Intakes of fruits, vegetables and carbohydrate and the risk of CVD

Center for Clinical Research and Health Promotion, University of Puerto Rico, Medical Sciences Campus, School of Dentistry Office A-107, PO Box 365067, San Juan, Puerto Rico PR00936.
Public Health Nutrition (Impact Factor: 2.68). 05/2008; 12(1):115-21. DOI: 10.1017/S1368980008002036
Source: PubMed


Low-carbohydrate diets could lead to reduced fruit and vegetable intake, which may be protective against CVD. The role of carbohydrate intake in modifying the association between fruits and vegetables and CVD has not been evaluated.
To evaluate whether carbohydrate intake affects the association between fruits and vegetables and CVD.
We included participants from two large prospective studies, the Nurses' Health Study (NHS) and the Health Professionals' Follow-Up Study (HPFS). We followed 70 870 eligible NHS females for 16 years and 38 918 eligible HPFS males for 14 years. Diet was assessed from an FFQ updated every 4 years. Our primary outcome was ischaemic CVD (fatal and non-fatal myocardial infarction and ischaemic stroke). We used Cox proportional hazards models to evaluate the relationship between fruits and vegetables and ischaemic CVD within groups with low, moderate or high carbohydrate intake.
Fruit intake was strongly related with carbohydrate intake, but vegetables showed a very small correlation. Vegetable intake showed stronger associations with ischaemic CVD among the low carbohydrate group (multivariate risk ratio (RR) = 0.82 for an increment of 3 servings/d; 95 % CI 0.68, 0.99); green leafy vegetables and carotene-rich fruits and vegetables followed a similar pattern. Total fruit intake was associated with a lower risk of ischaemic CVD only among participants with moderate carbohydrate intake (RR = 0.81 comparing extreme quintiles; 95 % CI 0.70, 0.94).
Total vegetables, green leafy vegetables and carotene-rich fruits and vegetables showed stronger associations with ischaemic CVD among the low carbohydrate group. No consistent trends were observed for fruit intake.

