| 29) Genkinger JM. (2004) | The Odyssey Cohort (= CLUE I + CLUE II). | 6,151 men and women aged 30-93 from Maryland.
(USA) | 1989-2002 | 378 (223 ever smokers, and 155 never smokers) | Cardiovascular disease mortality | Fruits and vegetables (apples, applesauce, pears, cantaloupes, oranges, grapefruit, and any other fruit such as bananas and fruit cocktail. Tomatoes, broccoli, spinach, mustard greens, turnip greens, collards, cabbage, carrots, mixed vegetables, green salads, sweet potatoes, yams, and any other vegetables such as green beans, corn, and peas. A second fruit and vegetable summary variable was created that additionally included juices such as orange and other fruits. Potatoes were excluded from both summary variables) |
| All subjects | Ever smokers | Never smokers |
HR = 0.76 (0.54-1.06; P = 0.15) for the highest vs lowest quintile of consumption.
Amount specific data (median servings/day):
0.87: HR = 1.
1.61: HR = 0.80 (0.56-1.12).
2.31: HR = 0.86 (0.62-1.20).
3.21: HR = 0.79 (0.56-1.09).
4.89: HR = 0.76 (0.54-1.06).
High consumption:
HR for ≥ 5 servings/day vs fewer: 1.04 (0.76-1.42). |
HR = 0.87 (0.62-1.23; No P-value) for the highest vs lowest tertile of consumption.
Amount specific data (tertiles. No amounts defined):
T1: HR = 1.
T1: HR = 0.95 (0.68-1.32).
T1: HR = 0.87 (0.62-1.23). |
HR = 0.78 (0.51-1.18; No P-value) for the highest vs lowest tertile of consumption.
Amount specific data (tertiles. No amounts defined):
T1: HR = 1.
T1: HR = 0.84 (0.51-1.18).
T1: HR = 0.78 (0.51-1.18). |
Similar estimates were observed when results were stratified by gender and body mass index (data not shown).Age, body mass index, and cholesterol concentration (all variables).
Smoking status and energy (all subjects only).
Hypertension (stratified by smoking status only).
Marital status and education did not significantly alter the risk estimates and thus were not included in the multivariate models. |
| 25) Rissanen TH. (2003) | The Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. | 1,950 men aged 42-60.
(Finland) | 12.8
(1984-89 to 2000) | 115? | Cardiovascular death | Fruits, berries and vegetables (including jams, nectars and juices, but excluding potatoes) |
RR = 0.61 (0.34-1.10; P = 0.037) for the highest vs lowest quintile of consumption.
Amount specific data (g/d):
< 133: RR = 1.
133-214: RR = 0.76 (0.45-1.30).
215-293: RR = 0.49 (0.26-0.91).
294-408: RR = 0.60 (0.34-1.03).
> 408: RR = 0.61 (0.34-1.10).
After additional adustment for dietary factors (energy, intakes of vitamin C and E, beta carotene, lycopene, folate and fiber):
RR = 0.66 (0.28-1.55; P = 0.127).
Amount specific data (g/d):
< 133: RR = 1.
133-214: RR = 0.76 (0.44-1.30).
215-293: RR = 0.50 (0.26-0.96).
294-408: RR = 0.62 (0.33-1.16).
> 408: RR = 0.66 (0.28-1.55).
| Age, examination years, urinary excretion of nicotine metabolites, alcohol, BMI, systolic blood pressure, diabetes, serum LDL, HDL and triglycerides, and maximal oxygen uptake. |
| 23) Bazzano LA. (2002) | The first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. | 9,608 adults aged 25-74.
(USA) | 19
(1971-75 to 1992) | 1,145 | Cardiovascular disease mortality | Fruit and vegetables (not defined, but fresh, canned, frozen, cooked, or raw, and juices) |
RR = 0.73 (0.58-0.92; P = 0.008) for the highest vs lowest quartile of consumption.
Amount specific data (times/d):
< 1: RR = 1.
1: RR = 0.91 (0.75-1.10).
2: RR = 0.84 (0.70-0.99).
≥ 3: RR = 0.73 (0.58-0.92).
This association did not change after additional adjusmtent for BMI, cholesterol and blood pressure: RR = 0.78 (0.62-0.98; P = < 0.05) or additional adjustment for dietary variables (including meat, poultry, fish and shellfish): RR = 0.75 (0.60-0.94; P = < 0.05).
