Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE) : A prospective cohort study
Background The association between intake of fruits, vegetables, and legumes with cardiovascular disease and deaths has been investigated extensively in Europe, the USA, Japan, and China, but little or no data are available from the Middle East, South America, Africa, or south Asia. Methods We did...
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Lopez-Jaramillo, Patricio Miller, Victoria Mente, Andrew Dehghan, Mahshid Rangarajan, Sumathy Zhang, Xiaohe Swaminathan, Sumathi Dagenais, Gilles Gupta, Rajeev Mohan, Viswanathan Lear, Scott A. Bangdiwala, Shrikant I. Schutte, Aletta Elisabeth Wentzel Viljoen, Edelweiss Avezum, Alvaro Altuntas, Yuksel Yusoff, Khalid Ismail, Noorhassim Peer, Nasheeta Chifamba, Jephat Diaz, Rafael Rahman, Omar Mohammadifard, Noushin Lanas, Fernando Zatonska, Katarzyna Wielgosz, Andreas Yusufali, Afzalhussein Iqbal, Romaina Khatib, Rasha Rosengren, Annika Kutty, V. Raman Li, Wei Liu, Jiankang Liu, Xiaoyun Yin, Lu Teo, Koon Anand, Sonia S. Yusuf, Salim The Prospective Urban Rural Epidemiology (PURE) study investigators 2019-06-25T14:57:09Z 2019-06-25T14:57:09Z 2017-11-04 13 p. Background The association between intake of fruits, vegetables, and legumes with cardiovascular disease and deaths has been investigated extensively in Europe, the USA, Japan, and China, but little or no data are available from the Middle East, South America, Africa, or south Asia. Methods We did a prospective cohort study (Prospective Urban Rural Epidemiology [PURE] in 135335 individuals aged 35 to 70 years without cardiovascular disease from 613 communities in 18 low-income, middle-income, and highincome countries in seven geographical regions: North America and Europe, South America, the Middle East, south Asia, China, southeast Asia, and Africa. We documented their diet using country-specific food frequency questionnaires at baseline. Standardised questionnaires were used to collect information about demographic factors, socioeconomic status (education, income, and employment), lifestyle (smoking, physical activity, and alcohol intake), health history and medication use, and family history of cardiovascular disease. The follow-up period varied based on the date when recruitment began at each site or country. The main clinical outcomes were major cardiovascular disease (defined as death from cardiovascular causes and non-fatal myocardial infarction, stroke, and heart failure), fatal and non-fatal myocardial infarction, fatal and non-fatal strokes, cardiovascular mortality, non-cardiovascular mortality, and total mortality. Cox frailty models with random effects were used to assess associations between fruit, vegetable, and legume consumption with risk of cardiovascular disease events and mortality. Findings Participants were enrolled into the study between Jan 1, 2003, and March 31, 2013. For the current analysis, we included all unrefuted outcome events in the PURE study database through March 31, 2017. Overall, combined mean fruit, vegetable and legume intake was 3·91 (SD 2·77) servings per day. During a median 7·4 years (5·5–9·3) of followup, 4784 major cardiovascular disease events, 1649 cardiovascular deaths, and 5796 total deaths were documented. Higher total fruit, vegetable, and legume intake was inversely associated with major cardiovascular disease, myocardial infarction, cardiovascular mortality, non-cardiovascular mortality, and total mortality in the models adjusted for age, sex, and centre (random effect). The estimates were substantially attenuated in the multivariable adjusted models for major cardiovascular disease (hazard ratio [HR] 0·90, 95% CI 0·74–1·10, ptrend=0·1301), myocardial infarction (0·99, 0·74–1·31; ptrend=0·2033), stroke (0·92, 0·67–1·25; ptrend=0·7092), cardiovascular