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


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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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).

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

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