Stratified by sex, age, or race
| Men | Women | < 60 years of age | > or = 60 years of age | White | Nonwhite |
| RR = 0.64 (0.45-0.89; P = < 0.01). |
RR = 0.89 (0.63-1.28; No P-value). |
RR = 0.64 (0.43-0.97; P = < 0.05). |
RR = 0.76 (0.59-0.97; < 0.05). |
RR = 0.70 (0.55-0.90; P = < 0.01). |
RR = 0.89 (0.52-1.53; No P-value). |
Risk estimates were not significantly different across strata of smoking status, diabetic status, vitamin use, and physical activity (data not shown).age, sex, race, history of diabetes, physical activity, education level, regular alcohol consumption, current cigarette smoking at baseline, vitamin supplement use, and total energy intake. |
Coronary heart disease:
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments |
| 41) Holmberg S (2009) | No cohort name defined | 1,752 farmers and non-farming rural men without a history of CHD.
(Sweden) | 12
(1990-91 to 2002-03) | 138 | Coronary heart disease risk (hospitalized or deceased due to CHD) | Fruits and vegetables (vegetables, legumes, root vegetables [except potatoes], and fruit) | OR = 0.65 (0.44-0.97) for daily vs less daily consumption.
Stratified by consumption of dairy fat:
| High intake of dairy fat | Low intake of dairy fat |
Not fruit and vegetables daily: OR = 1 (reference).
Fruit and vegetables daily: OR = 0.39 (0.21-0.73).
|
Not fruit and vegetables daily: OR = 0.92 (0.51-1.67).
Fruit and vegetables daily: OR = 1.70 (0.97-2.98).
|
Unadjusted.
Stratified analysis is adjusted for age, BMI, LDL, systolic blood pressure, physical workload, smoking, bread, and fish. |
| 39) Nabi H (2008) | The Whitehall II Prospective Cohort Study. | 10,308 subjects aged 34-55 from 20 civil service departments originally located in London. | 12.5
(1989-90 to 2003-04) | 619 | Risk of coronary heart disease (fatal CHD, non-fatal MI, and definite angina) | Fruits and vegetables (not defined) | HR = 1.13 (0.96-1.32) for nondaily vs daily fruits and vegetables. | Age and sex. |
| 27) Nettleton JA (2008) | The Atherosclerosis Risk In Communities (ARIC) Study. | 14,153 African-American and white adults age 45-64.
(USA) | 13.3
(1987-89 to 2003) | 1,140? (639 men, 501 women) | Incident heart failure | Fruits and vegetables (fruits and fruit juices, tomatoes, potatoes, cruciferous, carotenoid, green leafy, legumes, other vegetables) | RR = 1.02 (0.99-1.05; No P-value) for a 1 serving/d difference.
There were no significant interactions between dietary intake variables and BMI, sex, race, or baseline disease status (CVD, diabetes, or hypertension) (data not shown). | Energy intake, age, sex, race/center, education level, physical activity level, smoking status, drinking status, and prevalent disease (cardiovascular disease, diabetes, and hypertension). |
| 27) Steffen LM. (2003) | The Atherosclerosis Risk in Communities (ARIC) Study. | 11,940 subjects aged 45-64.
(USA) | 11
(1987-89 to 1999) | 535 | CAD incidence | Fruit and vegetables (fresh apples or pears, oranges, orange or grapefruit juice, peaches, apricots or plums, bananas, and other fruit, green beans, broccoli, cabbage, cauliflower, Brussels sprouts, carrots, corn, spinach, collard or other greens, peas or lima beans, dark-yellow winter squash, sweet potatoes, beans or lentils, tomatoes, and potatoes [not including French fries]) |
RR = 0.82 (0.57-1.17; P = 0.29) for the highest vs lowest quintile of consumption.
Amount specific data (servings/d):
1.5: HR = 1.
2.5: HR = 1.10 (0.84-1.45).
3.5: HR = 1.21 (0.91-1.60).
5.0: HR = 1.06 (0.78-1.44).
7.5: HR = 0.82 (0.57-1.17).
Stratified by race:
| African Americans | Whites |
RR = 0.37 (0.17-0.80; P = 0.01) for the highest vs lowest quintile of consumption.
Amount specific data (servings/d):
1.5: HR = 1.
2.5: HR = 0.96 (0.57-1.59).
3.5: HR = 0.70 (0.40-1.23).
5.0: HR = 0.75 (0.42-1.34).
7.5: HR = 0.37 (0.17-0.80). |
RR = 1.13 (0.75-1.71) for the highest vs lowest quintile of consumption.
Amount specific data (servings/d):
1.5: HR = 1.
2.5: HR = 1.11 (0.80-1.55).
3.5: HR = 1.48 (1.07-2.05).
5.0: HR = 1.21 (0.84-1.75).
