Nutr Res Pract.  2010 Aug;4(4):303-310.

Intakes of vegetables and related nutrients such as vitamin B complex, potassium, and calcium, are negatively correlated with risk of stroke in Korea

Affiliations
  • 1Department of Food and Nutrition, Hanyang University, 17 Haengdang-dong, Seongdong-gu, Seoul 133-791, Korea. yongsoon@hanyang.ac.kr

Abstract

Consumption of vegetables and fruits is associated with a reduced risk of stroke, but it is unclear whether their protective effects are due to antioxidant vitamins or folate and metabolically related B vitamins. The purpose of the study was to test the hypothesis that intake of fruits and vegetables, which are major sources of antioxidant and vitamin B complex vitamins, reduces the risk of stroke. Cases consisted of patients diagnosed with first event of stroke (n = 69). Controls (n = 69) were age-, sex-, and body mass index-matched to cases. Multivariable-adjusted regression analysis showed that subjects who ate four to six servings of vegetable per day had a 32% reduction in the risk of stroke, and those with more than six servings per day had a reduction of 69% after adjusting for age, sex, BMI, and family history of stroke. Intakes of total fat, plant fat, calcium, potassium, vitamin B1, vitamin B2, vitamin B6, niacin, and folate were significantly and negatively associated with the risk of stroke. Although the trend was not significant, stroke risk was reduced in the second quartile (1.21-2.66 servings per week) of fish intake. However, intake of fruits (average daily intake of 1.0 serving) and antioxidant vitamins such as carotene, vitamin C, and vitamin E was not associated with the risk of stroke. In conclusion, our observational study suggests that intake of fat and vegetables, rich sources of vitamin B complex, calcium, and potassium may protect against stroke.

Keyword

Fruit; human; stroke; vegetable; vitamin

MeSH Terms

Ascorbic Acid
Calcium
Carotenoids
Folic Acid
Fruit
Humans
Korea
Niacin
Plants
Potassium
Riboflavin
Stroke
Thiamine
Vegetables
Vitamin B 6
Vitamin B Complex
Vitamin E
Vitamins
Ascorbic Acid
Calcium
Carotenoids
Folic Acid
Niacin
Potassium
Riboflavin
Thiamine
Vitamin B 6
Vitamin B Complex
Vitamin E
Vitamins

