| 36) Takachi R. (2007) | The Japan Public Health Center-based Prospective Study (JPHC). | 77,891 subjects (35,909 men 41,982 and women) aged 45-74.
(Japan) | 5.8
(1995-1998 to 2002) | 1,386 (227 myocardial infarction, 1,159 stroke) | Risk of cardiovascular disease | Citrus fruits (defined as: mandarins, oranges, and 100% orange juice) | HR = 0.80 (0.67-0.95; P = 0.02). for the highest vs lowest quartile of consumption (not defined).
Amount specific data (quartiles):
Q1: HR = 1.
Q2: HR = 0.92 (0.79-1.07).
Q3: HR = 0.95 (0.81-1.12).
Q4: HR = 0.80 (0.67-0.95). | age, public health center area, BMI, physical activity, smoking, alcohol, energy, screening examination, medication, and daily vitamin supplement use. |
| 10) Joshipura KJ (2009) | The Nurses' Health Study
&
The Health Professional's Follow-up Study | 70,870 women aged 38-63, and 38,918 men aged 40-75. Subjects were without cancer, diabetes or CVD. | Men: 14 (1986-2000).
Women: 16 (1984-2000) | 2,040? men, and
1,852? women | Ischaemic CVD incidence (fatal and non-fatal MI and ischaemic stroke) | Total citrus fruit (not defined) |
Highest vs lowest quintile of consumption.
Stratified by energy from carbohydrate intake:
| < 40% | 40-55% | > 55% |
Men: RR = 0.78
Women: RR = 1.07
Men & women: RR = 0.92 (0.67-1.26)
|
Men: RR = 0.97
Women: RR = 0.87
Men & women: RR = 0.92 (0.81-1.05)
|
Men: RR = 0.99
Women: RR = 1.13
Men & women: RR = 1.05 (0.81-1.37)
|
Per increment of 1 serving/d.
Stratified by energy from carbohydrate intake:
| < 40% | 40-55% | > 55% |
Men: RR = 0.92
Women: RR = 0.96
Men & women: RR = 0.94 (0.81-1.08)
|
Men: RR = 1.01
Women: RR = 0.92
Men & women: RR = 0.97 (0.89-1.06)
|
Men: RR = 1.06
Women: RR = 1.04
Men & women: RR = 1.05 (0.93-1.19)
|
Effect modification: All associations were generally attenuated among the multivitamin supplement users (data not shown).Total energy, whole grains, age, smoking, alcohol, BMI, multivitamin and vitamin E supplement use, aspirin use, physical activity, family history of MI, history of hypertension, hypercholesterolaemia and incident diabetes, and menopausal status and hormone replacement therapy. |
| 10) Hung HC. (2004) | The Nurses' Health Study
&
The Health Professionals' Follow-up Study. | 71,910 women (aged 30-55) and
37,725 men (aged 40-75).
(USA) | 14
(1984-1998)
(women), and
12
(1986-1998)
(men) | 1964? women, and
1670? men.
1314 never smokers, 1513 past smokers, and 988 current smokers.
1625 non-vitamin supplement users, and 1444 vitamin supplement users. | Cardiovascular disease risk | Total citrus fruit (not defined) |
Stratified by sex:
| Men + women | Men | Women |
| RR = 0.95 (0.90-1.00; No P-value). | RR = 0.97 (No 95% CI; No P-value). | RR = 0.92 (No 95% CI; No P-value). |
Stratified by smoking status (men and women combined):
| Never | Past | Current |
| RR = 0.97 (0.89-1.07; No P-value). | RR = 0.96 (0.88-1.05; No P-value). | RR = 0.90 (0.80-1.01; No P-value). |
Stratified by multivitamin use (men and women combined):
| Non-vitamin use | Multivitamin use |
| RR = 0.95 (0.87-1.04; No P-value). | RR = 0.98 (0.90-1.08; No P-value). |
All RRs are for an increment of 1 serving/day.Total calorie intake, age, smoking status, alcohol use, body mass index, multivitamin and vitamin E supplement use, physical activity, family history of myocardial infarction, family history of colon cancer, personal history of hypertension, personal history of hypercholesterolemia, personal history of diabetes, and (for women only) family history of breast cancer, menopausal status, and use of hormone replacement therapy. |
Coronary heart disease:
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments |
| 37) Iso H (2007) | The JACC Study. | 43,011 men, and 59,504 women.
(Japan) | Not defined. | 602 men, and
398 women. | Ischemic heart disease mortality | Citrus fruits (not defined) |
| Men: | Women: |
HR = 0.98 (0.79-1.22) for the highest vs lowest tertile of consumption.
Amount specific data:
< 3/w: HR = 1.
3-4/w: HR = 0.85 (0.67-1.08).
≥ 5/w: HR = 0.98 (0.79-1.22).
|
HR = 0.77 (0.59-1.00; P = < 0.10) for the highest vs lowest tertile of consumption.
