Journal
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
Volume 50, Issue 1, Pages 212-222Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ije/dyaa155
Keywords
Fruit; vegetables; legumes; nuts; seeds; coronary heart disease
Categories
Funding
- UK Medical Research Council [MR/M012190/1, G0800270, MR/L003120/1, 1000143, MC_UU_12015/1, MC_UU_12015/5, MC_UU_12015/520]
- Cancer Research UK [C8221/A19170, 570/A16491, 14136, C570/A16491]
- Wellcome Trust (Our Planet Our Health, Livestock Environment and People) [205212/Z/16/Z]
- Cancer Research UK Population Research Fellowship [C60192/A28516]
- World Cancer Research Fund (WCRF UK), as part of the Word Cancer Research Fund International grant programme [2019/1953]
- European Union [HEALTH-F2-2012-279233]
- European Research Council [268834]
- British Heart Foundation [SP/09/002, RG/08/014, RG13/13/30194]
- UK National Institute of Health Research
- EU FP6 programme [LSHM_CT_2006_037197]
- European Commission (DGSANCO)
- International Agency for Research on Cancer
- Danish Cancer Society (Denmark)
- Ligue Contre le Cancer (France)
- Institut Gustave Roussy (France)
- Mutuelle Generale de l'Education Nationale (France)
- Institut National de la Sante et de la Recherche Medicale (INSERM) (France)
- German Cancer Aid (Germany)
- German Cancer Research Center (DKFZ) (Germany)
- Federal Ministry of Education and Research (BMBF) (Germany)
- Hellenic Health Foundation (Greece)
- Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy (Italy)
- National Research Council (Italy)
- Dutch Ministry of Public Health, Welfare and Sports (VWS)
- Netherlands Cancer Registry (NKR)
- LK Research Funds
- Dutch Prevention Funds
- Dutch ZON (Zorg Onderzoek Nederland)
- World Cancer Research Fund (WCRF)
- Health Research Fund (FIS) (Spain) [PI13/00061, PI13/01162]
- Regional Government of Andalucia (Spain)
- Regional Government of Asturias (Spain)
- Regional Government of Basque Country (Spain)
- Regional Government of Murcia (Spain) [6236]
- Regional Government of Navarra (Spain)
- ISCIII RETIC (Spain) [RD06/0020]
- Swedish Cancer Society (Sweden)
- Swedish Research Council (Sweden)
- County Council of Skane (Sweden)
- County Council of Vasterbotten (Sweden)
- NIHR Biomedical Research Centre Cambridge: Nutrition, Diet, and Lifestyle Research Theme [IS-BRC-1215-20014]
- British Heart Foundation Chair
- NIHR Senior Investigator Award
- Girdlers' New Zealand Health Research Council Fellowship
- National Institute for Health Research
- BHF-Turing Cardiovascular Data Science Award
- ECInnovative Medicines Initiative (BigData@Heart)
- Alpro Foundation [15-08-2016]
- Core MRC Unit support through the Nutritional Epidemiology Programme [MC_UU_12015/5]
- MRC [G0500300, G0800270, MR/N003284/1, MC_UU_00006/3, MC_UU_12015/1, MR/M012190/1, MR/L003120/1, MC_UU_12015/5, MC_UU_00006/1] Funding Source: UKRI
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This large prospective study in Europe found that higher intake of fruits and vegetables was associated with a lower risk of ischaemic heart disease. Additionally, nuts and seeds, dietary fiber, and fruit and vegetable fiber were also inversely associated with heart disease risk.
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, Ptrend = 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.
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