Total and specific fruit and vegetable consumption and risk of stroke: A prospective study
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).
References (16)
- et al.
Fruit and vegetable consumption and stroke: meta-analysis of cohort studies
Lancet
(2006) - et al.
Flavonoid intake and cardiovascular disease mortality: a prospective study in postmenopausal women
Am J Clin Nutr
(2007) - et al.
Flavonoid intake and risk of chronic diseases
Am J Clin Nutr
(2002) - et al.
Intake of fruit and vegetables and the risk of ischemic stroke in a cohort of Danish men and women
Am J Clin Nutr
(2003) - et al.
Dietary flavonol intake may lower stroke risk in men and women
J Nutr
(2010) - et al.
Dietary flavonoids, antioxidant vitamins, and incidence of stroke: the Zutphen study
Arch Intern Med
(1996) - et al.
Fruit and vegetable intake in relation to risk of ischemic stroke
JAMA
(1999) - et al.
Plant foods and the risk of cerebrovascular diseases: a potential protection of fruit consumption
Br J Nutr
(2009)