Skip to main content

Fruit and vegetable consumption in relation to primary headaches: the MEPHASOUS study

Abstract

Background

Fruit and vegetable consumption may beneficially affect the odds of primary headaches due to their antioxidant contents. However, no study has examined the association between fruit and vegetable consumption and primary headaches among university students.

Aim

To assess the relation between fruit and vegetable intakes and primary headaches among Iranian university students.

Methods

Overall, 83,214 university students with an age range of ≥ 18 years participated in the present study. Dietary intakes and also data on confounding variables were collected using validated questionnaires. Data on dietary intakes were collected using a validated dietary habits questionnaire. We used the International Classification of Headache Disorders-3 (ICHD-3) criteria to define primary headaches.

Results

Fruit consumption was negatively associated with primary headaches; such that after controlling for potential confounders, greater intake of fruits was associated with 30% lower odds of primary headaches (OR: 0.70, 95% CI 0.58–0.84). Such an inverse association was also found for vegetable consumption. In the fully adjusted model, students in the top category of vegetable consumption were 16% less likely to have primary headaches compared with those in the bottom category (OR: 0.84, 95% CI 0.74–0.95). Subgroup analysis revealed that fruit consumption was inversely associated with primary headaches in females, unlike males, and vegetable consumption was inversely associated with these headaches in males, as opposed to females. Moreover, fruit and vegetable consumption was related to lower odds of primary headaches in normal-weight students.

Conclusion

Fruit and vegetable intakes were associated with reduced odds of primary headaches.

Level of evidence

Level III, cross-sectional analytic studies.

This is a preview of subscription content, access via your institution.

References

  1. Taghavi M, Sadeghi A, Maleki V, Nasiri M, Khodadost M, Pirouzi A et al (2019) Adherence to the dietary approaches to stop hypertension-style diet is inversely associated with chronic kidney disease: a systematic review and meta-analysis of prospective cohort studies. Nutr Res 72:46–56. https://doi.org/10.1016/j.nutres.2019.10.007

    CAS  Article  PubMed  Google Scholar 

  2. Sadeghi O, Keshteli AH, Afshar H, Esmaillzadeh A, Adibi P (2019) Adherence to Mediterranean dietary pattern is inversely associated with depression, anxiety and psychological distress. Nutr Neurosci. https://doi.org/10.1080/1028415x.2019.1620425

    Article  PubMed  Google Scholar 

  3. Veronese N, Solmi M, Caruso MG, Giannelli G, Osella AR, Evangelou E et al (2018) Dietary fiber and health outcomes: an umbrella review of systematic reviews and meta-analyses. Am J Clin Nutr 107:436–444. https://doi.org/10.1093/ajcn/nqx082

    Article  PubMed  Google Scholar 

  4. Rocha VZ, Ras RT, Gagliardi AC, Mangili LC, Trautwein EA, Santos RD (2016) Effects of phytosterols on markers of inflammation: a systematic review and meta-analysis. Atherosclerosis 248:76–83. https://doi.org/10.1016/j.atherosclerosis.2016.01.035

    CAS  Article  PubMed  Google Scholar 

  5. Vergnaud AC, Norat T, Romaguera D, Mouw T, May AM, Romieu I et al (2012) Fruit and vegetable consumption and prospective weight change in participants of the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home, and Obesity study. Am J Clin Nutr 95:184–193. https://doi.org/10.3945/ajcn.111.019968

    CAS  Article  PubMed  Google Scholar 

  6. Julius JK, Fernandez CK, Grafa AC, Rosa PM, Hartos JL (2019) Daily fruit and vegetable consumption and diabetes status in middle-aged females in the general US population. SAGE Open Med 7:2050312119865116. https://doi.org/10.1177/2050312119865116

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lamb MJ, Griffin SJ, Sharp SJ, Cooper AJ (2017) Fruit and vegetable intake and cardiovascular risk factors in people with newly diagnosed type 2 diabetes. Eur J Clin Nutr 71:115–121. https://doi.org/10.1038/ejcn.2016.180

    CAS  Article  PubMed  Google Scholar 

  8. Mikkelsen K, Stojanovska L, Apostolopoulos V (2016) The effects of vitamin B in depression. Curr Med Chem 23:4317–4337. https://doi.org/10.2174/0929867323666160920110810

