Stroke: eating more fruit and vegetables reduced the risk

Clinical bottom line (level 1b)

  1. People who ate large amounts of fruit and vegetables were at lower risk of stroke.
Joshipura et al: JAMA 1999; 282 : 1233-1239
Expires December 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, validated in an independent set of patients.

Setting: community, USA

114279 patients healthy individuals from Nurses' Health Study (100% women, aged 30 to 55 in 1976) and the Health Professionals' Follow-up Study (100% men, aged 40 to 75 in 1986)

Excluded if
  • previously diagnosed with cancer, diabetes, or cardiovascular diseases
  • implausible amounts of food intake reported
  • left signficant portions of questionnaire blank


Factors studied:
  • smoking, alcohol consumption, family history of myocardial infarction, body mass index, multivitamin supplement use, vitamin E use, aspirin use, physical activity, hypertension, hypercholesterolaemia, post-menopausal hormone use in women



    Pooled logisitic regression analysis was used to adjust for confounding factors.

    ?100% followed for 10 to 15 years (to 1990)
    Outcomes studied:

    The evidence


    • Median intake of fruit and vegetables for women: 5.8 servings per day (quintile 1: 2.9; quintile 5: 10.2). Median intake for men: 5.1 servings per day (quintile 1: 2.6; quintile 5: 9.2)
    • Risk of stroke: quintile 5 v. quintile 1: RR 0.69 (95% CI: 0.52 to 0.92)
    • There was no apparent reduction in risk beyond 6 servings a day.
    • RIsks were lowest with high consumption of cruciferous vegetables (broccoli, cabbage, cauliflower, brussel sprouts), green leafy vegetables, citrus fruits and vitamin C-rich fruit and vegetables.

    Citation

    1. Joshipura KJ, Ascherio A, Manson JE, et al: fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 1999; 282 : 1233-1239
    Search Terms: from ACP Journal Club other articles noted
    Contributor: Chris Ball, December 2001
    Reviewer:

    Clinical Question.
    Patient healthy
    Intervention or Exposure fruit and vegetable intake
    Outcome stroke
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