Higher fruit and vegetable intake associated with less PAD

Greater Frequency of Fruit and Vegetable Consumption Is Associated With Lower Prevalence of Peripheral Artery Disease

Literature - Heffron SP, Rockman CB, Adelman MA, et al. - Arterioscler Thromb Vasc Biol. 2017;37: published online ahead of print


Guidelines recommend the consumption of at least 4.5 cups of fruits and vegetables (F&V) combined daily, mainly based on the F&V associations with a reduced risk of cancer and overall mortality [1-3]. Less robust data are available on the F&V associations with CV disease [4,5].

In this large community-based study, the association between F&V consumption and the presence of Peripheral Artery Disease (PAD) was assessed in approximately 3.7 million American adults (mean age 64.1+10.2 years, 64.1% female, 89.1% white). The study population consisted of self-referred individuals who underwent vascular screening tests at Life Line Screening Inc. between 2003 and 2008. Before undergoing anthropometric measures, individuals completed an extensive questionnaire regarding demographics, risk factors, medical history, physical activity and dietary intake.

Main results

  • Increasing age, female gender, non-sedentary lifestyle, increasing income, and frequent consumption (most days of the week) of fish, nuts, and red meat were positively associated with the daily consumption of F&V.
  • Non-white race, current or former smoking, being currently unmarried, and frequent consumption of fast food were inversely associated with daily intake of at least 3 servings of F&V.
  • After multivariable adjustment for age, gender, race/ethnicity, and clinical risk factors, there was an inverse association between F&V intake and the prevalence of PAD (P for trend <0.001).
  • Additional adjustment for income and dietary components other than F&V resulted in minimal attenuation of the association (P for goodness of fit = 0.12).
  • When adjusted analyses were stratified by gender, the association persisted, but was slightly more pronounced in men (P<0.01).
  • The stratification of the sample by cigarette smoking status (current, former, and never) showed that the inverse association of increasing F&V consumption with PAD was limited to subjects who currently or formerly smoked.
  • Among all subjects with abnormal ankle brachial index (ABI), 73.2% had an ABI of 0.9–0.7, 19.7% had an ABI of 0.7–0.5, and 7.1% had an ABI <0.5.
  • The inverse association with F&V intake was stronger with decreasing ABI in both crude and multivariable-adjusted models.


In a large community-based study, there was an inverse association between F&V consumption and prevalent PAD. These results suggest that increasing F&V consumption may be important in PAD prevention.


1. US Department of Health and Human Services and US Department of Agriculture. Dietary Guidelines for Americans 2015–2020. 8th ed. Washington, DC: U.S. Government Printing office; 2015.

2. Boffetta P, Couto E, Wichmann J, et al. Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). J Natl Cancer Inst. 2010;102:529–537.

3. Bellavia A, Larsson SC, Bottai M, et al. Fruit and vegetable consumption and all-cause mortality: a dose-response analysis. Am J Clin Nutr. 2013;98:454–459.

4. Dauchet L, Amouyel P, Dallongeville J. Fruits, vegetables and coronary heart disease. Nat Rev Cardiol. 2009;6:599–608.

5. Hu D, Huang J, Wang Y, et al. Fruits and vegetables consumption and risk of stroke: a meta-analysis of prospective cohort studies. Stroke. 2014;45:1613–1619.

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