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In addition, the results may not be generalisable to Australia, as the upper levels of intakes of carbohydrate reported in the study are much higher and the lower intakes of fats are very much lower than consumed here.It would be useful to see greater control of cultural, social, economic and other confounding variables, and more detailed analysis, including adoption of a food-based approach, in future reports of the PURE study.Consequently, the latest Australian Dietary Guidelines were 10 years out-of-date when they were published.Mr Shrapnel has a current appointment as an Advisor with the Sugar Research Advisory Service, and has consistently argued that carbohydrate recommendations are too high. The controversy that this study inevitably accentuates will not be resolved by such macronutrient-based studies.
The researchers say that diet advice to reduce fat is based on evidence from North America and Europe that may not apply to other countries.PURE found that lower intakes of fat and saturated fat (SFA) were associated with higher mortality, and had no benefit in terms of cardiovascular mortality.Importantly, this study refutes the claim often made that SFA variations in epidemiology just aren’t low enough to see the benefit of lower SFA.This paper reports initial associations, mainly in low and middle-income countries, between macronutrients (with a focus on carbohydrate, total and different types of fat) and cardiovascular disease and mortality.
The findings that higher intakes of fats including saturated fatty acids, monounsaturated fatty acids, and total polyunsaturated fatty acids, and also animal protein, were associated with lower mortality, whereas carbohydrate intake was associated with increased mortality make an important contribution to nutrition.Professor Lee wrote the published Lancet commentary for the previous PURE study paper on fruit, vegetables and legumes, and was chair of the NHMRC Australian Dietary Guidelines Working Committee, but states she has "no real or perceived conflicts of interest to declare regarding the PURE study or this paper."This is a good study, across a range of countries with high, mid and low average income populations.