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Nutrition and health (including climate and ecological aspects)

One-year changes in fruit and vegetable variety intake and cardiometabolic risk factors changes in a middle-aged Mediterranean population at high cardiovascular risk

European Journal of Clinical Nutrition volume 76, pages 1393–1402 (2022)Cite this article

Subjects

Abstract

Background and aims

Previous studies have shown beneficial associations between fruit and vegetable (FV) consumption and cardiometabolic risk factors. However, variety in FV, which may play an important role on cardiovascular health due to the different nutrient and phytochemical content among the different groups and subgroups of FV has been poorly investigated. We longitudinally investigated associations between 1-year changes in variety and quantity of FV and concurrent changes in cardiometabolic risk factors in elderly subjects with overweight/obesity and metabolic syndrome.

Methods

a one-year data longitudinal analysis of 6647 PREDIMED-plus study participants (48% women) was conducted. Data were collected at baseline, six months and 1-year of follow-up. Variety and quantity of FV were estimated using a food frequency questionnaire and continuous scores for variety were created based on items/month of FV. Linear mixed-models adjusted for potential confounders were performed to estimate associations (β-coefficients and 95% confidence interval) between 1-year changes in FV variety and/or quantity and concurrent changes in cardiometabolic risk factors.

Results

Two points increment in the FV variety score over one year was associated with a concurrent decrease in glucose (−0.33 mg/dL (0.58, −0.07)), body weight (−0.07 kg (−0.13, −0.02)) and waist circumference (WC) (−0.08 cm (−0.16, −10.01)). An increment of 100 g/d of FV over one year was associated with a concurrent decrease in triglycerides (−0.50 mg/dL (−0.93, −0.08)), glucose (−0.21 mg/dL (−0.32, −0.11)), body weight (−0.11 kg (−0.15, −0.07)) and WC (−0.10 cm (−0.14, −0.06)) over 1-year. Changes in FV consumption which led to higher quantity and variety over one year were associated with downward changes in glucose (−1.26 mg/dL (−2.09, −0.43)), body weight (−0.40 kg (−0.58, −0.23)) and WC (−0.50 cm (−0.73, −0.28)).

Conclusion

Greater variety, in combination with higher quantity of FV was significantly associated with a decrease in several cardiometabolic risk factors among elderly subjects at high cardiovascular risk.

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Fig. 1: Beta-coefficients and 95% CI for cardiometabolic changes by 1-year changes in categories of fruit and vegetable quantity and variety.

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Data availability

The datasets generated and analyzed during the current study are not expected to be made available outside the core research group, as neither participants’ consent forms nor ethics approval included permission for open access. However, the researchers will follow a controlled data-sharing collaboration model, as in the informed consent participants agreed with a controlled collaboration with other investigators for research related to the project’s aims. Therefore, investigators who are interested in this study can contact the PREDIMED Steering Committee by sending a request letter to predimed_scommittee@googlegroups.com. A data-sharing agreement indicating the characteristics of the collaboration and data management will be completed for the proposals that are approved by the Steering Committee.

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Acknowledgements

The authors would especially like to thank the PREDIMED-Plus participants for their enthusiastic collaboration, the PREDIMED-Plus personnel for their outstanding support and staff of all associated primary care centers for their exceptional work. CIBEROBN, CIBERESP and CIBERDEM are initiatives of the Carlos III Health Institute, Spain. The PREDIMED-Plus trial was supported by the Spanish government’s official funding agency for biomedical research, ISCIII, through the Fondo de Investigación para la Salud (FIS) and co-funded by European Union ERDF/ESF, “A way to make Europe”/ “Investing in your future” (five coordinated FIS projects led by JS-S and JVid, including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560 and PI19/01332), the Special Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to JS-S, the European Research Council (Advanced Research Grant 2013–2018, 340918) to MÁM-G, the Recercaixa Grant to JS-S (2013ACUP00194), grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016 and PI0137/2018), a grant from the Generalitat Valenciana (PROMETEO/2017/017), a SEMERGEN grant, and funds from the European Regional Development Fund (CB06/03). Study resulting from the SLT006/17/00246 grant was funded by the Department of Health of the Generalitat de Catalunya by the call “Acció instrumental de programes de recerca orientats en l’àmbit de la recerca i la innovació en salut.” We thank CERCA Programme/Generalitat de Catalunya for institutional support. This work is partially supported by ICREA under the ICREA Academia program. LL-G receives a predoctoral grant from the University of Rovira i Virgili (2019PMF-PIPF-16). SKN is supported by a postdoctoral fellowship from the Canadian Institutes of Health Research (CIHR) and is a volunteer member of the non-for profit group Plant Based Canada.

