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PURE Shakes Up Nutritional Field: Finds High Fat Intake Beneficial

A new study of dietary habits in 135,000 people around the world is set to shake up the nutrition field, with results showing high fat intake—including saturated fat—was associated with a reduced risk of mortality.

The PURE study, which followed participants from 18 countries for 7 years, also found that high carbohydrate intake was associated with an increased risk of mortality, although the data do not discriminate between processed and unprocessed carbohydrates.

While the study found a beneficial effect of increasing consumption of fruit, vegetables, and legumes on mortality, the maximum benefit was seen at three to four servings a day (equivalent to 375–500 g/day), with no additional benefit with higher intakes. The benefit from fruit, vegetables, and legumes was greater if they were eaten raw rather than cooked.

There was no association of either fat (total or saturated) or carbohydrate intake or fruit/vegetable/legume intake with major cardiovascular-disease events.

The study was presented at the European Society of Cardiology 2017 Congress. It was also published as two separate papers in the Lancet—one on the fat and carbohydrate outcome data[1] and one on fruit/vegetables/legumes outcome data[2]. A third paper in Lancet Diabetes and Endocrinology focuses on effects of the different dietary patterns on lipid levels and blood pressure[3].

The PURE trial documented 5796 deaths and 4784 major cardiovascular-disease events.

Hazard Ratio for Total Mortality (Highest Quintile vs Lowest Quintile)



HR (95% CI)

P for trend


 1.28 (1.12–1.46)  0.0001

Total fat

 0.77 (0.67–0.87)


Saturated fat

 0.86 (0.76–0.99)  0.0088

Monounsaturated fat

 0.81 (0.71–0.92)


Polyunsaturated fat

 0.80 (0.71–0.89)



  1. Dehghan M, Mente A, Zhang X, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): A prospective cohort study Lancet 2017: DOI:10.1016/ S0140-6736(17)32252-3. Abstract
  2. Miller V, Mente A, Dehghan M, et al.  Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): A prospective cohort study. Lancet2017;DOI:10.1016/ S0140-6736(17)32253-5. Abstract
  3. Mente A, Dehghan M, Rangarajan S et al. Association of dietary nutrients with blood lipids and blood pressure in 18 countries: A cross-sectional analysis from the PURE study.  Lancet Diabetes Endocrinol 2017;DOI:10.1016/ S2213-8587(17)30283-8. Abstract