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Available from: Kaumudi J Joshipura, Jun 03, 2014
    • "The cardiovascular effect of replacing saturated fat with PUFA appeared to depend on which studies were pooled in the meta-analyses. For example, the Oslo Diet Heart Study was included in the analyses described above, [6, 9, 12], but was excluded in another analysis [13] due to its multiple faceted intervention that encouraged increased consumption of nuts, fruits and vegetables in the intervention group and supplied Norwegian sardines canned in cod liver oil providing about 5g/day of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), thus containing numerous potential confounders to the PUFA under examination. Ramsden's systematic review involved a thorough analysis to identify the specific oil content of the experimental and control diets for each of the 4 RCTs revealing that mixed interventions of both n-3 and n-6 PUFA significantly reduced the risks of non-fatal MI by 27% (RR 0.73, 95%CI 0.54 to 0.99) and non-fatal MI and CHD death by 22% (RR 0.78, 95%CI 0.65 to 0.93); however, the observed reduction for CV death (RR 0.81, 95%CI 0.64 to 1.03) and all-cause mortality (RR 0.92; 95%CI 0.80 to 1.06) did not reach significance, suggesting a lack of power. "
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    ABSTRACT: Background: Lifestyle modification, including diet, is a key strategy for prevention and regression of cardiovascular disease (CVD), a leading cause of death worldwide. Traditionally, the study of the relationship between diet and CVD has focused on the analysis of single nutrients, or foods, in relation to CVD risk. Objective: In part one of this review, we present current epidemiologic and clinical evidence on nutrition and cardiovascular health with regards to specific foods and nutrients aimed at preventing CVD. Methods: The Cochrane Library database between 2006 and 2012 was searched for studies on effects of dietary factors on cardiovascular health. Discussion: Evidence is presented on soy protein, fats, fish, nuts, fruit, vegetables, electrolytes, vitamins, and carbohydrate including fibre, glycaemic index, and wholegrains. Evidence from specific foods underpins current dietary CVD prevention guidelines, that advise on replacing saturated with unsaturated fat, consuming carbohydrate foods that are wholegrain or of low glycaemic index, increased consumption of fruit, vegetables (particularly cruciferous), nuts, and oily fish. Other nutrients (such as soya protein, or reducing sodium intake) reduce CVD risk via favourable effects on disease contributors (such as LDL-cholesterol or blood pressure), but also infer/promote dietary change that impacts other nutrients (using less animal or processed foods, resulting in saturated fat reduction). The complexity and limitations of interpreting dietary epidemiologic studies is reviewed. With the general ineffectiveness of nutrient-based intervention, recently the shift has been towards the examination of associations between dietary patterns and cardiovascular health, which will be examined in the second part of this review.
    No preview · Article · Nov 2013
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    • "Another classification focuses on antioxidant content, e.g. vitamin C [9,13,15], folate [13] and carotene [13,15], which are implicated in the etiology of diseases such as CVD and cancer, and may contribute substantially to health inequality [4]. Finally, particular attention can be paid to the dietary variety of FV, as only a varied diet can provide the broad range of nutrients needed to achieve protection against chronic diseases [12,16,17]. "
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    ABSTRACT: We investigated whether socioeconomic differences affect fruit and vegetable (FV) consumption with respect to total intake and intake of various FV subgroups. Our study included 6667 adults aged 40-64 years who completed a dietary survey in the fourth Korean NHANES (2007-2009). FV intake was estimated from 24-hour recalls and food frequency questionnaires. Differences in FV consumption related to educational attainment were analyzed according to different nutritional categories of FV. Both men and women in the low-education group had the lowest intake of total FV and total fruits, and women also had the lowest intake of total vegetables. Also lowest in this group was consumption of mushrooms and vegetables (excluding kimchi) among men, and cruciferous and allium vegetables (excluding Chinese cabbage and radish) among women, while kimchi consumption was the highest in this group. Additionally, an association between educational level and intake of citrus fruits was evident among men. Adults in the low-education group consumed less carotene-rich FV, red fruit and/or vegetables, and dark-green leafy vegetables, fewer total vegetable dishes, and fewer types of fruit than in other groups. Men in this group had the lowest intake of yellow/orange fruit and/or vegetables, and women consumed the least folate-rich FV. There is a clear association between educational attainment and FV intake with regard to total intake, and to specific nutrients, bioactive compounds, colors, and variety.
    Full-text · Article · Jun 2012 · Nutrition research and practice
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    • "Adequate consumption of fruits and vegetables may reduce risks for cardiovascular disease [1], obesity [2], and diabetes [3] among adults. African American and Hispanic/Latino adults present with higher rates of heart disease [4], obesity [5], and diabetes [6] compared with their white peers. "
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    ABSTRACT: Background. Mediating and moderating variables may interfere with the association between neighborhood availability of grocery stores (NAG) and supermarkets (NAS) and fruit and vegetable (FV) intake. Objective. The purpose of this study was to test mediation of home availability of FV (HAFV) and moderation of impact of weekly stressful events (IWSE) on the association between NAG and NAS with FV consumption among African American (AA) and Hispanic/Latina (HL) women. Methods. Three hundred nine AA and HL, 25-60 year old women in the Health Is Power (HIP) randomized controlled trial completed validated measures of HAFV, IWSE, and FV intake at baseline. Trained field assessors coded NAG and NAS. Institutional Review Board approval was obtained. Results. NAG and NAS were not associated with FV intake or HAFV, so HAFV was not a mediator. HAFV (std. Beta = .29, P < 0.001) and IWSE (std. Beta = .17; P < 0.05) were related to FV intake (R(2) = 0.17; P < 0.001), but IWSE was not a moderator. Conclusion. Increasing HAFV and decreasing the IWSE should increase FV consumption. The extent to which the neighborhood environment is related to the home food environment and diet, and the mechanisms for the association between IWSE and diet should be examined in future research.
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