Am J Clin Nutr. 2023 Jun 13:S0002-9165(23)65969-6. doi: 10.1016/j.ajcnut.2023.06.007. Online ahead of print.
ABSTRACT
BACKGROUND: Diets dense in fruits and vegetables are associated with a reduced risk of preeclampsia, but pathways underlying this relationship are unclear. Dietary antioxidants may contribute to the protective effect.
OBJECTIVE: We determined the extent to which the effect of dietary fruit and vegetable density on preeclampsia is due to high intakes of dietary vitamin C and carotenoids.
DESIGN: We used data from 7572 participants in the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be (8 US medical centers, 2010‒2013). Usual daily periconceptional intake of total fruits and total vegetables was estimated from a food frequency questionnaire. We estimated the indirect effect of ≥2.5 cups/1000 kcal of fruits and vegetables through vitamin C and carotenoid on the risk of preeclampsia. We estimated these effects using targeted maximum likelihood estimation and an ensemble of machine learning algorithms, adjusting for confounders including other dietary components and health behaviors, and psychological, neighborhood, and sociodemographic factors.
RESULTS: Participants who consumed ≥2.5 cups of fruits and vegetables per 1000 kcal were less likely than those who consumed <2.5 cups/1000 kcal to develop preeclampsia (6.4% versus 8.6%). After confounder adjustment, we observed that higher fruit and vegetable density was associated with 2 fewer cases of preeclampsia (risk difference -2.0, 95% CI -3.9, -0.1) per 100 pregnancies compared with lower density diets. High dietary vitamin C and carotenoid intake was not associated with preeclampsia. The protective effect of high fruit and vegetable density on the risk of preeclampsia and late-onset preeclampsia were not mediated through dietary vitamin C and carotenoids CONCLUSIONS: Evaluating other nutrients and bioactives in fruits and vegetables and their synergy is worthwhile, along with characterizing the effect of individual fruits or vegetables on preeclampsia risk.
PMID:37321543 | DOI:10.1016/j.ajcnut.2023.06.007