Amount specific data:
< 3/w: HR = 1.
3-4/w: HR = 0.83 (0.61-1.16).
≥ 5/w: HR = 0.77 (0.59-1.00).
|
Age and study area. |
| 30) Dauchet L (2004) | The Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study. | Men aged 50-59 from France (n = 5982) and Northern Ireland (n = 2105). | 5
(1991-?) | Total coronary events: 249.
Acute coronary events: 133. | Total coronary events (MI, CHD death, and angina events).
Acute coronary events (MI and CHD death) | Citrus fruit (not defined) |
| Total coronary events: | Acute coronary events: |
RR = 0.76 (0.56-1.04; P = 0.14) for the highest vs lowest tertile of consumption.
Amount specific data (Freq/d):
≤ 0.07: RR = 1.
0.14-0.29: RR = 0.77 (0.56-1.05).
≥ 0.5: RR = 0.76 (0.56-1.04).
|
RR = 0.64 (0.41-0.99; P = < 0.03) for the highest vs lowest tertile of consumption.
Amount specific data (Freq/d):
≤ 0.07: RR = 1.
0.14-0.29: RR = 0.66 (0.44-1.03).
≥ 0.5: RR = 0.64 (0.41-0.99).
|
Age, centre, smoking, alcohol, physical activity, education, employment status, systolic blood pressure, total cholesterol, HDL-cholesterol, BMI, treatment for hypertension, diabetes or dyslipidaemia. |
| 11) Sahyoun NR. (1996) | No cohort name. | 725 subjects (254 men, and 471 women) aged 60-101 from Massachusetts.
(USA) | 9-12
(1981-84 to 1993) | 101? | Mortality from heart disease | Citrus fruit and juices (not defined) | RR = 0.90 (0.48-1.70; P = 0.65) for the highest vs lowest tertile of consumption.
Amount specific data (tertiles. No amounts defined):
T1: RR = 1.
T2: RR = 0.96 (0.58-1.60).
T3: RR = 0.90 (0.48-1.70). | Age, sex, disease status, and disabilities affecting shopping. |
| 10) Joshipura KJ (2001) | The Nurses' Health Study &
The Health Professionals' Follow-Up Study. | 84,251 women aged 34-59, and 42,148 men aged 40-75.
(USA) | Women: 14 (1980-1994).
Men: 8 (1986-1994). | 1,127? women and
1,063? men.
1.193? non-multivitamin supplement users and
729? multivitamin supplement users.
1.446? never or past smokers and
708? current smokers. | Coronary heart disease risk (nonfatal myocardial infarction or fatal coronary disease) | Total citrus fruit |
| Pooled | Women | Men |
RR = 0.88 (0.77-1.00; No P-value) for the highest vs lowest quintile of consumption.
Amount specific data (quintiles. not defined):
Q1: RR = 1.
Q2: RR = 0.93 (0.81-1.06).
Q3: RR = 0.95 (0.83-1.08).
Q4: RR = 0.94 (0.83-1.08).
Q5: RR = 0.88 (0.77-1.00).
RR for a 1-serving/d increase in intake: 0.94 (0.87-1.01).
|
RR = 0.88 (No 95% CI; No P-value) for the highest vs lowest quintile of consumption.
Amount specific data (median servings/d):
0.08: RR = 1.
Not defined: RR = 0.94.
Not defined: RR = 0.91.
Not defined: RR = 0.91.
1.80: RR = 0.88.
RR for a 1-serving/d increase in intake: 0.93.
|
RR = 0.87 (No 95% CI; No P-value) for the highest vs lowest quintile of consumption.
Amount specific data (median servings/d):
0.08: RR = 1.
Not defined: RR = 0.91.
Not defined: RR = 0.99.
Not defined: RR = 0.98.
1.88: RR = 0.87.
RR for a 1-serving/d increase in intake: 0.95.
|
Stratified by multivitamin supplement use:
| Participants not using multivitamin supplements | Participants using multivitamin supplements |
| RR = 0.95 (0.86-1.06). |
RR = 0.98 (0.86-1.11). |
Stratified by smoking status:
| Never or past smokers | Current smokers |
| RR = 0.95 (0.87-1.04). |
RR = 0.93 (0.80-1.08). |
Age, smoking status, alcohol intake, family history of myocardial infarction, BMI, vitamin supplement use, vitamin E use, physical activity, aspirin use, 2-year follow-up period, presence of hypertension, presence of hypercholesterolemia, total daily caloric intake, and postmenopausal hormone use (women). |
Stroke:
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments |
| 37) Iso H (2007) | The JACC Study. | 43,011 men, and 59,504 women.
(Japan) | Not defined. | 1,207 men, and
1,028 women. | Cerebrovascular mortality | Citrus fruits (not defined) |
| Men: | Women: |
HR = 0.82 (0.70-0.96; P = < 0.05) for the highest vs lowest tertile of consumption.
