Published Online
on December 18, 2006

A more recent version of this article appeared on January 16, 2007

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Submitted on May 23, 2006
Accepted on October 27, 2006

Greater Fish, Fruit, and Vegetable Intakes Are Related to Lower Incidence of Venous Thromboembolism. The Longitudinal Investigation of Thromboembolism Etiology

Lyn M. Steffen PhD^*, Aaron R. Folsom MD, Mary Cushman MD, David R. Jacobs Jr PhD, and Wayne D. Rosamond PhD

From the Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis (L.M.S., A.R.F., D.R.J.); Department of Medicine, College of Medicine, University of Vermont, Burlington (M.C.); Department of Nutrition, University of Oslo, Oslo, Norway (D.R.J.); and Department of Epidemiology, University of North Carolina at Chapel Hill (W.D.R.).

^* To whom correspondence should be addressed. E-mail: steffen{at}epi.umn.edu.

Background--Little is known about the role of dietary intake in the development of deep vein thrombosis or pulmonary embolus (venous thromboembolism [VTE]). Homocysteine, factor VIII, and von Willebrand factor levels, risk factors for VTE, are influenced by dietary intake. We tested the hypothesis that foods rich in B vitamins and -3 fatty acids are negatively associated and meat intake is positively associated with incidence of VTE.

Methods and Results--In a prospective study over 12 years, 14 962 middle-aged adults participating in the Atherosclerosis Risk in Communities study were followed up for incident VTE. All hospitalizations were identified, and 196 VTEs were validated by chart review. A food frequency questionnaire assessed dietary intake at baseline and year 6. In separate proportional hazards regression analyses, risk of developing VTE was computed across quintiles of selected nutrients, major food groups, and the Western diet pattern, with adjustment for demographic and lifestyle factors, body mass index, and diabetes. Hazard ratios and 95% confidence intervals of VTE incidence across quintiles of fruit and vegetable intake were 1.0 (reference), 0.73 (0.48 to 1.11), 0.57 (0.37 to 0.90), 0.47 (0.29 to 0.77), and 0.59 (0.36 to 0.99) (P_trend=0.03). Eating fish 1 or more times per week was associated with 30% to 45% lower incidence of VTE for quintiles 2 to 5 compared with quintile 1, suggestive of a threshold effect. Hazard ratios of VTE across quintiles of red and processed meat intake were 1.0, 1.24 (0.78 to 1.98), 1.21 (0.74 to 1.98), 1.09 (0.64 to 1.87), and 2.01 (1.15 to 3.53) (P_trend=0.02). Hazard ratios were attenuated only slightly after adjustment for factors VIIc and VIIIc and von Willebrand factor.

Conclusions--A diet including more plant food and fish and less red and processed meat is associated with a lower incidence of VTE.

Key words: diet • epidemiology • fish • folate • fruit and vegetables • venous thromboembolism • vitamin B6

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