A recent study has resulted in a flurry of headlines such as: New Study Favors Fat Over Carbs published in the New York Times (9/8//17). They report on a study called PURE (Prospective Urban and Rural Epidemiology) which was recently published in the medical journal The Lancet.
Just what is this study?
PURE is an epidemiological study, meaning it collects information about people and evaluates associations between different factors, such as diet and health outcomes. Epidemiological studies do not prove cause and effect. In this study, the diets and other lifestyle habits of approximately 135,000 people living mostly in the Middle East, Africa, South America, and South Asia were evaluated. These populations were chosen as they are not as well studied as US and European populations.
Based on complex statistical analysis, the researchers concluded that health improved and mortality declined with a higher intake of vegetables, fruits, and legumes, but that this benefit peaked at about 3 servings a day. They also concluded that health improved and mortality declined when the diet consisted of a higher percentage of calories from fat vs. carbohydrate.
Here’s what most of these stories left out:
- Many of the people in this study were poor and suffered from inadequate food. These people made up a significant component of the group with low fruit and vegetable intake. About 8% of these people died over the course of the study.
- Those who had a higher intake of fruits and vegetables (about 8 servings a day) were wealthier and better educated. Only about 3% of these people died over the course of the study.
- The statistical analysis also factored in socioeconomic status, smoking, exercise, and jobs, which in effect diluted the benefit of fruit, vegetable, and legume intake. As one commentator noted, saying that too many fruits, vegetables, and legumes are unhealthy is like saying that higher education causes poor health (David Katz, MD).
- Saturated fat intake varied between populations, but was lower than current recommendations even at highest level of intake. Those who had a diet higher in saturated fat also ate more calories and protein, indicating better availability of food.
- All carbohydrates were considered together, rather than evaluating healthful carbohydrates such as those found in fruits, vegetables, and legumes separate from less healthful sources such as white rice and other processed foods.
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Here’s the bottom line: as usual, it’s important to go beyond the headlines when making decisions about health and nutrition. A large body of research supports the benefits of diets rich in fruits, vegetables, and legumes and low in saturated fats. This study does not override those conclusions.