Author information

Author notes

  1. These authors contributed equally: Leyre López González, Dr. Nerea Becerra Tomás.

Authors and Affiliations

  1. Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Reus, Spain

    Leyre López-González, Nerea Becerra-Tomás, Nancy Babio, Stephanie K. Nishi & Jordi Salas-Salvadó

  2. Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain

    Leyre López-González, Nerea Becerra-Tomás, Nancy Babio, Stephanie K. Nishi & Jordi Salas-Salvadó

  3. University Hospital of Sant Joan de Reus, Nutrition Unit, Reus, Spain

    Leyre López-González, Nancy Babio & Jordi Salas-Salvadó

  4. Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain

    Nerea Becerra-Tomás, Nancy Babio, Miguel Ángel Martínez-González, Stephanie K. Nishi, Dolores Corella, Albert Goday, Dora Romaguera, Ángel M. Alonso-Gómez, Julia Wärnberg, J. Alfredo Martínez, Luís Serra-Majem, Ramon Estruch, M. Rosa Bernal-López, José Lapetra, Xavier Pintó, Josep A. Tur, José López-Miranda, Clotilde Vázquez, Emilio Ros, Zenaida Vázquez-Ruiz, José V. Sorlí, Olga Castañer, M. Angeles Zulet, Lucas Tojal-Sierra, Antonio García-Ríos, Rosa Casas, Ana M. Gómez-Pérez, José M. Santos-Lozano, Pilar Buil-Cosiales, Eva M. Asensio, Camille Lassale, Itziar Abete, Itziar Salaverria-Lete, Carmen Sayón-Orea & Jordi Salas-Salvadó

  5. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College of London, London, United Kingdom

    Nerea Becerra-Tomás

  6. University of Navarra, Department of Preventive Medicine and Public Health, University of Navarra, Navarra, Spain

    Miguel Ángel Martínez-González, Zenaida Vázquez-Ruiz, Pilar Buil-Cosiales & Carmen Sayón-Orea

  7. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Miguel Ángel Martínez-González

  8. Toronto 3D (Diet, Digestive tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada

    Stephanie K. Nishi

  9. Clinical Nutrition and Risk Factor Modification Centre, St. Michael´s Hospital, Unity Health Toronto, Toronto, ON, Canada

    Stephanie K. Nishi

  10. Department of Preventive Medicine, University of Valencia, Valencia, Spain

    Dolores Corella, José V. Sorlí & Eva M. Asensio

  11. Cardiovascular Risk and Nutrition research group (CARIN), Hospital del Mar Research Institute (IMIM), Barcelona, Spain

    Albert Goday, Olga Castañer, Camille Lassale & Helmut Schröder

  12. Departament de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain

    Albert Goday

  13. Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain

    Dora Romaguera & Elena Rayó

  14. CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain

    Jesús Vioque, Aurora Bueno-Cavanillas, Miguel Delgado-Rodríguez, Vicente Martín-Sánchez & Helmut Schröder

  15. Alicante Institute for Health and Biomedical Research (ISABIAL-UMH), Alicante, Spain

    Jesús Vioque

  16. Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain

    Ángel M. Alonso-Gómez, Lucas Tojal-Sierra & Itziar Salaverria-Lete

  17. Epi-PHAAN Research Group, School of Health Science, Universidad de Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071, Málaga, Spain

    Julia Wärnberg

  18. University of Navarra, Department of Nutrition, Food Science and Physiology, IDISNA, Pamplona, Spain

    J. Alfredo Martínez, M. Angeles Zulet & Itziar Abete

  19. Precision Nutrition Program, IMDEA Food, CEI UAM+CSIC, Madrid, Spain

    J. Alfredo Martínez

  20. University of Las Palmas de Gran Canaria, Research Institute of Biomedical and Health Sciences (IUIBS), Preventive Medicine Service, Centro Hospitalario Universitario Insular Materno Infantil (CHUIMI), Canarian Health Service, Las Palmas, Spain