7.5: HR = 1.13 (0.75-1.71). |
Age, race, sex, time-dependent energy intake, smoking status, pack-years of smoking, physical activity, alcohol intake, hormone replacement in women, BMI, waist-to-hip ratio, systolic blood pressure, and use of antihypertensive medications, HDL and LDL are included in the model for incident CAD. |
| 26) Bingham S (2008) | The EPIC Norfolk Cohort Study. | 11,134 men and women aged 45-75. | Not defined (1992-94 to ?) | 678 | The risk of developing IHD | Fruit and vegetables (not defined) |
Stratified by method for assessing diet:
| Diary | FFQ |
HR = 0.632 (0.48-0.82; P = 0.001) for the highest vs lowest quintile of consumption (486 vs 79 g/day).
HR = 0.904 (0.85-0.96; P = 0.001) for an increase of 1 quintile.
|
HR = 0.901 (0.70-1.67; P = 0.431) for the highest vs lowest quintile of consumption (824 vs 200 g/day).
HR = 0.961 (0.90-1.01; P = 0.186) for an increase of 1 quintile.
|
Sex, age, smoking, exercise, weight, systolic blood pressure and intake of energy and the energy yielding nutrients alcohol, fat and carbohydrate, and for plasma cholesterol. |
| 23) Bazzano LA. (2002) | The first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. | 9,608 adults aged 25-74.
(USA) | 19
(1971-75 to 1992) | 1,786 events (639 fatal) | Ischemic heart disease incidence and mortality | Fruit and vegetables (not defined, but fresh, canned, frozen, cooked, or raw, and juices) |
Ischemic heart disease incidence: RR = 1.01 (0.84-1.21; P = 0.8) for the highest vs lowest quartile of consumption.
Amount specific data (times/d):
< 1: RR = 1.
1: RR = 1.07 (0.91-1.27).
2: RR = 0.97 (0.83-1.14).
≥ 3: RR = 1.01 (0.84-1.21).
This association did not change after additional adjusmtent for BMI, cholesterol and blood pressure: RR = 1.03 (0.85-1.25; No P-value) or additional adjustment for dietary variables (including meat, poultry, fish and shellfish): RR = 1.03 (0.86-1.22).
Stratified by sex, age, or race
| Men | Women | < 60 years of age | > or = 60 years of age | White | Nonwhite |
| RR = 0.97 (0.78-1.21; No P-value). |
RR = 1.09 (0.80-1.49; No P-value). |
RR = 0.97 (0.72-1.30; No P-value). |
RR = 1.02 (0.79-1.31; No P-value). |
RR = 0.96 (0.79-1.18; No P-value). |
RR = 1.25 (0.91-1.71; No P-value). |
Ischemic heart disease mortality: RR = 0.76 (0.56-1.03; P = 0.07) for the highest vs lowest quartile of consumption.
Amount specific data (times/d):
< 1: RR = 1.
1: RR = 0.89 (0.68-1.17).
2: RR = 0.84 (0.65-1.09).
≥ 3: RR = 0.76 (0.56-1.03).
This association did not change after additional adjusmtent for BMI, cholesterol and blood pressure: RR = 0.80 (0.60-1.06; No P-value) or additional adjustment for dietary variables (including meat, poultry, fish and shellfish): RR = 0.78 (0.57-1.06).
Stratified by sex, age, or race
| Men | Women | < 60 years of age | > or = 60 years of age | White | Nonwhite |
| RR = 0.68 (0.44-1.05; No P-value). |
RR = 0.92 (0.55-1.52; No P-value). |
RR = 0.61 (0.36-1.06; No P-value). |
RR = 0.81 (0.58-1.15; No P-value). |
RR = 0.68 (0.48-0.97; P = < 0.05). |
RR = 1.19 (0.66-2.14; No P-value). |
Risk estimates were not significantly different across strata of smoking status, diabetic status, vitamin use, and physical activity (data not shown).age, sex, race, history of diabetes, physical activity, education level, regular alcohol consumption, current cigarette smoking at baseline, vitamin supplement use, and total energy intake. |
| 10) Sun Q (2008) | The Nurses' Health Study | 32,826 participants who provided blood samples in 1989-90 and were free of cancer or CVD.
(Nested case-control) | 6
(1990-?) | 146? | Nonfatal MI | Fruit and vegetables (not defined) | No significant difference in fruit and vegetable intake was found between cases (5 servings/d) and controls (6 servings/d; P = 0.81). | Matched for age, smoking status, and fasting status.
Unadjusted. |
| 10) Sun Q (2007) | The Nurses' Health Study | 32,826 women who provided blood samples in 1989-90.
(Nested case-control) | 1989-90 to 1996 | 166? | IHD incidence (nonfatal MI or IHD death) | Fruit and vegetables (not defined) | No significant difference was found in the amount of fruit and vegetable intake between cases (5 servings) and controls (6 servings). | Cases and controls were matched for age, smoking status, fasting status at blood drawing, and the date of blood drawing.