mortality (0·73, 0·53–1·02; ptrend=0·0568), non-cardiovascular mortality (0·84, 0·68–1·04; ptrend =0·0038), and total mortality (0·81, 0·68–0·96; ptrend<0·0001). The HR for total mortality was lowest for three to four servings per day (0·78, 95% CI 0·69–0·88) compared with the reference group, with no further apparent decrease in HR with higher consumption. When examined separately, fruit intake was associated with lower risk of cardiovascular, non-cardiovascular, and total mortality, while legume intake was inversely associated with non-cardiovascular death and total mortality (in fully adjusted models). For vegetables, raw vegetable intake was strongly associated with a lower risk of total mortality, whereas cooked vegetable intake showed a modest benefit against mortality. Interpretation Higher fruit, vegetable, and legume consumption was associated with a lower risk of non-cardiovascular, and total mortality. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at three to four servings per day (equivalent to 375–500 g/day). Funding Full funding sources listed at the end of the paper (see Acknowledgments). application/pdf 10.1016/S0140-6736(17)32253-5 0140-6736 https://repositorio.udes.edu.co/handle/001/3198 eng The Lancet Derechos Reservados - Elsevier Ltd., 2017 info:eu-repo/semantics/openAccess Atribución-NoComercial 4.0 Internacional (CC BY-NC 4.0) https://creativecommons.org/licenses/by-nc/4.0/ https://www.thelancet.com/action/showPdf?pii=S0140-6736%2817%2932253-5 Fruit Vegetable Legume Cardiovascular disease Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE) : A prospective cohort study Artículo de revista http://purl.org/coar/resource_type/c_6501 Text info:eu-repo/semantics/article http://purl.org/redcol/resource_type/ART info:eu-repo/semantics/publishedVersion Publication http://purl.org/coar/access_right/c_abf2 http://purl.org/coar/version/c_970fb48d4fbd8a85 |
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Universidad EIA |
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| title |
Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE) : A prospective cohort study |
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Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE) : A prospective cohort study Lopez-Jaramillo, Patricio Miller, Victoria Mente, Andrew Dehghan, Mahshid Rangarajan, Sumathy Zhang, Xiaohe Swaminathan, Sumathi Dagenais, Gilles Gupta, Rajeev Mohan, Viswanathan Lear, Scott A. Bangdiwala, Shrikant I. Schutte, Aletta Elisabeth Wentzel Viljoen, Edelweiss Avezum, Alvaro Altuntas, Yuksel Yusoff, Khalid Ismail, Noorhassim Peer, Nasheeta Chifamba, Jephat Diaz, Rafael Rahman, Omar Mohammadifard, Noushin Lanas, Fernando Zatonska, Katarzyna Wielgosz, Andreas Yusufali, Afzalhussein Iqbal, Romaina Khatib, Rasha Rosengren, Annika Kutty, V. Raman Li, Wei Liu, Jiankang Liu, Xiaoyun Yin, Lu Teo, Koon Anand, Sonia S. Yusuf, Salim The Prospective Urban Rural Epidemiology (PURE) study investigators Lopez-Jaramillo, Patricio Miller, Victoria Mente, Andrew Dehghan, Mahshid Rangarajan, Sumathy Zhang, Xiaohe Swaminathan, Sumathi Dagenais, Gilles Gupta, Rajeev Mohan, Viswanathan Lear, Scott A. Bangdiwala, Shrikant I. Schutte, Aletta Elisabeth Wentzel Viljoen, Edelweiss Avezum, Alvaro Altuntas, Yuksel Yusoff, Khalid Ismail, Noorhassim Peer, Nasheeta Chifamba, Jephat Diaz, Rafael Rahman, Omar Mohammadifard, Noushin Lanas, Fernando Zatonska, Katarzyna Wielgosz, Andreas Yusufali, Afzalhussein Iqbal, Romaina Khatib, Rasha Rosengren, Annika Kutty, V. Raman Li, Wei Liu, Jiankang Liu, Xiaoyun Yin, Lu Teo, Koon Anand, Sonia S. Yusuf, Salim The Prospective Urban Rural Epidemiology (PURE) study investigators Fruit Vegetable Legume Cardiovascular disease |
| title_short |
Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE) : A prospective cohort study |