    CAS  Article  PubMed  Google Scholar 

  9. Saghafian F, Malmir H, Saneei P, Keshteli AH, Hosseinzadeh-Attar MJ, Afshar H et al (2018) Consumption of fruit and vegetables in relation with psychological disorders in Iranian adults. Eur J Nutr 57:2295–2306. https://doi.org/10.1007/s00394-018-1652-y

    Article  PubMed  Google Scholar 

  10. Anjom-Shoae J, Sadeghi O, Keshteli AH, Afshar H, Esmaillzadeh A, Adibi P (2020) Legume and nut consumption in relation to depression, anxiety and psychological distress in Iranian adults. Eur J Nutr. https://doi.org/10.1007/s00394-020-02197-1

    Article  PubMed  Google Scholar 

  11. Sadeghi O, Hassanzadeh-Keshteli A, Afshar H, Esmaillzadeh A, Adibi P (2019) The association of whole and refined grains consumption with psychological disorders among Iranian adults. Eur J Nutr 58:211–225. https://doi.org/10.1007/s00394-017-1585-x

    Article  PubMed  Google Scholar 

  12. Steiner TJ, Stovner LJ, Vos T, Jensen R, Katsarava Z (2018) Migraine is first cause of disability in under 50 s: will health politicians now take notice? J Headache Pain 19:17. https://doi.org/10.1186/s10194-018-0846-2

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mansouri M, Sharifi F, Varmaghani M, Yaghubi H, Shokri A, Moghadas-Tabrizi Y et al (2020) Dairy consumption in relation to primary headaches among a large population of university students: the MEPHASOUS study. Complement Ther Med 48:102269. https://doi.org/10.1016/j.ctim.2019.102269

    Article  PubMed  Google Scholar 

  14. Wang X, Zhou HB, Sun JM, Xing YH, Zhu YL, Zhao YS (2016) The prevalence of migraine in university students: a systematic review and meta-analysis. Eur J Neurol 23:464–475. https://doi.org/10.1111/ene.12784

    CAS  Article  PubMed  Google Scholar 

  15. Vilaro MJ, Colby SE, Riggsbee K, Zhou W, Byrd-Bredbenner C, Olfert MD et al (2018) Food choice priorities change over time and predict dietary intake at the end of the first year of college among students in the U.S. Nutrients. https://doi.org/10.3390/nu10091296

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hilger J, Loerbroks A, Diehl K (2017) Eating behaviour of university students in Germany: dietary intake, barriers to healthy eating and changes in eating behaviour since the time of matriculation. Appetite 109:100–107. https://doi.org/10.1016/j.appet.2016.11.016

    Article  PubMed  Google Scholar 

  17. Betancourt-Nunez A, Marquez-Sandoval F, Gonzalez-Zapata LI, Babio N, Vizmanos B (2018) Unhealthy dietary patterns among healthcare professionals and students in Mexico. BMC Public Health 18:1246. https://doi.org/10.1186/s12889-018-6153-7

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mansouri M, Sharifi F, Varmaghani M, Yaghubi H, Tabrizi YM, Raznahan M et al (2017) Iranian university students lifestyle and health status survey: study profile. J Diabetes Metab Disord 16:48. https://doi.org/10.1186/s40200-017-0329-z

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mansouri M, Hasani-Ranjbar S, Yaghubi H, Rahmani J, Tabrizi YM, Keshtkar A et al (2018) Breakfast consumption pattern and its association with overweight and obesity among university students: a population-based study. Eat Weight Disord. https://doi.org/10.1007/s40519-018-0609-8

    Article  PubMed  Google Scholar 

  20. Mansouri M, Miri A, Varmaghani M, Abbasi R, Taha P, Ramezani S et al (2019) Vitamin D deficiency in relation to general and abdominal obesity among high educated adults. Eat Weight Disord 24:83–90. https://doi.org/10.1007/s40519-018-0511-4

    Article  PubMed  Google Scholar 

  21. Mansouri M, Abasi R, Nasiri M, Sharifi F, Vesaly S, Sadeghi O et al (2018) Association of vitamin D status with metabolic syndrome and its components: a cross-sectional study in a population of high educated Iranian adults. Diabetes Metab Syndr 12:393–398. https://doi.org/10.1016/j.dsx.2018.01.007

