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A healthy focus on diet can be an important part of any well-run workplace wellness program.

For example, we previously reported that the American Heart Association states that “Globally, increasing the consumption of fruits and vegetables could save millions of years lost to disability and premature death from heart disease, according to a study presented at the American Heart Association’s Epidemiology and Prevention | Lifestyle and Cardiometabolic Health 2017 Scientific Sessions.”

“Researchers used nutritional surveys and consumer expenditure surveys as well as data from previous studies on the impact of low fruit and vegetable consumption on the risk of heart disease to calculate the number of disability-adjusted life years (DALYs) – healthy years lost to heart-disease-related disability or death – for 195 countries.”

And understanding how to maintain a healthy diet — particularly in the workplace, where lack of time and options or increased workload and pressures can negatively impact food choices — remains an ongoing requirement. We've noted that MedPage Today reports that “the optimal level of fats in the diet, and which kinds, remain a topic of heated debate, as does the process by which the government’s official dietary guidelines have been developed.”

Indeed, a recent study published in The Lancet and titled Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study looks at the issue.

As the authors write: “Cardiovascular disease is a global epidemic with 80% of the burden of disease in low-income and middle-income countries. Diet is one of the most important modifiable risk factors for cardiovascular disease and other non-communicable diseases and current guidelines recommend a low-fat diet (<30% of energy) and limiting saturated fatty acids to less than 10% of energy intake by replacing them with unsaturated fatty acids. However, recommendations on lowering saturated fatty acids are largely based on one ecological study and observational studies done in European and North American countries such as Finland, where the intake of saturated fatty acids (about 20% of total energy intake) and cardiovascular disease mortality were both very high. Furthermore, dietary recommendations are based on the assumption of a linear association between saturated fatty acid intake and LDL cholesterol, and then the association between LDL cholesterol and cardiovascular disease events. However, this assumption does not consider the effect of saturated fatty acids on other lipoproteins (eg, HDL cholesterol), ratio of total cholesterol to HDL cholesterol, or on apolipoproteins (which could be a better marker of cardiovascular disease risk) and blood pressure, which also affect the risk of cardiovascular disease.”

So researchers conducted the PURE study: “The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35–70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3–9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires.”

Their interpretation of results: “High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.”

Their conclusion provides strong reason for employees to consult with a dietitian about how to maintain the appropriate diet for their own lifestyle and profile.

The authors write: “In this large prospective cohort study from 18 countries in five continents, we found that high carbohydrate intake (more than about 60% of energy) was associated with an adverse impact on total mortality and non-cardiovascular disease mortality. By contrast, higher fat intake was associated with lower risk of total mortality, non-cardiovascular disease mortality, and stroke. Furthermore, higher intakes of individual types of fat were associated with lower total mortality, non-cardiovascular disease mortality, and stroke risk and were not associated with risk of major cardiovascular disease events, myocardial infarction, or cardiovascular disease mortality.”

And further: “Our findings do not support the current recommendation to limit total fat intake to less than 30% of energy and saturated fat intake to less than 10% of energy. Individuals with high carbohydrate intake might benefit from a reduction in carbohydrate intake and increase in the consumption of fats.”

It should be noted, that in the same issue of The Lancet, other researchers note that the “PURE study challenges the definition of a healthy diet: but key questions remain.” These are important notes to consider for nutrition management.

They ask: “Is PURE less confounded by conscientiousness than observational studies done in European and North American countries? Conscientiousness is among the best predictors of longevity. For example, in a Japanese population, highly and moderately conscientious individuals had 54% and 50% lower mortality, respectively, compared with the least conscientious tertile. Conscientious individuals exhibit numerous health-related behaviours ranging from adherence to physicians' recommendations and medication regimens, to better sleep habits, to less alcohol and substance misuse. Importantly, conscientious individuals tend to eat more recommended foods and fewer restricted foods. Since individuals in European and North American populations have, for many decades, received influential diet recommendations, protective associations attributed to nutrients in studies of these populations are likely confounded by numerous other healthy behaviours. Because many of the populations included in PURE are less exposed to influential diet recommendations, the present findings are perhaps less likely to be confounded by conscientiousness.”

They conclude: “The PURE study is an impressive undertaking that will contribute to public health for years to come. Initial PURE findings challenge conventional diet–disease tenets that are largely based on observational associations in European and North American populations, adding to the uncertainty about what constitutes a healthy diet. This uncertainty is likely to prevail until well designed randomised controlled trials are done. Until then, the best medicine for the nutrition field is a healthy dose of humility.”