Elsevier

Atherosclerosis

Volume 227, Issue 1, March 2013, Pages 147-152
Atherosclerosis

Total and specific fruit and vegetable consumption and risk of stroke: A prospective study

https://doi.org/10.1016/j.atherosclerosis.2012.12.022Get rights and content

Abstract

Background

Fruit and vegetables is a heterogeneous food group with different content of dietary fiber, vitamins, minerals, carotenoids, and bioactive phytochemicals. Our objective was to examine the relation between specific consumption of fruit and vegetable subgroups and stroke risk in a cohort of Swedish women and men.

Methods and results

We prospectively followed 74,961 participants (34,670 women and 40,291 men) who had completed a food frequency questionnaire in the autumn of 1997 and were free from stroke, coronary heart disease, and cancer at baseline. Diagnoses of stroke in the cohort during follow-up were ascertained from the Swedish Hospital Discharge Registry. A total of 4089 stroke cases, including 3159 cerebral infarctions, 435 intracerebral hemorrhages, 148 subarachnoid hemorrhages, and 347 unspecified strokes, were ascertained during 10.2 years of follow-up. The multivariable relative risk (RR) of total stroke for the highest vs. lowest category of total fruit and vegetable consumption was 0.87 (95% confidence interval [CI] 0.78–0.97; P for trend = 0.01). The association was confined to individuals without hypertension (corresponding RR, 0.81; 95% CI, 0.71–0.93; P for trend = 0.01). Among individual fruits and vegetable subgroups, inverse associations with total stroke were observed for apples/pears (RR, 0.89; 95% CI, 0.80–0.98; P for trend = 0.02) and green leafy vegetables (RR, 0.92; 95% CI, 0.81–1.04; P for trend = 0.03).

Conclusion

This study shows an inverse association of fruit and vegetable consumption with stroke risk. Particularly consumption of apples and pears and green leafy vegetables was inversely associated with stroke.

Highlights

► Fruit and vegetables is a heterogeneous food group with different content of nutrients. ► It remains unclear which fruit and vegetable subgroups that are most protective against stroke. ► We examined the relation between fruit and vegetable consumption and stroke risk. ► Particularly consumption of apples/pears and green leafy vegetables was inversely associated with stroke.

Introduction

High consumption of fruit and vegetables has been associated with lower risk of stroke [1]. Fruit and vegetables is a heterogeneous food group with different content of dietary fiber, vitamins, minerals, carotenoids, and other bioactive phytochemicals. It remains unclear which fruit and vegetable subgroups that are most protective against stroke. Consumption of specific fruit and vegetable subgroups, such as apples and pears [2], [3], [4], citrus fruits [3], [5], [6], berries [7], [8], cruciferous vegetables [5], [6], [9], leafy vegetables [5], [9], and root vegetables [6], [9] has been inconsistently associated with risk of stroke in previous studies. Moreover, studies on fruit and vegetable consumption in relation to risk of hemorrhagic stroke are limited [7], [10].

To further examine the association between consumption of total fruits and vegetables, specific fruits, and vegetable subgroups and risk of total stroke and stroke types, we used data from two large prospective cohorts of Swedish women and men.

Section snippets

Study population

We used data from two prospective population-based cohorts of Swedish women and men, namely the Swedish Mammography Cohort (SMC) and the Cohort of Swedish Men (COSM). In the autumn of 1997, 39 227 women (SMC) and 48 850 men (COSM) who lived in central Sweden (Uppsala, Västmanland, and Örebro counties) completed a 350-item questionnaire that sought information on diet, lifestyle factors, and other factors that could affect the risk of chronic diseases. For the present analyses, we excluded women

Results

Over a mean follow-up of 10.2 years, we ascertained a total of 4089 cases of stroke (1680 in women and 2409 in men), including 3159 cerebral infarctions, 435 intracerebral hemorrhages, 148 subarachnoid hemorrhages, and 347 unspecified strokes. Baseline characteristics of the study population according to total fruit and vegetable consumption are shown in Table 1. Compared with participants with a low fruit and vegetable consumption, those with a high consumption were more likely to have a

Discussion

This prospective study of Swedish women and men confirms an inverse association between total fruit and vegetable consumption and stroke risk. The association appeared to be confined to participants without a history of hypertension. Consumption of total fruits but not total vegetables was significantly inversely associated with stroke. Among fruit and vegetable subgroups, only consumption of apples and pears and green leafy vegetables was significantly inversely associated with risk of total

Conflict of interest

None.

Acknowledgments

This study was supported by research grants from the Swedish Council for Working Life and Social Research (FAS), the Swedish Research Council/Committee for Infrastructure, and by a Research Fellow grant from Karolinska Institutet (to Dr. Larsson).

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