Mette Damborg Hansen1, Anne Mette Lund Würtz2, Camilla Plambeck Hansen1,3, Anne Tjønneland4,5, Eric Bruce Rimm6,7, Søren Paaske Johnsen8, Erik Berg Schmidt9, Kim Overvad1,9, Marianne Uhre Jakobsen1,10. 1. Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Aarhus, Denmark. 2. Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Aarhus, Denmark. amlw@ph.au.dk. 3. The Danish Clinical Registries (RKKP), Aarhus, Denmark. 4. The Danish Cancer Society Research Center, Copenhagen, Denmark. 5. Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 6. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. 7. Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. 8. Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark. 9. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. 10. Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark.
Abstract
PURPOSE: Intake of vegetables has been associated with a lower risk of ischemic stroke in observational studies controlling for total energy intake. However, adjustment for energy intake introduces a substitution aspect, which affects the interpretation of the results. We investigated replacement of potatoes with other vegetables, substitutions between vegetable subgroups, and risk of ischemic stroke and ischemic stroke subtypes. METHODS: The Danish Diet, Cancer and Health cohort included 57,053 participants aged 50-64 years at recruitment in 1993-1997. Diet was assessed from a validated 192-item semi-quantitative food frequency questionnaire. We calculated hazard ratios (HR) with 95% confidence intervals (CI) for the incidence of ischemic stroke using Cox proportional hazard regression. RESULTS: During 13.5 years of follow-up, 1879 cases of ischemic stroke were identified including 319 cases of large-artery atherosclerosis and 844 cases of small-vessel occlusion. The adjusted HR for total ischemic stroke associated with food substitutions of equal amounts (500 g/week) was 0.86 (95% CI 0.76, 0.97) for replacement of potatoes with fruiting vegetables and 0.92 (95% CI 0.84, 1.02) for replacement of potatoes with other root vegetables. The HR for replacing potatoes with the sum of other vegetables was 0.95 (95% CI 0.90, 1.00). Substitution of cabbage for either potatoes, fruiting vegetables or other root vegetables was associated with a statistically non-significant higher risk of ischemic stroke. The patterns of associations were similar for ischemic stroke subtypes and for equivalent substitutions using isocaloric amounts. CONCLUSION: Replacing potatoes with fruiting vegetables was associated with a lower risk of ischemic stroke.
PURPOSE: Intake of vegetables has been associated with a lower risk of ischemic stroke in observational studies controlling for total energy intake. However, adjustment for energy intake introduces a substitution aspect, which affects the interpretation of the results. We investigated replacement of potatoes with other vegetables, substitutions between vegetable subgroups, and risk of ischemic stroke and ischemic stroke subtypes. METHODS: The Danish Diet, Cancer and Health cohort included 57,053 participants aged 50-64 years at recruitment in 1993-1997. Diet was assessed from a validated 192-item semi-quantitative food frequency questionnaire. We calculated hazard ratios (HR) with 95% confidence intervals (CI) for the incidence of ischemic stroke using Cox proportional hazard regression. RESULTS: During 13.5 years of follow-up, 1879 cases of ischemic stroke were identified including 319 cases of large-artery atherosclerosis and 844 cases of small-vessel occlusion. The adjusted HR for total ischemic stroke associated with food substitutions of equal amounts (500 g/week) was 0.86 (95% CI 0.76, 0.97) for replacement of potatoes with fruiting vegetables and 0.92 (95% CI 0.84, 1.02) for replacement of potatoes with other root vegetables. The HR for replacing potatoes with the sum of other vegetables was 0.95 (95% CI 0.90, 1.00). Substitution of cabbage for either potatoes, fruiting vegetables or other root vegetables was associated with a statistically non-significant higher risk of ischemic stroke. The patterns of associations were similar for ischemic stroke subtypes and for equivalent substitutions using isocaloric amounts. CONCLUSION: Replacing potatoes with fruiting vegetables was associated with a lower risk of ischemic stroke.
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