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HomeCardiovascularIncreased fruit and veggies uptake reduces PAD risk

Increased fruit and veggies uptake reduces PAD risk

Eating more fruits and vegetables may reduce the risk of peripheral artery disease (PAD), according to a study of more than 3.6m individuals in the US.

"We hope that studies like this can be an important reminder of the role we as consumers have on heart disease and stroke,” Dr Jeffrey S Berger from New York University School of Medicine is quoted in Reuters Health as saying. “We often remember to take our medication, yet studies like this should remind us to eat our fruits and veggies every day. Moreover, we should continue reminding our young generation of this importance now before disease develops.”

Past research has linked fruit and vegetable consumption to a lower risk of coronary heart disease and stroke, but there has been little research into the effects of fruits and vegetables on arteries in the legs and arms, Berger’s team writes.

Peripheral artery disease, or PAD, usually arises as a narrowing of arteries to the legs that causes cramping, pain or tiredness in the muscles while walking or climbing stairs. It affects at least 8m to 12m Americans. Risk for PAD increases with age, and with a history of smoking, diabetes or high blood pressure.

To investigate whether fruit and vegetable consumption influences risk for PAD, Berger’s team analysed dietary data on 3,696,778 men and women with an average age of about 65, around 234,000 of whom had PAD.

The US Department of Agriculture/US Health and Human Services Dietary Guidelines for Americans recommend at least two servings of fruit and at least three servings of vegetables each day, but only 29% of participants in the study said they ate even three servings of fruits and vegetables daily. Nearly half said they consumed at least three servings of fruit and vegetables on fewer than half the days of the week.

Older white women were most likely to consume fruits and vegetables regularly, and younger black men were least likely to eat at least three servings daily. Fruit and vegetable consumption also varied by region, with those living in the Pacific states reporting the most regular consumption and those living in the south central states reporting the least regular consumption.

After adjusting for age, sex, race and other risk factors, the more fruits and vegetables the participants ate, the lower their likelihood of having PAD.

When researchers divided participants according to their smoking status, they found the relationship between fruit and vegetable intake and PAD was strongest among current smokers, less significant among former smokers and not significant among people who never smoked.

“Unfortunately, fruit and vegetable intake is quite low across the entire US,” Berger said. “Something as simple as eating fruits and vegetables could have a major impact on the prevalence of a life-altering disease, such as peripheral artery disease,” he said.
“Watch what you eat,” Berger advised. “And pay careful attention to eat fruits and vegetables every single day.”

“Increasing fruit and vegetable intake is important and can have far reaching health benefits,” said Dr Michelle L Redmond from University of Kansas School of Medicine-Wichita, who wasn’t involved in the study.

To get people to up their intake of greens, she said, “first, one must take into consideration factors that influence behaviours such as access and affordability of fresh fruits and vegetables (how do you change or lessen certain barriers to fruit/vegetable intake). Then design interventions or campaigns that are tailored to specific audiences to motivate and increase fruit/vegetable consumption. Finally, there is also a need to increase nutrition literacy.”

Getting people to eat more fruits and vegetables is a challenge in other countries, too, noted Dr Miguel A Martinez-Gonzalez from University of Navarra Medical School in Spain, who wasn’t involved in the study. He acknowledged the special importance of fruit and vegetable consumption for smokers but, "this advice should be given to everybody."

Abstract
Objective: Although fruit and vegetable (F&V) consumption is associated with lower risk of coronary heart disease and stroke, its association with peripheral artery disease (PAD) is less certain. We, thus, sought to characterize F&V intake and investigate the association between F&V consumption and presence of PAD in a large community sample.
Approach and Results: Self-referred participants at >20 000 US sites who completed medical and lifestyle questionnaires were evaluated by screening ankle brachial indices for PAD (ankle brachial index ≤0.9). Among 3 696 778 individuals, mean age was 64.1±10.2 years and 64.1% were female. Daily consumption of ≥3 servings of F&V was reported by 29.2%. Increasing age, female sex, white race, never smoking, being currently married, physical activity, increasing income, and frequent consumption of fish, nuts, and red meat were positively associated with daily consumption of F&V. After multivariable adjustment, there was a stepwise inverse association between F&V intake and PAD. Participants reporting daily intake of ≥3 servings of F&V had 18% lower odds of PAD than those reporting less than monthly consumption. In unadjusted and multivariable-adjusted models, the inverse association with F&V became stronger as ankle brachial index decreased. When stratified by smoking status, the association was present only among those subjects who currently or formerly smoked tobacco.
Conclusions: Our study demonstrates an inverse association of F&V consumption with prevalent PAD and overall low F&V consumption. These observations suggest the need to further efforts to increase F&V consumption and for more rigorous evaluation of the role of F&V in PAD prevention.

Authors
Sean P Heffron, Caron B Rockman, Mark A Adelman, Eugenia Gianos, Yu Guo, Jin Feng Xu, Jeffrey S Berger

[link url="http://www.reuters.com/article/us-health-fruitsandveg-peripheral-arteri-idUSKBN18K2DD"]Reuters Health report[/link]
[link url="http://atvb.ahajournals.org/content/early/2017/05/18/ATVBAHA.116.308474"]Arteriosclerosis, Thrombosis and Vascular Biology abstract[/link]

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