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

Abstract

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.

Sponsorship: Partially funded by the National Department of Health (FIS 01/0619) and Navarre Regional Government (Project 24/99) and by another grant from Banco Santander-Central-Hispano.

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References

  • Ainsworth BE, Haskell WL, Leon AS et al. 1993 Compendium of physical activities: classification of energy costs of human physical activities Med. Sci. Sports. Exerc. 25: 71–80

    Article  CAS  Google Scholar 

  • Beer-Borst S, Hercberg S, Morabia A et al. 2000 Dietary patterns in six European populations: results from EURALIM, a collaborative European data harmonization and information campaign Eur. J. Clin. Nutr. 54: 253–262

    Article  CAS  Google Scholar 

  • De Irala-Estévez J, Groth M, Johansson L, Oltersdorf U, Prättälä R, Martinez-González MA . 2000 A systematic review of socio-economic differences in food habits in Europe: consumption of fruits and vegetables Eur. J. Clin. Nutr. 54: 706–714

    Article  Google Scholar 

  • De Lorgeril M, Salen P, Martin JL et al. 1999 Mediterranean diet, traditional risk factors and the rate of cardiovascular complications after myocardial infarction; final report of the Lyon Diet Heart Study Circulation 99: 779–785

    Article  CAS  Google Scholar 

  • Fortes C, Forastiere F, Farchi S, Rapiti E, Pastori G, Perucci CA . 2000 Diet and overall survival in a cohort of very elderly people Epidemiology 11: 440–445

    Article  CAS  Google Scholar 

  • Fraser GE . 1994 Diet and coronary heart disease: beyond dietary fats and low-density-lipoprotein cholesterol Am. J. Clin. Nutr. 59: (5 Suppl): 1117S–1123S

    Article  CAS  Google Scholar 

  • Fraser GE, Sabaté J, Beeson WL, Strahan TM . 1992 A possible protective role of nut consumption on risk of coronary heart disease. The Adventist Health Study Arch. Intern. Med. 152: 1416–1424

    Article  CAS  Google Scholar 

  • Jacobs DR, Meyer KA, Kushi LH, Folsom AR . 1998 Whole-grain intake may reduce the risk of ischemic heart disease death in postmenopausal women: the lowa Women's Health Study Am. J. Clin. Nutr. 68: 248–257

    Article  CAS  Google Scholar 

  • Kouris-Blazos A, Gnardellis C, Wahlqvist ML et al. 1999 Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia Br. J. Nutr. 82: 57–61

    Article  CAS  Google Scholar 

  • Kris-Etherton P, Eckel RH, Howard BV, St Jeor S, Bazzarre TL . 2001 Lyon diet heart study: benefits of a Mediterranean-style, National Cholesterol Education Program/American Heart Association Step I dietary pattern on cardiovascular disease Circulation 103: 1823–1825

    Article  CAS  Google Scholar 

  • Kushi LH, Lenart EB, Willett WC . 1995 Health implications of Mediterranean diets in light of contemporary knowledge. 1. Plant foods and dairy products Am. J. Clin. Nutr. 61: (6 Suppl): 1407S–1415S

    Article  CAS  Google Scholar 

  • Kushi LH, Meyer KA, Jacobs DR . 1999 Cereals, legumes, and chronic disease risk reduction: evidence from epidemiologic studies Am. J. Clin. Nutr. 70: (3 Suppl): 451S–458S

    Article  CAS  Google Scholar 

  • Law MR, Morris JK . 1998 By how much does fruit and vegetable consumption reduce the risk of ischaemic heart disease? Eur. J. Clin. Nutr. 52: 549–556

    Article  CAS  Google Scholar 

  • Liu S, Stampfer MJ, Hu FB, Giovannucci E, Rimm E, Manson JE, Hennekens CH, Willett WC . 1999 Whole-grain consumption and risk of coronary heart disease: results from the Nurses' Health Study Am. J. Clin. Nutr. 70: 412–419

    Article  CAS  Google Scholar 

  • Liu S, Willett WC, Stampfer MJ, Hu FB, Franz M, Sampson L, Hennekens CH, Manson JE . 2000a A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women Am. J. Clin. Nutr. 71: 1455–1461

    Article  CAS  Google Scholar 

  • Liu S, Manson JE, Lee IM, Cole SR, Hennekens CH, Willett WC, Buring JE . 2000b Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study Am. J. Clin. Nutr. 72: 922–928

    Article  CAS  Google Scholar 

  • Lopes C, Von Hafe P, Ramos E, Fernando PB, Maciel MJ, Barros H . 1998 Diet and risk of myocardial infarction. A case–control community-based study. [Article in Portuguese] Acta Med. Port. 11: 311–317

    CAS  PubMed  Google Scholar 

  • Martin-Moreno JM, Boyle P, Gorgojo L, Maisonneuve P, Fernandez-Rodriguez JC, Salvini S, Willett WC . 1993 Development and validation of a food frequency questionnaire in Spain Int. J. Epidemiol. 22: 512–519

    Article  CAS  Google Scholar 

  • Naska A, Vasdekis VG, Trichopoulou A et al. 2000 Fruit and vegetable availability among ten European countries: how does it compare with the ‘five-a-day’ recommendation? DAFNE I and II projects of the European Commission Br. J. Nutr. 84: 549–556

