Vegetables are the key component of healthy diet and balanced diet. Recently there is more emphasis on increasing the consumption of vegetable becau

Vegetables are the key component of healthy diet and balanced diet. Recently there is more emphasis on increasing the consumption of vegetable because of their beneficial effect on cardiac health ,reported by epidemiological studies.() In a meta-analysis by Zhan et al. (2017), reported the pooled relative risk (RR) for CVDs between highest versus lowest vegetable intake category was 0.87 (95% CI: 0.830.91), which indicates a decreased CVD risk with increasing vegetable intake.Thus it is crucial to asses the recommended consumption of vegetable in the population.Although the developed dietary guidelines recommends combined intake of fruit and vegetable According to World Health Organization (WHO) and Food and Agriculture Organization (FAO) guidelines (2003), the recommended consumption of fruits and vegetables is at least 400 g/day.However the recommended intake of vegetable ,but majority of studies suggest that 3 servings should come from the vegetable(food based dietary guide line,2018, Research W.C.R.F.A.I.f.C. Food, Nutrition, Physical Activity, and the Prevention of Cancer,2007)therefore the intake should be >240g/d.This essay aims to analyse NDNS data for the vegetable consumption in UK population and discuss the role of beneficical effect of vegetable in lowering the cardiovascular disease .

Vegetable consumption in UK adult population

In UK adult population according to NDNS data the mean intake of vegetable in age group 19-64 was lower in previous year and it was increased in 209 g/d which is still lower than the recommended intake of 3 servings a day. The intake in men and women are nearly same ,however the womens intake was slight lower than the males. There is no separate statical analysis on different catagories of vegetable intake .The data is present in the form of disagrreated food as wellas stastical analysis on 5 a day data consist of combined data on fruit and vegetable consumption.As vegetable are potential source of vitamin , mineral , fiber .The percentage of vegetable as source of these phytochemical bioactive compound is observed as low .In case of fibers there is continuous decrease in raw vegetable as source in contrast the vegetable dishes contributes 17% of fiber in diet.Similar findings can be seen in the intake of vitamin A from raw vegetable is only 7%and from vegetable dishes is 23%.

Further the zinc ,folate, magnesium from the raw vegetable is very low while from the vegetable dishes is high .

Mineral and vitamin Raw cooked

Magnessium 4% 8%

Folate 6% 14%

Zinc 1% 7%

This suggest that vegetable consumption is below recommended level.

Benefits of vegetable consumption and cvdCardiovascular disease is a leading cause of mortality in UK (Allender,S.Peto,VScarborough et al,2009).There are modifiable and non modifiable factors associated with development of cvd . Diet is a major modifiable factor which contributes to prevent and manage the CVD (Willet,WC,1994).Majority of studies f studies demonstrated the negative association of vegetable consumption and(,Park Y.,2010).The cardioprotective effect of vegetable is because of presence of phytonutrients,bioactive compounds (Liu R.H.) .Wiztum,1994 proposed antioxidant hypothesis suggested that antioxidants compounds such as flavnols are protective against CVD. Vegetables rich in antioxidant prevent the lipid oxidation in arterial wall vessel.Gazino etal observed the protective effect of green leafy vegetable for those consuming green leafy vegetable more than one serving per day found significantly invesre associated with CVD (95%CI 0.31-0.77,)p= 0.49 .Green leafy vegetable are rich in antioxidant beta carotene which tends to prevent the LDL oxidation by scanvanging free radical and modulating theenergy producing mitochondrial enzyme(Jayachandran KS,2010)

Further cruciferous vegetable groups are reportedly potential contributor in lowering the risk of CVD .Zhang et al reported that risk of cvd incidence lowered ---0.80(95%CI 0.72-.89)for the highest intake of cruciferous roup t the lowest intake group in a cohort study of Shanghai women health .This effect can be explained by the presence of sulphur containing group sulforaphane reduces the oxidative stress and inflammation in cardiovascular system by activating Nrf2(Zakkar M, Van der Heiden K, Luong LA, et al,2009).