    Luís Serra-Majem

  21. Department of Internal Medicine, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain

    Ramon Estruch & Rosa Casas

  22. Servicio de Medicina Interna, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, Spain

    M. Rosa Bernal-López

  23. Department of Family Medicine, Research Unit, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain

    José Lapetra & José M. Santos-Lozano

  24. Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain

    Xavier Pintó

  25. Barcelona University, Barcelona, Spain

    Xavier Pintó

  26. Research Group on Community Nutrition & Oxidative Stress, University of Balearic Islands, Palma de Mallorca, Spain

    Josep A. Tur

  27. Department of Internal Medicine, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain

    José López-Miranda & Antonio García-Ríos

  28. Department of Preventive Medicine, University of Granada, Granada, Spain

    Aurora Bueno-Cavanillas

  29. Division of Preventive Medicine, Faculty of Medicine, University of Jaén, Jaén, Spain

    Miguel Delgado-Rodríguez

  30. Department of Endocrinology and Nutrition, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, Spain

    Pilar Matía-Martín

  31. Nutritional Genomics and Epigenomics Group, IMDEA Food, CEI UAM+CSIC, Madrid, Spain

    Lidia Daimiel

  32. Institute of Biomedicine (IBIOMED), University of León, León, Spain

    Vicente Martín-Sánchez

  33. CIBER Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain

    Josep Vidal

  34. Departament of Endocrinology, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain

    Josep Vidal

  35. Department of Endocrinology, Fundación Jiménez-Díaz, Madrid, Spain

    Clotilde Vázquez

  36. Lipid Clinic, Department of Endocrinology and Nutrition, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain

    Emilio Ros

  37. Research Support Unit Tarragona-Reus, Institut Universitari d´Investigació en l´Atenció Primària Jordi Gol (IDIAP Jordi Gol), Institut Català de la Salut, Tarragona, Spain

    Francisco M. Martín-Luján

  38. Universitat Rovira i Virgili. Departament de Medicina i Cirurgia, Reus, Spain

    Francisco M. Martín-Luján

  39. Unidad de Gestión Clínica Arroyo de la Miel. Distrito de Atención Primaria Costa del Sol. Servicio Andaluz de Salud, Benalmádena, Málaga, Spain

    Rosa Carabaño-Moral

  40. Centro de Salud Santa Pola, Alicante, Spain

    Josefa Román-Maciá

  41. Unidad de Gestión Clínica de Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario de Málaga (Virgen de la Victoria), Universidad de Málaga, Málaga, Spain

    Ana M. Gómez-Pérez

  42. Atención Primaria. Servicio Navarro de Salud, Navarra, Spain

    Pilar Buil-Cosiales

  43. IdiSNA, Instituto de Investigación Sanitaria de Navarra, Navarra, Spain

    Pilar Buil-Cosiales

Authors
  1. Leyre López-González
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  2. Nerea Becerra-Tomás
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  3. Nancy Babio
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  4. Miguel Ángel Martínez-González
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  5. Stephanie K. Nishi
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  6. Dolores Corella
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  7. Albert Goday
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  8. Dora Romaguera
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  9. Jesús Vioque
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  10. Ángel M. Alonso-Gómez
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  11. Julia Wärnberg
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  12. J. Alfredo Martínez
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  13. Luís Serra-Majem
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  14. Ramon Estruch
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  15. M. Rosa Bernal-López
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  16. José Lapetra
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  17. Xavier Pintó
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  18. Josep A. Tur
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  19. José López-Miranda
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  20. Aurora Bueno-Cavanillas
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  21. Miguel Delgado-Rodríguez
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  22. Pilar Matía-Martín
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  23. Lidia Daimiel
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  24. Vicente Martín-Sánchez
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  25. Josep Vidal
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  26. Clotilde Vázquez
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  27. Emilio Ros
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  28. Zenaida Vázquez-Ruiz
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  29. Francisco M. Martín-Luján
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  30. José V. Sorlí
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  31. Olga Castañer
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  32. M. Angeles Zulet
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  33. Lucas Tojal-Sierra
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  34. Rosa Carabaño-Moral
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  35. Josefa Román-Maciá
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  36. Elena Rayó
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  37. Antonio García-Ríos
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  38. Rosa Casas
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  39. Ana M. Gómez-Pérez
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  40. José M. Santos-Lozano
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  41. Pilar Buil-Cosiales
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  42. Eva M. Asensio
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  43. Camille Lassale
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  44. Itziar Abete
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  45. Itziar Salaverria-Lete
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  46. Carmen Sayón-Orea
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  47. Helmut Schröder
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  48. Jordi Salas-Salvadó
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Consortia

