Journal List > Korean J Community Nutr > v.19(5) > 1038480

Kim and Choi: Factors Associated with Fruit and Vegetable Consumption of Subjects Having a History of Stroke: Using 5th Korea National Health and Nutrition Examination Survey (2010, 2011)

Abstract

Objectives

Intake of fruits and vegetables has protective effects against stroke attack. This study intended to examine the status of consuming fruits and vegetables and to find out which factors may influence the frequency of consumption of fruits and vegetables in individuals with a history of stroke.

Methods

The data of 208 subjects from 5th (2010, 2011) Korea National Health and Nutrition Examination Survey (KNHNES) who reported a stroke diagnosis was used for analysis. To identify major factors influencing the consumption of fruits and vegetables, a classification-tree analysis was carried out.

Results

Among those who reported a stroke diagnosis, the frequencies of consumption of fruits and vegetables were influenced by their age, place of residence (urban or rural), economic status, educational level, occupation, number of family members, frequency of eating out, and having meals (breakfast or lunch) with family members. Two factors from fruits and three factors from vegetables were generated by exploratory factor analyses. Urban residents ate fruits and vegetables more frequently in all factors than rural residents. Eating frequencies of 'seasonal fruits (orange, apple, strawberry, melon, pear and watermelon)', 'easily-accessible fruits (persimmon, tangerine, grape, peach, banana)', and 'Western-style vegetables (cabbage, mushroom, carrot, tomato, spinach)' were influenced by the socioeconomic status. Eating frequencies of 'Korean-style vegetables (bean sprout, radish leaves, pumpkin/squash, sea weed)', 'preserved vegetables (Korean cabbage, radish, laver, cucumber)' were influenced by having breakfast with amily members.

Conclusions

The results of this study suggested that by eating more fruits and vegetables, more preventive effects against secondary stroke attack are expected in stroke patients who live in the rural areas and who do not eat breakfast with family members. In addition, more outreach and education programs are needed for them.

Figures and Tables

Fig. 1
A classification tree model for fruit consumption frequency.
Fruit 1: Seasonal fruits (orange, apple, strawberry, melon, pear, watermelon), Fruit 2: Easily-accessible fruits (persimmon, tangerine, grape, peach, banana), 1) Mean ± SD, sum of the consumption frequency scores for each fruit (0: rarely eat, 1: 6~7 times/year, 2: 1 time/month, 3: 2~3 times/month, 4: 1 time/week, 5: 2~3 times/week, 6: 4~6 times/week, 7: 1 time/day, 8: 2 times/day, 9: 3 times/day) The maximum scores are 54 (F1) and 45 (F2) for each. 2) N (%)
*: p < 0.05, **: p < 0.01, ***: p < 0.001
kjcn-19-468-g001
Fig. 2
A classification tree model for vegetable consumption frequency.
Vegetable 1: Western-style vegetables (cabbage, mushrooms, carrot, tomato, spinach), Vegetable 2: Korean-style vegetables (bean sprout, radish leaves, pumpkin/squash, seaweed), Vegetable 3: Preserved vegetables (Korean cabbage, radish, laver, cucumber), 1) Mean ± SD, of the consumption frequency scores for each vegetable (0: rarely eat, 1: 6~7 times/year, 2: 1 time/month, 3: 2~3 times/ month, 4: 1 time/week, 5: 2~3 times/week, 6: 4~6 times/week, 7: 1 time/day, 8: 2 times/day, 9: 3 times/day) The maximum scores are 45 (V1), 36 (V2), 36 (V3) for each. 2) N (%)
*: p < 0.05, **: p < 0.01, ***: p < 0.001
kjcn-19-468-g002
Table 1
Validity and reliability of fruit and vegetable consumption frequency measure
kjcn-19-468-i001
Table 2
Fruit and vegetable consumption frequency by characteristics of the study subjects
kjcn-19-468-i002

