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Fruit and Vegetable Intake and Coronary Heart Disease
- Kaumudi J. Joshipura, ScD;
- Frank B. Hu, MD; and
- Walter C. Willett, MD
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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.
Kaumudi J. Joshipura, ScD
Frank B. Hu, MD
Walter C. Willett, MD
Harvard School of Public Health; Boston, MA 02115
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
