title: Raw and processed fruit and vegetable consumption and 10-year stroke incidence in a population-based cohort study in the Netherlands.
abstract: OBJECTIVE
  Prospective cohort studies have shown that high fruit and vegetable consumption is related to a lower risk of stroke. Whether food processing affects this association is unknown. We evaluated the associations of raw and processed fruit and vegetable consumption independently from each other with 10-year stroke incidence and stroke subtypes in a prospective population-based cohort study in the Netherlands.
  
  
  METHODS
  We used data of 20 069 men and women aged 20-65 years and free of cardiovascular diseases at baseline who were enrolled from 1993 to 1997. Diet was assessed using a validated 178-item food frequency questionnaire. Hazard ratios (HRs) were calculated for total, ischemic and hemorrhagic stroke incidence using multivariable Cox proportional hazards models.
  
  
  RESULTS
  During a mean follow-up time of 10.3 years, 233 incident stroke cases were documented. Total and processed fruit and vegetable intake were not related to incident stroke. Total stroke incidence was 30% lower for participants with a high intake of raw fruit and vegetables (Q4: >262 g/day; HR: 0.70; 95% confidence intervals (95% CIs): 0.47-1.03) compared with those with a low intake (Q1: ≤92 g/day) and the trend was borderline significant (P for trend=0.07). Raw vegetable intake was significantly inversely associated with ischemic stroke (>27 vs ≤27 g/day; HR: 0.50; 95% CI: 0.34-0.73), and raw fruit borderline significantly with hemorrhagic stroke (>120 vs ≤120 g/day; HR: 0.53; 95% CI: 0.28-1.01).
  
  
  CONCLUSIONS
  High intake of raw fruit and vegetables may protect against stroke. No association was found between processed fruit and vegetable consumption and incident stroke.
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands. Linda.oudegriep@wur.nl
authors.forename: L M
authors.initials: LM
authors.lastname: Oude Griep
authors.forename: W M M
authors.initials: WM
authors.lastname: Verschuren
authors.forename: D
authors.initials: D
authors.lastname: Kromhout
authors.forename: M C
authors.initials: MC
authors.lastname: Ocké
authors.forename: J M
authors.initials: JM
authors.lastname: Geleijnse
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005511:Food Handling; D005638:Fruit / Q000737:chemistry; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014675:Vegetables / Q000737:chemistry; D055815:Young Adult