1) The consumption frequency score of a factor is sum of the scores for each food (0: rarely eat, 1: 6~7 times/year, 2: 1 time/month, 3: 2~3 times/month, 4: 1 time/week, 5: 2~3 times/week, 6: 4~6 times/week, 7: 1 time/day, 8: 2 times/day, 9: 3 times/day) included in the factor (Fruit 1: seasonal fruits, orange, apple, strawberry, melon, pear, watermelon, Fruit 2: easily-accessible fruits, persimmon, tangerine, grape, peach, banana, Vegetable 1: Western-style vegetables, cabbage, mushrooms, carrot, tomato, spinach, Vegetable 2: Korean-style vegetables, bean sprout, radish leaves, pumpkin/squash, seaweed, Vegetable 3: preserved vegetables, Korean cabbage, radish, laver, cucumber).

2) Mean ± SD

abc: Values with Different superscripts in a column are significantly different by Scheffe's multiple range test (p < 0.05).

*: p < 0.05, **: p < 0.01, ***: p < 0.001

References

1. Addo J, Ayerbe L, Mohan KM, Crichton S, Sheldenkar A, Chen R, Wolfe CD, McKevitt C. Socioeconomic status and stroke: an updated review. Stroke. 2012; 43(4):1186–1191.
2. Avendaño M, Kunst AE, Huisman M, LentheFV , Bopp M, Borrell C, Valkonen T, Regidor E, Costa G, Donkin A, Borgan JK, Deboosere P, Gadeyne S, Spadea T, Andersen O, Mackenbach JP. Educational level and stroke mortality: a comparison of 10 European populations during the 1990s. Stroke. 2004; 35(2):432–437.
3. Cahill LE, Chiuve SE, Mekary RA, Jensen MK, Flint AJ, Hu FB, Rimm EB. Prospective study of breakfast eating and incident coronary heart disease in a cohort of male US health professionals. Circulation. 2013; 128(4):337–343.
4. Cox AM, McKevitt C, Rudd AG, Wolfe CD. Socioeconomic status and stroke. Lancet Neurol. 2006; 5(2):181–188.
5. Dauchet L, Amouyel P, Dallongeville J. Fruit and vegetable consumption and risk of stroke: a meta-analysis of cohort studies. Neurology. 2005; 65(8):1193–1197.
6. De Gregorio J, Lee JW. Education and income inequality: new evidence from cross-country data. Rev Income Wealth. 2002; 48(3):395–416.
7. Farshchi HR, Taylor MA, Macdonald IA. Deleterious effects of omitting breakfast on insulin sensitivity and fasting lipid profiles in healthy lean women. Am J Clin Nutr. 2005; 81(2):388–396.
8. Fjellström K. Mealtime and meal patterns from a cultural perspective. Scand J Nutr. 2004; 48(4):161–164.
9. Fung TT, Chiuve SE, McCullough ML, Rexrode KM, Logroscino G, Hu FB. Adherence to a DASH-Style diet and risk of coronary heart disease and stroke in women. Arch Intern Med. 2008; 168(7):713–720.
10. Fung TT, Rexrode KM, Mantzoros CS, Manson JE, Willett WC, Hu FB. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation. 2009; 119(8):1093–1100.
11. Fung TT, Stampfer MJ, Manson JE, Rexrode KM, Willett WC, Hu FB. Prospective study of major dietary patterns and stroke risk in women. Stroke. 2004; 35(9):2014–2019.
12. He FJ, Nowson CA, MacGregor GA. Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet. 2006; 367(9507):320–326.
13. He K, Song Y, Daviglus ML, Liu K, Van Horn L, Dyer AR. Fish consumption and incidence of stroke: a meta-analysis of cohort studies. Stroke. 2004; 35(7):1538–1542.
14. Irala-Estévez JD, Groth M, Johansson L, Oltersdorf U, Prättälä R, Martínez-González MA. A systematic review of socio-economic differences in food habits in Europe: consumption of fruit and vegetables. Eur J Clin Nutr. 2000; 54(9):706–714.
