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Vitamins and plant ingredients

Consumption of healthy foods at different content of antioxidant vitamins and phytochemicals and metabolic risk factors for cardiovascular disease in men and women of the Moli–sani study



To categorize healthy food groups into categories of low-antioxidant (LAC) or high-antioxidant vitamins and phytochemicals content (HAC) and comparatively associate them with metabolic risk factors for cardiovascular disease (CVD).


A total of 6879 women (55±12 years) and 6892 men (56±12 years) were analyzed from the Moli–sani cohort, randomly recruited from the general population. The European Prospective Investigation into Cancer and Nutrition Food Frequency Questionnaire was used for dietary assessment. The antioxidant content of each food group was evaluated using Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione and United States Department of Agriculture (USDA) food composition tables. Healthy foods, according to a Mediterranean dietary pattern, were categorized into HAC or LAC; total food antioxidant content (FAC) score was constructed for a comparative evaluation of the consumption of these two groups.


In men, an increase in FAC score, which represents an increased consumption of HAC with respect to LAC foods, was associated with a decrease in systolic blood pressure, diastolic blood pressure and C-reactive protein (CRP) (β=−0.5, P=0.02, β=−0.3, P=0.02 and β=−0.03, P=0.03, respectively). Logistic regression analyses showed that in men 15% (30 units) increase in FAC score was associated with 6% decrease in the likelihood of having hypertension (odds ratio (OR)=0.94, 95% confidence interval (CI) 0.91–0.98) and 3% decrease in the likelihood of having a high CRP risk level (OR=0.97, 95% CI 0.94–0.99). No significant associations were observed in women.


A possible greater protective role of healthy HAC as compared with healthy LAC foods on hypertension and inflammation was detected in men. These results stress the importance of studying healthy foods according to their content in antioxidant vitamins and phytochemicals, in primary prevention of CVD.

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  1. Di Giuseppe R, Arcari A, Serafini M, Di Castelnuovo A, Zito F, De Curtis A et al. Total dietary antioxidant capacity and lung function in an Italian population: a favorable role in premenopausal/never smoker women. Eur J Clin Nutr 2012; 66: 61–68.

    CAS  Article  Google Scholar 

  2. De Pablo P, Dietrich T, Karlson EW . Antioxidants and other novel cardiovascular risk factors in subjects with rheumatoid arthritis in a large population sample. Arthritis Rheum 2007; 57: 953–962.

    CAS  Article  Google Scholar 

  3. Ross R . Atherosclerosis: an inflammatory disease. N Engl J Med 1999; 340: 115–126.

    CAS  Article  Google Scholar 

  4. Hansson GK . Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005; 352: 1685–1695.

    CAS  Article  Google Scholar 

  5. Ridker PM, Hennekens CH, Buring JE, Rifai N . C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000; 342: 836–843.

    CAS  Article  Google Scholar 

  6. Kizhakekuttu TJ, Widlansky ME . Natural antioxidants and hypertension: promise and challenges. Cardiovasc Ther 2010; 28: 20–32.

    Article  Google Scholar 

  7. Dauchet L, Amouyel P, Hercberg S, Dallongeville J . Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr 2006; 136: 2588–2593.

    CAS  Article  Google Scholar 

  8. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997; 336: 1117–1124.

    CAS  Article  Google Scholar 

  9. Rimm EB, Stampfer MJ, Ascherio A, Giovannucci E, Colditz GA, Willett WC . Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med 1993; 328: 1450–1456.

    CAS  Article  Google Scholar 

  10. Stanner SA, Hughes J, Kelly CNM, Buttriss J . A review of the epidemiological evidence for the ‘antioxidant hypothesis’. Public Health Nutr 2004; 7: 407–422.

    CAS  Article  Google Scholar 

  11. Verlangieri AJ, Kapeghian JC, El-Dean S, Bush M . Fruit and vegetable consumption and cardiovascular mortality. Med Hypotheses 1985; 16: 7–15.

