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REPLY
Fruit and Vegetable Intake and Coronary Heart Disease
Kaumudi J. Joshipura, ScD;
Frank B. Hu, MD; and
Walter C. Willett, MD
16 July 2002 | Volume 137 Issue 2 | Page 144
IN RESPONSE:
The suggestion by Drs. Alves-Rodrigues and Thomas that the cardioprotective effect of green leafy vegetables may be related to high lutein levels is based on an animal study of lutein and arteriosclerosis (1) and a study among humans examining the relation between lutein and other antioxidants and coronary disease (2). In our study, we mentioned that antioxidant vitamins, folate, fiber, and such minerals as potassium may contribute to the apparent beneficial effects of fruits and vegetables, and we agree that lutein may also partly explain this benefit.
Dr. Lindenauer and colleagues propose a new term, NNEB, as a better alternative to relative risk or to NNTB. We estimated that for one person in our study sample to avoid a coronary event, 1443 persons would have to increase consumption of fruits and vegetables by one serving per day for 12 years. Lindenauer and colleagues suggest that the NNTB may not adequately convey the magnitude of the behavioral change required to prevent one event. However, the NNEB is more difficult to interpret because it does not include information on number of participants and time. Also, as we mentioned in our study, any estimates like these are largely dependent on characteristics of the study sample and can be very misleading (for example, they could easily vary 50-fold depending on age distribution). Furthermore, it is important to differentiate between implications for drug trials and implications for fruits and vegetables, which are unlikely to have side effects and are beneficial for many diseases.
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Author and Article Information
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Harvard School of Public Health Boston, MA 02115 (Joshipura, Hu, Willett)
1. Dwyer JH, Navab M, Dwyer KM, Hassan K, Sun P, Shircore A, et al. Oxygenated carotenoid lutein and progression of early atherosclerosis: the Los Angeles atherosclerosis study Circulation. 2001;103:2922-7. [PMID: 11413081].[Abstract/Free Full Text]
2. Howard AN, Williams NR, Palmer CR, Cambou JP, Evans AE, Foote JW, et al. Do hydroxy-carotenoids prevent coronary heart disease? A comparison between Belfast and Toulouse Int J Vitam Nutr Res. 1996;66:113-8. [PMID: 8843985].[Medline]
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The Effect of Fruit and Vegetable Intake on Risk for Coronary Heart Disease
Kaumudi J. Joshipura, Frank B. Hu, JoAnn E. Manson, Meir J. Stampfer, Eric B. Rimm, Frank E. Speizer, Graham Colditz, Alberto Ascherio, Bernard Rosner, Donna Spiegelman, AND Walter C. Willett
- Annals 2001 134: 1106-1114.
[ABSTRACT][SUMMARY][Full Text]
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