水果而非蔬菜可降低腹主动脉瘤风险

对两项前瞻性瑞典男性与女性的前瞻性队列研究的一项大型数据库分析结果显示，摄入水果，而非蔬菜，与腹主动脉瘤风险降低相关，尤其是与腹主动脉瘤破裂风险降低相关。



最终分析的研究人群包括36,109例来自瑞典乳腺X线检查队列（建立于1987~1990年）的女性和44,317例来自瑞典男性队列的男性（建立于1997年）。两个队列均于1997年对涉及广泛内容的问卷做出回应，除与性别有关的问题之外，其他问题均相同，包括96个食品项目问题和其他生活方式因素问题。将结果与瑞典住院患者注册和瑞典国家死亡原因注册系统相链接，追踪这些患者的结局。在1987年以来，瑞典国家健康保险覆盖率已接近100%。通过临床事件，而非广泛筛查，识别出所有AAA病例。通过Nordic手术操作分类识别AAA修补术。为了对动脉瘤位置和AAA修补术的破裂状况进行分类，研究者将队列与瑞典血管外科注册系统相链接（建立于1987年，占瑞典所有AAA修补术的93.1%）。根据96个食品项目问卷的结果，对水果和蔬菜摄入量进行汇总，并转化为每日摄入量分类，最低为从不摄入，最高为不低于每日3次。评估的协变量包括教育、酒精摄入量、饮食、身体活动、腰围以及吸烟持续时间和数量。研究人群种族单一。从瑞典住院患者注册、瑞典国家糖尿病注册和问卷的自报告数据中获取心血管疾病、糖尿病、高血压和高胆固醇血症病史的数据。

结果显示，在为期13年的随访期间(1998-2010)，研究者发现共有1,086例原发病例（男性为899例；占83%）和222例AAA破裂病例（男性共181例；占82%）。男性和女性未破裂AAA患者的平均年龄分别为74和76岁。男性和女性破裂AAA患者的平均年龄分别为76和78.5岁。使用Cox比例风险分析估计风险率。“AAA风险随水果摄入量增加而降低(P =0.003)，而未见与蔬菜摄入量显著相关，”瑞典乌普萨拉大学的Otto Stackelberg医生及其同事写道(Circulation 2013;128:795-802)。与水果摄入量为最低四分位间距（每天不足0.7份）的个体相比，水果摄入量为最高四分位间距（每天超过2份）的个体AAA风险降低了25%，AAA破裂风险降低了43%。蔬菜消耗量与AAA风险未见相关性。无论对于破裂还是未破裂AAA，吸烟或个体性别对水果摄入相关的AAA风险无影响。根据研究者报告，摄入水果和蔬菜较多的男性和女性个体接受的教育程度更高、摄入更多鱼、肉和全麦食品，并且更倾向于身材较瘦和身体活动较多，更少为吸烟者。此外，水果摄入量高者较少摄入酒精，而蔬菜摄入量高者摄入酒精较多。

研究者的结论为，“含水果丰富的饮食可能有助于预防很多血管疾病，这项研究的证据显示，AAA风险降低可能为这种饮食方式的益处之一。”

该研究由瑞典研究委员会和瑞典卡罗林斯卡研究所提供的基金资助。作者披露无相关利益冲突。

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By: MARK S. LESNEY, Cardiology News Digital Network

The consumption of fruits, but not vegetables, was associated with a decreased risk of abdominal aortic aneurysm, especially the risk of rupture, according to results of a large database study of two prospective cohorts of Swedish men and women.

"The risk of AAA decreased with increasing consumption of fruit (P =.003), whereas no significant association was observed for vegetable consumption," wrote Dr. Otto Stackelberg and his colleagues at Uppsala (Sweden) University (Circulation 2013;128:795-802).
 
The study population in the final analysis consisted of 36,109 women from the Swedish Mammography Cohort (established between 1987 and 1990) and 44,317 men from the Cohort of Swedish Men (established in 1997).

Both cohorts responded in 1997 to extensive questionnaires – identical except for sex-specific questions – that included 96 food-item questions accompanied by other lifestyle factors. Results were linked to the Swedish Inpatient Register and the Swedish National Cause of Death register to follow outcomes of these patients.

National health coverage in Sweden has been nearly 100% since 1987. All cases of AAA were identified by clinical events, not by general screening. AAA repair was identified via the Nordic Classification of Surgical Procedures. To classify aneurysmal localization and rupture status of AAA repairs, the researchers linked the cohorts to the Swedish Registry for Vascular Surgery (founded in 1987, which accounted for 93.1% of all AAA repairs in Sweden).

Fruit and vegetable consumption was summed from results of the 96 food item questionnaire and converted to daily consumption categories ranging from never to greater than or equal to 3 times daily.

Covariates assessed included education, alcohol consumption, diet, physical activity, waist circumference, and smoking duration and amount. The study population was ethnically homogenous. History of cardiovascular disease, diabetes, hypertension, and hypercholesterolemia was obtained from the Swedish Inpatient Register, the Swedish National Diabetes Register, and the self-reported data from the questionnaire.

During 13 years of follow-up (1998-2010), the researchers found that there were 1,086 primary cases (899 in men; 83%) and 222 cases of ruptured AAA (181 in men; 82%). The mean age for nonruptured AAA was 74 years in men and 76 years in women. For ruptured AAA it was 76 and 78.5 years in men and women, respectively. Cox proportional hazard analysis was used to estimate hazard ratios.

Individuals in the highest quartile of fruit consumption (greater than 2 servings per day) had a 25% lower risk of AAA and a 43% lower risk of ruptured AAA, compared with those in the lowest quartiles of fruit consumption (less than 0.7 servings per day). No association was observed between vegetable consumption and AAA risk. There was no impact of smoking or sex of the individual on the fruit consumption–related AAA risk for both ruptured and nonruptured AAA.

Men and women with a high consumption of fruit and vegetables were more educated, consumed more fish, meat, and whole grains, and were more likely to be leaner and physically active, and less likely to be smokers, according to the researchers. In addition, high consumers of fruit consumed less alcohol, whereas the reverse was true of high consumers of vegetables.

"A diet high in fruits may help to prevent many vascular diseases, and this study provides evidence that a lower risk of AAA will be among the benefits," the researchers concluded.

The study was funded by grants from the Swedish Research Council and the Karolinska Institute. The authors reported they had no disclosures.