on behalf of the PREDIMED-Plus Investigators

Contributions

All the principal PREDIMED-plus investigators contributed to study concept and design and to data extraction from the participants. LL-G, NB-T, NB and JS-S performed the statistical analyses. LL-G, NB-T, NB and JS-S drafted the manuscript. All authors reviewed the manuscript for important intellectual content and approved the final version to be published.

Corresponding authors

Correspondence to Nancy Babio or Jordi Salas-Salvadó.

Ethics declarations

Competing interests

JS-S serves on the board of (and receives grant support through his institution from) the International Nut and Dried Fruit Council and the Eroski Foundation. He also serves on the Executive Committee of the Instituto Danone, Spain, and on the Scientifc Committee of the Danone International Institute. He has received research support from the Patrimonio Comunal Olivarero, Spain, and Borges S.A., Spain. He receives consulting fees or travel expenses from Eroski Foundation, the Instituto Danone, Spain, Abbot Laboratories, and Mundipharma. ER has received research funding through his institution from the California Walnut Commission, Folsom, CA, USA; was a paid member of its Health Research Advisory Group; and is a non-paid member of its Scientifc Advisory Council. SKN is a volunteer member of the non-for-profit organization called Plant-Based Canada. RE reports grants from Cerveza y Salud, Spain and Fundación Dieta Mediterranea, Spain. Also personal fees for given lectures from Brewers of Europe, Belgium; Fundación Cerveza y Salud, Spain; Pernaud-Ricard, Mexico; Instituto Cervantes, Alburquerque, USA; Instituto Cervantes, Milano, Italy; Instituto Cervantes, Tokio, Japan; Lilly Laboratories, Spain and Wine and Culinary International Forum, Spain and non-financial support to organize a National Congress on Nutrition. Also feeding trials with product from Grand Fountain and Uriach Laboratories, Spain. LL-G, NB-T, NB, MAM-G, DC, AG, DR, JV, AMA-G, JW, JAM, LS-M, FT, JL, XP, JAT, JL-M, AB-C, MD-R, PM-M, LD, VM-S, JV, CV, ZV-R, FM-L, JV-S, OC, MA-Z, LT-S, RC-M, JR-M, ER, AG-R, RC, JS-L, PB, EM-A, CL, IA, IS-L, MC-S and HS have nothing to declare.

Ethics approval

The PREDIMED-plus trial was registered at the International Standard Randomized Controlled Trial (ISRCTN89898870; registration date; 24 July 2014). All participants provided written informed consent, and the study protocol and procedures were approved according to the ethical standards of the Declaration of Helsinki by all the participating institutions: CEI Provincial de Málaga, CEI de los Hospitales Universitarios Virgen Macarena y Virgen del Rocío, CEI de la Universidad de Navarra, CEI de les Illes Balears, CEIC del Hospital Clínic de Barcelona, CEIC del Parc de Salut Mar, CEIC del Hospital Universitari Sant Joan de Reus, CEI del Hospital San Cecilio, CEIC de la Fundación Jiménez Díaz, CEIC Euskadi, CEI en Humanos de la Universidad de Valencia, CEIC del Hospital Universitario de Gran Canaria Doctor Negrín, CEIC del Hospital Universitario de Bellvitge, CEI de Córdoba, CEI del Instituto Madrileño de Estudios Avanzados, CEIC del Hospital Clínico San Carlos, CCEI de la Investigación Biomédica de Andalucía and CCEIC de León. The code of the Ethical Committe aproval of the Cordinated Center (CEIC del Hospital Universitari Sant Joan de Reus) is 13-07-25/7proj2 (approval date: 30/07/2013).

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Members of the PREDIMED-Plus Investigators are listed in Supplementary Information.

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López-González, L., Becerra-Tomás, N., Babio, N. et al. One-year changes in fruit and vegetable variety intake and cardiometabolic risk factors changes in a middle-aged Mediterranean population at high cardiovascular risk. Eur J Clin Nutr 76, 1393–1402 (2022). https://doi.org/10.1038/s41430-022-01124-3

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