Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study

Tomatoes have natural anti-thrombotic effects

The prevention of arterial thrombotic diseases has a high priority in developed countries. An inappropriate diet may be an important risk factor for thrombotic events. The daily intake of an anti-thrombotic diet may offer a convenient and effective way of prevention. The aim of the present study was to test tomato extracts for anti-thrombotic effects and to identify those varieties that have such an effect. A shear-induced platelet-function test (haemostatometry) was used to test anti-thrombotic potential in vitro. Extracts from those tomato varieties that showed a significant anti-thrombotic activity in vitro were further assessed in vivo, using a laser-induced thrombosis test in mice. One tomato variety (KG99-4) showed significant anti-thrombotic activity both in vitro and in vivo. KG99-4 inhibited not only platelet-rich thrombus formation but also had a thrombolytic effect. It is concluded that haemostatometry can detect and classify the anti-thrombotic potential of fruits and vegetables and offers a simple way of screening for such effects.

Relation between changes in intakes of dietary fiber and grain products and changes in weight and development of obesity among middle-aged women

BACKGROUND

Although increased consumption of dietary fiber and grain products is widely recommended to maintain healthy body weight, little is known about the relation of whole grains to body weight and long-term weight changes.

OBJECTIVE

We examined the associations between the intakes of dietary fiber and whole- or refined-grain products and weight gain over time.

DESIGN

In a prospective cohort study, 74,091 US female nurses, aged 38-63 y in 1984 and free of known cardiovascular disease, cancer, and diabetes at baseline, were followed from 1984 to 1996; their dietary habits were assessed in 1984, 1986, 1990, and 1994 with validated food-frequency questionnaires. Using multiple models to adjust for covariates, we calculated average weight, body mass index (BMI; in kg/m(2)), long-term weight changes, and the odds ratio of developing obesity (BMI > or = 30) according to change in dietary intake.

RESULTS

Women who consumed more whole grains consistently weighed less than did women who consumed less whole grains (P for trend < 0.0001). Over 12 y, those with the greatest increase in intake of dietary fiber gained an average of 1.52 kg less than did those with the smallest increase in intake of dietary fiber (P for trend < 0.0001) independent of body weight at baseline, age, and changes in covariate status. Women in the highest quintile of dietary fiber intake had a 49% lower risk of major weight gain than did women in the highest quintile (OR = 0.51; 95% CI: 0.39, 0.67; P < 0.0001 for trend).

CONCLUSION

Weight gain was inversely associated with the intake of high-fiber, whole-grain foods but positively related to the intake of refined-grain foods, which indicated the importance of distinguishing whole-grain products from refined-grain products to aid in weight control.

Perceived stress as a predictor of the self-reported new diagnosis of symptomatic CHD in older women

This article describes one aspect of a prospective cohort study of 10,432 women aged between 70 and 75 years. After a 3-year period, 503 women self-reported a new diagnosis by a doctor of angina or myocardial infarction (symptomatic coronary heart disease [CHD]). Time one psychosocial variables (Duke Social Support Index, time pressure, Perceived Stress Scale, Mental Health Index, having a partner, educational attainment, and location of residence) were analyzed using univariate binary logistic regression for their ability to predict subsequent symptomatic CHD. Of these variables, the Duke Social Support Index, Perceived Stress Scale and the Mental Health Index were found to be significant predictors of symptomatic CHD diagnosis. Only the Perceived Stress Scale, however, proved to be a significant independent predictor. After controlling for time one nonpsychosocial variables, as well as the frequency of family doctor visits, perceived stress remained a significant predictor of the new diagnosis of symptomatic CHD in this cohort of older women over a 3-year period.

The Association Between Fruit and Vegetable Consumption and Peripheral Arterial Disease

BACKGROUND

High fruit and vegetable consumption has been associated with a lower risk of cardiovascular diseases, but few studies have focused on peripheral arterial disease. In this study, we evaluated the association of consumption of fruits and vegetables with peripheral arterial disease.

METHODS

In a cohort of 44,059 men initially free of cardiovascular disease and diabetes, we documented 295 cases of peripheral arterial disease during a 12-year follow-up. Fruit and vegetable consumption was assessed by food frequency questionnaire.

RESULTS

In the age-adjusted model, men in the highest quintile had a relative risk of 0.55 (95% confidence interval = 0.38-0.80) for overall fruit and vegetable intake, 0.52 (0.36-0.77) for fruit intake, and 0.54 (0.36-0.81) for vegetable intake, compared with those in the lowest quintile of intake. However, the associations were greatly weakened after adjustment for smoking and other traditional cardiovascular disease risk factors. Comparing men in the highest quintile versus the lowest quintile, relative risks and 95% confidence intervals were 0.95 (0.62-1.44) for overall fruit and vegetable intake, 0.97 (0.64-1.48) for fruit intake, and 0.76 (0.50-1.17) for vegetable intake.

CONCLUSIONS

We did not find evidence that fruit and vegetable consumption protects against peripheral arterial disease, although a modest benefit cannot be excluded.

Dynamics of the Nutrition Transition toward the Animal Foods Sector in China and its Implications: A Worried Perspective

Many changes in diet and in physical activity are occurring simultaneously in the developing world. These diet shifts include large increases in energy density, in the proportion of the population consuming a high fat diet and in animal product intake. Animal source foods (ASF) play a major role in these diet shifts. This article documents the large shifts in the composition of diets and obesity across the developing world and notes that these changes are accelerating. Using China as a case study, evidence of the speeding up of this process is presented in descriptive and more rigorous dynamic longitudinal analysis. The implications of these changes for dietary and obesity patterns and cardiovascular disease are great. Indeed, developing countries are at a point where the prevalence of obesity is greater than that of undernutrition and concerns related to intake of saturated fat and energy imbalance must be considered more seriously by the agriculture sector. Current agriculture development policy in many developing countries focuses on livestock promotion and does not consider the potential adverse health consequences of this strategy. Although linkages between ASF intake and obesity cannot be established as clearly as they are for high ASF intakes, heart disease and cancer, the potential adverse health effects linked with an increased ASF intake should no longer be ignored.

The postprandial effects of dietary antioxidants in humans

Traditional risk factors as measured in the fasted individual are reported to be responsible for the prediction of only half of the incident cases of cardiovascular disease. However, many complex and deleterious reactions occur in the postprandial state. The consequences of oxidative reactions occurring during this time represent major risk for fatal and nonfatal heart disease, ischemia, and stroke, and include oxidative modifications to low-density lipoproteins (LDL), decreased production and bioactivity of nitric oxide (NO) in endothelial cells, and reduced endothelial function. Supplementation with antioxidants may prevent or reduce many of these risks. Antioxidants have been shown to reduce oxidative modification to LDL cholesterol, prevent glucose auto-oxidation, improve the bioactivity of NO, and attenuate or prevent the decrease in endothelial function associated with the postprandial state. Because many nonfasting reactions represent major risk for disease, postprandial risk analysis must form a larger part of the diagnostic strategy for disease prevention in the future.

Antibacterial activity of vegetables and juices

OBJECTIVE

We evaluated the antibacterial activities of various fruit and vegetable extracts on common potential pathogens including antibiotic-resistant strains.

METHODS

Standardized bacterial inocula were added to serial dilutions of sterile vegetable and fruit extracts in broth, with final bacterial concentrations of 10(4-5) cells/mL. After overnight incubation at 35 degrees C, antibacterial activity was measured by minimum inhibitory and minimum bactericidal dilutions (for raw juices) or concentrations (for tea).