| title_full |
Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE) : A prospective cohort study |
| title_fullStr |
Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE) : A prospective cohort study |
| title_full_unstemmed |
Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE) : A prospective cohort study |
| title_sort |
fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (pure) : a prospective cohort study |
| author |
Lopez-Jaramillo, Patricio Miller, Victoria Mente, Andrew Dehghan, Mahshid Rangarajan, Sumathy Zhang, Xiaohe Swaminathan, Sumathi Dagenais, Gilles Gupta, Rajeev Mohan, Viswanathan Lear, Scott A. Bangdiwala, Shrikant I. Schutte, Aletta Elisabeth Wentzel Viljoen, Edelweiss Avezum, Alvaro Altuntas, Yuksel Yusoff, Khalid Ismail, Noorhassim Peer, Nasheeta Chifamba, Jephat Diaz, Rafael Rahman, Omar Mohammadifard, Noushin Lanas, Fernando Zatonska, Katarzyna Wielgosz, Andreas Yusufali, Afzalhussein Iqbal, Romaina Khatib, Rasha Rosengren, Annika Kutty, V. Raman Li, Wei Liu, Jiankang Liu, Xiaoyun Yin, Lu Teo, Koon Anand, Sonia S. Yusuf, Salim The Prospective Urban Rural Epidemiology (PURE) study investigators Lopez-Jaramillo, Patricio Miller, Victoria Mente, Andrew Dehghan, Mahshid Rangarajan, Sumathy Zhang, Xiaohe Swaminathan, Sumathi Dagenais, Gilles Gupta, Rajeev Mohan, Viswanathan Lear, Scott A. Bangdiwala, Shrikant I. Schutte, Aletta Elisabeth Wentzel Viljoen, Edelweiss Avezum, Alvaro Altuntas, Yuksel Yusoff, Khalid Ismail, Noorhassim Peer, Nasheeta Chifamba, Jephat Diaz, Rafael Rahman, Omar Mohammadifard, Noushin Lanas, Fernando Zatonska, Katarzyna Wielgosz, Andreas Yusufali, Afzalhussein Iqbal, Romaina Khatib, Rasha Rosengren, Annika Kutty, V. Raman Li, Wei Liu, Jiankang Liu, Xiaoyun Yin, Lu Teo, Koon Anand, Sonia S. Yusuf, Salim The Prospective Urban Rural Epidemiology (PURE) study investigators |
| author_facet |
Lopez-Jaramillo, Patricio Miller, Victoria Mente, Andrew Dehghan, Mahshid Rangarajan, Sumathy Zhang, Xiaohe Swaminathan, Sumathi Dagenais, Gilles Gupta, Rajeev Mohan, Viswanathan Lear, Scott A. Bangdiwala, Shrikant I. Schutte, Aletta Elisabeth Wentzel Viljoen, Edelweiss Avezum, Alvaro Altuntas, Yuksel Yusoff, Khalid Ismail, Noorhassim Peer, Nasheeta Chifamba, Jephat Diaz, Rafael Rahman, Omar Mohammadifard, Noushin Lanas, Fernando Zatonska, Katarzyna Wielgosz, Andreas Yusufali, Afzalhussein Iqbal, Romaina Khatib, Rasha Rosengren, Annika Kutty, V. Raman Li, Wei Liu, Jiankang Liu, Xiaoyun Yin, Lu Teo, Koon Anand, Sonia S. Yusuf, Salim The Prospective Urban Rural Epidemiology (PURE) study investigators Lopez-Jaramillo, Patricio Miller, Victoria Mente, Andrew Dehghan, Mahshid Rangarajan, Sumathy Zhang, Xiaohe Swaminathan, Sumathi Dagenais, Gilles Gupta, Rajeev Mohan, Viswanathan Lear, Scott A. Bangdiwala, Shrikant I. Schutte, Aletta Elisabeth Wentzel Viljoen, Edelweiss Avezum, Alvaro Altuntas, Yuksel Yusoff, Khalid Ismail, Noorhassim Peer, Nasheeta Chifamba, Jephat Diaz, Rafael Rahman, Omar Mohammadifard, Noushin Lanas, Fernando Zatonska, Katarzyna Wielgosz, Andreas Yusufali, Afzalhussein Iqbal, Romaina Khatib, Rasha Rosengren, Annika Kutty, V. Raman Li, Wei Liu, Jiankang Liu, Xiaoyun Yin, Lu Teo, Koon Anand, Sonia S. Yusuf, Salim The Prospective Urban Rural Epidemiology (PURE) study investigators |
| building |
Repositorio digital |
| topic |
Fruit Vegetable Legume Cardiovascular disease |
| topic_facet |
Fruit Vegetable Legume Cardiovascular disease |
| publishDate |
2017-11-04 |
| language |
English |
| format |
Artículo de revista |
| description |
Background The association between intake of fruits, vegetables, and legumes with cardiovascular disease and deaths has been investigated extensively in Europe, the USA, Japan, and China, but little or no data are available from the Middle East, South America, Africa, or south Asia.
