title: Adherence to the USDA dietary recommendations for fruit and vegetable intake and risk of fatal stroke among ethnic groups: a prospective cohort study.
abstract: BACKGROUND
  Stroke is the fourth leading cause of death in the U.S. and stroke mortality rates differ substantially by ethnic group. The impact of adherence to the USDA dietary guidelines on risk for fatal stroke among different ethnic groups has not previously been examined.
  
  
  METHODS
  A prospective cohort design was used to examine associations between adherence with dietary recommendations for fruit and vegetable intake and risk for stroke mortality among 174,888 men and women representing five ethnic groups; African American, Native Hawaiian, Japanese American, Latino, and Caucasian. Dietary intake was assessed using a mailed quantitative food frequency questionnaire. Associations were examined using Cox proportional hazards models.
  
  
  RESULTS
  There was no evidence that ethnicity modified associations between fruit and vegetable intake and stroke mortality. When data for different ethnicities were combined, a reduced risk for fatal stroke was observed among women who were adherent with the USDA dietary recommendations for vegetable intake, although this result did not reach statistical significance (RR = 0.84, 95% CI = 0.68-1.04). No associations were observed among men.
  
  
  CONCLUSIONS
  The results of this study do not provide evidence that dietary intake of fruits and vegetables differentially impacts risk for stroke mortality among different ethnic groups.
authors.affiliation: Department of Medicine, University of Alberta, 5-10 University Terrace, 8303 112 Street, Edmonton, Alberta T6G 2T4, Canada. gita.sharma@ualberta.ca.
authors.forename: Sangita
authors.initials: S
authors.lastname: Sharma
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Pakserescht
authors.forename: Kennedy
authors.initials: K
authors.lastname: Cruickshank
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Green
authors.forename: Laurence N
authors.initials: LN
authors.lastname: Kolonel
mesh_terms: D001741:Black or African American; D000368:Aged; D015331:Cohort Studies; D004032:Diet; D005006:Ethnicity; D005260:Female; D005638:Fruit; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology* / Q000401:mortality; D011795:Surveys and Questionnaires; D014481:United States; D016885:United States Department of Agriculture; D014675:Vegetables; D044465:White People
references.citation: Ethn Dis. 2009 Winter;19(1):49-55
references.pmid: 19341163
references.citation: N Engl J Med. 1997 Aug 7;337(6):365-72
references.pmid: 9241125
references.citation: J Hum Nutr Diet. 2013 Apr;26(2):156-68
references.pmid: 23398393
references.citation: Am J Clin Nutr. 2002 Oct;76(4):889-96
references.pmid: 12324305
references.citation: Am J Epidemiol. 2000 Feb 15;151(4):346-57
references.pmid: 10695593
references.citation: Br J Nutr. 2013 Apr 28;109(8):1479-89
references.pmid: 22947145
references.citation: Stroke. 2012 Mar;43(3):637-44
references.pmid: 22207512
references.citation: Stroke. 1995 Sep;26(9):1713-23
references.pmid: 7660420
references.citation: Am J Clin Nutr. 2007 Jun;85(6):1495-502
references.pmid: 17556684
references.citation: J Rehabil Res Dev. 2001 Mar-Apr;38(2):281-9
references.pmid: 11392661
references.citation: Stroke. 1998 Aug;29(8):1602-4
references.pmid: 9707200
references.citation: J Am Diet Assoc. 2003 Sep;103(9):1195-8
references.pmid: 12963952
references.citation: Am J Clin Nutr. 2000 Nov;72(5):1223-31
references.pmid: 11063453
references.citation: Stroke. 2004 Sep;35(9):2014-9
references.pmid: 15232120
references.citation: Stroke. 2003 Oct;34(10):2355-60
references.pmid: 14500940
references.citation: Nutr J. 2013 May 20;12:65
references.pmid: 23688109
references.citation: Arthritis Rheum. 2005 Jun;52(6):1843-7
references.pmid: 15934094
references.citation: Epidemiol Rev. 2000;22(2):187-202
references.pmid: 11218371
references.citation: Expert Rev Cardiovasc Ther. 2009 Aug;7(8):955-63
references.pmid: 19673673
references.citation: J Am Soc Nephrol. 2007 Jan;18(1):287-92
references.pmid: 17167112
references.citation: Stroke. 2012 Feb;43(2):335-40
references.pmid: 22135074
references.citation: Eur J Clin Nutr. 2011 Jul;65(7):791-9
references.pmid: 21427746
references.citation: Stroke. 2001 Jul;32(7):1473-80
references.pmid: 11441188
references.citation: Am J Epidemiol. 2000 Feb 15;151(4):358-70
references.pmid: 10695594
references.citation: Int J Obes Relat Metab Disord. 2000 Jan;24(1):20-6
references.pmid: 10702746
references.citation: Neurology. 2005 Oct 25;65(8):1193-7
references.pmid: 16247045
references.citation: J Cardiovasc Med (Hagerstown). 2010 Mar;11(3):207-20
references.pmid: 19829128
references.citation: JAMA. 1995 Apr 12;273(14):1113-7
references.pmid: 7707599
references.citation: J Am Diet Assoc. 2004 Dec;104(12):1873-7
references.pmid: 15565084
references.citation: Am J Clin Nutr. 2000 Nov;72(5):1214-22
references.pmid: 11063452