International Journal of Epidemiology, Vol 26, 1-13, Copyright © 1997 by International Epidemiological Association
AR Ness and JW Powles
BACKGROUND: Increased interest in the potential cardio-protective effects
of fruit and vegetables is currently unsupported by systematic reviews of
the reported associations of these foods with risk. METHOD: All ecological,
case-control, cohort studies and unconfounded trials in humans were
eligible for inclusion. Eligible outcomes were symptomatic coronary heart
disease, stroke and total circulatory disease. Only studies of diet that
reported on fresh fruit and vegetables or a nutrient which could serve as a
proxy (reversing the usual direction of inference) were included. MEDLINE
(1966-1995) and EMBASE (1980-1995) were searched using the terms
cerebrovascular disorder, coronary heart disease, fruit(s) and vegetable(s)
as keywords. Personal bibliographies, books and reviews were also searched,
as were citations in located reports. RESULTS: For coronary heart disease
nine of ten ecological studies, two of three case-control studies and six
of 16 cohort studies found a significant protective association with
consumption of fruit and vegetables or surrogate nutrients. For stroke
three of five ecological studies, none (of one) case-control study and six
of eight cohort studies found a significant protective association with
consumption of fruit and vegetables or surrogate nutrients. For total
circulatory disease, one of two cohort studies reported a significant
protective association. No attempt was made to arrive at a summary measure
of the association because of the differences in study type, study quality
and the different exposure measures used. CONCLUSIONS: Although null
findings may be underreported the results are consistent with a strong
protective effect of fruit and vegetables for stroke and a weaker
protective effect on coronary heart disease. Greater use of food-based
hypotheses and analyses, would complement existing nutrient-based analyses
and help guide the search for underlying causes.
ARTICLES
Fruit and vegetables, and cardiovascular disease: a review
Institute of Public Health, University Forvie Site, Cambridge, UK.
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K. B. Michels, Edward Giovannucci, K. J. Joshipura, B. A. Rosner, M. J. Stampfer, C. S. Fuchs, G. A. Colditz, F. E. Speizer, and W. C. Willett Prospective Study of Fruit and Vegetable Consumption and Incidence of Colon and Rectal Cancers J Natl Cancer Inst, November 1, 2000; 92(21): 1740 - 1752. [Abstract] [Full Text] [PDF]
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 R. M. Krauss, R. H. Eckel, B. Howard, L. J. Appel, S. R. Daniels, R. J. Deckelbaum, J. W. Erdman Jr, P. Kris-Etherton, I. J. Goldberg, T. A. Kotchen, et al. AHA Dietary Guidelines : Revision 2000: A Statement for Healthcare Professionals From the Nutrition Committee of the American Heart Association Stroke, November 1, 2000; 31(11): 2751 - 2766. [Full Text] [PDF]
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R. M. Krauss, R. H. Eckel, B. Howard, L. J. Appel, S. R. Daniels, R. J. Deckelbaum, J. W. Erdman Jr, P. Kris-Etherton, I. J. Goldberg, T. A. Kotchen, et al. AHA Dietary Guidelines : Revision 2000: A Statement for Healthcare Professionals From the Nutrition Committee of the American Heart Association Circulation, October 31, 2000; 102(18): 2284 - 2299. [Full Text] [PDF]
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S. Liu, J. E Manson, I-M. Lee, S. R Cole, C. H Hennekens, W. C Willett, and J. E Buring Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study Am. J. Clinical Nutrition, October 1, 2000; 72(4): 922 - 928. [Abstract] [Full Text] [PDF]