Amount specific data:
< 3/w: HR = 1.
3-4/w: HR = 0.93 (0.79-1.09).
≥ 5/w: HR = 0.82 (0.70-0.96).
|
HR = 0.71 (0.60-0.84; P = < 0.01) for the highest vs lowest tertile of consumption.
Amount specific data:
< 3/w: HR = 1.
3-4/w: HR = 0.95 (0.79-1.14).
≥ 5/w: HR = 0.71 (0.60-0.84).
|
Age and study area. |
| 26) Johnsen SP (2003) | The Danish Diet, Cancer, and Health Study. | 54,506 men and women aged 50-64. | 3.09 (1993-1997) | 266? | Ischemic stroke risk | Citrus fruit (eg, oranges and grapefruit) |
RR = 0.63 (0.41-0.96; P-value is unclear. According to table = 0.14. According to text = 0.03) for the highest vs lowest quintile of consumption.
Amount specific data (quintiles. median intake in g/d):
Q1 (2.9): RR = 1.
Q3 (14.4): RR = 0.77 (0.52-1.14).
Q5 (100.0): RR = 0.63 (0.41-0.96).
No data was shown for quintile 2 + 4! | Sex, total energy intake, smoking status, systolic blood pressure, diastolic blood presssure, total serum cholesterol, history of diabetes, BMI, alcohol intake, intake of red meat, intake of n-3 polyunsaturated fatty acids, physical activity, and education. Age was used as the time axis. |
| 10) Joshipura KJ (1999) | The Nurses' Health Study
&
The Health Professionals' Follow-Up Study | 75,596 women aged 34-59, and 38,683 men aged 40-75.
(USA) | Women: 14
(1980-1994).
Men: 8
(1986-1994). | 570?
295 non-users of vitamin supplements, and 216 users of multivitamin supplements.
388 never & past smokers, and 172 current smokers. | Ischemic stroke risk | Total citrus fruit (not defined) |
| Pooled | Women
(366? cases) | Men
(204? cases) |
RR = 0.72 (0.47-1.11) for the highest vs lowest quintile of consumption.
Amount specific data (not defined):
Q1: RR = 1.
Q2: RR = 0.91 (0.52-1.60).
Q3: RR = 0.85 (0.66-1.09).
Q4: RR = 0.78 (0.60-1.01).
Q5: RR = 0.72 (0.47-1.11).
RR for an increment of 1 serving/day:
0.81 (0.68-0.96).
|
RR = 0.59 (0.42-0.82) for the highest vs lowest quintile of consumption.
Amount specific data (servings/day):
0.08: RR = 1.
Not defined: RR = 0.70 (0.51-0.96).
Not defined: RR = 0.82 (0.60-1.10).
Not defined: RR = 0.72 (0.52-0.98).
1.80: RR = 0.59 (0.42-0.82).
RR for an increment of 1 serving/day:
0.75 (0.62-0.91).
|
RR = 0.92 (0.59-1.44) for the highest vs lowest quintile of consumption.
Amount specific data (servings/day):
0.08: RR = 1.
Not defined: RR = 1.24 (0.80-1.92).
Not defined: RR = 0.92 (0.59-1.45).
Not defined: RR = 0.92 (0.59-1.44).
1.88: RR = 0.92 (0.59-1.44).
RR for an increment of 1 serving/day:
0.93 (0.73-1.18).
|
Stratified by vitamin supplement use:
| No vitamin supplement | Multivitamin supplement |
| RR for an increment of 1 serving/day: 0.77 (0.62-0.97).
|
RR for an increment of 1 serving/day: 0.86 (0.61-1.23).
|
Stratified by smoking status:
| Never and past smokers | Current smokers |
| RR for an increment of 1 serving/day: 0.88 (0.74-1.05).
|
RR for an increment of 1 serving/day: 0.88 (0.48-1.63).
|
Age, smoking, alcohol, family history of MI, BMI, vitamin supplement use, vitamin E use, physical activity, aspirin use, time period, hypertension and hypercholesterolemia, total energy intake, and amon women, postmenopausal hormone use. |
| 6) Keli SO (1996) | The Zutphen Study.
(The Dutch contribution to The Seven Countries Study) | 552 men aged 50-69. | 15
(1970-1985) | 42 | Stroke incidence | Citrus fruit (not defined) |
No association: RR = 0.93 (0.39-2.22; P = 0.86) for the highest vs lowest tertile of consumption.
Amount specific data (g/d):
< 28: RR = 1.
28-91.6: RR = 0.91 (0.44-1.89).
≥ 91.7: RR = 0.93 (0.39-2.22). | Age, average systolic blood pressure, serum cholesterol, energy intake, lifetime cigarette smoking exposure, fish consumption, and alcohol habits. |
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