Suggests a role for lifestyle counseling in PAD management
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According to a cross-sectional study of more than 3.7 million people, those who reported daily intake of at least three servings of fruits and vegetables had significantly lower risk of PAD (adjusted OR 0.81, 95% CI 0.79-0.83) than those reporting that they ate three servings less than once a month, wrote Jeffrey Berger, MD, of New York University School of Medicine, and colleagues in Arteriosclerosis, Thrombosis and Vascular Biology, an American Heart Association journal.
PAD risks were equally low among those eating three servings of fruits and vegetables most days of the week (OR 0.80, 95% CI 0.79-0.82), again compared with those with less-than-monthly consumption of three servings.
Even eating three servings once every 2-3 weeks was associated with lower odds of PAD, the researchers found (OR 0.89, 95% CI 0.87-0.91).
"Our current study provides important information to the public that something as simple as adding more fruits and vegetables to your diet could have a major impact on the prevalence of life-altering peripheral artery disease," Berger said.
"We need to increase the nutrition status in our country. We spend so much time thinking about the latest drugs and technologies -- we need to spend more time thinking about lifestyle -- especially sufficient fruit and vegetable intake," Berger told MedPage Today.
"People have more control on their cardiovascular health. Things like eating well and exercise can have a great impact on the risk of cardiovascular disease," he continued.
Berger and colleagues collected data from medical and lifestyle questionnaires and ankle brachial index (ABI) tests at more than 20,000 sites across America, involving a total of nearly 3.7 million individuals. Mean age of participants was 64 years, 64% were female, and 89% were white.
Percentages eating three servings of fruits and vegetables at various frequencies were as follows:
- Daily: 29.2%
- 4-5 times/week: 22.9%
- 2-3 times/week 25.9%
- Once/week to once/month: 15.0%
- Less than once monthly: 7.1%
Among all participants with abnormal ABI, 73.2% (n=121,389) had ABI 0.9-0.7, 19.7% (n=32,648) had ABI 0.7-0.5, and 7.1% (n=11,717) had ABI <0 .5.="" p=""> Using a logistic regression model, the researchers found that increasing age, female sex, non-sedentary lifestyle, increasing income, and frequent consumption (most days of the week) of fish, nuts, and red meat were positively associated with daily consumption of fruits and vegetables.
Conversely, non-white race, current or former smoking, being currently unmarried, and frequent consumption of fast food were inversely associated with daily intake of at least three servings of fruits and vegetables. Geography was also a factor, with several states in the South having rates of less-than-monthly consumption above 20%.
When stratified by smoking status, the association of lower PAD and increased fruits and vegetables was present only among participants who were current or former smokers.
"Our study gives further evidence for the importance of incorporating more fruits and vegetables in the diet," concluded co-author Sean Heffron, MD, also of New York University School of Medicine.
"One-on-one dietary assessments and counseling for PAD patients, as well as greater public health awareness of the importance of fruit and vegetable consumption, are both needed," he wrote.
Limitations included the cross-sectional nature of the study which prevented the researchers from commenting on incidence of PAD, as well as the use of a non-validated survey instrument which left participants to define a "serving" for themselves.
Arteriosclerosis, Thrombosis, and Vascular BiologySource Reference: Heffron S, et al "Greater frequency of fruit and vegetable consumption is associated with lower prevalence of peripheral artery disease" Arterioscler Thromb Vasc Biol 2017; DOI: 10.1161/ATVBAHA.116.308474.