RESULTS

Among the vegetable and fruit extracts tested, all green vegetables showed no antibacterial activity on Staphylococcus epidermidis and Klebsiella pneumoniae. All purple and red vegetable and fruit juices had antibacterial activities in dilutions ranging from 1:2 to 1:16. Garlic juice had significant activity, with bactericidal action in dilutions ranging up to 1:128 of the original juice. Tea also had significant activity, with bactericidal action in concentrations ranging up to 1.6 mg/mL, against a spectrum of pathogens including resistant strains such as methicillin- and ciprofloxacin-resistant staphylococci, vancomycin-resistant enterococci, and ciprofloxacin-resistant Pseudomonas aeruginosa.

CONCLUSIONS

Tea and garlic have the potential for exploration of broader applications as antibacterial agents.

Vegetable and Fruit Intake and Stroke Mortality in the Hiroshima/Nagasaki Life Span Study

BACKGROUND AND PURPOSE

Fruits and vegetables are known for their beneficial effects on chronic diseases. The purpose of the present study was to investigate the protective effect of a diet rich in fruits and vegetables on total stroke mortality and its 2 main subtypes in men and women separately.

METHODS

A prospective cohort study of 40 349 Japanese men and women was initiated in 1980-1981 and followed until 1998. Fruit and vegetable intake was assessed at baseline on the basis of the response to a food frequency questionnaire. During the 18-year follow-up period, deaths from stroke were registered.

RESULTS

A total of 1926 stroke deaths were identified during the follow-up period. An increasing frequency of intake of green-yellow vegetables and fruit was associated with a reduced risk of death from intracerebral hemorrhage and cerebral infarction. Daily intake of green-yellow vegetables was associated with a significant 26% reduction in the risk of death from total stroke in men and women compared with an intake of once or less per week. The protective effect associated with daily fruit and vegetable intake was observed for both cerebral infarction and intracerebral hemorrhage mortality but was slightly stronger and clearer for infarction than for hemorrhage, with a 32% reduction in men and a 30% reduction in women. Daily fruit intake was associated with a significant 35% reduction in risk of total stroke in men and a 25% reduction in women and was equally strong for both intracerebral hemorrhage and cerebral infarction.

CONCLUSIONS

Daily consumption of green-yellow vegetables and fruits is associated with a lower risk of total stroke, intracerebral hemorrhage, and cerebral infarction mortality. The protective effects are similar in both men and women.

Type 2 diabetes and the vegetarian diet

Based on what is known of the components of plant-based diets and their effects from cohort studies, there is reason to believe that vegetarian diets would have advantages in the treatment of type 2 diabetes. At present there are few data on vegetarian diets in diabetes that do not in addition have weight loss or exercise components. Nevertheless, the use of whole-grain or traditionally processed cereals and legumes has been associated with improved glycemic control in both diabetic and insulin-resistant individuals. Long-term cohort studies have indicated that whole-grain consumption reduces the risk of both type 2 diabetes and cardiovascular disease. In addition, nuts (eg, almonds), viscous fibers (eg, fibers from oats and barley), soy proteins, and plant sterols, which may be part of the vegetarian diet, reduce serum lipids. In combination, these plant food components may have a very significant impact on cardiovascular disease, one of the major complications of diabetes. Furthermore, substituting soy or other vegetable proteins for animal protein may also decrease renal hyperfiltration, proteinuria, and renal acid load and in the long term reduce the risk of developing renal disease in type 2 diabetes. The vegetarian diet, therefore, contains a portfolio of natural products and food forms of benefit for both the carbohydrate and lipid abnormalities in diabetes. It is anticipated that their combined use in vegetarian diets will produce very significant metabolic advantages for the prevention and treatment of diabetes and its complications.

Plant-based foods and prevention of cardiovascular disease: an overview

Evidence from prospective cohort studies indicates that a high consumption of plant-based foods such as fruit and vegetables, nuts, and whole grains is associated with a significantly lower risk of coronary artery disease and stroke. The protective effects of these foods are probably mediated through multiple beneficial nutrients contained in these foods, including mono- and polyunsaturated fatty acids, n-3 fatty acids, antioxidant vitamins, minerals, phytochemicals, fiber, and plant protein. In dietary practice, healthy plant-based diets do not necessarily have to be low in fat. Instead, these diets should include unsaturated fats as the predominant form of dietary fat (eg, fats from natural liquid vegetable oils and nuts), whole grains as the main form of carbohydrate, an abundance of fruit and vegetables, and adequate n-3 fatty acids. Such diets, which also have many other health benefits, deserve more emphasis in dietary recommendations to prevent chronic diseases.

Effect of orange juice intake on vitamin C concentrations and biomarkers of antioxidant status in humans

BACKGROUND

Consumption of fruit and vegetables is associated with improved health and a decreased prevalence of chronic degenerative processes.

OBJECTIVES

The objectives were to assess the bioavailability of vitamin C from orange juice and its influence on plasma vitamin C and 8-epi-prostaglandin F(2 alpha) (8-epi-PGF(2 alpha)) concentrations in a healthy human population.

DESIGN

Six men and 6 women consumed 500 mL commercial fresh-squeezed orange juice/d for 14 d, corresponding to an intake of 250 mg ascorbic acid/d. On the first day of the study, the subjects drank the juice in one dose (dose-response study), and on days 2-14 they consumed 250 mL in the morning and 250 mL in the afternoon. Blood was collected every hour for 6 h on the first day and again on days 7 and 14.

RESULTS

Baseline plasma vitamin C concentrations were significantly higher (P = 0.03) among the women than among the men (56.4 +/- 4.4 compared with 44.3 +/- 3.5 micromol/L). In the dose-response study, the maximum increase in plasma vitamin C occurred 3 h postdose in both the men and the women. Vitamin C concentrations remained significantly higher on days 7 and 14 than at baseline. Baseline concentrations of 8-epi-PGF(2 alpha) were significantly higher (P = 0.03) among the men than among the women (249.6 +/- 25.4 compared with 177.7 +/- 6.2 pg/mL) but decreased significantly (P = 0.04) by day 14 of the intervention. A significant inverse correlation was observed between vitamin C and 8-epi-PGF(2 alpha) (r = -0.791, P = 0.0022). Among smokers, baseline vitamin C was lower and 8-epi-PGF(2 alpha) higher than among nonsmokers.

CONCLUSIONS

Drinking orange juice (500 mL/d) increases plasma concentrations of vitamin C and reduces concentrations of 8-epi-PGF(2 alpha) in humans. These effects were significantly more pronounced in smokers.

The activities of antioxidant nutrients in human plasma depend on the localization of attacking radical species

The oxidation of endogenous antioxidant nutrients in human plasma was determined to examine their activities against free radicals generated in the aqueous and lipid compartments of plasma. Free radicals were induced at a constant rate in the aqueous compartment by the hydrophilic radical generator, 2,2'-azobis-(2-amidinopropane)dihydrochloride (AAPH; 10-20 mmol/L) and in the lipid compartment by the lipophilic radical generator, 2,2'-azobis(4-methoxy-2,4-dimethylvaleronitrile) (MeO-AMVN; 1-2 mmol/L). The depletion of endogenous plasma antioxidant nutrients (lutein, cryptoxanthin, beta-carotene, lycopene, alpha-tocopherol, ascorbic acid, uric acid) was determined after incubation with either AAPH or MeO-AMVN at 37 degrees C using HPLC. The oxidation of the aqueous and lipid compartments of plasma was selectively monitored by a fluorimetric method using either the hydrophilic probe, 2',7'-dichlorodihydrofluorescein (DCFH) or the lipophilic probe, 4,4-difluoro-5-(4-phenyl-1,3-butadienyl)-4-bora-3a, 4a-diaza-s-indacene-3-undecanoic acid (BODIPY 581/591). When plasma was incubated with AAPH, the rates of consumption of the antioxidant nutrients were as follows: ascorbic acid > alpha-tocopherol > uric acid > lycopene > lutein > cryptoxanthin > beta-carotene. When plasma was incubated with MeO-AMVN, alpha-tocopherol and carotenoids were depleted at similar rates and ahead of the major water-soluble antioxidants. Our study indicates that the antioxidant nutrients present in both the lipid and aqueous compartments can remove free radicals generated in plasma, and their activity depends on the localization of the attacking radical species.

