risk of cardiovascular, non-cardiovascular and total mortality. Our findings show the lowest risk of death in those who consume three to four servings (equivalent to 375-500 grams per day) of fruits, vegetables and legumes per day, with little additional benefit for intake beyond that range.
When examined separately, fruit intake is associated with lower risk of cardiovascular, non-cardiovascular and total mortality, while legume intake is inversely associated with non-cardiovascular and total mortality. For vegetables, raw vegetable intake is more strongly associated with lower risk of total mortality compared to cooked vegetable intake.
MedicalResearch.com: What should readers take away from your report?
Response: Our data suggest that the minimum intake of fruits, vegetables and legumes should be 3 to 4 servings per day (equivalent to 375 to 500 grams per day). Fruits and vegetables are relatively expensive in most middle and low income countries and the current recommendations of 5 daily servings is unaffordable for most people in South Asia, China, Southeast Asia and Africa and poorer people in HIC. Even a small reduction in the recommendation from 400 to 375 grams per day may have important implications on household spending and food security in poor countries. For people in higher income countries already eating 5 servings per day, this is not a suggestion to eat less. Fruit, vegetable and legume intake should be seen as part of an overall healthy diet and lifestyle.
Raw vegetable intake was more strongly associated with a lower risk of death compared to cooked vegetable intake but raw vegetables are rarely eaten in many regions including South Asia, Africa and Southeast Asia. Dietary guidelines do not differentiate between the benefits of raw versus cooked vegetables. Our results indicate that recommendations should emphasize raw vegetable intake over cooked.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We intend to examine the associations of different types of fruits and vegetables versus cardiovascular disease and mortality. Additionally, we plan to investigate the association between fruits, vegetables and legumes and specific causes of non-cardiovascular death. As more data accumulate with increased follow up and the expansion of enrolment in the PURE study to 200,000 individuals, we will be in a better position to conduct more robust analyses of the associations between diet and specific causes of mortality in PURE.
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Published online: August 29, 2017
Victoria Miller, Andrew Mente, Mahshid Dehghan, Sumathy Rangarajan, Xiaohe Zhang, Sumathi Swaminathan, Gilles Dagenais, Rajeev Gupta, Viswanathan Mohan, Scott Lear, Shrikant I Bangdiwala, Aletta E Schutte, Edelweiss Wentzel-Viljoen, Alvaro Avezum, Yuksel Altuntas, Khalid Yusoff, Noorhassim Ismail, Nasheeta Peer, Jephat Chifamba, Rafael Diaz, Omar Rahman, Noushin Mohammadifard, Fernando Lana, Katarzyna Zatonska, Andreas Wielgosz, Afzalhussein Yusufali, Romaina Iqbal, Patricio Lopez-Jaramillo, Rasha Khatib, Annika Rosengren, V Raman Kutty, Wei Li, Jiankang Liu, Xiaoyun Liu, Lu Yin, Koon Teo, Sonia Anand, Salim Yusuf
on behalf of the Prospective Urban Rural Epidemiology (PURE) study investigators
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