    CAS  PubMed  Google Scholar 

  • Pietinen P, Rimm EB, Korhonen P, Hartman AM, Willet WC, Albanes D, Virtamo J . 1996 Intake of dietary fiber and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study Circulation 94: 2720–2727

    Article  CAS  Google Scholar 

  • Rijnkels JM, Hollanders VM, Woutersen RA, Koeman JH, Alink GM . 1997 Interaction of dietary fat with a vegetables-fruit mixture on 1,2-dimethylhydrazine-induced colorectal cancer in rats Nutr. Cancer. 27: 261–266

    Article  CAS  Google Scholar 

  • Rimm EB, Ascherio A, Giovannucci E, Spiegelman D, Stampfer MJ, Willett WC . 1996 Vegetable, fruit, and cereal fiber intake and risk of coronary heart disease among men JAMA 275: 447–451

    Article  CAS  Google Scholar 

  • Rothman KJ, Greenland S . 1998 Case–control studies In: ed. KJ Rothman and S Greenland Modern Epidemiology 2nd ed. Philadelphia: Lippincott-Raven 93–114

    Google Scholar 

  • Serra-Majem L, Ribas L, Tresserras R, Ngo J, Salleras LI . 1995 How could changes in diet explain changes in coronary heart disease mortality in Spain? The Spanish paradox Am. J. Clin. Nutr. 61: 1351–1357

    Article  Google Scholar 

  • Singh RB, Niaz AM, Ghosh S, Agarwal P, Ahmad S, Begum R, Onouchi Z, Kummerow FA . 1995 Randomized, controlled trial of antioxidant vitamins and cardioprotective diet on hyperlipidemia, oxidative stress, and development of experimental atherosclerosis: the diet and antioxidant trial on atherosclerosis (DATA) Cardiovasc. Drugs. Ther. 9: 763–771

    Article  CAS  Google Scholar 

  • Todd S, Woodward M, Tunstall-Pedoe H, Bolton-Smith C . 1999 Dietary antioxidant vitamins and fiber in the etiology of cardiovascular disease and all-causes mortality: results from the Scottish Heart Health Study Am. J. Epidemiol. 150: 1073–1080

    Article  CAS  Google Scholar 

  • Trichopoulou A, Breslin L . 1998 Network for the Pan-European Food Data Bank based on Household Budget Surveys (DAFNE-II) Brussels: DG XII, European Commission

    Google Scholar 

  • Trichopoulou A, Kouris-Blazos A, Wahlqvist ML et al. 1995 Diet and overall survival in elderly people Br. Med. J. 311: 1457–1460

    Article  CAS  Google Scholar 

  • Tzonou A, Kalandidi A, Trichopoulou A et al. 1993 Diet and coronary heart disease: a case–control study in Athens, Greece Epidemiology 4: 511–516

    Article  CAS  Google Scholar 

  • WHO MONICA Project. 1990 MONICA manual part IV(a) Geneva: WHO pp 11–32

  • Willett W, Stampfer MJ . 1998 Implications of total energy intake for epidemiologic analysis In: Nutritional Epidemiology 2nd edn, ed. W Willett, pp 273–301 New York: Oxford University Press

    Chapter  Google Scholar 

  • Willett WC, Sacks F, Trichopoulou A et al. 1995 Mediterranean diet pyramid: a cultural model for healthy eating Am. J. Clin. Nutr. 61: (6 Suppl): 1402S–1406S

    Article  CAS  Google Scholar 

  • Wolk A, Manson JE, Stampfer MJ, Colditz GA, Hu FB, Speizer FE, Hennekens CH, Willett WC . 1999 Long-term intake of dietary fiber and decreased risk of coronary heart disease among women JAMA 281: 1998–2004

    Article  CAS  Google Scholar 

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Acknowledgements

We are specially indebted to Ms Carmen de la Fuente, our dietitian, who updated the food composition databank according to current Spanish food composition tables and worked in the calculation of nutrients taken into account as potential confounders in our analyses. We thank the following persons for technical assistance and support: Professor Jokin De Irala-Estévez, Professor J Alfredo Martínez, Dr Isabel Coma MD, Dr Almudena Sánchez-Villegas, Ms Jane Hoashi and Ms Estefanía Ruiz-Gaona. We thank the Cardiology Chairmen of the three hospitals that participated in this study: Hospital de Navarra (Dr Enrique de los Arcos, MD), Hospital Virgen del Camino (Dr Eugenio Torrano, MD), and University Clinic of Navarre (Dr Joaquin Barba, MD).

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Correspondence to MA Martínez-González.

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Martínez-González, M., Fernández-Jarne, E., Martínez-Losa, E. et al. Role of fibre and fruit in the Mediterranean diet to protect against myocardial infarction: a case–control study in Spain. Eur J Clin Nutr 56, 715–722 (2002). https://doi.org/10.1038/sj.ejcn.1601382

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  • DOI: https://doi.org/10.1038/sj.ejcn.1601382

Keywords

  • coronary heart disease
  • case–control studies
  • nutritional epidemiology
  • conditional logistic regression
  • plant foods

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