Multivitamin supplements are inversely associated with risk of myocardial infarction in men and women--Stockholm Heart Epidemiology Program (SHEEP)

Epidemiologic data relating multivitamin supplement use to the risk of cardiovascular disease are sparse and inconsistent. We examined the association between self-selected use of low dose multivitamin supplements and the risk of myocardial infarction (MI). Our results are based on data from a large population-based, case-control study of subjects aged 45-70 y residing in Sweden, a country in which consumption of fruits and vegetables is relatively low and foods are not fortified with folic acid. The study included 1296 cases (910 men, 386 women) with a first nonfatal MI and 1685 controls (1143 men, 542 women) frequency-matched to the cases by sex, age and hospital catchment area. Odds ratios (OR) and 95% CI were calculated from unconditional logistic regression models. Among controls, 57% of the women and 35% of the men used dietary supplements; corresponding figures for the cases were 42 and 27%, respectively. Of those taking supplements, 80% used multivitamin preparations. After adjustment for major cardiovascular risk factors, the OR of MI comparing regular users of supplements with nonusers were 0.79 (95% CI 0.63-0.98) for men and 0.66 (95% CI 0.48-0.91) for women. This inverse association was not modified by such healthy lifestyle habits as consumption of fruits and vegetables, intake of dietary fiber, smoking habits and level of physical activity, although never smoking appeared to outweigh the association in women. Findings from this study indicate that use of low dose multivitamin supplements may aid in the primary prevention of MI.

The relation between dietary flavonol intake and coronary heart disease mortality: a meta-analysis of prospective cohort studies

OBJECTIVE

To assess the association of dietary flavonol intake with the subsequent risk of coronary heart disease (CHD) mortality.

DESIGN

Meta-analysis of prospective cohort studies published before September 2001. Studies were identified by MEDLINE and EMBASE searches and by scanning relevant reference lists. The following information was extracted from published reports: size of cohort, mean age, mean duration of follow-up, number of fatal CHD events, mean flavonol intake, main sources of flavonol intake, degree of adjustment for potential confounders, and the relation of CHD mortality to dietary flavonol intake measured at baseline.

RESULTS

Seven prospective cohorts of men and women were identified including a total of 2087 fatal CHD events. Comparison of individuals in the top third with those in the bottom third of dietary flavonol intake yielded a combined risk ratio of 0.80 (95% CI 0.69-0.93) after adjustment for known CHD risk factors and other dietary components.

CONCLUSION

This overview of prospective cohort studies indicates that high dietary intake of flavonols from a small number of fruits and vegetables, tea and red wine may be associated with a reduced risk from CHD mortality in free-living populations.

Vegetable intake and long-term survival among middle-aged men in Italy

PURPOSE

To examine prospectively the relationship between vegetable consumption and long-term survival.

METHODS

In 1965, a total of 1536 Italian males from two Italian rural cohorts of the Seven Countries Study, aged 45-65 years, were examined. Information on lifestyle and food consumption collected at this visit, and total and cause-specific mortality data collected in 30 years of follow-up were analyzed for the present study.

RESULTS

During a period of 30 years, 1096 deaths occurred (308 from coronary heart disease, 325 from cancer, 158 from cerebrovascular disease and 305 from all other causes). The age-adjusted life expectancy for men consuming more than 60 g/day of vegetables was nearly 2 years longer than for men consuming less than 20 g/day. This increase in survival was more striking in smokers than nonsmokers (2.1 vs. a 1 year gain). The association also held for both geographic cohorts, although the pattern of vegetable consumption was very different in the two villages.

CONCLUSIONS

The results suggest a positive association between vegetable intake and life expectancy. Vegetable intake may be especially protective for smokers although the biological explanation for such an effect is unclear.

Oxidant and antioxidant status in vegetarians and fish eaters

An adequate antioxidant reserve which is usually present in a vegetarian diet is associated with higher life expectancy. On the other hand habitual consumption of fish is associated with lower risk of cardiovascular diseases which is attributed to the polyunsaturated fatty acids (PUFA) present in it. However the PUFA are readily susceptible to oxidation leading to the formation of free radicals which is known to be involved in the causation of several diseases.The oxidant-antioxidant status of 23 vegetarians and 22 fish eaters was studied by determining the plasma lipid peroxides measured as malondialdehyde (MDA) and the antioxidants, viz. glutathione (GSH), ascorbic acid, ceruloplasmin and uric acid.Results show that the ascorbic acid values were significantly higher in vegetarians. In addition, MDA correlated negatively with ascorbic acid only in vegetarians. However, correlation of MDA with glutathione showed a significant negative correlation only in fish eaters. There was no statistically significant difference in the MDA, GSH, ceruloplasmin and uric acid levels. The mechanism behind these findings are not clear and needs to be explored.

A 2-year stage of change evaluation of dietary fat and fruit and vegetable intake behaviors of cardiac rehabilitation patients

PURPOSE

To track the 2-year movement of cardiac rehabilitation patients through the stages of change for dietary fat reduction and increasing fruit and vegetable intake.

DESIGN

A cross-sectional, longitudinal evaluation of a convenience sample of cardiac rehabilitation patients.

SETTING

Department of Pulmonary and Cardiac Rehabilitation, Moses H. Cone Memorial Hospital, Greensboro, North Carolina.

SUBJECTS

Subjects (n = 118) were predominately white, overweight, married men with a history of tobacco use.

INTERVENTION

Group nutrition education sessions for 12 weeks.

MEASURES

Stage of change assessments for dietary fat reduction and increasing fruit and vegetable intake were performed at the start (baseline), conclusion (3 months), and 2 years after cardiac rehabilitation.

RESULTS

Baseline staging demonstrated patients' efforts to reduce dietary fat intake (preparation, 10.2%; action, 35.6%; maintenance, 47.5%). The assessment at 2 years staged 87.3% of the population in the maintenance stage. In contrast, the precontemplation (30.0%), contemplation (7.6%), and preparation (49.2%) stages dominated baseline staging for modifying fruit and vegetable intake. Patients in the precontemplation and contemplation stages increased to 58.5% at 2 years.

CONCLUSIONS

Cardiac rehabilitation patients are in different stages for two food behaviors linked to the same illness. Results support the appropriateness of nutrition education that emphasizes instrumental information for affecting fat reduction behaviors. Modifying fruit and vegetable intake behaviors is more appropriately addressed with noninstrumental interventions that emphasize health benefits and barriers to change.

High-pressurized orange juice consumption affects plasma vitamin C, antioxidative status and inflammatory markers in healthy humans

We examined the bioavailability of vitamin C in orange juice processed using high pressure (HP) and its effects on plasma levels of vitamin C, uric acid (UA), F2-isoprostanes (8-epiPGF(2alpha)), C-reactive protein (CRP) and prostaglandin E(2) (PGE(2)) in a healthy human population. Subjects (6 men, 6 women) enrolled in the study consumed 500 mL/d of HP orange juice for 14 d, corresponding to an intake of 250 mg of vitamin C. On d 1 of the study, subjects drank the juice in one dose; on d 2 until the end of the study, d 14, they drank 250 mL in the morning and 250 mL in the afternoon. Blood was collected every h for 6 h, on d 1, and then on d 7 and 14 of the study. Baseline plasma vitamin C concentration was higher (P = 0.014) in women (55.8 +/- 3.8 micro mol/L) than in men (42.8 +/- 2.1 micro mol/L). The maximum plasma vitamin C increase occurred 3 h after drinking the juice, and it remained elevated on d 7 and 14. Plasma 8-epiPGF(2alpha) concentration did not differ between men and women at baseline. However, it was lower at the end of the study in both men (P = 0.044) and women (P = 0.034). Plasma levels of vitamin C and 8-epiPGF(2alpha) were inversely correlated (r = -0.615, P = 0.001). Plasma CRP concentrations tended to be lower on d 14 than at baseline in men (P = 0.317) and women (P = 0.235). Plasma PGE(2) was lower at the end of the study in both men and women (P <or= 0.037). Drinking orange juice increases plasma vitamin C, and decreases 8-epiPGF(2alpha) and PGE(2) levels in humans, which may help reduce the risk of chronic diseases.

