1. Individuals who ate two servings of fruit a day had a 25% lower risk of abdominal aortic aneurysms than those who did not consume fruit.
2. No association was seen between vegetable consumption and abdominal aortic aneurysms risk.
Evidence Rating Level: 2 (Good)
Study Rundown: Abdominal aortic aneurysms (AAA) remain relatively common, occurring in 1.7% to 4.5% of men over 65 years old. Screening for this condition is imperative, as detecting and intervening on AAAs with preventive surgery mitigates the risk of rupture. AAA rupture carries a mortality risk as high as 70%. Well-established risk factors for AAA include old age, male sex, and smoking; though recent evidence suggests that inflammation and oxidative stress contribute to the pathophysiology of AAA, few studies have examined the role of diet and antioxidant consumption in AAA development. This prospective study found that consumption of fruits but not vegetables was inversely associated with the risk of AAA, and that this risk reduction was more pronounced in ruptured than nonruptured AAA. The authors speculate that fruits may contain antioxidants that counteract the oxidative stress believed to contribute to AAA development and expansion. Further research is necessary to explain the lack of association between consumption of vegetables, which also contain antioxidants, and AAAs. As with many population-based cohort studies, this trial was conducted in Sweden, a country whose socialized medical system allows for easy trial enrollment and follow-up, but whose relatively homogeneous population limits the generalizability of results.
Relevant Reading: Pathophysiology and epidemiology of abdominal aortic aneurysms.
In-Depth [prospective population-based cohort study]: This study investigated the association of fruit and vegetable consumption with the risk of developing an abdominal aortic aneurysm (AAA). Participants included 44317 men and 36109 women in Sweden, aged 46 to 84 years at the start of the 13-year follow-up (1998–2010) period. Participants’ fruit and vegetable consumption was assessed with a 96-item food frequency questionnaire at baseline. By using linked data from Swedish Inpatient Register and the Swedish Vascular Registry, investigators were able to identify all individual hospital discharges or deaths attributable to ruptured and nonruptured AAA among study participants. Using Cox proportional hazard models, investigators estimated the hazard ratios between participants in the highest quartile of fruit consumption (>2 servings/d) and lowest (<0.7 servings/d). Covariates (including education, alcohol consumption, diet, physical activity, waist circumference, smoking status, and several comorbid conditions) were controlled for in the ultimate analysis.
In this cohort, 1086 primary cases of AAA (899 in men, 82.8%) were identified, 222 of which ruptured. Men and women with a high consumption of fruit and vegetables had higher educational level, consumed more fish, meat, and whole grains, were more likely to be leaner and physically active, and were less likely to be current smokers. The risk of AAA decreased with increasing consumption of fruit (P for linear trend=0.003), whereas no significant association was observed for vegetable consumption. After adjusting for covariates, those with the highest fruit consumption had a 25% (95% CI, 9%–38%) lower risk of AAA, and a 43% (95% CI, 11%–64%) lower risk of ruptured AAA.
By Elizabeth Kersten and Andrew Bishara
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