Aurora Perez-Cornago1, Francesca L Crowe1,2, Paul N Appleby1, Kathryn E Bradbury1,3, Angela M Wood4,5,6,7,8,9,10, Marianne Uhre Jakobsen11,12, Laura Johnson13, Carlotta Sacerdote14, Marinka Steur15, Elisabete Weiderpass16, Anne Mette L Würtz11, Tilman Kühn17, Verena Katzke17, Antonia Trichopoulou18, Anna Karakatsani18,19, Carlo La Vecchia18,20, Giovanna Masala21, Rosario Tumino22, Salvatore Panico23, Ivonne Sluijs24, Guri Skeie25,26, Liher Imaz27, Dafina Petrova28,29,30, J Ramón Quirós31, Sandra Milena Colorado Yohar30,32,33, Paula Jakszyn34,35, Olle Melander36,37, Emily Sonestedt38, Jonas Andersson39, Maria Wennberg40, Dagfinn Aune41,42,43, Elio Riboli41, Matthias B Schulze44,45, Emanuele di Angelantonio4,5,6,7,46, Nicholas J Wareham9, John Danesh4,6,7,9,47,48, Nita G Forouhi15, Adam S Butterworth4,5,6,7,46, Timothy J Key1. 1. Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. 2. Institute of Applied Health Research, University of Birmingham, Birmingham, UK. 3. National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand. 4. British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. 5. British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK. 6. National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, UK. 7. National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, UK. 8. Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK. 9. Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK. 10. The Alan Turing Institute, London, UK. 11. Department of Public Health, Aarhus University, Aarhus, Denmark. 12. Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark. 13. Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, UK. 14. Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy. 15. MRC Epidemiology Unit, University of Cambridge, Cambridge, UK. 16. International Agency for Research on Cancer, World Health Organization, Lyon, France. 17. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. 18. Hellenic Health Foundation, Athens, Greece. 19. 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece. 20. Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milan, Italy. 21. Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy. 22. Cancer Registry and Histopathology Department, "M.P.Arezzo" Hospital, ASP Ragusa, Italy. 23. Dipartimento Di Medicina Clinica E Chirurgia Federico Ii University, Naples, Italy. 24. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. 25. Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway. 26. The Nutrition Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK. 27. Public Health Division of Gipuzkoa, Health Department of Basque Country, Spain. 28. Andalusian School of Public Health (EASP), Granada, Spain. 29. Instituto de Investigaciœn Biosanitaria de Granada (ibs.GRANADA), Universidad de Granada, Granada, Spain. 30. CIBER de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain. 31. Public Health Directorate, Asturias, Spain. 32. Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain. 33. Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, MedellÚn, Colombia. 34. Nutrition and Cancer Unit, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain. 35. Facultad de Ciencias de la salud, Universidad Ramon LLul, Barcelona, Spain. 36. Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden. 37. Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden. 38. Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden. 39. Department of Public Health and Clinical Medicine, Research Unit Skellefteå, Umeå University, Umeå, Sweden. 40. Department of Public Health and Clinical Medicine, Section of Sustainable Health/Nutritional Research, Umeå University, Umeå, Sweden. 41. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. 42. Department of Nutrition, Bjørknes University College, Oslo, Norway. 43. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway. 44. Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany. 45. Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany. 46. Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK. 47. British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK. 48. Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK.
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.
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.
Authors: A Agudo; N Slimani; M C Ocké; A Naska; A B Miller; A Kroke; C Bamia; D Karalis; P Vineis; D Palli; H B Bueno-de-Mesquita; P H M Peeters; D Engeset; A Hjartåker; C Navarro; C Martínez Garcia; P Wallström; J X Zhang; A A Welch; E Spencer; C Stripp; K Overvad; F Clavel-Chapelon; C Casagrande; E Riboli Journal: Public Health Nutr Date: 2002-12 Impact factor: 4.022
Authors: E Riboli; K J Hunt; N Slimani; P Ferrari; T Norat; M Fahey; U R Charrondière; B Hémon; C Casagrande; J Vignat; K Overvad; A Tjønneland; F Clavel-Chapelon; A Thiébaut; J Wahrendorf; H Boeing; D Trichopoulos; A Trichopoulou; P Vineis; D Palli; H B Bueno-De-Mesquita; P H M Peeters; E Lund; D Engeset; C A González; A Barricarte; G Berglund; G Hallmans; N E Day; T J Key; R Kaaks; R Saracci Journal: Public Health Nutr Date: 2002-12 Impact factor: 4.022
Authors: Diane E Threapleton; Darren C Greenwood; Charlotte E L Evans; Christine L Cleghorn; Camilla Nykjaer; Charlotte Woodhead; Janet E Cade; Christopher P Gale; Victoria J Burley Journal: BMJ Date: 2013-12-19
Authors: Aurora Perez-Cornago; Ruth C Travis; Paul N Appleby; Konstantinos K Tsilidis; Anne Tjønneland; Anja Olsen; Kim Overvad; Verena Katzke; Tilman Kühn; Antonia Trichopoulou; Eleni Peppa; Maria Kritikou; Sabina Sieri; Domenico Palli; Carlotta Sacerdote; Rosario Tumino; H B As Bueno-de-Mesquita; Antonio Agudo; Nerea Larrañaga; Elena Molina-Portillo; Eva Ardanaz; Maria-Dolores Chirlaque; Cristina Lasheras; Pär Stattin; Maria Wennberg; Isabel Drake; Johan Malm; Julie A Schmidt; Kay-Tee Khaw; Marc Gunter; Heinz Freisling; Inge Huybrechts; Dagfinn Aune; Amanda J Cross; Elio Riboli; Timothy J Key Journal: Int J Cancer Date: 2017-05-15 Impact factor: 7.396
Authors: Jeffrey D Stanaway; Ashkan Afshin; Charlie Ashbaugh; Catherine Bisignano; Michael Brauer; Giannina Ferrara; Vanessa Garcia; Demewoz Haile; Simon I Hay; Jiawei He; Vincent Iannucci; Haley Lescinsky; Erin C Mullany; Marie C Parent; Audrey L Serfes; Reed J D Sorensen; Aleksandr Y Aravkin; Peng Zheng; Christopher J L Murray Journal: Nat Med Date: 2022-10-10 Impact factor: 87.241