Methods We did a prospective cohort study (Prospective Urban Rural Epidemiology [PURE] in 135335 individuals aged 35 to 70 years without cardiovascular disease from 613 communities in 18 low-income, middle-income, and highincome countries in seven geographical regions: North America and Europe, South America, the Middle East, south Asia, China, southeast Asia, and Africa. We documented their diet using country-specific food frequency questionnaires at baseline. Standardised questionnaires were used to collect information about demographic factors, socioeconomic status (education, income, and employment), lifestyle (smoking, physical activity, and alcohol intake), health history and medication use, and family history of cardiovascular disease. The follow-up period varied based on the date when
recruitment began at each site or country. The main clinical outcomes were major cardiovascular disease (defined as death from cardiovascular causes and non-fatal myocardial infarction, stroke, and heart failure), fatal and non-fatal myocardial infarction, fatal and non-fatal strokes, cardiovascular mortality, non-cardiovascular mortality, and total mortality. Cox frailty models with random effects were used to assess associations between fruit, vegetable, and legume consumption with risk of cardiovascular disease events and mortality.
Findings Participants were enrolled into the study between Jan 1, 2003, and March 31, 2013. For the current analysis, we included all unrefuted outcome events in the PURE study database through March 31, 2017. Overall, combined mean fruit, vegetable and legume intake was 3·91 (SD 2·77) servings per day. During a median 7·4 years (5·5–9·3) of followup, 4784 major cardiovascular disease events, 1649 cardiovascular deaths, and 5796 total deaths were documented.
Higher total fruit, vegetable, and legume intake was inversely associated with major cardiovascular disease, myocardial infarction, cardiovascular mortality, non-cardiovascular mortality, and total mortality in the models adjusted for age, sex, and centre (random effect). The estimates were substantially attenuated in the multivariable adjusted models for major cardiovascular disease (hazard ratio [HR] 0·90, 95% CI 0·74–1·10, ptrend=0·1301), myocardial infarction (0·99, 0·74–1·31; ptrend=0·2033), stroke (0·92, 0·67–1·25; ptrend=0·7092), cardiovascular mortality (0·73, 0·53–1·02; ptrend=0·0568), non-cardiovascular mortality (0·84, 0·68–1·04; ptrend =0·0038), and total mortality (0·81, 0·68–0·96; ptrend<0·0001). The
HR for total mortality was lowest for three to four servings per day (0·78, 95% CI 0·69–0·88) compared with the reference group, with no further apparent decrease in HR with higher consumption. When examined separately, fruit intake was associated with lower risk of cardiovascular, non-cardiovascular, and total mortality, while legume intake was inversely associated with non-cardiovascular death and total mortality (in fully adjusted models). For vegetables, raw vegetable intake was strongly associated with a lower risk of total mortality, whereas cooked vegetable intake showed a modest benefit against mortality.
Interpretation Higher fruit, vegetable, and legume consumption was associated with a lower risk of non-cardiovascular, and total mortality. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at three to four servings per day (equivalent to 375–500 g/day).
Funding Full funding sources listed at the end of the paper (see Acknowledgments).
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0140-6736 |
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https://repositorio.udes.edu.co/handle/001/3198 |
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https://repositorio.udes.edu.co/handle/001/3198 |
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1789502202937606144 |
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11.257267 |