15. Joshipura KJ, Ascherio A, Manson JE, Stampfer MJ, Rimm EB, Speizer FE, Hennekens CH, Spiegelman D, Willett WC. Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA. 1999; 282(13):1233–1239.
16. Kang BS, Kim GS. Statistic for social science. 3rd ed. Seoul: Hannarae;2011. p. 541–566.
17. Kass GV. An exploratory technique for investigating large quantities of categorical data. Appl Stat. 1980; 29(2):119–127.
18. Kim EM, Choi MK. An analysis of food consumption patterns of the elderly from the Korea National Health and Nutrition Examination Survey (KNHANES V-1). J Korean Soc Food Sci Nutr. 2013; 42(5):818–827.
19. Kokubo Y, Iso H, Ishihara J, Okada K, Inoue M, Tsugane S. JPHC Study Group. Association of dietary intake of soy, beans, and isoflavones with risk of cerebral and myocardial infarctions in Japanese populations: the Japan Public Health Center-based (JPHC) study cohort I. Circulation. 2007; 116(22):2553–2562.
20. Korea Center for Disease Control and Prevention. Korea Health Statistics 2010: Korea National Health and Nutrition Examination Survey (KNHANES V). 2012. cited April 25, 2014. Available from https://knhanes.cdc.go.kr/knhanes/index.do.
21. Korean Statistical Information Service. 2008~2010 national wage workers by occupation/income level. 2011. cited April 25, 2014. Available from http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1ES1B20&vw_cd=&list_id=&scrId=&seqNo=&lang_mode=ko&obj_var_id=&itm_id=&conn_path=K1&path.
22. Korean Statistical Information Service. Annual report on the cause of death statistics. 2013. cited April 25, 2014. Available from http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1B34E07&vw_cd=MT_ZTITLE&list_id=D11&seqNo=&lang_mode=ko&language=kor&obj_var_id=&itm_id=&conn_path=E1.
23. Korean Statistical Information Service. 2013 national wage workers by Sex/Education level/income level. 2014. cited April 25, 2014. Available from http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1ES3D04&vw_cd=&list_id=&scrId=&seqNo=&lang_mode=ko&obj_var_id=&itm_id=&conn_path=K1&path.
24. Lallukka T, Pitkäniemi J, Rahkonen O, Roos E, Laaksonen M, Lahelma E. The association of income with fresh fruit and vegetable consumption at different levels of education. Eur J Clin Nutr. 2010; 64(3):324–327.
25. Larsson SC, Virtamo J, Wolk A. Coffee consumption and risk of stroke in women. Stroke. 2011; 42(4):908–912.
26. Larsson SC, Virtamo J, Wolk A. Chocolate consumption and risk of stroke: a prospective cohort of men and meta-analysis. Neurology. 2012; 79(12):1223–1229.
27. Lee DP, Park SH, Kim TY, Seong JI, Shin EJ, Kim JH. An analysis of the reasons for income and development gap between urban and rural regions. Seoul: Korea Rural Economy Institute;2004. p. 70–73.
28. Lee KI, Hwang YJ, Kim DW, Ban HJ, Park IH. The consumer behavior survey for food. Seoul: Korea Rural Economy Institute;2013. p. 211–212.
29. Liese AD, Weis KE, Pluto D, Smith E, Lawson A. Food store types, availability, and cost of foods in a rural environment. J Am Diet Assoc. 2007; 107(11):1916–1923.
30. Liu S, Manson JE, Stampfer MJ, Rexrode KM, Hu FB, Rimm EB, Willett WC. Whole grain consumption and risk of ischemic stroke in women: a prospective study. JAMA. 2000; 284(12):1534–1540.
