Plant foods, dietary fibre and risk of ischaemic heart disease in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Abstract

Background Epidemiological evidence indicates that diets rich in plant foods are associated with a lower risk of ischaemic heart disease (IHD), but there is sparse information on fruit and vegetable subtypes and sources of dietary fibre. This study examined the associations of major plant foods, their subtypes and dietary fibre with risk of IHD in the European Prospective Investigation into Cancer and Nutrition (EPIC). Methods We conducted a prospective analysis of 490 311 men and women without a history of myocardial infarction or stroke at recruitment (12.6 years of follow-up, n cases = 8504), in 10 European countries. Dietary intake was assessed using validated questionnaires, calibrated with 24-h recalls. Multivariable Cox regressions were used to estimate hazard ratios (HR) of IHD. Results There was a lower risk of IHD with a higher intake of fruit and vegetables combined [HR per 200 g/day higher intake 0.94, 95% confidence interval (CI): 0.90–0.99, P-trend = 0.009], and with total fruits (per 100 g/day 0.97, 0.95–1.00, P-trend = 0.021). There was no evidence for a reduced risk for fruit subtypes, except for bananas. Risk was lower with higher intakes of nuts and seeds (per 10 g/day 0.90, 0.82–0.98, P-trend = 0.020), total fibre (per 10 g/day 0.91, 0.85–0.98, P-trend = 0.015), fruit and vegetable fibre (per 4 g/day 0.95, 0.91–0.99, P-trend = 0.022) and fruit fibre (per 2 g/day 0.97, 0.95–1.00, P-trend = 0.045). No associations were observed between vegetables, vegetables subtypes, legumes, cereals and IHD risk. Conclusions In this large prospective study, we found some small inverse associations between plant foods and IHD risk, with fruit and vegetables combined being the most strongly inversely associated with risk. Whether these small associations are causal remains unclear.

Health effects associated with vegetable consumption: a Burden of Proof study

“…Our analysis of vegetable consumption and IHD included 78 observations from 17 prospective cohort studies 21 , 32 , 34 , 37 , 39 , 40 , 42 , 46 , 49 , 50 , 53 , 54 , 57 , 60 , 61 , 66 , 67 , including a total of 1,952,226 participants and 41,494 IHD events. Five studies used IHD incidence 32 , 40 , 46 , 60 , 61 as the endpoint to estimate effect sizes; four studies used mortality 39 , 53 , 54 , 57 ; and eight studies used both IHD incidence and mortality 21 , 34 , 37 , 42 , 49 , 50 , 66 , 67 .…”

“…Our analysis of vegetable consumption and IHD included 78 observations from 17 prospective cohort studies 21 , 32 , 34 , 37 , 39 , 40 , 42 , 46 , 49 , 50 , 53 , 54 , 57 , 60 , 61 , 66 , 67 , including a total of 1,952,226 participants and 41,494 IHD events. Five studies used IHD incidence 32 , 40 , 46 , 60 , 61 as the endpoint to estimate effect sizes; four studies used mortality 39 , 53 , 54 , 57 ; and eight studies used both IHD incidence and mortality 21 , 34 , 37 , 42 , 49 , 50 , 66 , 67 . Fourteen studies determined outcomes using administrative medical records, disease registries or death certificates 21 , 32 , 34 , 37 , 39 , 40 , 49 , 50 , 53 , 54 , 57 , 61 , 66 , 67 ; one study supplemented records with self-reported incidence 42 ; and two studies used physician diagnosis 46 , 60 .…”

“…Five studies used IHD incidence 32 , 40 , 46 , 60 , 61 as the endpoint to estimate effect sizes; four studies used mortality 39 , 53 , 54 , 57 ; and eight studies used both IHD incidence and mortality 21 , 34 , 37 , 42 , 49 , 50 , 66 , 67 . Fourteen studies determined outcomes using administrative medical records, disease registries or death certificates 21 , 32 , 34 , 37 , 39 , 40 , 49 , 50 , 53 , 54 , 57 , 61 , 66 , 67 ; one study supplemented records with self-reported incidence 42 ; and two studies used physician diagnosis 46 , 60 . All studies but one adjusted their effect size measure for age 21 , 32 , 34 , 37 , 39 , 40 , 42 , 46 , 49 , 50 , 53 , 54 , 57 , 60 , 61 , 67 , and ten studies either adjusted for or stratified by sex 21 , 37 , 40 , 46 , 49 , 57 , 60 , 61 , 66 , 67 .…”

“…Fourteen studies determined outcomes using administrative medical records, disease registries or death certificates 21 , 32 , 34 , 37 , 39 , 40 , 49 , 50 , 53 , 54 , 57 , 61 , 66 , 67 ; one study supplemented records with self-reported incidence 42 ; and two studies used physician diagnosis 46 , 60 . All studies but one adjusted their effect size measure for age 21 , 32 , 34 , 37 , 39 , 40 , 42 , 46 , 49 , 50 , 53 , 54 , 57 , 60 , 61 , 67 , and ten studies either adjusted for or stratified by sex 21 , 37 , 40 , 46 , 49 , 57 , 60 , 61 , 66 , 67 . Other common adjustment variables include smoking ( n = 16) 23 – 27 , 29 – 31 , 69 , alcohol consumption ( n = 14) 21 , 32 , 34 , 37 , 40 , 42 , 49 , 50 , 53 , 54 , 57 , 60 , 61 , 67 , BMI ( n ...…”

Nutritional Composition and Antioxidant Activity of Selected Underutilized Fruits Grown in Sri Lanka

“…Dietary fiber intake also significantly reduces the risk of developing stroke, hypertension, diabetes, obesity, and certain gastrointestinal diseases [2][3][4]. Phytochemicals exhibiting antioxidant properties effectively scavenge free radicals and thereby mitigate oxidative damage to biomolecules, leading to reduced age-related disease conditions, such as cancer and atherosclerosis [1,5].…”