Vegetable diversity in relation with subclinical atherosclerosis and 15-year atherosclerotic vascular disease deaths in older adult women

  • Lauren C. BlekkenhorstEmail author
  • Joshua R. Lewis
  • Catherine P. Bondonno
  • Marc Sim
  • Amanda Devine
  • Kun Zhu
  • Wai H. Lim
  • Richard J. Woodman
  • Lawrence J. Beilin
  • Peter L. Thompson
  • Richard L. Prince
  • Jonathan M. Hodgson
Original Contribution



Increasing vegetable intake and diversity are recommended to maintain better health. Evidence for the health benefits of vegetable diversity, separate from total intake, is scarce. We aimed to investigate the associations of vegetable diversity with subclinical measures of atherosclerosis and atherosclerotic vascular disease (ASVD) mortality.


Vegetable diversity was assessed within a validated food frequency questionnaire using a single question, ‘How many different vegetables do you usually consume each day (< 1 to ≥ 6 per day)’. Cox proportional hazards modelling was used to examine the association between vegetable diversity and ASVD mortality in 1226 women aged ≥ 70 years without clinical ASVD or diabetes mellitus at baseline (1998). In 2001, B-mode ultrasonography was used to measure common carotid artery intima–media thickness (CCA-IMT) (n = 954) and carotid plaque severity (n = 968).


Over 15 years (15,947 person-years) of follow-up, 238 ASVD-related deaths were recorded. For each additional different vegetable consumed per day, there was 17% lower hazard for ASVD mortality (HR = 0.83, 95% CI 0.78, 0.93, P = 0.001); a 1.7% lower mean CCA-IMT (B ± SE: − 0.013 ± 0.004, P < 0.001); and a 1.8% lower maximum CCA-IMT (B ± SE: − 0.017 ± 0.004, P < 0.001). Further adjustment for total vegetable intake attenuated the association between vegetable diversity and ASVD mortality (P = 0.114), but not CCA-IMT (P = 0.024). No association was observed between vegetable diversity and carotid plaque severity (P > 0.05).


Vegetable diversity may contribute to benefits in lowering risk of ASVD in older women. The reduction in risk is partly explained by increased total vegetable consumption.

Clinical trial registry

The Perth Longitudinal Study of Aging in Women (PLSAW) trial registration ID is ACTRN12617000640303. This study was retrospectively registered on the Australian New Zealand Clinical Trials Registry at


Cardiovascular diseases Atherosclerosis Mortality Vegetables Diversity Older women 



Atherosclerotic vascular disease


Common carotid artery intima–media thickness


Chronic Kidney Disease Epidemiology Collaboration


Estimated glomerular filtration rate


Framingham risk scores


High-density lipoprotein


International Classification of Diseases


International Classification of Primary Care-Plus


Low-density lipoprotein


Nutrient reference values


Perth Longitudinal Study of Aging in Women


Western Australian Data Linkage System (WADLS).



The authors wish to thank the staff at the Western Australian Data Linkage Branch; Hospital Morbidity Data Collection; Registry of Births, Deaths and Marriages; Victorian Department of Justice and Regulation; and the National Coronial Information System for their work on providing the data for this study.

Author contributions

LCB, JRL, MS, AD, RLP, and JMH: study concept and design; JRL, AD, KZ, WHL, PLT, and RLP: acquisition of data; LCB, RJW, and JMH: statistical analysis and interpretation of data; LCB: drafting of the manuscript; and all authors: critical revision of the manuscript for important intellectual content.


The Perth Longitudinal Study of Aging in Women (PLSAW) study was funded by Healthway the Western Australian Health Promotion Foundation and by Project Grants 254627, 303169, and 572604 from the National Health and Medical Research Council (NHMRC) of Australia. The analysis was supported by an NHMRC of Australia Project Grant 1084922. NHMRC of Australia Fellowships supported the salaries of JRL and JMH. None of these funding agencies had any role in the conduct of the study; collection, management, analysis, or interpretation of the data; or the preparation, review or approval of the manuscript.

Compliance with ethical standards

Conflict of interest

All authors have no potential conflicts of interest.

Supplementary material

394_2019_1902_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Lauren C. Blekkenhorst
    • 1
    Email author
  • Joshua R. Lewis
    • 1
    • 2
    • 3
    • 4
  • Catherine P. Bondonno
    • 1
    • 2
  • Marc Sim
    • 1
  • Amanda Devine
    • 1
  • Kun Zhu
    • 2
    • 5
  • Wai H. Lim
    • 2
    • 6
  • Richard J. Woodman
    • 7
  • Lawrence J. Beilin
    • 2
  • Peter L. Thompson
    • 8
  • Richard L. Prince
    • 2
    • 5
  • Jonathan M. Hodgson
    • 1
    • 2
  1. 1.School of Health and Medical SciencesEdith Cowan UniversityJoondalupAustralia
  2. 2.Medical SchoolThe University of Western AustraliaPerthAustralia
  3. 3.Centre for Kidney ResearchChildren’s Hospital at WestmeadWestmeadAustralia
  4. 4.School of Public Health, Sydney Medical SchoolThe University of SydneySydneyAustralia
  5. 5.Department of Endocrinology and DiabetesSir Charles Gairdner HospitalNedlandsAustralia
  6. 6.Renal MedicineSir Charles Gairdner HospitalNedlandsAustralia
  7. 7.Flinders Centre for Epidemiology and BiostatisticsFlinders UniversityAdelaideAustralia
  8. 8.Department of Cardiovascular MedicineSir Charles Gairdner HospitalNedlandsAustralia

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