A mixed fruit and vegetable concentrate increases plasma antioxidant vitamins and folate and lowers plasma homocysteine in men

Fruit and vegetable consumption is inversely associated with coronary heart disease (CHD) risk. The aim of the present study was to determine the effect of supplementation with dehydrated juice concentrates from mixed fruit and vegetables on selected plasma vitamins and antioxidant status. We assessed CHD risk by measuring the concentrations of homocysteine, lipids, lipoproteins, glucose and insulin. Men were recruited to participate in a randomized double-blind, crossover trial with 2 periods of 6 wk, separated by a 3-wk wash-out period. Supplementation with the encapsulated mixed extract (Juice Plus) was compared with physically similar placebo capsules. Thirty-two men (13 smokers, 19 nonsmokers) completed the study with a mean compliance of 88%. Compared with placebo, supplementation increased the concentrations of plasma beta-carotene (0.24 +/- 0.15 vs. 1.12 +/- 0.70 micro mol/L; mean +/- SD; P < 0.0001), retinol (1.87 +/- 0.33 vs. 2.00 +/- 0.43 micro mol/L; P < 0.05), alpha-tocopherol (16.8 +/- 7.3 vs. 19.3 +/- 6.8 micro mol/L; P < 0.01), ascorbic acid (72.1 +/- 19.4 vs. 84.1 +/- 13.5 micro mol/L; P < 0.002) and folic acid (24.5 +/- 10.0 vs. 44.9 +/- 16.9 nmol/L; P < 0.0001). Plasma homocysteine was reduced (8.2 +/- 1.5 vs. 7.6 +/- 1.1; P < 0.05) and inversely related (r = -0.40, P < 0.001) with serum folate concentrations. Plasma vitamin C was positively correlated with the resistance of LDL to oxidation (r = 0.26, P < 0.05) and the plasma ferric reducing/antioxidant power (FRAP) tended to be greater after supplementation than after the placebo period (1125.5 +/- 144.1 vs. 1180.3 +/- 158.1 micro mol/L; P < 0.065). Plasma glucose, insulin and lipid concentrations were unaffected. Responses of smokers and nonsmokers did not differ. In the absence of dietary modification, supplementation with a fruit and vegetable concentrate produced responses consistent with a reduction in CHD risk.

Flavonoid intake and the risk of cardiovascular disease in women

BACKGROUND

Despite emerging evidence of the role of flavonoids in cardiovascular disease (CVD) prevention, the association remains unclear.

OBJECTIVE

We examined whether flavonoids and selected flavonols and flavones or their food sources are associated with CVD risk.

DESIGN

Women (n = 38 445) free of CVD and cancer participated in a prospective study with a mean follow-up of 6.9 y. On the basis of a food-frequency questionnaire, total flavonoids and selected flavonols and flavones were categorized into quintiles, and food sources were categorized into 4 groups. Relative risks were computed for important vascular events (519 events; excluding revascularizations) and CVD (729 events), including myocardial infarction, stroke, revascularization, and CVD death.

RESULTS

The mean flavonoid intake was 24.6 +/- 18.5 mg/d, primarily as quercetin (70.2%). For both CVD and important vascular events, no significant linear trend was observed across quintiles of flavonoid intake (P = 0.63 and 0.80, respectively). No individual flavonol or flavone was associated with CVD. Broccoli and apple consumption were associated with nonsignificant reductions in CVD risk: 25-30% and 13-22%, respectively. A small proportion of women (n = 1185) consuming > or =4 cups (946 mL) tea/d had a reduction in the risk of important vascular events but with a nonsignificant linear trend (P = 0.07).

CONCLUSIONS

Flavonoid intake was not strongly associated with a reduced risk of CVD. The nonsignificant inverse associations for broccoli, apples, and tea with CVD were not mediated by flavonoids and warrant further study.

Effect of supplemental phytonutrients on impairment of the flow-mediated brachial artery vasoactivity after a single high-fat meal

OBJECTIVES

Our objective was to determine if long-term daily administration of phytonutrient supplements can prevent the immediate adverse impact of a high-fat meal and increase the production of nitric oxide.

BACKGROUND

Ingestion of a high-fat meal impairs flow-mediated vasodilation of the brachial artery for at least 4 h; however, co-ingestion of vitamin antioxidants or a green salad has been shown to prevent this effect.

METHODS

Flow-mediated brachial artery reactivity test (BART) both before and 3 h after a 900 calorie 50 g fat meal was evaluated in 38 healthy volunteers (age 36.4 +/- 10.1 years). Subjects were randomized to four weeks of daily supplementation with a powdered fruit vegetable juice concentrate (Juice Plus [JP]) along with a complex supplement providing nutritional antioxidants and various herbal extracts (Vineyard [V]), JP alone, or a matching placebo. At three and four weeks, BART was repeated both before and after the high-fat meal. Serum nitrate/nitrite concentrations were measured at baseline and at four weeks.

RESULTS

Four weeks of the JP-V combination blunted the detrimental effect of the high-fat meal (-47.5 +/- 23.4% at baseline vs. -1.7 +/- 9.7% at four weeks [p < 0.05]). Four weeks of JP alone had a similar beneficial effect (-45.1 +/- 19.7% at baseline vs. -16.6 +/- 10.3% at four weeks [p < 0.05]), whereas there was no substantial effect of the placebo. In the subjects treated with supplements, concentrations of serum nitrate/nitrite increased from 78 +/- 39 to 114 +/- 62 microm/l (p < 0.02).

CONCLUSIONS

Daily ingestion of modest amounts of a fruit/vegetable juice concentrate with or without adjunctive phytonutrient supplementation can reduce the immediate adverse impact of high-fat meals on flow-mediated vasoactivity and increase nitrate/nitrite blood concentration.

Increasing children's acceptance of vegetables; a randomized trial of parent-led exposure

Despite considerable epidemiological evidence of the health benefits of a diet high in fruit and vegetables, consumption in pre-school children remains well below recommended levels. This study evaluated the effectiveness of an exposure-based intervention, carried out by parents in the home, in increasing children's liking for a previously disliked vegetable. 156 parents of 2-6 year old children were randomly assigned to Exposure, Information or Control groups after a pre-intervention taste test at which a 'target' vegetable was selected. Parents in the Exposure group gave their child a taste of this vegetable daily for 14 days, parents in the Information group were given nutritional advice and a leaflet, and parents in the Control group received no further intervention. All participants took part in a post-intervention taste test. Greater increases in liking, ranking and consumption of the 'target' vegetable from pre- to post-intervention occurred in the Exposure group than in either of the other two groups. Only the Exposure group showed significant increases across all three outcomes. It can be concluded that a parent-led, exposure-based intervention involving daily tasting of a vegetable holds promise for improving children's acceptance of vegetables. These findings suggest a parental advice strategy which could be disseminated directly to parents or by health professionals.

