Intakes of fruits, vegetables and carbohydrate and the risk of CVD
Open accessAbstract
Background: 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. Objective: To evaluate whether carbohydrate intake affects the association between fruits and vegetables and CVD. Design: 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. Results: 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). Conclusions: 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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A diet rich in vegetables, which contain high concentrations of inorganic NO3-, significantly protects against coronary heart disease and stroke.
“Conversely, a diet rich in vegetables, which contain high concentrations of inorganic NO3-, significantly protects against both coronary heart disease and stroke [16], [2], [20].”
From Nitrate-responsive oral microbiome modulates nitric oxide homeostasis and blood pressure in humans (2018) · cites this paper as [20]
The Multivariate analyses report a significant association between higher vegetable intake and lower combined ischaemic CVD risk in the low-carbohydrate group. The Abstract also reports earlier findings linking fruit and vegetable intake to lower risks of stroke and CHD. The paper does not attribute these associations to inorganic nitrate, establish a protective causal effect, or report a significant vegetable-specific effect for CHD and stroke separately. (LLM, conf=0.88)
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- Authors
- Joshipura, K. J., Hung, H.-C., Li, T. Y., Hu, F. B., Rimm, E. B., Stampfer, M. J., Colditz, G., & Willett, W. C.
- Affiliations
- Harvard University (US)
- Meiho University (TW)
- Brigham and Women's Hospital (US)
- Corresponding author
- Joshipura, Kaumudi J
- Venue
- Public Health Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2009-01
- Volume
- 12
- Issue
- 1
- Pages
- 115-121
- ISSN
- 1368-9800 (ISSN-L)
- 1475-2727
- PMC
- PMC2736062
- OpenAlex
- W2088488258
- Cited by
- 52
- References
- 24
- Citations by year
- 2023: 2 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 4 · 2016: 4 · 2015: 2 · 2014: 4 · 2013: 5 · 2012: 6
- FWCI
- 3.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Public Health Nutrition (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- National Heart, Lung, and Blood Institute (R01HL035464, HL35464, R01HL034595)
- National Cancer Institute (R01CA040356, CA-55075, CA-40356, P01CA087969, P01CA055075)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Biochemistry › Phytochemicals and Antioxidant Activities
- Keywords
- fruit consumption, vegetable consumption, carbohydrate intake, myocardial infarction, ischemic stroke, low-carbohydrate diet, leafy vegetables, dietary change, Nurses' Health Study, Health Professionals Follow-up Study
- MeSH terms
- Adult, Cardiovascular Diseases, Diet, Diet Surveys, Dietary Carbohydrates, Female, Fruit, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, Risk Factors, Vegetables, Multivariate Analysis, Diet, Carbohydrate-Restricted
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