Raw and processed fruit and vegetable consumption and 10-year stroke incidence in a population-based cohort study in the Netherlands

Background/Objectives: 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. Subjects/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 strok