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

• Published in: Public health nutrition Vol. 12; no. 1; pp. 115 - 121
• Main Authors: Joshipura, Kaumudi J, Hung, Hsin-Chia, Li, Tricia Y, Hu, Frank B, Rimm, Eric B, Stampfer, Meir J, Colditz, Graham, Willett, Walter C
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.01.2009
• Subjects: Adult; adults; Carbohydrate; Carbohydrates; cardiovascular diseases; Cardiovascular Diseases - epidemiology; Carotene; Cerebral infarction; Cohort; CVD; Diabetes; Diet; Diet Surveys; Diet, Carbohydrate-Restricted; dietary carbohydrate; Dietary Carbohydrates - administration & dosage; dietary surveys; disease prevalence; Female; food frequency questionnaires; Food intake; Fruit; Fruits; fruits (food); Fruits and vegetables; Health professionals; Heart attacks; High carbohydrate diet; Humans; Hypertension; Ischaemic disease; Ischemia; Low carbohydrate diet; Male; Medical personnel; men; Middle Aged; Multivariate Analysis; Myocardial infarction; Nutrient deficiency; Nutrition; Prospective Studies; Public health; Questionnaires; Risk; risk assessment; Risk Factors; Statistical models; Stroke; Surveys and Questionnaires; Trends; Vegetables; Vitamin C; Women; Womens health; CVD; Ischaemic disease; Cohort; Diet; Health professionals; Fruits and vegetables; Carbohydrate
• ISSN: 1368-9800; 1475-2727; 1475-2727
• DOI: 10.1017/S1368980008002036

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.