Abstract
Background/Objectives:
In cohort studies, fruit and vegetable (F&V) intake is associated with lower cardiovascular diseases (CVDs). Former smokers often have a higher F&V intake than current smokers. If a high intake of F&V precedes smoking cessation, the latter may explain the favorable association between F&V intake and CVD among smokers. The objective was to assess whether higher F&V intake precedes smoking cessation.
Subjects/Methods:
The study population comprised 1056 male smokers from Lille (France) and Belfast (Northern Ireland) aged 50–59 years on inclusion in 1991. At baseline, participants completed self-administered questionnaires related to smoking habits, demographic, socioeconomic factors and diet. At the 10-year follow-up, smoking habits were assessed by mailed questionnaire.
Results:
After 10 years, 590 out of 1056 smokers had quit smoking (70.7% of smoker in Lille and 37.8% in Belfast). After adjusting for center, consumption of F&V was associated with quitting (odds ratio (OR) for high versus low F&V intake: 1.73; 95% confidence interval (CI): (1.22–2.45); P-trend=0.002). After further adjustment for sociodemographic factors, body mass index and medical diet, the association was still statistically significant (OR: 1.59; 95% CI (1.12–2.27); P-trend=0.01). In a model fully adjusted for age, smoking intensity, alcohol consumption and physical activity, the association was no longer significant (P=0.14).
Conclusions:
Higher F&V intake precedes smoking cessation. Hence, smoking cessation could affect the causal interpretation of the association between F&V and CVD in smokers.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
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.
He FJ, Nowson CA, Lucas M, MacGregor GA . Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies. J Hum Hypertens 2007; 21: 717–728.
Dauchet L, Amouyel P, Dallongeville J . Fruit and vegetable consumption and risk of stroke: a meta-analysis of cohort studies. Neurology 2005; 65: 1193–1197.
He FJ, Nowson CA, MacGregor GA . Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet 2006; 367: 320–326.
Joshipura KJ, Ascherio A, Manson JE, Stampfer MJ, Rimm EB, Speizer FE et al. Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 1999; 282: 1233–1239.
Dauchet L, Amouyel P, Dallongeville J . Fruits, vegetables and coronary heart disease. Nat Rev Cardiol 2009; 6: 599–608.
Potischman N, Weed DL . Causal criteria in nutritional epidemiology. Am J Clin Nutr 1999; 69: 1309S–1314S.
Skuladottir H, Tjoenneland A, Overvad K, Stripp C, Christensen J, Raaschou Nielsen O et al. Does insufficient adjustment for smoking explain the preventive effects of fruit and vegetables on lung cancer? Lung Cancer 2004; 45: 1–10.
Wyndels K, Dallongeville J, Simon C, Bongard V, Wagner A, Ruidavets JB et al. Regional factors interact with educational and income tax levels to influence food intake in France. Eur J Clin Nutr 2011; 65: 1067–1075.
Karnath B . Smoking cessation. Am J Med 2002; 112: 399–405.
Song YM, Cho HJ . Risk of stroke and myocardial infarction after reduction or cessation of cigarette smoking: a cohort study in korean men. Stroke 2008; 39: 2432–2438.
Kawachi I, Colditz GA, Stampfer MJ, Willett WC, Manson JE, Rosner B et al. Smoking cessation in relation to total mortality rates in women. A prospective cohort study. Ann Intern Med 1993; 119: 992–1000.
Rosenberg L, Kaufman DW, Helmrich SP, Shapiro S . The risk of myocardial infarction after quitting smoking in men under 55 years of age. N Engl J Med 1985; 313: 1511–1514.
Liu S, Lee IM, Ajani U, Cole SR, Buring JE, Manson JE . Intake of vegetables rich in carotenoids and risk of coronary heart disease in men: The Physicians’ Health Study. Int J Epidemiol 2001; 30: 130–135.
Hung HC, Joshipura KJ, Jiang R, Hu FB, Hunter D, Smith-Warner SA et al. Fruit and vegetable intake and risk of major chronic disease. J Natl Cancer Inst 2004; 96: 1577–1584.
Dauchet L, Montaye M, Ruidavets JB, Arveiler D, Kee F, Bingham A et al. Association between the frequency of fruit and vegetable consumption and cardiovascular disease in male smokers and non-smokers. Eur J Clin Nutr 2010; 64: 578–586.
Dallongeville J, Marecaux N, Fruchart JC, Amouyel P . Cigarette smoking is associated with unhealthy patterns of nutrient intake: a meta-analysis. J Nutr 1998; 128: 1450–1457.
Morabia A, Curtin F, Bernstein MS . Effects of smoking and smoking cessation on dietary habits of a Swiss urban population. Eur J Clin Nutr 1999; 53: 239–243.
Dyer AR, Elliott P, Stamler J, Chan Q, Ueshima H, Zhou BF . Dietary intake in male and female smokers, ex-smokers, and never smokers: the INTERMAP study. J Hum Hypertens 2003; 17: 641–654.
