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