31. Lutfiyya MN, Chang LF, Lipsky MS. A cross-sectional study of US rural adults’ consumption of fruits and vegetables: do they consume at least five servings daily? BMC Public Health. 2012; 12:280.
32. Mekary RA, Giovannucci E, Willett WC, van Dam RM, Hu FB. Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking. Am J Clin Nutr. 2012; 95(5):1182–1189.
33. Mizrahi A, Knekt P, Montonen J, Laaksonen MA, Heliövaara M, Järvinen R. Plant foods and the risk of cerebrovascular diseases: a potential protection of fruit consumption. Br J Nutr. 2009; 102(7):1075–1083.
34. National Stroke Association. Physical activity and healthy diet. 2014. cited April 25, 2014. Available from http://www.stroke.org/site/PageServer?pagename=eathealthy.
35. Oude Griep LM, Verschuren WM, Kromhout D, Ocké MC, Geleijnse JM. Colors of fruit and vegetables and 10-year incidence of stroke. Stroke. 2011; 42(11):3190–3195.
36. Oude Griep LM, Verschuren WM, Kromhout D, Ocké MC, Geleijnse JM. Raw and processed fruit and vegetable consumption and 10-year stroke incidence in a population-based cohort study in the Netherlands. Eur J Clin Nutr. 2011; 65(7):791–799.
37. Park KA, Kim JS, Choi SM. Study on altered food preference and food frequency in stroke patients. Korean J Nutr. 2003; 36(6):622–634.
38. Park TH, Kim MK, Lee KB, Park JM, Lee SJ, Jung KW, Cho YJ, Lee JS, Lee JY, Bae HJ. Prevalence of risk factors for ischemic stroke in Korean: a systematic review. J Korean Neurol Assoc. 2009; 27(1):19–27.
39. Park Y. Intakes of vegetables and related nutrients such as vitamin B complex, potassium, and calcium, are negatively correlated with risk of stroke in Korea. Nutr Res Pract. 2010; 4(4):303–310.
40. Sacco RL. Secondary prevention of ischemic stroke: a 1998 US perspective. Cerebrovasc Dis. 1999; 9:suppl 3. 37–44.
41. Sacco RL, Elkind M, Boden-Albala B, Lin IF, Kargman DE, Hauser WA. The protective effect of moderate alcohol consumption on ischemic stroke. JAMA. 1999; 281(1):53–60.
42. Sauvaget C, Nagano J, Allen N, Kodama K. Vegetable and fruit intake and stroke mortality in the Hiroshima/Nagasaki life span study. Stroke. 2003; 34(10):2355–2360.
43. Sidenvall B, Nydahl M, Fjellström C. The meal as a gift-the meaning of cooking among retired women. JAppl Gerontol. 2000; 19(4):405–423.
44. Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010; 92(5):1189–1196.
45. Sung SJ, Jung DG, Lee WK, Kim YJ, Lee HS. Life style and eating behavior of stroke patients in Daegu and Gyeongbukprovince, Korea. J Korean Soc Food Sci Nutr. 2009; 38(3):319–332.
46. Sung SJ, Jung DG, Lee WK, Kim YJ, Lee HS. Analysis of relative risk of stroke by nutrient intake levels: case-control study in Daegu Gyeongbuk area, Korea. J Korean Soc Food Sci Nutr. 2009; 38(8):1050–1061.
47. United States Department of Health and Human Services and United States Department of Agriculture. Dietary guidelines for americans. 7th ed. Washington DC: United States Government Printing Office;2010. p. 79–80.
48. Van der Heijden AA, Hu FB, Rimm EB, Van dam RM. A prospective study of breakfast consumption and weight gain among U.S. men. Obesity (Silver Spring). 2007; 15(10):2463–2469.
49. Zhang Y, Tuomilehto J, Jousilahti P, Wang Y, Antikainen R, Hu G. Lifestyle factors on the risks of ischemic and hemorrhagic strokes. Arch Intern Med. 2011; 171(20):1811–1818.
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