Morabia A, Wynder EL . Dietary habits of smokers, people who never smoked, and exsmokers. Am J Clin Nutr 1990; 52: 933–937.
Hebert JR, Kabat GC . Differences in dietary intake associated with smoking status. Eur J Clin Nutr 1990; 44: 185–193.
Yarnell JW . The PRIME study: classical risk factors do not explain the severalfold differences in risk of coronary heart disease between France and Northern Ireland. Prospective Epidemiological Study of Myocardial Infarction. QJM 1998; 91: 667–676.
Ducimetiere P, Ruidavets JB, Montaye M, Haas B, Yarnell J . Five-year incidence of angina pectoris and other forms of coronary heart disease in healthy men aged 50–59 in France and Northern Ireland: the Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study. Int J Epidemiol 2001; 30: 1057–1062.
Dauchet L, Ferrieres J, Arveiler D, Yarnell JW, Gey F, Ducimetiere P et al. Frequency of fruit and vegetable consumption and coronary heart disease in France and Northern Ireland: the PRIME study. Br J Nutr 2004; 92: 963–972.
Hymowitz N, Cummings KM, Hyland A, Lynn WR, Pechacek TF, Hartwell TD . Predictors of smoking cessation in a cohort of adult smokers followed for five years. Tob Control 1997; 6 (Suppl 2:S57-62), S57–S62.
Fraser GE, Sabate J, Beeson WL, Strahan TM . A possible protective effect of nut consumption on risk of coronary heart disease. The Adventist Health Study. Arch Intern Med 1992; 152: 1416–1424.
Knekt P, Reunanen A, Jarvinen R, Seppanen R, Heliovaara M, Aromaa A . Antioxidant vitamin intake and coronary mortality in a longitudinal population study. Am J Epidemiol 1994; 139: 1180–1189.
Gillman MW, Cupples LA, Gagnon D, Posner BM, Ellison RC, Castelli WP et al. Protective effect of fruits and vegetables on development of stroke in men. JAMA 1995; 273: 1113–1117.
Key TJ, Thorogood M, Appleby PN, Burr ML . Dietary habits and mortality in 11,000 vegetarians and health conscious people: results of a 17 year follow up. BMJ 1996; 313: 775–779.
Knekt P, Jarvinen R, Reunanen A, Maatela J . Flavonoid intake and coronary mortality in Finland: a cohort study. BMJ 1996; 312: 478–481.
Pietinen P, Rimm EB, Korhonen P, Hartman AM, Willett WC, Albanes D et al. 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 1996; 94: 2720–2727.
Sahyoun NR, Jacques PF, Russell RM . Carotenoids vitamins C and E, and mortality in an elderly population. Am J Epidemiol 1996; 144: 501–511.
Mann JI, Appleby PN, Key TJ, Thorogood M . Dietary determinants of ischaemic heart disease in health conscious individuals. Heart 1997; 78: 450–455.
Joshipura KJ, Ascherio A, Manson JE, Stampfer MJ, Rimm EB, Speizer FE et al. Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 1999; 282: 1233–1239.
Cox BD, Whichelow MJ, Prevost AT . Seasonal consumption of salad vegetables and fresh fruit in relation to the development of cardiovascular disease and cancer. Public Health Nutr 2000; 3: 19–29.
Hirvonen T, Pietinen P, Virtanen M, Ovaskainen ML, Hakkinen S, Albanes D et al. Intake of flavonols and flavones and risk of coronary heart disease in male smokers. Epidemiology 2001; 12: 62–67.
Liu S, Manson JE, Lee IM, Cole SR, Hennekens CH, Willett WC et al. Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study. Am J Clin Nutr 2000; 72: 922–928.
Strandhagen E, Hansson PO, Bosaeus I, Isaksson B, Eriksson H . High fruit intake may reduce mortality among middle-aged and elderly men. The Study of Men Born in 1913. Eur J Clin Nutr 2000; 54: 337–341.
Joshipura KJ, Hu FB, Manson JE, Stampfer MJ, Rimm EB, Speizer FE et al. The effect of fruit and vegetable intake on risk for coronary heart disease. Ann Intern Med 2001; 134: 1106–1114.
Appleby PN, Key TJ, Thorogood M, Burr ML, Mann J . Mortality in British vegetarians. Public Health Nutr 2002; 5: 29–36.
Bazzano LA, He J, Ogden LG, Loria CM, Vupputuri S, Myers L et al. Fruit and vegetable intake and risk of cardiovascular disease in US adults: the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Am J Clin Nutr 2002; 76: 93–99.
Johnsen SP, Overvad K, Stripp C, Tjonneland A, Husted SE, Sorensen HT . Intake of fruit and vegetables and the risk of ischemic stroke in a cohort of Danish men and women. Am J Clin Nutr 2003; 78: 57–64.