Unadjusted. |
| 8) Gillman MW (1995) | The Framingham Study. | 832 men aged 45-65. | 20
(1966-69 to ?) | Not defined. | Risk of coronary heart disease | Fruits and vegetables (peaches, grapes, oranges, and orange juice; apples, bananas, and apple juice; canned and frozen fruits; beets, onions and winter squash; lettuce, cucumbers, green peppers, and raw tomatoes; broccoli, carrots, summer squash, and cooked tomatoes; tomato sauce; peas and lima beans; baked beans; corn; potatoes; sweet potatoes; and potato chips) | Intake of fruits and vegetables was not associated with risk of CHD (No data shown). | Not defined, but possibly: Systolic blood pressure, serum cholesterol, cigarette smoking, glucose intolerance, BMI, physical activity, left ventricular hypertrophy, energy intake, and consumption of ethanol and fat. |
Stroke:
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments |
| 27) Steffen LM. (2003) | The Atherosclerosis Risk in Communities (ARIC) Study. | 11,940 subjects aged 45-64.
(USA) | 11
(1987-89 to 1999) | 214 | Ischemic stroke incidence | Fruit and vegetables (fresh apples or pears, oranges, orange or grapefruit juice, peaches, apricots or plums, bananas, and other fruit, green beans, broccoli, cabbage, cauliflower, Brussels sprouts, carrots, corn, spinach, collard or other greens, peas or lima beans, dark-yellow winter squash, sweet potatoes, beans or lentils, tomatoes, and potatoes [not including French fries]) |
RR = 0.94 (0.54-1.63; P = 0.40) for the highest vs lowest quintile of consumption.
Amount specific data (servings/d):
1.5: HR = 1.
2.5: HR = 1.55 (1.02-2.37).
3.5: HR = 1.10 (0.69-1.76).
5.0: HR = 1.04 (0.63-1.70).
7.5: HR = 0.94 (0.54-1.63). | Age, race, sex, time-dependent energy intake, smoking status, pack-years of smoking, physical activity, alcohol intake, hormone replacement in women, BMI, waist-to-hip ratio, systolic blood pressure, and use of antihypertensive medications. |
| 23) Bazzano LA. (2002) | The first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. | 9,608 adults aged 25-74.
(USA) | 19
(1971-75 to 1992) | 888 events (218 fatal) | Stroke incidence and mortality | Fruit and vegetables (not defined, but fresh, canned, frozen, cooked, or raw, and juices) |
Stroke incidence: RR = 0.73 (0.57-0.95; P = 0.01) for the highest vs lowest quartile of consumption.
Amount specific data (times/d):
< 1: RR = 1.
1: RR = 1.04 (0.86-1.26).
2: RR = 0.93 (0.76-1.13).
≥ 3: RR = 0.73 (0.57-0.95).
This association did not change after additional adustment for BMI, cholesterol and blood pressure: RR = 0.77 (0.60-0.99; P = < 0.05) or additional adjustment for dietary variables (including meat, poultry, fish and shellfish): RR = 0.75 (0.58-0.97; P = < 0.05).
Stratified by sex, age, or race
| Men | Women | < 60 years of age | > or = 60 years of age | White | Nonwhite |
| RR = 0.65 (0.43-0.99; P = < 0.05). |
RR = 0.75 (0.53-1.07; No P-value). |
RR = 0.80 (0.51-1.27; No P-value). |
RR = 0.68 (0.50-0.93; P = < 0.05). |
RR = 0.72 (0.55-0.95; P = < 0.05). |
RR = 0.80 (0.43-1.50; No P-value). |
Stroke mortality: RR = 0.58 (0.33-1.02; P = 0.05) for the highest vs lowest quartile of consumption.
Amount specific data (times/d):
< 1: RR = 1.
1: RR = 0.83 (0.56-1.22).
2: RR = 0.74 (0.48-1.12).
≥ 3: RR = 0.58 (0.33-1.02).
This association became nonsignificant after additional adjustment for BMI, cholesterol and blood pressure: RR = 0.61 (0.35-1.07) or additional adjustment for dietary variables (including meat, poultry, fish and shellfish): RR = 0.63 (0.37-1.08).
Stratified by sex, age, or race
| Men | Women | < 60 years of age | > or = 60 years of age | White | Nonwhite |
| RR = 0.77 (0.32-1.81; No P-value). |
RR = 0.47 (0.21-1.02; No P-value). |
RR = 0.39 (0.10-1.51; No P-value). |
RR = 0.65 (0.35-1.22; No P-value). |
RR = 0.49 (0.28-0.85; P = < 0.05). |
RR = 1.08 (0.33-3.54; No P-value). |
Risk estimates were not significantly different across strata of smoking status, diabetic status, vitamin use, and physical activity (data not shown).age, sex, race, history of diabetes, physical activity, education level, regular alcohol consumption, current cigarette smoking at baseline, vitamin supplement use, and total energy intake. |
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