Using a correction factor to correct for overreporting in a food-frequency questionnaire does not improve biomarker-assessed validity of estimates for fruit and vegetable consumption

To correct for overreporting of fruit and vegetable (FV) consumption in a food-frequency questionnaire, summary questions about consumption of main FV groups are often used to calculate correction factors. This study compared the ability to rank people according to their FV intake of those summary questions and the sum of questions on individual FV items within categories, and of corrected or uncorrected estimates of specific sorts of FV. Healthy middle-age women (n = 161) completed a food-frequency questionnaire about FV consumption during the previous month and gave a single fasting blood sample. Correction factors were calculated as the reported frequency on a summary question divided by the summed frequencies of all items in a category. Plasma carotenoids and vitamin C served as biomarkers of FV consumption. Significant correlations between FV consumption and biomarkers were observed (e.g., Spearman's correlation coefficient r with total carotenoids/vitamin C: 0.32/0.34 for vegetables, 0.30/0.25 for fruits). Summary estimates of cooked, raw and total vegetable consumption correlated higher with biomarkers than sum estimates. For fruits no differences in correlations between sum and summary estimates were observed. Applying a correction factor on the consumption of carrots and total cabbage resulted in lower correlations with relevant biomarkers. For broccoli/cauliflower, Brussels sprouts and citrus fruits, correlations with biomarkers did not change after correction. We conclude that summary questions may suffice to rank individuals according to their intake of main FV categories, and that correction for overreporting of individual FV items is probably not advisable when ranking individuals according to intake of these items.

Is intake of breakfast cereals related to total and cause-specific mortality in men?

BACKGROUND

Prospective studies suggested that substituting whole-grain products for refined-grain products lowers the risks of type 2 diabetes and cardiovascular disease (CVD) in women. Although breakfast cereals are a major source of whole and refined grains, little is known about their direct association with the risk of premature mortality.

OBJECTIVE

We prospectively evaluated the association between whole- and refined-grain breakfast cereal intakes and total and CVD-specific mortality in a cohort of US men.

DESIGN

We examined 86,190 US male physicians aged 40-84 y in 1982 who were free of known CVD and cancer at baseline.

RESULTS

During 5.5 y, we documented 3114 deaths from all causes, including 1381 due to CVD (488 myocardial infarctions and 146 strokes). Whole-grain breakfast cereal intake was inversely associated with total and CVD-specific mortality, independent of age; body mass index; smoking; alcohol intake; physical activity; history of diabetes, hypertension, or high cholesterol; and use of multivitamins. Compared with men who rarely or never consumed whole-grain cereal, men in the highest category of whole-grain cereal intake (> or = 1 serving/d) had multivariate-estimated relative risks of total and CVD-specific mortality of 0.83 (95% CI: 0.73, 0.94; P for trend < 0.001) and 0.80 (0.66, 0.97; P for trend < 0.001), respectively. In contrast, total and refined-grain breakfast cereal intakes were not significantly associated with total and CVD-specific mortality. These findings persisted in analyses stratified by history of type 2 diabetes, hypertension, and high cholesterol.

CONCLUSIONS

Both total mortality and CVD-specific mortality were inversely associated with whole-grain but not refined-grain breakfast cereal intake. These prospective data highlight the importance of distinguishing whole-grain from refined-grain cereals in the prevention of chronic diseases.

Types of carbohydrates and risk of cardiovascular disease

The purpose of this review is to provide an overview of the role of dietary carbohydrates in the etiology of cardiovascular disease (CVD) among women. Many factors are thought to affect insulin resistance, and little is known about the role of diet. Through effects on postprandial glucose and insulin, dietary glycemic load may have an important role in the insulin resistance syndrome (IRS). Dietary fiber, through its influence on the glycemic load or through other pathways, may also have important effects on this syndrome. Many short-term experimental studies have supported these hypotheses. Interestingly, associations may be stronger among overweight individuals than among nonoverweight individuals. Similar to findings for fruits and vegetables, whole grain intake has been found to be consistently associated with a reduction in risk of coronary heart disease (CHD) among both men and women. Several large randomized trials of primary and secondary prevention to date have demonstrated the efficacy of diets based on an abundance of plant foods and, therefore, high carbohydrate quality. The recommendations to follow a diet including an abundance of fiber-rich foods in order to prevent CVD and diabetes are based on a wealth of consistent scientific evidence. More long-term controlled trials are needed to improve our understanding of efficacy and mechanisms. Women and a variety of racial/ethnic groups should be represented in these studies whenever possible.

Weight control and the management of obesity after menopause: the role of physical activity

BACKGROUND

Postmenopausal women have an increased tendency for gaining weight. The declines of endogenous estrogen, together with physical inactivity, are probably the major causes of this phenomenon. Postmenopausal overweight and obesity leads to increased rates of hypertension, diabetes mellitus, coronary artery disease, and all cause mortality. Additional consequences may include hormone-dependent cancer, gallstones, nephrolithiasis, and osteoarthritis. Weight loss can reverse many of these complications, reduce the number and dosages of medications used, and improve longevity. This difficult task requires lifestyle modification.

OBJECTIVES

To review the current information about the effects of physical activity on postmenopausal weight gain and its consequences and to provide basic strategies to treat obesity during the menopause transition.

METHODS

A Medline search together with a manual search of selected articles.

CONCLUSION

Several options for weight loss are available, yet lifestyle modification is essential in managing postmenopausal obesity and overweight. While this demands dietary and behavioral changes, a major element of this modification is regular physical activity, which reduces obesity-related morbidity and mortality. The amendment to a healthier lifestyle is achievable at the postmenopausal years. All medical personnel should advocate against overweight and obesity and provide tools for their management.

Modifying children's food preferences: the effects of exposure and reward on acceptance of an unfamiliar vegetable

OBJECTIVE

The aim of this study was to evaluate two interventions (one reward-based and one exposure-based) for increasing children's acceptance of an unfamiliar vegetable compared with a no-treatment control. It was predicted that the exposure condition would increase liking for, and consumption of, the vegetable relative to either the reward or control group.

DESIGN

Using a randomized controlled design, participants were assigned to one of two intervention groups (exposure or reward) or to a no-treatment control condition, for a 2 week period. Liking for, and consumption of, red pepper was assessed before and after the treatment period.

SETTING

The study was conducted in three primary schools in London.

SUBJECTS

Parental consent was obtained for 49 out of a possible 72 children.

INTERVENTIONS

Interventions comprised eight daily sessions during which participants in the exposure group were offered a taste of sweet red pepper and told that they could eat as much as they liked. Participants in the reward group were shown a sheet of cartoon stickers and told that they could choose one of them on condition that they ate at least one piece of the pepper.

RESULTS

The exposure-based intervention significantly increased both liking (P=0.006) and consumption (P=0.03) compared with the control group. The outcome of the reward intervention was intermediate and did not differ significantly from the exposure or control conditions.

CONCLUSIONS

Repeated exposure to the taste of unfamiliar foods is a promising strategy for promoting liking of previously rejected foods in children.

The cow and the coronary: epidemiology, biochemistry and immunology

BACKGROUND

Certified death rates from coronary heart disease (CHD) are positively correlated country-by-country with milk consumption, particularly with that of the non-fat portion of milk. CHD death is also associated with circulating antibodies against milk fat-globule membrane (MFGM), raising the possibility that milk intake might be a specific risk factor for CHD. We studied the epidemiology and immunology of milk to see if the association is causal.

METHODS

We plotted the intake of various foods country-by-country against CHD death rates to see if they were correlated in space and/or in time. We prepared fluorescein-tagged human antibodies against bovine MFGM to see if they showed any auto-reactivity against human tissue.

RESULTS

Milk showed a positive correlation with CHD death rates in both space and time (r>0.9 in some cases). Beef was not correlated and cheese was negatively correlated, though not strongly. Wine was strongly negatively correlated. Human anti-bovine MFGM antibodies bind to human large granular lymphocytes and also to human platelets, causing aggregation.

