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  1. Your mom didn't know how right she was when she told you to eat your fruits & vegetables (F/V), at least if you are a girl... This new study [1] in the journal Circulation assessed the diets of 2500 young black and white men and women (~25 years of age, 62% female) and then measured their level of artery calcification 20 years later using computed tomography - arguably the 'gold standard' for assessing artery health. It found that people eating the most F/V (highest tertile - 7-9 servings / day) were 25% less likely 20 years later to have developed calcified arteries relative to the lowest F/V eaters (2-4 servings / day). From the full text, here are a few of the highlights, including one kicker: Fruits and vegetables were about equally protective Including legumes in with the vegetable category kept the association about the same - i.e. legumes were about as good for arteries as fruits & veggies. Of course people eating lots of F/V had healthier diets in other ways as well, but the inverse association between F/V and artery calcification was still significant even after controlling for these other dietary factors. Shockingly left out of the abstract was the fact that the inverse relationship between F/V intake and artery calcification (CAC) was only observed in women! To quote the full text: [R]eported intake of F/V did not appear to be associated with prevalent CAC among men: OR (95% CI) 1.0 (ref), 0.77 (0.52-1.12), 0.89 (0.60-1.31), p-value for trend 0.67 Here was their explanation for this surprising results: The lack of association between F/V intake and CAC in men in our study may be due to a lack of power, as our study included only 935 male participants. However, a less significant association between CVD and F/V intake in men has been seen in other studies. Data from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart study demonstrated a 15% (95% CI: 6% to 23%) lower risk for CHD mortality per 80gram/day increase in fruit and vegetable intake in women, but a non-significant 2% (95% CI: -2% to +2%) CHD mortality reduction in men (p-value for heterogeneity 0.007) [2] Similar findings were reported in a cohort of Japanese women and men.3 In the CHD risk factor study INTERHEART, the 3 lifestyle behaviors associated with a lower risk of CHD were F/V intake, exercise, and moderate alcohol consumption, and the protective effects of exercise and moderate alcohol consumption were larger in women compared to men with a trend towards F/V intake being more protective in women as well.[3] So why did the researchers leave out this surprising lack of inverse relationship between F/V intake and later artery calcification in men from both the abstract and from the popular press coverage of this study? Perhaps so as to avoid undermining the credibility of their (laudable) public health message, as summarized in the concluding sentence of the abstract: Our results reinforce the importance of establishing a high intake of F/V as part of a healthy dietary pattern early in life. Somehow I was unaware of the attenuated CVD benefits men seem to get from eating lots fruits and vegetables. --Dean ---------- [1] Circulation. 2015 Oct 26. pii: CIRCULATIONAHA.114.012562. [Epub ahead of print] The Association of Fruit and Vegetable Consumption During Early Adulthood With the Prevalence of Coronary Artery Calcium After 20 Years of Follow-Up: The CARDIA Study. Miedema MD(1), Petrone A(2), Shikany JM(3), Greenland P(4), Lewis CE(3), Pletcher MJ(5), Gaziano JM(2), Djousse L(2). Free full text: http://circ.ahajournals.org/content/early/2015/10/14/CIRCULATIONAHA.114.012562.long BACKGROUND: -The relationship between intake of fruits and vegetables (F/V) during young adulthood and coronary atherosclerosis later in life is unclear. METHODS AND RESULTS: -We studied participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a cohort of young, healthy black and white individuals at baseline (1985-1986). Intake of F/V at baseline was assessed using a semi-quantitative interview administered diet history and CAC was measured at year 20 (2005-2006) using computed tomography. We used logistic regression to adjust for relevant variables and estimate the adjusted odds ratios (OR) and 95% confidence intervals (CI) across energy-adjusted, sex-specific tertiles of total servings of F/V per day. Among our sample (n=2,506), the mean (SD) age at baseline was 25.3 (3.5) years and 62.7% were female. After adjustment for demographics and lifestyle variables, higher intake of F/V was associated with a lower prevalence of CAC: OR (95% CI) =1.00 (reference), 0.78 (0.59-1.02), and 0.74 (0.56-0.99), from the lowest to the highest tertile of F/V, p-value for trend <0.001. There was attenuation of the association between F/V and CAC after adjustment for other dietary variables but the trend remained significant: OR (95% CI): 1.00 (reference), 0.84 (0.63-1.11), and 0.92 (0.67-1.26), p-value for trend <0.002]. CONCLUSIONS: -In this longitudinal cohort study, higher intake of F/V during young adulthood was associated with lower odds of prevalent CAC after 20 years of follow-up. Our results reinforce the importance of establishing a high intake of F/V as part of a healthy dietary pattern early in life. PMID: 26503880 ------------ [2] Eur Heart J. 2011;32:1235–1243. Fruit and vegetable intake and mortality from ischaemic heart disease: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart study. Crowe FL, Roddam AW, Key TJ, Appleby PN, Overvad K, Jakobsen MU, Tjønneland A, Hansen L, Boeing H, Weikert C, Linseisen J, Kaaks R, Trichopoulou A, Misirli G, Lagiou P, Sacerdote C, Pala V, Palli D, Tumino R, Panico S, Bueno-de-Mesquita HB, Boer J, van Gils CH, Beulens JW, Barricarte A, Rodríguez L, Larrañaga N, Sánchez MJ, Tormo MJ, Buckland G, Lund E, Hedblad B, Melander O, Jansson JH, Wennberg P, Wareham NJ, Slimani N, Romieu I, Jenab M, Danesh J, Gallo V, Norat T, Riboli E; ------------ [3] Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): casecontrol study. Lancet. 2004;364:937–952.
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