title: Fruit and vegetable consumption and mortality in Eastern Europe: Longitudinal results from the Health, Alcohol and Psychosocial Factors in Eastern Europe study.
abstract: BACKGROUND
  It is estimated that disease burden due to low fruit and vegetable consumption is higher in Central and Eastern Europe (CEE) and the former Soviet Union (FSU) than any other parts of the world. However, no large scale studies have investigated the association between fruit and vegetable (F&V) intake and mortality in these regions yet.
  
  
  METHODS
  The Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) study is a prospective cohort study with participants recruited from the Czech Republic, Poland and Russia.
  
  
  METHODS
  Dietary data was collected using food frequency questionnaire. Mortality data was ascertained through linkage with death registers. Multivariable adjusted hazard ratios were calculated by Cox regression models.
  
  
  RESULTS
  Among 19,333 disease-free participants at baseline, 1314 died over the mean follow-up of 7.1 years. After multivariable adjustment, we found statistically significant inverse association between cohort-specific quartiles of F&V intake and stroke mortality: the highest vs lowest quartile hazard ratio (HR) was 0.52 (95% confidence interval (CI): 0.28-0.98). For total mortality, significant interaction (p = 0.008) between F&V intake and smoking was found. The associations were statistically significant in smokers, with HR 0.70 (0.53-0.91, p for trend: 0.011) for total mortality, and 0.62 (0.40-0.97, p for trend: 0.037) for cardiovascular disease (CVD) mortality. The association was appeared to be mediated by blood pressure, and F&V intake explained a considerable proportion of the mortality differences between the Czech and Russian cohorts.
  
  
  CONCLUSIONS
  Our results suggest that increasing F&V intake may reduce CVD mortality in CEE and FSU, particularly among smokers and hypertensive individuals.
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK denes.stefler.10@ucl.ac.uk.
authors.forename: Denes
authors.initials: D
authors.lastname: Stefler
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK.
authors.forename: Hynek
authors.initials: H
authors.lastname: Pikhart
authors.affiliation: Centre for Health Monitoring, National Institute of Public Health, Czech Republic.
authors.forename: Ruzena
authors.initials: R
authors.lastname: Kubinova
authors.affiliation: Department of Epidemiology and Population Sciences, Jagiellonian University, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pajak
authors.affiliation: Department of Epidemiology and Population Sciences, Jagiellonian University, Poland.
authors.forename: Urszula
authors.initials: U
authors.lastname: Stepaniak
authors.affiliation: Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Russia Novosibirsk State Medical University, Russia.
authors.forename: Sofia
authors.initials: S
authors.lastname: Malyutina
authors.affiliation: Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Russia.
authors.forename: Galina
authors.initials: G
authors.lastname: Simonova
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Peasey
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Marmot
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Bobak
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D004032:Diet / Q000009:adverse effects; D005061:Europe, Eastern / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014675:Vegetables
keywords: Fruit and vegetable intake; former Soviet Union; mortality; Central and Eastern Europe