CONCLUSIONS

We suggest that non-fat aspects of milk, particularly the Ca/Mg ratio, lactose and MFGM antigens, have specific coronary atherogenic effects, both biochemical and immunological, and the simultaneous attack from these three directions may explain why this foodstuff has such a strong effect. Wine appears to be an antidote for the harmful effects of milk.

Estimation of fruit and vegetable intake using a two-item dietary questionnaire: a potential tool for primary health care workers

BACKGROUND AND AIM

High fruit and vegetable intake is associated with health benefits for cancer and cardiovascular disease. An increase is therefore integral in recommendations for the prevention of chronic disease. However, measuring intake requires either extensive dietary assessment or the measurement of specific bio-markers which is neither cheap nor feasible for the routine assessment of an individual's diet in a community or primary care setting. Within the context of a study evaluating a dietary counselling programme to increase fruit and vegetable intake our aim was to assess the use of a simple tool to estimate fruit and vegetable intake.

METHODS AND RESULTS

We studied associations between bio-markers [plasma ascorbic acid, beta-carotene and alpha-tocopherol 24-hour urinary potassium excretion] and a two-item fruit and vegetable consumption questionnaire in 271 subjects (105 men and 166 women), aged 18 to 70 years. After controlling for age, sex, vitamin supplement use, smoking and body mass, those reporting a daily intake of > or = 5 portions of fruit and vegetables had higher potassium excretion (difference 15.6 [95% confidence interval: 6.2 to 25.0] mmol/24 h), urinary potassium/creatinine ratio (1.2 [0.5 to 2.0]) and plasma vitamin C (10.0 [-0.9 to 20.8] mumol/L) than those reporting < or = 2.5 portions per day. beta-carotene (p = 0.04), vitamin C (p = 0.01) and potassium excretion (p < 0.001) were associated with fruit rather than vegetable intake. The two-item questionnaire had high specificity; over 3/4 of participants who reported low intake also had bio-markers below the upper third of the distribution.

CONCLUSION

Self report of fruit and vegetable intake through a simple questionnaire is confirmed by bio-markers for those eating less than five portions of fruit and vegetables a day. Although the tool is amenable to improvements for the detection of vegetable portions, it may prove useful for monitoring dietary preventive approaches in primary care without the use of invasive and costly biochemical measurements.

Low intake of fruits, berries and vegetables is associated with excess mortality in men: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study

Diets rich in fruits and vegetables have been of interest because of their potential health benefits against chronic diseases such as cardiovascular disease (CVD) and cancer. The aim of this work was to assess the association of the dietary intake of a food group that includes fruits, berries and vegetables with all-cause, CVD-related and non-CVD-related mortality. The subjects were Finnish men aged 42-60 y examined in 1984-1989 in the prospective Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. Dietary intakes were assessed by 4-d food intake record during the baseline phase of the KIHD Study. The risk of all-cause and non-CVD-related deaths was studied in 2641 men and the risk of CVD-related death in 1950 men who had no history of CVD at baseline. During a mean follow-up time of 12.8 y, cardiovascular as well as noncardiovascular and all-cause mortality were lower among men with the highest consumption of fruits, berries and vegetables. After adjustment for the major CVD risk factors, the relative risk for men in the highest fifth of fruit, berry and vegetable intake for all-cause death, CVD-related and non-CVD-related death was 0.66 [95% confidence interval (CI) 0.50-0.88], 0.59 (0.33-1.06), and 0.68 (0.46-1.00), respectively, compared with men in the lowest fifth. These data show that a high fruit, berry and vegetable intake is associated with reduced risk of mortality in middle-aged Finnish men. Consequently, the findings of this work indicate that diets that are rich in plant-derived foods can promote longevity.

Bioactive compounds in foods: their role in the prevention of cardiovascular disease and cancer

"Bioactive compounds" are extranutritional constituents that typically occur in small quantities in foods. They are being intensively studied to evaluate their effects on health. The impetus sparking this scientific inquiry was the result of many epidemiologic studies that have shown protective effects of plant-based diets on cardiovascular disease (CVD) and cancer. Many bioactive compounds have been discovered. These compounds vary widely in chemical structure and function and are grouped accordingly. Phenolic compounds, including their subcategory, flavonoids, are present in all plants and have been studied extensively in cereals, legumes, nuts, olive oil, vegetables, fruits, tea, and red wine. Many phenolic compounds have antioxidant properties, and some studies have demonstrated favorable effects on thrombosis and tumorogenesis and promotion. Although some epidemiologic studies have reported protective associations between flavonoids or other phenolics and CVD and cancer, other studies have not found these associations. Various phytoestrogens are present in soy, but also in flaxseed oil, whole grains, fruits, and vegetables. They have antioxidant properties, and some studies demonstrated favorable effects on other CVD risk factors, and in animal and cell culture models of cancer. However, because phytoestrogens act both as partial estrogen agonists and antagonists, their effects on cancer are likely complex. Hydroxytyrosol, one of many phenolics in olives and olive oil, is a potent antioxidant. Resveratrol, found in nuts and red wine, has antioxidant, antithrombotic, and anti-inflammatory properties, and inhibits carcinogenesis. Lycopene, a potent antioxidant carotenoid in tomatoes and other fruits, is thought to protect against prostate and other cancers, and inhibits tumor cell growth in animals. Organosulfur compounds in garlic and onions, isothiocyanates in cruciferous vegetables, and monoterpenes in citrus fruits, cherries, and herbs have anticarcinogenic actions in experimental models, as well as cardioprotective effects. In summary, numerous bioactive compounds appear to have beneficial health effects. Much scientific research needs to be conducted before we can begin to make science-based dietary recommendations. Despite this, there is sufficient evidence to recommend consuming food sources rich in bioactive compounds. From a practical perspective, this translates to recommending a diet rich in a variety of fruits, vegetables, whole grains, legumes, oils, and nuts.

A cost constraint alone has adverse effects on food selection and nutrient density: an analysis of human diets by linear programming

Economic constraints may contribute to the unhealthy food choices observed among low socioeconomic groups in industrialized countries. The objective of the present study was to predict the food choices a rational individual would make to reduce his or her food budget, while retaining a diet as close as possible to the average population diet. Isoenergetic diets were modeled by linear programming. To ensure these diets were consistent with habitual food consumption patterns, departure from the average French diet was minimized and constraints that limited portion size and the amount of energy from food groups were introduced into the models. A cost constraint was introduced and progressively strengthened to assess the effect of cost on the selection of foods by the program. Strengthening the cost constraint reduced the proportion of energy contributed by fruits and vegetables, meat and dairy products and increased the proportion from cereals, sweets and added fats, a pattern similar to that observed among low socioeconomic groups. This decreased the nutritional quality of modeled diets, notably the lowest cost linear programming diets had lower vitamin C and beta-carotene densities than the mean French adult diet (i.e., <25% and 10% of the mean density, respectively). These results indicate that a simple cost constraint can decrease the nutrient densities of diets and influence food selection in ways that reproduce the food intake patterns observed among low socioeconomic groups. They suggest that economic measures will be needed to effectively improve the nutritional quality of diets consumed by these populations.

Nutrição e exercício na prevenção e controle das doenças cardiovasculares

As doenças cardiovasculares constituem a principal causa de mortalidade no mundo e o seu crescimento significativo nos países em desenvolvimento alerta para o potencial impacto nas classes menos favorecidas. São influenciadas por um conjunto de fatores de risco, alguns modificáveis mediante alterações no estilo de vida, como a dieta adequada e o exercício regular. O objetivo da presente revisão é abordar esses aspectos a fim de prevenir e controlar as doenças cardiovasculares. O consumo de vegetais, frutas, grãos integrais, soja, azeite e peixes deve ser aumentado, ainda que limitando a quantidade de gordura. Os alimentos ricos em ácidos graxos saturados e trans devem ser evitados, assim como o uso excessivo de sal e bebidas alcoólicas. Além do exercício aeróbio, as atividades contra resistência vêm aumentando sua importância na reabilitação cardíaca. Essas mudanças de estilo de vida deveriam ser prioridades na Saúde Pública a fim de deter o avanço das doenças cardiovasculares em nosso país.

