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Kaumudi J. Joshipura, ScD; Alberto Ascherio, MD; JoAnn E. Manson, MD; Meir J. Stampfer, MD; Eric B. Rimm, ScD; Frank E. Speizer, MD; Charles H. Hennekens, MD; Donna Spiegelman, ScD; Walter C. Willett, MD

JAMA. 1999;282:1233-1239.

Context  Few studies have evaluated the relationship between fruit and vegetable intake and cardiovascular disease.

Objective  To examine the associations between fruit and vegetable intake and ischemic stroke.

Design, Setting, and Subjects  Prospective cohort studies, including 75,596 women aged 34 to 59 years in the Nurses' Health Study with 14 years of follow-up (1980-1994), and 38,683 men aged 40 to 75 years in the Health Professionals' Follow-up Study with 8 years of follow-up (1986-1994). All individuals were free of cardiovascular disease, cancer, and diabetes at baseline.

Main Outcome Measure  Incidence of ischemic stroke by quintile of fruit and vegetable intake.

Results  A total of 366 women and 204 men had an ischemic stroke. After controlling for standard cardiovascular risk factors, persons in the highest quintile of fruit and vegetable intake (median of 5.1 servings per day among men and 5.8 servings per day among women) had a relative risk (RR) of 0.69 (95% confidence interval [CI], 0.52-0.92) compared with those in the lowest quintile. An increment of 1 serving per day of fruits or vegetables was associated with a 6% lower risk of ischemic stroke (RR, 0.94; 95% CI, 0.90-0.99; P=.01, test for trend). Cruciferous vegetables (RR, 0.68 for an increment of 1 serving per day; 95% CI, 0.49-0.94), green leafy vegetables (RR, 0.79; 95% CI, 0.62-0.99), citrus fruit including juice (RR, 0.81; 95% CI, 0.68-0.96), and citrus fruit juice (RR, 0.75; 95% CI, 0.61-0.93) contributed most to the apparent protective effect of total fruits and vegetables. Legumes or potatoes were not associated with lower ischemic stroke risk. The multivariate pooled RR for total stroke was 0.96 (95% CI, 0.93-1.00) for each increment of 2 servings per day.

Conclusions  These data support a protective relationship between consumption of fruit and vegetables—particularly cruciferous and green leafy vegetables and citrus fruit and juice—and ischemic stroke risk.

Author Affiliations: Departments of Epidemiology (Drs Joshipura, Ascherio, Manson, Stampfer, Rimm, Spiegelman, and Willett), Nutrition (Drs Ascherio, Stampfer, Rimm, and Willett), Environmental Health (Dr Speizer), and Biostatistics (Dr Spiegelman), Harvard School of Public Health; Department of Oral Health Policy and Epidemiology (Dr Joshipura), Harvard School of Dental Medicine; Channing Laboratory (Drs Stampfer, Rimm, Speizer, and Willett) and the Division of Preventive Medicine (Dr Manson), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. Dr Hennekens now resides in Boca Raton, Fla.

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