a1 Center for Clinical Research and Health Promotion, University of Puerto Rico, Medical Sciences Campus, School of Dentistry Office A-107, PO Box 365067, San Juan, Puerto Rico PR00936
a2 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
a3 Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
a4 Graduate Institute of Health Care, Meiho Institute of Technology, PingTong, Taiwan
a5 Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
a6 Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
a7 Washington University School of Medicine, St. Louis, MO, USA
a8 Alvin J Siteman Cancer Center, St Louis, MO, USA
Background Low-carbohydrate diets could lead to reduced fruit and vegetable intake, which may be protective against CVD. The role of carbohydrate intake in modifying the association between fruits and vegetables and CVD has not been evaluated.
Objective To evaluate whether carbohydrate intake affects the association between fruits and vegetables and CVD.
Design We included participants from two large prospective studies, the Nurses’ Health Study (NHS) and the Health Professionals’ Follow-Up Study (HPFS). We followed 70 870 eligible NHS females for 16 years and 38 918 eligible HPFS males for 14 years. Diet was assessed from an FFQ updated every 4 years. Our primary outcome was ischaemic CVD (fatal and non-fatal myocardial infarction and ischaemic stroke). We used Cox proportional hazards models to evaluate the relationship between fruits and vegetables and ischaemic CVD within groups with low, moderate or high carbohydrate intake.
Results Fruit intake was strongly related with carbohydrate intake, but vegetables showed a very small correlation. Vegetable intake showed stronger associations with ischaemic CVD among the low carbohydrate group (multivariate risk ratio (RR) = 0·82 for an increment of 3 servings/d; 95 % CI 0·68, 0·99); green leafy vegetables and carotene-rich fruits and vegetables followed a similar pattern. Total fruit intake was associated with a lower risk of ischaemic CVD only among participants with moderate carbohydrate intake (RR = 0·81 comparing extreme quintiles; 95 % CI 0·70, 0·94).
Conclusions Total vegetables, green leafy vegetables and carotene-rich fruits and vegetables showed stronger associations with ischaemic CVD among the low carbohydrate group. No consistent trends were observed for fruit intake.
(Received April 03 2007)
(Accepted February 02 2008)