    CAS  Article  Google Scholar 

  12. Galland L . Diet and inflammation. Nutr Clin Pract 2010; 25: 634–640.

    Article  Google Scholar 

  13. Chun OK, Chung SJ, Claycombe KJ, Song WO . Serum C-reactive protein concentrations are inversely associated with dietary flavonoid intake in U.S. adults. J Nutr 2008; 138: 753–760.

    CAS  Article  Google Scholar 

  14. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D . Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 2003; 348: 2599–2608.

    Article  Google Scholar 

  15. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A . Adherence to Mediterranean diet and health status: meta-analysis. BMJ 2008; 337: 1344.

    Article  Google Scholar 

  16. Iacoviello L, Bonanni A, Costanzo S, De Curtis A, Di Castelnuovo A, Olivieri M et al. The Moli-Sani Project, a randomized, prospective cohort study in the Molise region in Italy, design, rationale and objectives. Ital J Public Health 2007; 4: 110–118.

    Google Scholar 

  17. Centritto F, Iacoviello L, di Giuseppe R, De Curtis A, Costanzo S, Zito F et al. Dietary patterns, cardiovascular risk factors and C-reactive protein in a healthy Italian population. Nutr Metab Cardiovasc Dis 2009; 19: 697–706.

    CAS  Article  Google Scholar 

  18. Nuorti JP, Butler JC, Farley MM, Harrison LH, McGeer A, Kolczak MS et al. Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team. N Engl J Med 2000; 342: 681–689.

    CAS  Article  Google Scholar 

  19. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 2000; 32 (Suppl), 498–504.

    Article  Google Scholar 

  20. Pisani P, Faggiano F, Krogh V, Palli D, Vineis P, Berrino F . Relative validity and reproducibility of a food frequency dietary questionnaire for use in the Italian EPIC centers. Int J Epidemiol 1997; 26: 152–160.

    Article  Google Scholar 

  21. Pala V, Sieri S, Palli D, Salvini S, Berrino F, Bellegotti M et al. Diet in the Italian EPIC cohorts: presentation of data and methodological issues. Tumori 2003; 89: 594–607.

    Article  Google Scholar 

  22. Italian food composition tables. Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione. Accessed 20 December 2011.

  23. USDA National Nutrient Database for Standard Reference, Release 24. US Department of Agriculture, Agricultural Research Service. Accessed 20 December 2011.

  24. USDA Database for the Flavonoid Content of Selected Foods Release 3. U.S. Department of Agriculture Agricultural Research Service. Accessed 20 December 2011.

  25. Di Giuseppe R, Di Castelnuovo A, Centritto F, Zito F, De Curtis A, Costanzo S et al. Regular consumption of dark chocolate is associated with low serum concentrations of C-reactive protein in a healthy Italian population. J Nutr 2008; 138: 1939–1945.

    CAS  Article  Google Scholar 

  26. Di Castelnuovo A, Costanzo S, Donati MB, Iacoviello L, de Gaetano G . Prevention of cardiovascular risk by moderate alcohol consumption: epidemiologic evidence and plausible mechanisms. Intern Emerg Med 2010; 5: 291–297.

    Article  Google Scholar 

  27. Wu JN, Ho SC, Zhou C, Ling WH, Chen WQ, Wang CL et al. Coffee consumption and risk of coronary heart diseases: a meta-analysis of 21 prospective cohort studies. Int J Cardiol 2009; 137: 216–225.

    Article  Google Scholar 

  28. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO, Criqui M et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107: 499–511.

    Article  Google Scholar 

  29. Parslow RA, Sachdev P, Salonikas C, Lux O, Jorm AF, Naidoo D . Associations between plasma antioxidants and hypertension in a community-based sample of 415 Australians aged 60-64. J Hum Hypertens 2005; 19: 219–226.

    CAS  Article  Google Scholar 

  30. Rouse IL, Beilin LJ, Armstrong BK, Vandongen R . Blood-pressure-lowering effect of a vegetarian diet: controlled trial in normotensive subjects. Lancet 1983; 1: 5–10.

