Fruit and vegetable consumption and mortality in Eastern Europe: Longitudinal results from the Health, Alcohol and Psychosocial Factors in Eastern Europe study.

Denes Stefler,Sofia Malyutina,Anne Peasey,Galina Simonova,Michael G Marmot,Andrzej Pajak,Ruzena Kubinova,Hynek Pikhart,Martin Bobak,Urszula Stepaniak

doi:10.1177/2047487315582320

Abstract

BackgroundIt is estimated that disease burden due to low fruit and vegetable consumption is higher in Central and Eastern Europe (CEE) and the former Soviet Union (FSU) than any other parts of the world. However, no large scale studies have investigated the association between fruit and vegetable (F&V) intake and mortality in these regions yet.DesignThe Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) study is a prospective cohort study with participants recruited from the Czech Republic, Poland and Russia.MethodsDietary data was collected using food frequency questionnaire. Mortality data was ascertained through linkage with death registers. Multivariable adjusted hazard ratios were calculated by Cox regression models.ResultsAmong 19,333 disease-free participants at baseline, 1314 died over the mean follow-up of 7.1 years. After multivariable adjustment, we found statistically significant inverse association between cohort-specific quartiles of F&V intake and stroke mortality: the highest vs lowest quartile hazard ratio (HR) was 0.52 (95% confidence interval (CI): 0.28–0.98). For total mortality, significant interaction (p = 0.008) between F&V intake and smoking was found. The associations were statistically significant in smokers, with HR 0.70 (0.53–0.91, p for trend: 0.011) for total mortality, and 0.62 (0.40–0.97, p for trend: 0.037) for cardiovascular disease (CVD) mortality. The association was appeared to be mediated by blood pressure, and F&V intake explained a considerable proportion of the mortality differences between the Czech and Russian cohorts.ConclusionsOur results suggest that increasing F&V intake may reduce CVD mortality in CEE and FSU, particularly among smokers and hypertensive individuals.

Highlights

The World Health Organisation (WHO) Global Burden of Disease (GBD) project has estimated that the disease burden due to inadequate fruit and vegetable (F&V) consumption is higher in Central and Eastern Europe (CEE)/former Soviet Union (FSU) than any other parts of the world.[9]
We investigated the relationship between F&V intake and mortality from all-causes, cardiovascular disease (CVD), coronary heart disease (CHD) and stroke in three populations participating in the Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) project,[10] the largest cohort study with population data on dietary habits in CEE and FSU
Mean arterial blood pressure declined but BMI increased and serum cholesterol level did not change with increasing F&V consumption, which suggests that blood pressure is a Cohort-specific fruit and vegetable intake quartiles

Summary

Introduction

A number of observational epidemiological studies have found inverse associations between fruit and vegetable (F&V) intake and the risk of cardiovascular disease (CVD), coronary heart disease (CHD) and stroke.[1,2,3,4] The mechanisms how F&V intake might reduce disease risk are not entirely clear; while the antioxidant hypothesis was not confirmed,[5] blood pressure. We investigated the relationship between F&V intake and mortality from all-causes, CVD, CHD and stroke in three populations participating in the Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) project,[10] the largest cohort study with population data on dietary habits in CEE and FSU. We examined the potential mediating role of blood pressure, and whether F&V intake explained any of the mortality differences between the study populations

Methods

Results

Summary of main findings