Background-Dietary factors affecting the risk of developing abdominal aortic aneurysm (AAA) are scarcely investigated.The aim of this study was to investigate the associations of fruit and vegetable consumption with the risk to develop AAA. Methods and Results-The prospective Cohort of Swedish Men and the Swedish Mammography Cohort, consisting of 44 317 men and 36 109 women, 46 to 84 years of age at the start of the 13-year follow-up (1998-2010), were used. Fruit and vegetable consumption was assessed at baseline with a 96-item food-frequency questionnaire. By linkage to the Swedish Inpatient Register and the Swedish Vascular Registry (Swedvasc), 1086 primary cases of AAA (222 ruptured) were identified. Cox proportional hazards models were used to estimate hazard ratios with 95% confidence intervals (CIs). Those in the highest quartile of fruit consumption (>2.0 servings/d), in comparison with those in the lowest quartile (<0.7 servings/d), had a 25% (95% CI, 9%-38%) lower risk of AAA, and a 43% (95% CI, 11%-64%) lower risk of ruptured AAA, specifically. Consumption of 2 fruits per day was associated with 31% (95% CI, 11%-47%) lower risk of nonruptured AAA, and 39% (95% CI, 1%-63%) lower risk of ruptured AAA, in comparison with no consumption of fruit. No association was observed between vegetable consumption and AAA risk. Conclusions-We observed an inverse association between consumption of fruit, but not vegetables, and the risk of AAA, with a more pronounced association with ruptured AAA. information to participants and a returned completed questionnaire was considered to imply informed consent. Of the eligible 48 850 men and 39 227 women, we excluded those with the following characteristics: incorrect Personal Identity Number (a unique number identifying all Swedish citizens used for linkage of registers), previous diagnosis of AAA or cancer (except for nonmelanoma skin cancer; to avoid possible misclassification of exposure), implausible energy intake (±3 standard deviations [SDs] of the mean log-transformed energy), or missing data on fruit or vegetable consumption. For final analyses, 44 317 men and 36 109 women remained. The study was approved by the regional Ethical Review Board at Karolinska Institutet (Stockholm, Sweden).
Ascertainment of AAA Cases and Follow-Up of the CohortsBy linkage to the Swedish Inpatient Register and the Swedish National Cause of Death register, all individual discharges, or deaths, attributable to nonruptured (International Classification of Diseases, Tenth Revision: I71.4) and ruptured (International Classification of Diseases, Tenth Revision: I71.3) AAA were identified through December 2010. AAA repair was identified by using the Nordic Classification of Surgical Procedures (Nomesco). Although no specific validity assessment of AAA diagnosis or repair in the Swedish Inpatient Register has been performed, the national coverage has been nearly 100% since 1987 20 with a high validity in general. 21 Surgical codes have been reported as incorrect in 2%, and missing in 5.3%, of...