Higher Fruit, Vegetable Intake Associated With Lower Stroke Risk

Mindy Hung

September 18, 2003

Sept. 18, 2003 — Daily consumption of green or yellow vegetables and fruits is associated with a lower risk of total stroke, intracerebral hemorrhage, and cerebral infarction mortality in men and women, according to results of a 16-year Japanese prospective cohort study. The findings, from the October issue of Stroke, were published online before print Sept. 18.

"Longitudinal studies in both Japanese and American populations have consistently shown fruit and vegetable consumption to be inversely associated with stroke incidence and mortality, although the studies have not considered potential differences between men and women, or between stroke subtypes," write Catherine Sauvaget, MD, PhD, and colleagues from the Radiation Effects Research Foundation in Hiroshima, Japan.

The authors drew 40,349 participants from among subjects in the Life Span Study, an ongoing longitudinal investigation of persons exposed and not exposed to radiation from the Hiroshima and Nagasaki atomic bombings.

After exclusion of patients with self-reported history of stroke, the study population consisted of 39,337 subjects (14,966 men and 23,371 women). For men, the mean age at baseline was 54 years (range, 34-97 years) and 58 years for women (range 35-103 years).

The researchers administered a food frequency questionnaire to participants to assess fruit and vegetable intake at baseline, as well as sociodemographic information, lifestyle factors, and medical history. Investigators began follow-up on Jan. 1, 1980, for men, and on Feb. 1, 1981, for women, and continued until patients' death or March 31, 1998, whichever came first.

A total of 1,926 stroke deaths were identified through Japan's nationwide family registration system during the follow-up period. Daily intake of green or yellow vegetables and fruit was associated with a 26% reduction in the risk of death from total stroke in men and women compared with an intake of once or less per week.

Investigators observed a protective effect for infarction and a clearer one for hemorrhage associated with daily fruit and vegetable consumption; risk reduction for intracerebral hemorrhage was 32% in men and 30% in women.

The authors noted that adjustment for smoking status did not alter the associations appreciably. The protective effect also remained after investigators controlled for potential confounders such as radiation dose, city, body mass index, education level, alcohol consumption, and past history of hypertension, diabetes, and myocardial infarction.

Study limitations include the use of a one-time dietary questionnaire; the small array of food types categorized in the questionnaire and the absence of information on portion size also meant that total energy intake was not adjusted for in analysis.

"The potential protective effects of fruits and vegetables are thought to be mediated through their effects on lowering blood pressure and/or their antioxidant effects," investigators write. "Future research needs to clarify the mechanisms through which a higher intake of vegetables and fruits may protect against stroke."

Stroke. Published online Sept. 18, 2003.

Reviewed by Gary D. Vogin, MD

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