    Article  PubMed  Google Scholar 

  22. McAbee GN, Morse AM, Assadi M (2016) Pediatric aspects of headache classification in the international classification of headache disorders-3 (ICHD-3 beta version). Curr Pain Headache Rep 20:7. https://doi.org/10.1007/s11916-015-0537-5

    Article  PubMed  Google Scholar 

  23. Dabbagh-Moghadam A, Mozaffari-Khosravi H, Nasiri M, Miri A, Rahdar M, Sadeghi O (2017) Association of white and red meat consumption with general and abdominal obesity: a cross-sectional study among a population of Iranian military families in 2016. Eat Weight Disord 22:717–724. https://doi.org/10.1007/s40519-017-0385-x

    Article  PubMed  Google Scholar 

  24. Vaduganathan M, Pareek M, Qamar A, Pandey A, Olsen MH, Bhatt DL (2018) Baseline blood pressure, the 2017 ACC/AHA high blood pressure guidelines, and long-term cardiovascular risk in SPRINT. Am J Med 131:956–960. https://doi.org/10.1016/j.amjmed.2017.12.049

    Article  PubMed  Google Scholar 

  25. Barbanti P, Fofi L, Aurilia C, Egeo G, Caprio M (2017) Ketogenic diet in migraine: rationale, findings and perspectives. Neurol Sci 38:111–115. https://doi.org/10.1007/s10072-017-2889-6

    Article  PubMed  Google Scholar 

  26. Finocchi C, Sivori G (2012) Food as trigger and aggravating factor of migraine. Neurol Sci 33(Suppl 1):S77–S80. https://doi.org/10.1007/s10072-012-1046-5

    Article  PubMed  Google Scholar 

  27. Nazari F, Eghbali M (2012) Migraine and its relationship with dietary habits in women. Iran J Nurs Midwifery Res 17:S65–S71

    PubMed  PubMed Central  Google Scholar 

  28. Mirzababaei A, Khorsha F, Togha M, Yekaninejad MS, Okhovat AA, Mirzaei K (2018) Associations between adherence to dietary approaches to stop hypertension (DASH) diet and migraine headache severity and duration among women. Nutr Neurosci. https://doi.org/10.1080/1028415x.2018.1503848

    Article  PubMed  Google Scholar 

  29. Ferrara LA, Pacioni D, Di Fronzo V, Russo BF, Speranza E, Carlino V et al (2015) Low-lipid diet reduces frequency and severity of acute migraine attacks. Nutr Metab Cardiovasc Dis 25:370–375. https://doi.org/10.1016/j.numecd.2014.12.006

    CAS  Article  PubMed  Google Scholar 

  30. Jafarpour M, Yousefi G, Hamedi A, Shariat A, Salehi A, Heydari M (2016) Effect of a traditional syrup from Citrus medica L. fruit juice on migraine headache: a randomized double blind placebo controlled clinical trial. J Ethnopharmacol 179:170–176. https://doi.org/10.1016/j.jep.2015.12.040

    Article  PubMed  Google Scholar 

  31. Almeida-de-Souza J, Santos R, Lopes L, Abreu S, Moreira C, Padrao P et al (2018) Associations between fruit and vegetable variety and low-grade inflammation in Portuguese adolescents from LabMed Physical Activity Study. Eur J Nutr 57:2055–2068. https://doi.org/10.1007/s00394-017-1479-y

    CAS  Article  PubMed  Google Scholar 

  32. Ramachandran R (2018) Neurogenic inflammation and its role in migraine. Semin Immunopathol 40:301–314. https://doi.org/10.1007/s00281-018-0676-y

    CAS  Article  PubMed  Google Scholar 

  33. Henning SM, Yang J, Shao P, Lee RP, Huang J, Ly A et al (2017) Health benefit of vegetable/fruit juice-based diet: role of microbiome. Sci Rep 7:2167. https://doi.org/10.1038/s41598-017-02200-6

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. Arzani M, Jahromi SR, Ghorbani Z, Vahabizad F, Martelletti P, Ghaemi A et al (2020) Gut-brain Axis and migraine headache: a comprehensive review. J Headache Pain 21:15. https://doi.org/10.1186/s10194-020-1078-9

