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Vegetable diversity in relation with subclinical atherosclerosis and 15-year atherosclerotic vascular disease deaths in older adult women

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Abstract

Purpose

Increasing vegetable intake and diversity are recommended to maintain better health. Evidence for the health benefits of vegetable diversity, separate from total intake, is scarce. We aimed to investigate the associations of vegetable diversity with subclinical measures of atherosclerosis and atherosclerotic vascular disease (ASVD) mortality.

Methods

Vegetable diversity was assessed within a validated food frequency questionnaire using a single question, ‘How many different vegetables do you usually consume each day (< 1 to ≥ 6 per day)’. Cox proportional hazards modelling was used to examine the association between vegetable diversity and ASVD mortality in 1226 women aged ≥ 70 years without clinical ASVD or diabetes mellitus at baseline (1998). In 2001, B-mode ultrasonography was used to measure common carotid artery intima–media thickness (CCA-IMT) (n = 954) and carotid plaque severity (n = 968).

Results

Over 15 years (15,947 person-years) of follow-up, 238 ASVD-related deaths were recorded. For each additional different vegetable consumed per day, there was 17% lower hazard for ASVD mortality (HR = 0.83, 95% CI 0.78, 0.93, P = 0.001); a 1.7% lower mean CCA-IMT (B ± SE: − 0.013 ± 0.004, P < 0.001); and a 1.8% lower maximum CCA-IMT (B ± SE: − 0.017 ± 0.004, P < 0.001). Further adjustment for total vegetable intake attenuated the association between vegetable diversity and ASVD mortality (P = 0.114), but not CCA-IMT (P = 0.024). No association was observed between vegetable diversity and carotid plaque severity (P > 0.05).

Conclusions

Vegetable diversity may contribute to benefits in lowering risk of ASVD in older women. The reduction in risk is partly explained by increased total vegetable consumption.

Clinical trial registry

The Perth Longitudinal Study of Aging in Women (PLSAW) trial registration ID is ACTRN12617000640303. This study was retrospectively registered on the Australian New Zealand Clinical Trials Registry at http://www.anzctr.org.au.

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Abbreviations

ASVD:

Atherosclerotic vascular disease

CCA-IMT:

Common carotid artery intima–media thickness

CKD-EPI:

Chronic Kidney Disease Epidemiology Collaboration

eGFR:

Estimated glomerular filtration rate

FRS:

Framingham risk scores

HDL:

High-density lipoprotein

ICD:

International Classification of Diseases

ICPC-Plus:

International Classification of Primary Care-Plus

LDL:

Low-density lipoprotein

NRVs:

Nutrient reference values

PLSAW:

Perth Longitudinal Study of Aging in Women

WADLS:

Western Australian Data Linkage System (WADLS).

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Acknowledgements

The authors wish to thank the staff at the Western Australian Data Linkage Branch; Hospital Morbidity Data Collection; Registry of Births, Deaths and Marriages; Victorian Department of Justice and Regulation; and the National Coronial Information System for their work on providing the data for this study.

Funding

The Perth Longitudinal Study of Aging in Women (PLSAW) study was funded by Healthway the Western Australian Health Promotion Foundation and by Project Grants 254627, 303169, and 572604 from the National Health and Medical Research Council (NHMRC) of Australia. The analysis was supported by an NHMRC of Australia Project Grant 1084922. NHMRC of Australia Fellowships supported the salaries of JRL and JMH. None of these funding agencies had any role in the conduct of the study; collection, management, analysis, or interpretation of the data; or the preparation, review or approval of the manuscript.

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Authors and Affiliations

  1. School of Health and Medical Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia

    Lauren C. Blekkenhorst, Joshua R. Lewis, Catherine P. Bondonno, Marc Sim, Amanda Devine & Jonathan M. Hodgson

  2. Medical School, The University of Western Australia, Perth, WA, Australia

    Joshua R. Lewis, Catherine P. Bondonno, Kun Zhu, Wai H. Lim, Lawrence J. Beilin, Richard L. Prince & Jonathan M. Hodgson

  3. Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia

    Joshua R. Lewis

  4. School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Joshua R. Lewis

  5. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia

    Kun Zhu & Richard L. Prince

  6. Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia

    Wai H. Lim

  7. Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA, Australia

    Richard J. Woodman

  8. Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia

    Peter L. Thompson

Authors
  1. Lauren C. Blekkenhorst
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  2. Joshua R. Lewis
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  3. Catherine P. Bondonno
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  4. Marc Sim
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  5. Amanda Devine
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  6. Kun Zhu
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  7. Wai H. Lim
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  9. Lawrence J. Beilin
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  10. Peter L. Thompson
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  11. Richard L. Prince
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  12. Jonathan M. Hodgson
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Contributions

LCB, JRL, MS, AD, RLP, and JMH: study concept and design; JRL, AD, KZ, WHL, PLT, and RLP: acquisition of data; LCB, RJW, and JMH: statistical analysis and interpretation of data; LCB: drafting of the manuscript; and all authors: critical revision of the manuscript for important intellectual content.

Corresponding author

Correspondence to Lauren C. Blekkenhorst.

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Blekkenhorst, L.C., Lewis, J.R., Bondonno, C.P. et al. Vegetable diversity in relation with subclinical atherosclerosis and 15-year atherosclerotic vascular disease deaths in older adult women. Eur J Nutr 59, 217–230 (2020). https://doi.org/10.1007/s00394-019-01902-z

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