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T. Yokoyama, C. Date, Y. Kokubo, N. Yoshiike, Y. Matsumura, and H. Tanaka Serum Vitamin C Concentration Was Inversely Associated With Subsequent 20-Year Incidence of Stroke in a Japanese Rural Community : The Shibata Study Stroke, October 1, 2000; 31(10): 2287 - 2294. [Abstract] [Full Text] [PDF]
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T. Hirvonen, J. Virtamo, P. Korhonen, D. Albanes, and P. Pietinen Intake of Flavonoids, Carotenoids, Vitamins C and E, and Risk of Stroke in Male Smokers Stroke, October 1, 2000; 31(10): 2301 - 2306. [Abstract] [Full Text] [PDF]
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M. Gronbaek, U. Becker, D. Johansen, A. Gottschau, P. Schnohr, H. O. Hein, G. Jensen, and T. I.A. Sorensen Type of Alcohol Consumed and Mortality from All Causes, Coronary Heart Disease, and Cancer Ann Intern Med, September 19, 2000; 133(6): 411 - 419. [Abstract] [Full Text] [PDF]
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L. A Yochum, A. R Folsom, and L. H Kushi Intake of antioxidant vitamins and risk of death from stroke in postmenopausal women Am. J. Clinical Nutrition, August 1, 2000; 72(2): 476 - 483. [Abstract] [Full Text] [PDF]
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A. Scalbert and G. Williamson Dietary Intake and Bioavailability of Polyphenols J. Nutr., August 1, 2000; 130(8): 2073S - 2085. [Abstract] [Full Text]
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F. E Thompson, V. Kipnis, A. F Subar, S. M Krebs-Smith, L. L Kahle, D. Midthune, N. Potischman, and A. Schatzkin Evaluation of 2 brief instruments and a food-frequency questionnaire to estimate daily number of servings of fruit and vegetables Am. J. Clinical Nutrition, June 1, 2000; 71(6): 1503 - 1510. [Abstract] [Full Text] [PDF]
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 H. Moore, A. J Adamson, T. Gill, and C. Waine Nutrition and the health care agenda: a primary care perspective Fam. Pract., April 1, 2000; 17(2): 197 - 202. [Abstract] [Full Text] [PDF]
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S. A. Smith-Warner, P. J. Elmer, T. M. Tharp, L. Fosdick, B. Randall, M. Gross, J. Wood, and J. D. Potter Increasing Vegetable and Fruit Intake: Randomized Intervention and Monitoring in an At-Risk Population Cancer Epidemiol. Biomarkers Prev., March 1, 2000; 9(3): 307 - 317. [Abstract] [Full Text]
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K. J. Joshipura, A. Ascherio, J. E. Manson, M. J. Stampfer, E. B. Rimm, F. E. Speizer, C. H. Hennekens, D. Spiegelman, and W. C. Willett Fruit and Vegetable Intake in Relation to Risk of Ischemic Stroke JAMA, October 6, 1999; 282(13): 1233 - 1239. [Abstract] [Full Text] [PDF]
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J. W Lampe Health effects of vegetables and fruit: assessing mechanisms of action in human experimental studies Am. J. Clinical Nutrition, September 1, 1999; 70(3): 475S - 490. [Abstract] [Full Text] [PDF]
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K. H van het Hof, I. A Brouwer, C. E West, E. Haddeman, R. P. Steegers-Theunissen, M. van Dusseldorp, J. A Weststrate, T. K. Eskes, and J. G. Hautvast Bioavailability of lutein from vegetables is 5 times higher than that of {beta}-carotene Am. J. Clinical Nutrition, August 1, 1999; 70(2): 261 - 268. [Abstract] [Full Text] [PDF]
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A. Tjonneland, M. Gronbæk, C. Stripp, and K. Overvad Wine intake and diet in a random sample of 48763 Danish men and women Am. J. Clinical Nutrition, January 1, 1999; 69(1): 49 - 54. [Abstract] [Full Text] [PDF]
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F. R. Artalejo, P. Guallar-Castillon, J. R. B. Banegas, B. d. A. Manzano, and J. d. R. Calero Consumption of Fruit and Wine and the Decline in Cerebrovascular Disease Mortality in Spain (1975–1993) Stroke, August 1, 1998; 29(8): 1556 - 1561. [Abstract] [Full Text] [PDF]
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