Plant foods, dietary fibre and risk of ischaemic heart disease in the EPIC cohort

Research output: Contribution to journalArticlepeer-review


  • Aurora Perez-Cornago
  • Paul N. Appleby
  • Kathryn E Bradbury
  • Angela M Wood
  • Marianne Uhre Jakobsen
  • Laura Johnson
  • Carlotta Sacerdote
  • Marinka Steur
  • Elisabete Weiderpass
  • Anne Mette L Würtz
  • Tilman Kühn
  • Verena Katzke
  • Antonia Trichopoulou
  • Anna Karakatsani
  • Carlo La Vecchia
  • Giovanna Masala
  • Rosario Tumino
  • Salvatore Panico
  • Ivonne Sluijs
  • Guri Skeie
  • Liher Imaz
  • Dafina Petrova
  • J. Ramón Quirós
  • Sandra Milena Colorado Yohar
  • Paula Jakszyn
  • Olle Melander
  • Emily Sonestedt
  • Jonas Andersson
  • Maria Wennberg
  • Dagfinn Aune
  • Elio Riboli
  • Matthias B. Schulze
  • Emanuele Di Angelantonio
  • Nicholas J Wareham
  • John Danesh
  • Nita G Forouhi
  • Adam S. Butterworth
  • Timothy J Key

Colleges, School and Institutes

External organisations

  • University of Cambridge


Background: Epidemiological evidence indicates that diets rich in plant foods are associated with a lower risk of ischaemic heart disease (IHD), but there is sparse information on fruit and vegetable subtypes and sources of dietary fibre. This study examined the associations of major plant foods, their subtypes and dietary fibre with risk of IHD in EPIC.

Methods: We conducted a prospective analysis of 490,311 men and women in ten European countries without a history of myocardial infarction or stroke at recruitment (12.6 years of follow-up, n cases=8504). Dietary intake was assessed using validated questionnaires, calibrated with 24-hour recalls. Multivariable Cox regressions were used to estimate hazard ratios (HR) of IHD.

Results: There was a lower risk of IHD with a higher intake of fruit and vegetables combined (HR per 200 g/day higher intake 0.94, 95% CI:0.90-0.99, P-trend=0.009), and total fruits (per 100g/day 0.97, 0.95-1.00, P-trend=0.021). There was no evidence for a reduced risk for fruit subtypes, except for bananas. Risk was lower with higher intakes of nuts and seeds (per 10g/day 0.90, 0.82-0.98, P-trend=0.020), total fibre (per 10g/day 0.95, 0.85-0.98, P-trend=0.015), fruit and vegetable fibre (per 4g/day 0.95, 0.91-0.99, P-trend=0.022), and fruit fibre (per 2 g/day 0.97, 0.95-1.00, P-trend=0.045). No associations were observed between vegetables, vegetables subtypes, legumes, cereals and IHD risk.

Conclusions: In this large prospective study, we found some small inverse associations between plant foods and IHD risk, with fruit and vegetables combined being the most strongly inversely associated with risk. Whether these small associations are causal remains unclear.

Bibliographic note

Not yet published 16/11/20.


Original languageEnglish
Article numberdyaa155
Number of pages11
JournalInternational Journal of Epidemiology
Early online date27 Nov 2020
Publication statusE-pub ahead of print - 27 Nov 2020


  • fruit, vegetables, legumes, nuts, seeds, coronary heart disease