2017 UWA Agriculture Postgraduate Showcase7 June 2017

Cardiovascular health benefits of vegetables and their componentsLauren C BlekkenhorstPhD CandidateSchool of Medicine and Pharmacology

SupervisorsProf Jonathan Hodgson

Prof Richard PrinceProf Amanda Devine

Dr Joshua Lewis

Funding bodiesNHMRC

Healthway

Co-investigatorsProf Kevin Croft

Prof Richard WoodmanProf Jon Lundberg

Prof Peter ThompsonA/Prof Germaine WongDr Catherine Bondonno

Dr Natalie WardDr Sujata Shinde

Dr Wai LimDr Kerry Ivey

OthersLynne McCahon

Data Linkage Western Australia

Medical Research Foundation

PLSAW study participants

Acknowledgements

Cardiovascular disease Number 1 cause of death Kills 1 person every 12 minutes

Tobacco useHarmful use of alcoholPhysical inactivityObesityUnhealthy diet

Diets low in vegetables – 1.8 million deaths globally

>90% do not achieve vegetable recommendations

Keep emphasising the importance of increasing vegetables?

Streamline recommendations – focus on vegetables that are more beneficial?

Dietary nitrate

↓ Blood pressure

Nitric oxide

(CP Bondonno, 2016)

Vegetable types

Cruciferous

Allium

Leafy green

Yellow/orange/red

Legumes

Development of a nitrate database Nitrate intake

Cardiovascular disease mortality

Subclinical atherosclerosis

~80% nitrate intake comes from vegetables

Records identified through database searching

(n=12,275)

Cab abstracts (n=5,575) Medline (n=4,036) Agricola (n=2,664)

Records after duplicates removed

(n=9,932)

Records screened

(n=9,932)

Records excluded (n=9,235)

Full-text articles assessed for eligibility

(n=697)

Studies included in database

(n=255)

Full-text articles excluded (n=442)

Additional records identified through other sources

(n=66)

Included

Eligibility

Screening

Identification

Records identified through database searching

(n=12,275)

Cab abstracts (n=5,575) Medline (n=4,036) Agricola (n=2,664)

Records after duplicates removed

(n=9,932)

Records screened

(n=9,932)

Records excluded (n=9,235)

Full-text articles assessed for eligibility

(n=697)

Studies included in database

(n=255)

Full-text articles excluded (n=442)

Additional records identified through other sources

(n=66)

Included

Eligibility

Screening

Identification

Records identified through database searching

(n=12,275)

Cab abstracts (n=5,575) Medline (n=4,036) Agricola (n=2,664)

Records after duplicates removed

(n=9,932)

Records screened

(n=9,932)

Records excluded (n=9,235)

Full-text articles assessed for eligibility

(n=697)

Studies included in database

(n=255)

Full-text articles excluded (n=442)

Additional records identified through other sources

(n=66)

Included

Eligibility

Screening

Identification

Records identified through database searching

(n=12,275)

Cab abstracts (n=5,575) Medline (n=4,036) Agricola (n=2,664)

Records after duplicates removed

(n=9,932)

Records screened

(n=9,932)

Records excluded (n=9,235)

Full-text articles assessed for eligibility

(n=697)

Studies included in database

(n=255)

Full-text articles excluded (n=442)

Additional records identified through other sources

(n=66)

Included

Eligibility

Screening

Identification

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Nitrate content ≥ 2000 mg/kg FW

Nitrate content 1000 to < 2000 mg/kg FW

Nitrate content 500 to < 1000 mg/kg FW

Nitrate content ≤ 500 mg/kg FW

Chi

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Nitrate content mg/kg fresh weight

Chinese flat cabbageArugula

False pak-choiCorn salad

Mustard greensPotherb mustard

Pak choiSwiss chard

Chinese broccoliSea beet

Garden cressChinese amaranth

Nitrate content ≥ 2000 mg/kg fresh weight

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Nitrate content ≥ 2000 mg/kg FW

