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<jats:title>Aims<\/jats:title>\n                    <jats:p>To develop a healthy diet score that is associated with health outcomes and is globally applicable using data from the Prospective Urban Rural Epidemiology (PURE) study and replicate it in five independent studies on a total of 245 000 people from 80 countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A healthy diet score was developed in 147 642 people from the general population, from 21 countries in the PURE study, and the consistency of the associations of the score with events was examined in five large independent studies from 70 countries. The healthy diet score was developed based on six foods each of which has been associated with a significantly lower risk of mortality [i.e. fruit, vegetables, nuts, legumes, fish, and dairy (mainly whole-fat); range of scores, 0\u20136]. The main outcome measures were all-cause mortality and major cardiovascular events [cardiovascular disease (CVD)]. During a median follow-up of 9.3 years in PURE, compared with a diet score of \u22641 points, a diet score of \u22655 points was associated with a lower risk of mortality [hazard ratio (HR) 0.70; 95% confidence interval (CI) 0.63\u20130.77)], CVD (HR 0.82; 0.75\u20130.91), myocardial infarction (HR 0.86; 0.75\u20130.99), and stroke (HR 0.81; 0.71\u20130.93). In three independent studies in vascular patients, similar results were found, with a higher diet score being associated with lower mortality (HR 0.73; 0.66\u20130.81), CVD (HR 0.79; 0.72\u20130.87), myocardial infarction (HR 0.85; 0.71\u20130.99), and a non-statistically significant lower risk of stroke (HR 0.87; 0.73\u20131.03). Additionally, in two case-control studies, a higher diet score was associated with lower first myocardial infarction [odds ratio (OR) 0.72; 0.65\u20130.80] and stroke (OR 0.57; 0.50\u20130.65). A higher diet score was associated with a significantly lower risk of death or CVD in regions with lower than with higher gross national incomes (P for heterogeneity &amp;lt;0.0001). The PURE score showed slightly stronger associations with death or CVD than several other common diet scores (P &amp;lt; 0.001 for each comparison).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A diet comprised of higher amounts of fruit, vegetables, nuts, legumes, fish, and whole-fat dairy is associated with lower CVD and mortality in all world regions, especially in countries with lower income where consumption of these foods is low.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehad269","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T11:39:28Z","timestamp":1685014768000},"page":"2560-2579","source":"Crossref","is-referenced-by-count":161,"title":["Diet, cardiovascular disease, and mortality in 80 countries"],"prefix":"10.1093","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6879-7675","authenticated-orcid":false,"given":"Andrew","family":"Mente","sequence":"first","affiliation":[{"name":"Population Health Research Institute, Hamilton Health Sciences and McMaster University , 2nd Floor, Room C2-105, 237 Barton St East, Hamilton, Ontario L8L 2X2 , Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University , 1280 Main St W, Hamilton, Ontario L8S 4L8 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2636-4518","authenticated-orcid":false,"given":"Mahshid","family":"Dehghan","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton Health Sciences and McMaster University , 2nd Floor, Room C2-105, 237 Barton St East, Hamilton, Ontario L8L 2X2 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2420-5986","authenticated-orcid":false,"given":"Sumathy","family":"Rangarajan","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton Health Sciences and McMaster University , 2nd Floor, Room C2-105, 237 Barton St East, Hamilton, Ontario L8L 2X2 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"O\u2019Donnell","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University , Hamilton, Ontario , Canada"},{"name":"HRB-Clinical Research Facility, University of Galway , Galway, Connacht , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weihong","family":"Hu","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton Health Sciences and McMaster University , 2nd Floor, Room C2-105, 237 Barton St East, Hamilton, Ontario L8L 2X2 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilles","family":"Dagenais","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universit\u00e9 Laval Institut universitaire de cardiologie et de pneumologie de Qu\u00e9bec , Quebec City G1V 4G5 , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Wielgosz","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Ottawa , Ottawa, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"A. Lear","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, and Department of Biomedical Physiology & Kinesiology, Simon Fraser University Vancouver , Burnaby, British Columbia , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Wei","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences , Beijing, Xicheng District , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Diaz","sequence":"additional","affiliation":[{"name":"Estudios Clinicos Latinoamerica ECLA, Universidad Nacional de Rosario , Rosario, Santa Fe , 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Madras Diabetes Research Foundation and Dr. Mohan\u2019s Diabetes Specialities Centre , Chennai, Tamil Nadu , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8356-3137","authenticated-orcid":false,"given":"Rajeev","family":"Gupta","sequence":"additional","affiliation":[{"name":"Eternal Heart Care Centre and Research Institute, Rajasthan University of Health Sciences , Jaipur, Rajasthan , India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"Szuba","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Wroclaw Medical University, 4th Military Hospital , Wroclaw, Lower Silesian Voivodeship , Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romaina","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences and Medicine, Aga Khan University , Karachi, Sindh , 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Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edelweiss","family":"Wentzel-Viljoen","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Centre of Excellence for Nutrition , Potchefstroom, North West Province , South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jephat","family":"Chifamba","sequence":"additional","affiliation":[{"name":"College of Health Sciences, Physiology Department, University of Zimbabwe , Harare, Harare Metropolitan Province , Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Dans","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of the Philippines , Ermita, Manila, Metro Manila , Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6692-3874","authenticated-orcid":false,"given":"Khalid F","family":"Alhabib","sequence":"additional","affiliation":[{"name":"Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University , Riyadh, Riyadh Province , Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Yeates","sequence":"additional","affiliation":[{"name":"Department of Medicine, Queen's University , 94 Stuart Street, Etherington Hall, Kingston, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koon","family":"Teo","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, Hamilton Health Sciences and McMaster University , 2nd Floor, Room C2-105, 237 Barton St East, Hamilton, Ontario L8L 2X2 , Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University , 1280 Main St W, Hamilton, Ontario L8S 4L8 , Canada"},{"name":"Department of Medicine, McMaster University , Hamilton, Ontario , 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Impact, McMaster University , 1280 Main St W, Hamilton, Ontario L8S 4L8 , Canada"},{"name":"Department of Medicine, McMaster University , Hamilton, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,7,6]]},"reference":[{"key":"2023072113315208600_ehad269-B1","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1056\/NEJMoa1311890","article-title":"Cardiovascular risk and events in 17 low-, middle-, and high-income countries","volume":"371","author":"Yusuf","year":"2014","journal-title":"N Engl J Med"},{"key":"2023072113315208600_ehad269-B2","first-page":"e29","article-title":"Heart disease and stroke statistics\u20142015 update: a report from the American Heart Association","volume":"131","author":"Mozaffarian","year":"2015","journal-title":"Circulation"},{"key":"2023072113315208600_ehad269-B3","author":"Dietary Guidelines Advisory 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