Nitric oxide formation and corresponding relaxation of porcine coronary arteries induced by plant phenols: essential structural features

The high intake of polyphenols is thought to contribute to the beneficial cardiovascular effects of plant-centered diets. A putative mechanism underlying the cardioprotective activity is thought to be a plant phenol-induced increase of nitric oxide formation by the constitutive endothelial nitric oxide synthase. Twenty-eight phenols of different classes commonly occurring in plant foods were examined for their capability of enhancing the endothelial nitric oxide release of isolated porcine coronary arteries by direct real-time measurement of the luminal surface nitric oxide concentration with an amperometric microsensor. Additionally, the relaxing activity of the phenols was measured on porcine coronary rings. Quercetin, myricetin, leucocyanidol, and oligomeric proanthocyanidins induced the highest increases in nitric oxide release (delta[NO] > 8.5 nM ); caffeic acid, fisetin, hyperosid, and isoquercitrin were moderately active (5 nM < delta[NO] < 8.5 nM ); the other phenolic compounds caused only marginal increases of the nitric oxide levels (delta[NO] < 5 nM). The nitric oxide-stimulating activity of the phenols was uniformly positively correlated with their vasorelaxing activity. However, endothelium-dependent vasorelaxations were limited to phenols inducing nitric oxide elevations > 5 nM (= Km value of the soluble guanylate cyclase). Analysis of structure-activity relations revealed that a high nitric oxide activity was confined to a flavan-moiety with free hydroxyl-residues at C3, C3', C4', C5, and C7 and a hydroxyl-, oxo-, or phenolic substituent at C4, whereas the caffeic acid scaffolding emerged as the minimally essential motif for the nitric oxide-dependent vasorelaxation.

The effect of wild blueberry (Vaccinium angustifolium) consumption on postprandial serum antioxidant status in human subjects

The aim of the present study was to determine whether the consumption of wild blueberries (Vaccinium angustifolium), a concentrated source of non-nutritive antioxidant phytochemicals, would enhance postprandial serum antioxidant status in healthy human subjects. A single-blinded crossover study was performed in a group of eight middle-aged male subjects (38-54 years). Subjects consumed a high-fat meal and a control supplement followed 1 week later by the same high-fat meal supplemented with 100.0 g freeze-dried wild blueberry powder. Upon brachial vein catheterization, fasting and postprandial serum samples were taken sequentially and analysed for lipids and glucose and for serum antioxidant status. Serum antioxidant status was determined using the oxygen radical absorbance capacity (ORAC) assay and the total antioxidant status (TAS) assay. The wild-blueberry treatment was associated with a significant treatment effect as determined by the ORAC assay (water-soluble fraction ORAC(perchloric acid (PCA)), P=0.04). Significant increases in serum antioxidant status above the controls were observed at 1 h (ORAC(PCA) (8.5 % greater), P=0.02; TAS (4.5 % greater), P=0.05), and 4 h (ORAC(total) (15.0 % greater), P=0.009; ORAC(acetone) (16.0 % greater), P=0.007) post-consumption of the high-fat meal. In conclusion, the consumption of wild blueberries, a food source with high in vitro antioxidant properties, is associated with a diet-induced increase in ex vivo serum antioxidant status. It has been suggested that increasing the antioxidant status of serum may result in the reduced risk of many chronic degenerative diseases.

Frequent intake of tropical fruits that are rich in beta-cryptoxanthin is associated with higher plasma beta-cryptoxanthin concentrations in Costa Rican adolescents

Dietary tocopherols and carotenoids may play a role in preventing cancer and cardiovascular diseases. Because these may begin to develop during adolescence, dietary patterns during this period could influence long-term risk. The objective of this study was to examine the intake and plasma concentrations of the major carotenoids and tocopherols in 159 adolescents (mean +/- SD, 15.5 +/- 2.5 y old) living in Costa Rica. All participants completed a 135-item food-frequency questionnaire and provided a fasting blood sample. Carotenoid and tocopherol intakes were adjusted for total energy and plasma concentrations for total cholesterol. The relative abundance of carotenoids in the diet was similar to their distribution in plasma; lycopene was the most abundant, followed by beta-carotene and lutein + zeaxanthin. gamma-Tocopherol was more abundant than alpha-tocopherol in the diet, but alpha-tocopherol was approximately sevenfold higher in plasma. The highest diet-plasma correlations (adjusted for age, sex and body mass index) were 0.38 for beta-cryptoxanthin, 0.33 for gamma-tocopherol and 0.17 for lutein + zeaxanthin (all P < 0.05). All other correlations were r < 0.15. Papaya intake was the best food predictor of plasma beta-cryptoxanthin concentrations (r = 0.41). Subjects that frequently (> or =3/d) consumed tropical fruits with at least 50 micro g/100 g beta-cryptoxanthin (papaya, tangerine, orange and watermelon) had twofold the plasma beta-cryptoxanthin concentrations of those with intakes of <4/wk (P for trend = 0.0009). In sum, the diet-plasma carotenoid and tocopherol correlations were generally low in Costa Rican adolescents. Intakes of beta-cryptoxanthin and papaya, a tropical fruit frequently consumed in Latin America, were the best predictors of beta-cryptoxanthin concentrations in plasma.

Role of fibre and fruit in the Mediterranean diet to protect against myocardial infarction: a case-control study in Spain

OBJECTIVE

To assess the association between a first acute myocardial infarction and the consumption of fibre and fruit.

DESIGN

Hospital-based case-control study with incident cases. A validated semi-quantitative food frequency questionnaire (136 items) was used to assess food intake.

SETTING

Three third-level university hospitals in Pamplona (Spain).

SUBJECTS

Cases were subjects aged under 80, newly diagnosed with acute myocardial infarction. Each case patient (n=171) was matched to a control subject of the same gender and age (5 y bands) admitted to the same hospital.

RESULTS

An inverse association was apparent for the three upper quintiles of fibre intake. After adjustment for non-dietary and dietary confounders, an inverse linear trend was clearly significant, showing the highest relative reduction of risk (86%) for the fifth quintile (OR=0.14, 95% confidence interval: 0.03-0.67). An inverse association was also apparent for fruit intake, but not for vegetables or legumes.

CONCLUSIONS

Our data suggest that a substantial part of the postulated benefits of the Mediterranean diet on coronary risk might be attributed to a high intake of fibre and fruit.

Recent discoveries in inclusive food-based approaches and dietary patterns for reduction in risk for cardiovascular disease

PURPOSE OF REVIEW

To discuss new evidence-based dietary recommendations founded on an inclusive food strategy and to address the challenges that are posed by integrating a growing list of heart healthy foods into the diet without increasing energy intake beyond that required to achieve a healthy body weight.

RECENT FINDINGS

New food-based dietary recommendations issued by the American Heart Association with the objective of reducing risk for cardiovascular disease (CVD) promote an inclusionary approach. The American Heart Association recommends a variety of foods to target four major goals: achieve a healthy overall diet, achieve a healthy weight, promote desirable lipid levels, and promote desirable blood pressure. Specific foods recommended include fruits and vegetables, grain products (including whole grains), fish, lean meat and poultry, fat-free or low-fat dairy products, and legumes. In addition, the new National Cholesterol Education Program Adult Treatment Panel III recommends reductions in saturated fat and cholesterol and therapeutic dietary options for enhancing LDL-cholesterol lowering, with inclusion of plant stanols/sterols (2 g/day) and increased viscous (soluble) fiber (10-25 g/day). In parallel with the evolution of new dietary recommendations is the expanding list of specific foods that have cardioprotective effects. Additional foods on this list are nuts, soy, legumes, alcohol, tea, and garlic.