Rissanen TH, Voutilainen S, Virtanen JK, Venho B, Vanharanta M, Mursu J et al. Low intake of fruits, berries and vegetables is associated with excess mortality in men: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. J Nutr 2003; 133: 199–204.
Sauvaget C, Nagano J, Allen N, Kodama K . Vegetable and fruit intake and stroke mortality in the Hiroshima/Nagasaki Life Span Study. Stroke 2003; 34: 2355–2360.
Steffen LM, Jacobs DR, Stevens J, Shahar E, Carithers T, Folsom AR . Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 2003; 78: 383–390.
Genkinger JM, Platz EA, Hoffman SC, Comstock GW, Helzlsouer KJ . Fruit, vegetable, and antioxidant intake and all-cause, cancer, and cardiovascular disease mortality in a community-dwelling population in Washington County, Maryland. Am J Epidemiol 2004; 160: 1223–1233.
Ness AR, Maynard M, Frankel S, Smith GD, Frobisher C, Leary SD et al. Diet in childhood and adult cardiovascular and all cause mortality: the Boyd Orr cohort. Heart 2005; 91: 894–898.
Tucker KL, Hallfrisch J, Qiao N, Muller D, Andres R, Fleg JL . The combination of high fruit and vegetable and low saturated fat intakes is more protective against mortality in aging men than is either alone: the Baltimore Longitudinal Study of Aging. J Nutr 2005; 135: 556–561.
Nakamura K, Nagata C, Oba S, Takatsuka N, Shimizu H . Fruit and vegetable intake and mortality from cardiovascular disease are inversely associated in Japanese women but not in men. J Nutr 2008; 138: 1129–1134.
Nothlings U, Schulze MB, Weikert C, Boeing H, van der Schouw YT, Bamia C et al. Intake of vegetables, legumes, and fruit, and risk for all-cause, cardiovascular, and cancer mortality in a European diabetic population. J Nutr 2008; 138: 775–781.
Takachi R, Inoue M, Ishihara J, Kurahashi N, Iwasaki M, Sasazuki S et al. Fruit and vegetable intake and risk of total cancer and cardiovascular disease: Japan Public Health Center-Based Prospective Study. Am J Epidemiol 2008; 167: 59–70.
Nagura J, Iso H, Watanabe Y, Maruyama K, Date C, Toyoshima H et al. Fruit, vegetable and bean intake and mortality from cardiovascular disease among Japanese men and women: the JACC Study. Br J Nutr 2009; 102: 285–292.
Bendinelli B, Masala G, Saieva C, Salvini S, Calonico C, Sacerdote C et al. Fruit, vegetables, and olive oil and risk of coronary heart disease in Italian women: the EPICOR Study. Am J Clin Nutr 2011; 93: 275–283.
Crowe FL, Roddam AW, Key TJ, Appleby PN, Overvad K, Jakobsen MU et al. Fruit and vegetable intake and mortality from ischaemic heart disease: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart study. Eur Heart J 2011; 32: 1235–1243.
Ebbert JO, Yang P, Vachon CM, Vierkant RA, Cerhan JR, Folsom AR et al. Lung cancer risk reduction after smoking cessation: observations from a prospective cohort of women. J Clin Oncol 2003; 21: 921–926.
Acknowledgements
We thank the following organizations for facilitating the recruitment of the PRIME subjects: the Health ScreeningCentres coordinated by the Social Security Department in Lille (Institut Pasteur), Strasbourg, Toulouse and Tourcoing; the Occupational Medicine Services in the Haute-Garonne county and the Strasbourg Urban Area; the Association Interenterprises des Services Medicaux du Travail de Lille et environs; the Comité pour le Développement de la Médecine du Travail; the Mutuelle Générale des PTT du Bas-Rhin; the Laboratoire d’Analyses de l’Institut de Chimie Biologique de la Faculté de Médecine de Strasbourg; and the Department of Health (NI) and the Northern Ireland Chest Heart and Stroke Association. We also thank the external members of the event validation committees (Professor L Guize, Dr CMorrison, Dr M-T Guillanneuf and Professor M Giroud) and the Alliance Partnership Program for its financial support. The PRIME study was supported by grants from INSERM, the Lille Pasteur Institute and the Merck, Sharpand Dohme-Chibret Laboratory.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
Supplementary Information accompanies the paper on European Journal of Clinical Nutrition website
Supplementary information
Rights and permissions
About this article
Cite this article
Poisson, T., Dallongeville, J., Evans, A. et al. Fruit and vegetable intake and smoking cessation. Eur J Clin Nutr 66, 1247–1253 (2012). https://doi.org/10.1038/ejcn.2012.70
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/ejcn.2012.70
Keywords
This article is cited by
-
Self-management practices of smokers with asthma and/or chronic obstructive pulmonary disease: a cross-sectional survey
COPD Research and Practice (2017)