    Article  PubMed  PubMed Central  Google Scholar 

  35. Williams RL, Wood LG, Collins CE, Callister R (2016) Comparison of fruit and vegetable intakes during weight loss in males and females. Eur J Clin Nutr 70:28–34. https://doi.org/10.1038/ejcn.2015.123

    CAS  Article  PubMed  Google Scholar 

  36. Miri A, Nasiri M, Zonoori S, Yarahmad F, Dabbagh-Moghadam A, Askari G et al (2018) The association between obesity and migraine in a population of Iranian adults: a case-control study. Diabetes Metab Syndr 12:733–736. https://doi.org/10.1016/j.dsx.2018.04.020

    Article  PubMed  Google Scholar 

  37. Merki-Feld GS, Imthurn B, Gantenbein AR, Sandor P (2019) Effect of desogestrel 75 microg on headache frequency and intensity in women with migraine: a prospective controlled trial. Eur J Contracept Reprod Health Care 24:175–181. https://doi.org/10.1080/13625187.2019.1605504

    Article  PubMed  Google Scholar 

  38. Roque C, Mendes-Oliveira J, Duarte-Chendo C, Baltazar G (2019) The role of G protein-coupled estrogen receptor 1 on neurological disorders. Front Neuroendocrinol 55:100786. https://doi.org/10.1016/j.yfrne.2019.100786

    CAS  Article  PubMed  Google Scholar 

  39. Anjom-Shoae J, Sadeghi O, Hassanzadeh Keshteli A, Afshar H, Esmaillzadeh A, Adibi P (2018) The association between dietary intake of magnesium and psychiatric disorders among Iranian adults: a cross-sectional study. Br J Nutr 120:693–702. https://doi.org/10.1017/s0007114518001782

    CAS  Article  PubMed  Google Scholar 

  40. Anjom-Shoae J, Keshteli AH, Sadeghi O, Pouraram H, Afshar H, Esmaillzadeh A et al (2019) Association between dietary insulin index and load with obesity in adults. Eur J Nutr. https://doi.org/10.1007/s00394-019-02012-6

    Article  PubMed  Google Scholar 

  41. Sadeghi O, Sadeghian M, Rahmani S, Maleki V, Larijani B, Esmaillzadeh A (2019) Whole-grain consumption does not affect obesity measures: an updated systematic review and meta-analysis of randomized clinical trials. Adv Nutr. https://doi.org/10.1093/advances/nmz076

    Article  PubMed Central  Google Scholar 

  42. Cox AJ, West NP, Cripps AW (2015) Obesity, inflammation, and the gut microbiota. Lancet Diabetes Endocrinol 3:207–215. https://doi.org/10.1016/s2213-8587(14)70134-2

    CAS  Article  PubMed  Google Scholar 

  43. Cavestro C, Ferrero M, Mandrino S, Di Tavi M, Rota E (2019) Novelty in inflammation and immunomodulation in migraine. Curr Pharm Des 25:2919–2936. https://doi.org/10.2174/1381612825666190709204107

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors acknowledge the staffs, fieldworkers, and participants of the MEPHASOUS project that without whom this work would not have been possible. This study was supported by the Tarbiat Modares University, Tehran, Iran.

Funding

The study was financially supported by the Tarbiat Modares University, Tehran, Iran, in collaboration with the health organization of Ministry of Science and Technology (CHOMST), Tehran, Iran.

Author information

Authors and Affiliations

Authors

Contributions

MM, FS, MV, and AK contributed to study conception, design, and data collection. OS contributed to statistical analysis. OS, HR and AS contributed to manuscript drafting. All authors acknowledge the full responsibility for the analyses and interpretation of the report. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Omid Sadeghi.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Ethics approval and consent to participate

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All participants provided a signed written consent form. The ethics committee of the MST, Tehran, Iran, approved the whole project (code: 4/5/109779).

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mansouri, M., Sharifi, F., Varmaghani, M. et al. Fruit and vegetable consumption in relation to primary headaches: the MEPHASOUS study. Eat Weight Disord 26, 1617–1626 (2021). https://doi.org/10.1007/s40519-020-00984-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-020-00984-7

Keywords

  • Fruit
  • Vegetable
  • Headache
  • Migraine disorders
  • University students