Reference

1. Mackay J, Mensah G. Atlas of heart disease and stroke. 2004. Geneva: World Health Organization.
2. Korea Institute for Health and Social Affairs. Report on 2007 Korean National Health and Nutrition Examination Survey. 2009. Seoul: Ministry of Health and Welfare.
3. Spence JD. Nutrition and stroke prevention. Stroke. 2006. 37:2430–2435.
Article
4. He FJ, Nowson CA, MacGregor GA. Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet. 2006. 367:320–326.
Article
5. Fung TT, Stampfer MJ, Manson JE, Rexrode KM, Willett WC, Hu FB. Prospective study of major dietary patterns and stroke risk in women. Stroke. 2004. 35:2014–2019.
Article
6. 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.
Article
7. Joshipura KJ, Hung HC, Li TY, Hu FB, Rimm EB, Stampfer MJ, Colditz G, Willett WC. Intakes of fruits, vegetables and carbohydrate and the risk of CVD. Public Health Nutr. 2009. 12:115–121.
Article
8. McNulty H, Scott JM. Intake and status of folate and related B-vitamins: considerations and challenges in achieving optimal status. Br J Nutr. 2008. 99:S48–S54.
Article
9. Sies H, Stahl W. Vitamins E and C, β-carotene, and carotenoids as antioxidants. Am J Clin Nutr. 1995. 62:1315S–1321S.
10. Daviglus ML, Orencia AJ, Dyer AR, Liu K, Morris DK, Persky V, Chavez N, Goldberg J, Drum M, Shekelle RB, Stamler J. Dietary vitamin C, β-carotene and 30-year risk of stroke: results from the Western Electric Study. Neuroepidemiology. 1997. 16:69–77.
Article
11. Yochum LA, Folsom AR, Kushi LH. Intake of antioxidant vitamins and risk of death from stroke in postmenopausal women. Am J Clin Nutr. 2000. 72:476–483.
Article
12. Keli SO, Hertog MG, Feskens EJ, Kromhout D. Dietary flavonoids antioxidant vitamins and incidence of stroke: the Zutphen study. Arch Intern Med. 1996. 156:637–642.
Article
13. Kok FJ, de Bruijn AM, Vermeeren R, Hofman A, van Laar A, de Bruin M, Hermus RJ, Valkenburg HA. Serum selenium, vitamin antioxidants, and cardiovascular mortality: 9-year follow-up study in the Netherlands. Am J Clin Nutr. 1987. 45:462–468.
Article
14. Hennekens CH, Buring JE, Manson JE, Stampfer M, Rosner B, Cook NR, Belanger C, LaMotte F, Gaziano JM, Ridker PM, Willett W, Peto R. Lack of effect of long-term supplementation with beta carotene on the incidence of malignant neoplasms and cardiovascular disease. N Engl J Med. 1996. 334:1145–1149.
Article
15. Blot WJ, Li JY, Taylor PR, Guo W, Dawsey S, Wang GQ, Yang CS, Zheng SF, Gail M, Li GY, et al. Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst. 1993. 85:1483–1492.
Article
16. Van Guelpen B, Hultdin J, Johansson I, Stegmayr B, Hallmans G, Nilsson TK, Weinehall L, Witthöft C, Palmqvist R, Winkvist A. Folate, vitamin B12, and risk of ischemic and hemorrhagic stroke: a prospective, nested case-referent study of plasma concentrations and dietary intake. Stroke. 2005. 36:1426–1431.
Article
17. Weng LC, Yeh WT, Bai CH, Chen HJ, Chuang SY, Chang HY, Lin BF, Chen KJ, Pan WH. Is ischemic stroke risk related to folate status or other nutrients correlated with folate intake? Stroke. 2008. 39:3152–3158.
Article
18. Gillman MW, Cupples LA, Gagnon D, Posner BM, Ellison RC, Castelli WP, Wolf PA. Protective effect of fruits and vegetables on development of stroke in men. JAMA. 1995. 273:1113–1117.
Article
19. Joshipura KJ, Ascherio A, Manson JE, Stampfer MJ, Rimm EB, Speizer FE, Hennekens CH, Spiegelman D, Willett WC. Fruits and vegetable intake in relation to risk of ischemic stroke. JAMA. 1999. 282:1233–1239.
Article
20. Al-Delaimy WK, Rexrode KM, Hu FB, Albert CM, Stampfer MJ, Willett WC, Manson JE. Folate intake and risk of stroke among women. Stroke. 2004. 35:1259–1263.
Article
21. Woo KS, Chook P, Lolin YI, Cheung AS, Chan LT, Sun YY, Sanderson JE, Metreweli C, Celermajer DS. Hyperhomocyst(e) inemia is a risk factor for arterial endothelial dysfunction in humans. Circulation. 1997. 96:2542–2544.
Article
22. Bazzano LA, He J, Ogden LG, Loria C, Vupputuri S, Myers L, Whelton PK. Dietary intake of folate and risk of stroke in US men and women: NHANES I Epidemiologic Follow-up study. National Health and Nutrition Examination Survey. Stroke. 2002. 33:1183–1188.
Article
23. Ganji SH, Qin S, Zhang L, Kamanna VS, Kashyap ML. Niacin inhibits vascular oxidative stress, redox-sensitive genes, and monocyte adhesion to human aortic endothelial cells. Atherosclerosis. 2009. 202:68–75.
Article
24. Savige GS. Candidate foods in the Asia-Pacific region for cardiovascular protection: fish, fruit and vegetables. Asia Pac J Clin Nutr. 2001. 10:134–137.
Article
25. Ascherio A, Rimm EB, Hernán MA, Giovannucci EL, Kawachi I, Stampfer MJ, Willett WC. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation. 1998. 98:1198–1204.
Article
26. Umesawa M, Iso H, Date C, Yamamoto A, Toyoshima H, Watanabe Y, Kikuchi S, Koizumi A, Kondo T, Inaba Y, Tanabe N, Tamakoshi A. Dietary intake of calcium in relation to mortality from cardiovascular disease: the JACC Study. Stroke. 2006. 37:20–26.
Article
27. Franse LV, Pahor M, Di Bari M, Somes GW, Cushman WC, Applegate WB. Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program. Hypertension. 2000. 35:1025–1030.
Article
28. John JH, Ziebland S, Yudkin P, Roe LS, Neil HA. Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: a randomized controlled trial. Lancet. 2002. 359:1969–1974.
Article
29. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH, Karanja N. DASH Collaborative Research Group. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997. 336:1117–1124.
Article
30. Vokó Z, Hollander MS, Hofman A, Koudstaal PJ, Breteler MM. Dietary antioxidants and the risk of ischemic stroke. The Rotterdam Study. Neurology. 2003. 61:1273–1275.
Article
31. Boden-Albala B, Elkind M, White H, Szumski A, Paik MC, Sacco RL. Dietary total fat intake and ischemic stroke risk: The Northern Manhattan Study. Neuroepidemiology. 2009. 32:296–301.
Article
32. Gillman MW, Cupples LA, Millen BE, Ellison RC, Wolf PA. Inverse association of dietary fat with development of ischemic stroke in men. JAMA. 1997. 278:2145–2159.
Article
33. Sauvaget C, Nagano J, Hayashi M, Yamada M. Animal protein, animal fat, and cholesterol intakes and the risk of cerebral infarction mortality in the adult health study. Stroke. 2004. 35:1531–1537.
Article
34. Seino F, Date C, Nakayama T, Yoshiike N, Yokoyama T, Yamaguchi M, Tanaka H. Dietary lipids and incidence of cerebral infarction in a Japanese rural community. J Nutr Sci Vitaminol (Tokyo). 1997. 43:83–99.
Article
35. US Department of Health and Human Services and US department of Agriculture. Dietary guidelines for Americans. 2000. Washington: US Government Printing Office;6.
36. He K, Song Y, Daviglus ML, Liu K, Van Horn L, Dyer AR, Goldbourt U, Greenland P. Fish consumption and incidence of stroke: a meta-analysis of cohort studies. Stroke. 2004. 35:1538–1542.
37. Mozaffarian D, Longstreth WT Jr, Lemaitre RN, Manolio TA, Kuller LH, Burke GL, Siscovick DS. Fish consumption and stroke risk in elderly individuals: the cardiovascular health study. Arch Intern Med. 2005. 165:200–206.
Article
38. Harris WS, Park Y, Isley WL. Cardiovascular disease and long-chain omega-3 fatty acids. Curr Opin Lipidol. 2003. 14:9–14.
Article
39. Park Y, Lim J, Kwon Y, Lee J. Correlation of erythrocyte fatty acid composition and dietary intakes with markers of atherosclerosis in patients with myocardial infarction. Nutr Res. 2009. 29:391–396.
Article
40. Park Y, Park S, Yi H, Kim HY, Kang SJ, Kim J, Ahn H. Low level of n-3 polyunsaturated fatty acids in erythrocytes is a risk factor for both acute ischemic and hemorrhagic stroke in Koreans. Nutr Res. 2009. 29:825–830.
Article
Full Text Links
  • NRP
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr