Fruit Intake and Abdominal Aortic Calcification in Elderly Women: A Prospective Cohort Study

Abstract

Cardiovascular disease (CVD) is the leading cause of death worldwide. There is a consistent inverse relationship between fruit intake with CVD events and mortality in cross-sectional and prospective observational studies, but the relationship of fruit intake with measurements of atherosclerosis in humans is less clear. Nutritional effects on abdominal aortic calcification (AAC), a marker for subclinical intimal and medial atherosclerotic vascular disease, have not been studied previously. The aim of this study was to examine the cross-sectional relationship of total and individual fruit (apple, pear, orange and other citrus, and banana) intake with AAC, scored between 0 and 24. The current study assessed baseline data for a cohort of 1052 women over 70 years of age who completed both a food frequency questionnaire assessing fruit intake, and underwent AAC measurement using dual energy X-ray absorptiometry. AAC scores were significantly negatively correlated with total fruit and apple intakes (p < 0.05), but not with pear, orange or banana intakes (p > 0.25). In multivariable-adjusted logistic regression, each standard deviation (SD; 50 g/day) increase in apple intake was associated with a 24% lower odds of having severe AAC (AAC score >5) (odd ratio OR): 0.76 (0.62, 0.93), p = 0.009). Total and other individual fruit intake were not associated with increased odds of having severe AAC. Apple but not total or other fruit intake is independently negatively associated with AAC in older women.

Keywords: abdominal aortic calcification; apples; atherosclerosis; cardiovascular disease; fruit.

Figure 1

The odds ratio and 95% confidence interval of severe abdominal aortic calcification for each SD increase in total fruit, apple, pear, banana and orange intake. Multivariable adjusted for age, BMI, energy intake, energy expended in physical activity, alcohol consumption, prevalent atherosclerotic vascular disease, previous type 2 diabetes, use of antihypertensive medication, use of cholesterol-lowering medication (statins), and smoking status.

Figure 2

The odds ratio and 95% confidence interval of severe abdominal aortic calcification for each SD increase in apple intake (50 g/day) stratified by estimated glomerular filtration rate (eGFR) diabetes, BMI, prevalent atherosclerotic vascular disease (ASVD), use of antihypertensive medication, use of statins and smoking status. Multivariable adjusted for age, BMI, energy intake, energy expended in physical activity, alcohol consumption, prevalent atherosclerotic vascular disease, previous type 2 diabetes, use of antihypertensive medication, use of cholesterol-lowering medication (statins), and smoking status. There was no significant interaction of apple intake with any of the strata for these parameters in predicting severe AAC (p > 0.05).