SUMMARY

It will be challenging to include all foods that reduce CVD risk in the diet and still maintain energy control. Strategies are needed that facilitate developing heart healthy dietary patterns that maximally reduce CVD risk.

Fruit and vegetable intake and risk of cardiovascular disease in US adults: the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study

BACKGROUND

Epidemiologic studies report inconsistent findings on the association of fruit and vegetable intake with the risk of cardiovascular disease.

OBJECTIVE

The objective was to examine the relation between fruit and vegetable intake and the risk of cardiovascular disease.

DESIGN

We studied 9608 adults aged 25-74 y participating in the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study and free of cardiovascular disease at the time of their baseline examination between 1971 and 1975. Fruit and vegetable intake at baseline was measured with a food-frequency questionnaire. The incidence of and mortality from cardiovascular disease were obtained from medical records and death certificates.

RESULTS

Over an average of 19 y, 888 strokes (218 fatal), 1786 ischemic heart disease events (639 fatal), 1145 cardiovascular disease deaths, and 2530 all-cause deaths were documented. Consuming fruit and vegetables > or = 3 times/d compared with <1 time/d was associated with a 27% lower stroke incidence [relative risk (RR): 0.73; 95% CI: 0.57, 0.95; P for trend = 0.01), a 42% lower stroke mortality (0.58; 0.33, 1.02; P for trend = 0.05), a 24% lower ischemic heart disease mortality (0.76; 0.56, 1.03; P for trend = 0.07), a 27% lower cardiovascular disease mortality (0.73; 0.58, 0.92; P for trend = 0.008), and a 15% lower all-cause mortality (0.85; 0.72, 1.00; P for trend = 0.02) after adjustment for established cardiovascular disease risk factors.

CONCLUSION

We showed an inverse association of fruit and vegetable intake with the risk of cardiovascular disease and all-cause mortality in the general US population.

Lifelong vegetarianism and risk of breast cancer: a population-based case-control study among South Asian migrant women living in England

To investigate the role of lifelong vegetarianism on the aetiology of female breast cancer, we conducted a population-based case-control study among South Asian migrant women from the Indian subcontinent resident in England. A total of 240 South Asian breast cancer cases were identified from 2 cancer registries during 1995-1999. For each case, 2 age-matched South Asian controls were randomly selected from the age-sex register of the case practice. Lifelong vegetarians had a slight reduction, although not statistically significant, in the odds of breast cancer relative to lifelong meat-eaters, which persisted after adjustment for socio-demographic and reproductive variables [odds ratio (OR)=0.77; 95% confidence interval (CI)=0.50-1.18]. Analysis by food group revealed no linear trend in the odds of breast cancer with increasing consumption of meat (p=0.10) but the odds were higher for women in the top 75%. In contrast, there were strong inverse trends in the odds of breast cancer with increasing intake of vegetables (p=0.005), pulses (p=0.007) and fibre [non-starch polysaccharides, NSP (p=0.02)], with women in the highest 25% of intake of these foods having about 50% of the odds of those in the lowest ones. Adjustment for intake of vegetables and pulses reverted the odds of breast cancer in lifelong vegetarians relative to lifelong meat-eaters (OR=1.04; 95% CI=0.65-1.68) and attenuated the quartile-specific estimates for meat intake, whereas the inverse trends in the odds of breast cancer with intake of vegetables and pulses remained after adjustment for type of diet or meat intake. These findings suggest that lifelong vegetarianism may be associated with a reduction in the risk of breast cancer through its association with a higher intake of vegetables and pulses. Although it is not possible to exclude the possibility that lifelong meat abstention may also play a role, the findings provide evidence that a diet rich in vegetables and pulses, such as those typically found in South Asian diets, may be protective against this cancer.

Inhibitory effects of cocoa flavanols and procyanidin oligomers on free radical-induced erythrocyte hemolysis

Excessive peroxidation of biomembranes is thought to contribute to the initiation and progression of numerous degenerative diseases. The present study examined the inhibitory effects of a cocoa extract, individual cocoa flavanols (-)-epicatechin and (+)-catechin, and procyanidin oligomers (dimer to decamer) isolated from cocoa on rat erythrocyte hemolysis. In vitro, the flavanols and the procyanidin oligomers exhibited dose-dependent protection against 2,2'-azo-bis (2-amidinopropane) dihydrochloride (AAPH)-induced erythrocyte hemolysis between concentrations of 2.5 and 40 microM. Dimer, trimer, and tetramer showed the strongest inhibitory effects at 10 microM, 59.4%, 66.2%, 70.9%; 20 microM, 84.1%, 87.6%, 81.0%; and 40 microM, 90.2%, 88.9%, 78.6%, respectively. In a subsequent experiment, male Sprague-Dawley rats (approximately 200 g; n = 5-6) were given a 100-mg intragastric dose of a cocoa extract. Blood was collected over a 4-hr time period. Epicatechin and catechin, and the dimers (-)-epicatechin-(4beta>8)-epicatechin (Dimer B2) and (-)-epicatechin-(4beta>6)-epicatechin (Dimer B5) were detected in the plasma with concentrations of 6.4 microM, and 217.6, 248.2, and 55.4 nM, respectively. Plasma antioxidant capacity (as measured by the total antioxidant potential [TRAP] assay) was elevated (P < 0.05) between 30 and 240 min following the cocoa extract feeding. Erythrocytes obtained from the cocoa extract-fed animals showed an enhanced resistance to hemolysis (P < 0.05). This enhanced resistance was also observed when erythrocytes from animals fed the cocoa extract were mixed with plasma obtained from animals given water only. Conversely, plasma obtained from rats given the cocoa extract improved the resistance of erythrocytes obtained from rats given water only. These results show cocoa flavanols and procyanidins can provide membrane protective effects.

Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women

BACKGROUND

Recent prospective data suggest that intake of rapidly digested and absorbed carbohydrates with a high dietary glycemic load is associated with an increased risk of ischemic heart disease.

OBJECTIVE

We examined whether a high dietary glycemic load was associated with elevated hs-CRP concentrations and whether this association was modified by body mass index (BMI; in kg/m(2)).

DESIGN

In 244 apparently healthy women, we measured plasma hs-CRP concentrations and determined average dietary glycemic loads with a validated semiquantitative food-frequency questionnaire. Using multiple regression models, we evaluated the association between dietary glycemic load and plasma hs-CRP after adjusting for age; treatment status; smoking status; BMI; physical activity level; parental history of myocardial infarction; history of hypertension, diabetes, and high cholesterol; postmenopausal hormone use; alcohol intake; and other dietary variables.

RESULTS

We found a strong and statistically significant positive association between dietary glycemic load and plasma hs-CRP. The median hs-CRP concentration for the lowest quintile of dietary glycemic load was 1.9 mg/L and for the highest quintile was 3.7 mg/L; corresponding multivariate-adjusted geometric means were 1.4 and 3.8 mg/L, respectively (P for trend < 0.01). This association was significantly modified by BMI. Among women with a BMI greater-than-or-equal 25, the multivariate-adjusted geometric mean hs-CRP concentration in the lowest quintile was 1.6 mg/L and in the highest quintile was 5.0 mg/L; however, among women with a BMI < 25, the corresponding means were 1.1 and 3.1 mg/L, respectively (P = 0.01 for interaction).

CONCLUSIONS

Dietary glycemic load is significantly and positively associated with plasma hs-CRP in healthy middle-aged women, independent of conventional risk factors for ischemic heart disease. Exacerbation of the proinflammatory process may be a mechanism whereby a high intake of rapidly digested and absorbed carbohydrates increases the risk of ischemic heart disease, especially in overweight women prone to insulin resistance.