    CAS  Article  Google Scholar 

  31. Margetts BM, Beilin LJ, Vandongen R, Armstrong BK . Vegetarian diet in mild hypertension: a randomised controlled trial. BMJ 1986; 293: 1468–1471.

    CAS  Article  Google Scholar 

  32. Harrison DG, Gongora MC . Oxidative stress and hypertension. Med Clin North Am 2009; 93: 621–635.

    CAS  Article  Google Scholar 

  33. Miyagawa K, Ohashi M, Yamashita S, Kojima M, Sato K, Ueda R et al. Increased oxidative stress impairs endothelial modulation of contractions in arteries from spontaneously hypertensive rats. J Hypertens 2007; 25: 415–421.

    CAS  Article  Google Scholar 

  34. Nakazono K, Watanabe N, Matsuno K, Sasaki J, Sato T, Inoue M . Does superoxide underlie the pathogenesis of hypertension? Proc Natl Acad Sci 1991; 88: 10045–10048.

    CAS  Article  Google Scholar 

  35. Laursen JB, Rajagopalan S, Galis Z, Tarpey M, Freemam BA, Harrison DG . Role of superoxide in angiotensin II-induced but not catecholamine-induced hypertension. Circulation 1997; 95: 588–593.

    CAS  Article  Google Scholar 

  36. Schnackenberg CG, Welch WJ, Wilcox CS . Normalization of blood pressure and renal vascular resistance in SHR with a membrane-permeable superoxide dismutase mimetic: role of nitric oxide. Hypertension 1998; 32: 59–64.

    CAS  Article  Google Scholar 

  37. Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC . Fruit and vegetable intakes, C-reactive protein, and the metabolic syndrome. Am J Clin Nutr 2006; 84: 1489–1497.

    CAS  Article  Google Scholar 

  38. Ide T, Tsutsui H, Ohashi N, Hayashidani S, Suematsu N, Tsuchihashi M et al. Greater oxidative stress in healthy young men compared with premenopausal women. Arterioscler Thromb Vasc Biol 2002; 22: 438–442.

    CAS  Article  Google Scholar 

  39. Meijer GA, Westerterp KR, Saris WH, ten Hoor F . Sleeping metabolic rate in relation to body composition and the menstrual cycle. Am J Clin Nutr 1992; 55: 637–640.

    CAS  Article  Google Scholar 

  40. Kris-Etherton PM, Lichtenstein AH, Howard BV, Steinberg D, Witztum JL . Antioxidant vitamin supplements and cardiovascular disease. Circulation 2004; 110: 637–641.

    CAS  Article  Google Scholar 

  41. Pounis G, Makri S, Gougias L, Makris H, Papakonstantinou M, Panagiotakos D et al. Consumer perception and use of iron fortified foods is associated with their knowledge and understanding of nutritional issues. Food Qual Pref 2011; 22: 683–688.

    Article  Google Scholar 

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We thank Associazione Cuore-Sano (Campobasso, Italy), IL Instrumentation-Laboratory (Milano, Italy), Derby-Blue (San Lazzaro di Savena, Bologna, Italy), Caffè Monforte (Campobasso, Italy) and Sepinia SpaA (Sepino, Italy) for their support to the MOLI-SANI project. The Moli-sani cohort recruitment was supported by an unrestricted grant from Pfizer Foundation (Rome, Italy) and the Italian Ministry of University and Research (MIUR, Rome, Italy), Programma Triennale di Ricerca, Decreto no.1588.

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Correspondence to L Iacoviello.

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Pounis, G., Costanzo, S., di Giuseppe, R. et al. Consumption of healthy foods at different content of antioxidant vitamins and phytochemicals and metabolic risk factors for cardiovascular disease in men and women of the Moli–sani study. Eur J Clin Nutr 67, 207–213 (2013).

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  • antioxidants
  • vitamins
  • phytochemicals
  • cardiovascular disease
  • inflammation

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