Nitrate content 1000 to < 2000 mg/kg FW

Nitrate content 500 to < 1000 mg/kg FW

Nitrate content ≤ 500 mg/kg FW

Chi

nese

flat

cab

bage

Arug

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Fals

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Sea

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Gar

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Spin

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Kale

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Spi

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Gre

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Bell

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Nitrate content 1000 to < 2000 mg/kg fresh weight

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Nitrate content ≥ 2000 mg/kg FW

Nitrate content 1000 to < 2000 mg/kg FW

Nitrate content 500 to < 1000 mg/kg FW

Nitrate content ≤ 500 mg/kg FW

Chi

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flat

cab

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Arug

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Fals

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ucum

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end

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para

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nip

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SpinachWatercress

KaleLettuceRadish

BeetNew Zealand Spinach

CeleryWater spinach

KohlrabiMalabar spinach

Chinese cabbageFennel

Rutabago

Nitrate content 500 to < 1000 mg/kg fresh weight

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Nitrate content ≥ 2000 mg/kg FW

Nitrate content 1000 to < 2000 mg/kg FW

Nitrate content 500 to < 1000 mg/kg FW

Nitrate content ≤ 500 mg/kg FW

Chi

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flat

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Fals

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EndiveFenugreek

TurnipChicory leaves

Nitrate content ≤ 500 mg/kg fresh weight

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Nitrate content ≥ 2000 mg/kg FW

Nitrate content 1000 to < 2000 mg/kg FW

Nitrate content 500 to < 1000 mg/kg FW

Nitrate content ≤ 500 mg/kg FW

Chi

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flat

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Fals

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Bean

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Spring onionSquash

AmaranthWinter melon

CabbageBitter melon

YamGarden bean

TaroGreen onion

CeleriacEggplantBroccoli

PumpkinLeek

RhubarbCucumber

CauliflowerCarrotPotato

OkraBelgium endive

Bell pepperBlack salsify

AsparagusParsnip

OnionRadicchio

TomatoSweet potato

ChicoryBean sprouts

Brussel sproutsPea

CornMushroom

15 year follow-up study (1998-2013)

n=1500

70-85 years

25 vegetable

items

0 10 20 30 40 50 60 70 80 90 100

Vegetable

Fruit

Meat

Other

Grain

Dairy

Percentage by Weight (%)0 10 20 30 40 50 60 70 80 90 100

Vegetable

Fruit

Meat

Other

Grain

Dairy

Percentage by Weight (%)

0.2%0.2%

2.7%2.7%

3.0%3.0%

84.4%84.4%

6.4%6.4%

3.3%3.3%

Nitrate intake by food group

Vegetables 84.4%

Nitrate intake by vegetable

Cardiovascular disease survival rate

T1 (<52.7 mg/d): Referent

T2 (52.7-76.4 mg/d): HR 0.58 (95%CI 0.42, 0.82), P = 0.002

T3 (>76.4 mg/d): HR 0.65 (95%CI 0.47, 0.92), P = 0.013

P for trend = 0.016

T1 (<52.7 mg/d): Referent

T2 (52.7-76.4 mg/d): HR 0.58 (95%CI 0.42, 0.82), P = 0.002

T3 (>76.4 mg/d): HR 0.65 (95%CI 0.47, 0.92), P = 0.013

P for trend = 0.016

Common carotid artery intima media thickness

Common carotid artery intima-media thickness (CCA-IMT)

Mean CCA-IMT (mm) Maximum CCA-IMT (mm)

Summary

↓ risk of cardiovascular disease mortality

↓ carotid artery intima-media thickness

Vegetables types

Cardiovascular disease mortality

13% ↓

11% ↓

18% ↓

Common carotid artery intima-media thickness

0.8% ↓

Cruciferous, allium and nitrate-rich vegetables

Summary

reduced risk of cardiovascular disease mortality and subclinical

atherosclerosis

Questions?

reduced CVD death

reduced CVD death and atherosclerosis

reduced CVD death and atherosclerosis