Elsevier

Nutrition

Volume 47, March 2018, Pages 50-55
Nutrition

Applied nutritional investigation
Dietary intakes of fat soluble vitamins as predictors of mortality from heart failure in a large prospective cohort study

https://doi.org/10.1016/j.nut.2017.09.009Get rights and content

Highlights

  • Intakes of fish, natto, fruits, and vegetables are associated with a low risk for heart failure.

  • These foods are major sources of vitamins D, K, A, and E in the Japanese diet.

  • Intakes of vitamins K, E, and D are associated with reduced rates of death from heart failure.

  • The reduced risk of heart failure mortality was evident in Japanese women but not in men.

Abstract

Objectives

A few reports have investigated the association of dietary vitamin intakes with risk of heart failure in Asia. Therefore, we examined the relation between dietary intakes of fat-soluble vitamins A, K, E, and D and mortality from heart failure in the Japanese population.

Methods

A total of 23 099 men and 35 597 women ages 40 to 79 y participated in the Japan Collaborative Cohort Study and completed a food frequency questionnaire from which dietary intakes of vitamins A, K, E, and D were calculated. The Cox proportional hazard model was used to estimate the sex-specific risks of heart failure mortality according to increasing quintiles of fat-soluble vitamin intakes.

Results

During the median 19.3 y follow-up period, there were 567 deaths from heart failure (240 men, 327 women). Dietary vitamin A intake showed no association with heart failure mortality in both sexes; however, the reduced risk was observed in women but not in men with dietary intakes of vitamins K, E, and D. The multivariable hazard ratios (95% confidence interval) in the highest versus the lowest intake quintiles among women were 0.63 (0.45–0.87; P for trend = 0.006) for vitamin K, 0.55 (0.36–0.78; P for trend = 0.006) for vitamin E, and 0.66 (0.48–0.93; P for trend = 0.01) for vitamin D. The association for each vitamin was slightly attenuated but remained statistically significant after mutual adjustment for intakes of the other vitamins.

Conclusions

High dietary intakes of fat-soluble vitamins K, E, and D were associated with a reduced risk of heart failure mortality in Japanese women but not men.

Introduction

Heart failure is a complex syndrome that stands on the activation of numerous biological mechanisms that follow or coincide with myocardial injury and lead to inadequate systematic perfusion [1]. In developed countries with a high proportion of aging population, such as in Japan, heart failure is a notable public health burden [2]. Intakes of seafood and fish [3], [4], fermented soybeans [5], and fruits and vegetables [5], [6] have been associated with a reduced risk of heart failure. In the Japanese diet, seafood and fish are the main dietary contributors of vitamin D [7], natto (i.e., fermented soybeans) is a major source of vitamin K [8], and vitamins A and E are mainly provided by the consumption of fruits and vegetables [9]. Whether the observed reduced risks with higher intakes of these foods are attributed to the effect of their content of fat-soluble vitamins (i.e., A, K, E, and D) remains unclear.

Dietary antioxidant capacity was inversely associated with the risk of cardiovascular diseases including heart failure [10]. However, the association between dietary intakes of vitamins A and E and cardiovascular mortality is questionable [11], [12], [13]. Conflicting observations also exist on the impact of vitamin K intake on cardiovascular health [14], [15], [16], [17]. In addition, there is growing evidence on the protective effects of vitamin D against cardiovascular disease [18], [19] including heart failure [18], [20].

When taking these contradictory findings together, the associations between dietary intakes of fat-soluble vitamins and risk of heart failure still need to be investigated, especially in Asian populations. Therefore, we aimed to examine the association between dietary intakes of vitamins A, K, E, and D and the risk of mortality from heart failure among men and women enrolled in the Japan Collaborative Cohort study (JACC), a large prospective study.

Section snippets

Study population and baseline covariates

With a total of 110 585 Japanese participants including middle-aged (40–79 y) men (n = 46 395) and women (n = 64 190) from 45 communities across Japan, the Ministry of Education, Sports, and Science sponsored the JACC study from 1988 to 1990. A detailed description of the JACC study was published previously [21].

Data on baseline lifestyle and participant characteristics including demographic data, medical history of chronic diseases, diabetes mellitus and hypertension, alcohol consumption

Results

As shown in Table 1, participants in the highest quintile of fat-soluble vitamin intake were older; more educated; less likely to smoke; and consumed more sodium, potassium, calcium, saturated fat, n-3 fatty acids, and dietary fiber compared with those in the lowest quintile but they consumed less alcohol. Moreover, men in the highest intake quintiles of vitamins A, K, and D and women in the highest intake quintiles of vitamin A and K were more likely to be hypertensive and diabetic.

During 965

Discussion

Analysis of data from 58 646 Japanese men and women with a median follow-up period of 19.3 y in a large prospective cohort study revealed that higher dietary intakes of vitamins K, E, and D were associated with a reduced risk of heart failure mortality in women only. Dietary intake of vitamin A was not related to heart failure mortality in either sex. These associations remained statistically significant even after controlling for known cardiovascular risk factors, mutual adjustment of

Conclusions

In this large, community-based, prospective cohort study, higher dietary intakes of fat-soluble vitamins (K, E, and D) were associated with a reduced risk of mortality from heart failure among Japanese women but not men.

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      The same benefits has been observed for Ω-3 polyunsaturated fatty acids consumption and better pharmacological intervention and acute treatment of patients with CVD was observed [9]. Moreover, it is well accepted that fat soluble vitamins via several pathways possess benefits in the prevention of CVD [10,11]. In the past, a lot of studies indicate that the assumption of high dietary cholesterol consumption is associated with high blood cholesterol levels and CVD.

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    Sources of support: This study was supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Science, Sports and Culture of Japan (61010076, 62010074, 63010074, 1010068, 2151065, 3151064, 4151063, 5151069, 6279102, 11181101, 17015022, 18014011, 20014026, and 20390156) and Comprehensive Research on Cardiovascular and Lifestyle Related Diseases (H26-Junkankitou [Seisaku]-Ippan-001).

    Conflicts of interest: None.

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