Background
Common carotid intima-media thickness (ccIMT) is an established risk marker for cardiovascular events, including myocardial infarction and stroke, which are of high public health relevance. While a higher fruit intake is generally considered beneficial for cardiovascular health, recent studies have shown that a fruit intake of > 2 portions per day may be harmful. Therefore, we tested if there is an association between categories of fruit intake and mean ccIMT.
Methods
We conducted an exploratory, non-prespecified, cross-sectional analysis of baseline values of 167 mostly middle-aged participants of a controlled lifestyle intervention, recruited from the general population in rural northwest Germany (male: n = 58; female: n = 109). Fruit intake was classified into low (<1 portion of fruit/day), intermediate (1-2 portions of fruit/day), and high (>2 portions of fruit/day). Mean ccIMT was measured in accordance with the Mannheim consensus. Between-group differences in mean ccIMT were assessed with analysis of covariance.
Results
Mean age was 57.3 ± 0.7 years (mean ± SEM). Mean fruit intake was 1.6 ± 0.1 portions/day. Average mean ccIMT was 0.679 ± 0.010 mm. There was a significant difference in mean ccIMT between subjects with low (0.676 ± 0.020 mm; n = 50), intermediate (0.653 ± 0.014 mm; n = 72), and high fruit intake (0.724 ± 0.019 mm; n = 45; p = 0.016). But this difference was attenuated when adjusting for age, sex, and homocysteine (p = 0.418).
Conclusions
We found only a non-significant association between consuming >2 portions of fruit per day and ccIMT. Thus, our study could not confirm a negative effect of fruit intake on ccIMT. Age, sex, and homocysteine may confound this association.
Key messages
Current recommendations of 2 portions of fruit per day seem adequate and do not negatively influence carotid intima-media thickness.
Future studies should address confounding of the association between fruit intake and cardiovascular risk markers.
Common carotid intima-media thickness (ccIMT) progression is a risk marker for cardiovascular disease (CVD), whereas healthy lifestyle habits are associated with lower ccIMT. The objective of the present study was to test whether a healthy lifestyle intervention can beneficially affect ccIMT progression. A community-based non-randomised, controlled lifestyle intervention was conducted, focusing on a predominantly plant-based diet (strongest emphasis), physical activity, stress management and social health. Assessments of ccIMT were made at baseline, 6 months and 1 year. Participants had an average age of 57 years and were recruited from the general population in rural northwest Germany (intervention: n 114; control: n 87). From baseline to 1 year, mean ccIMT significantly increased in both the intervention (0⋅026 [95 % CI 0⋅012, 0⋅039] mm) and control group (0⋅045 [95 % CI 0⋅033, 0⋅056] mm). The 1-year trajectory of mean ccIMT was lower in the intervention group (P = 0⋅022; adjusted for baseline). In a subgroup analysis with participants with high baseline mean ccIMT (≥0⋅800 mm), mean ccIMT non-significantly decreased in the intervention group (−0⋅016 [95 % CI −0⋅050, 0⋅017] mm; n 18) and significantly increased in the control group (0⋅065 [95 % CI 0⋅033, 0⋅096] mm; n 12). In the subgroup, the 1-year trajectory of mean ccIMT was significantly lower in the intervention group (between-group difference: −0⋅051 [95 % CI −0⋅075, −0⋅027] mm; P < 0⋅001; adjusted for baseline). The results indicate that healthy lifestyle changes may beneficially affect ccIMT within 1 year, particularly if baseline ccIMT is high.