Another group Red,Yellow,orange group vegetable are also reported as protective in lowering the incidence of CVD.Framingham offspring study by Jacques et al observed the inverse association between tomato consumption and CVD 0.94(95%CI0.89-0.99) and 0.90(95%CI0.83-0.99)for every one serve increase per day.Simila finding was observed in carrot and squash consumption. Gaziano et al observed 40%lowering risk on consuming carrot and squash with more than one serving per day.

In addition to this the minerals like Zinc, Magnessium, presenent in vegetable are also found to play important role in attenuating the CVDrisk.Dietary Zinc inhibits the reactive oxygen species induced oxidation of LDL cholesterol .This mechanism of dietary Zinc lowers the risk of artherosclerosis (B.Henning,M.Toborek,C.J.McClain).In a study by C.J.Bates,M.hames dietary zinc was reported inversely associated with CVD. HR (95%CI)1SD increment of intake (2.56mg/d) was 0.84(0.71-0.99)p=0.4

Furthermore Magnesium from dietary source is also associated with lowering 22%of CVD risk (RR:0.70;95% CI:0.56-0.88)per 0.2mmol .Because magnesium enhances the endothelium dependent vasodialatin,improves the lipid metabolism and inhibit the platelet aggregation(Shechter M.,2010).Mzaffrin D,2010 recommended increased intake of magnesium rich foodper serving estimated to lower the cardio vascular mortality by 28%.green leafy vegetable are rich source of magnesium.

Folate are also important for maintaining the cardiac health .It regulates the homocysteine metabolism,it is a potential risk factor for CVD.This was confirmed by a Japanese cohort study by Rin Zhe Lui,2012.It is inversely associated with lowerein the risk of CVD 62%.0.62(0.43-039).

Lastly the vegetable serve as source of plant stanols which have lipid lowering effect .The phytol stanol competes with the cholesterol by binding to the miscelle.and reduces the cholesterol content of miscelle.Another mechanism by which plant stanols reduces the lipid is it interact with enterocyte ATP binding transport protiens so that cholesterol directed back to the intestine.

These benefits of vegetable can be evidently seen in the prospective cohort studies

Independent effect of raw and cooked vegetable study

The study design is observational prospective cohort study aimed to measure the independent effect of raw and cooked vegetable in a UKbiobank cohort followed for..health outcome in terms of occurnece of CVD. In sub group analysis Researchers examined the specific effect of raw and cooked vegetable impact on adjusted model of cofounding factors such as ethnicity,sex,age,socioeconomic factors, demographics. Researchers observed the total vegetable intake lowers the cvd mortality risk by 17%(0.83(0.71-0.96),however this association was not statistically significant,due to presence of potential cofounding factors in the minimal adjusted model .

GLOBAL VEGETABLE INTAKE

Globally 70% deaths are accountfr non communicable disease,9Darfoesr.oduroS.A.,2018)the major risk factor are the unhealthy diet including low vegetable intake(Riley L,Guthold R.2016).It was observed from a systematic analysis that vegetable intake in 136 countries against the recommendations of >240g/d is low .Only 10(7%) out of 136 countries reported adequate intake f vegetable and rest countries have below recommended values.In Asia weighed mean average intake of vegetable ranged from 81g/day to 349g.day in east Asia .In contrast to Asia countries like America,weighed mean intake of vegetable ranged from 156g-263g/d in north America ,similar data on intake obtained from oceania where mean intake was ranged from 73g/d to 196 g/d which was the lowest intake among other countries.In Europe the mean intake ranged from lowest 123g/d in weatern Europe to highest 270g/d in eastern Europe only four europeon countries met the recommendation.240g/d value .This means that globally the mean intake of vegetable is 1 serving or 2 serving per day (186g/day)ranged from minimum 56g/day in cental America to highest 349g/d in EastAsia.In UK adult population the mean vegetable consumption is 206g/d .Thus ,the intake is below recommended value ,however it is more than the mean intake of vegetable globally which is 186g/d .

Scientific community reaction

The scientific community observed the finding of this study was not reflected in the headline of the journal and criticised it on various parameters. According to expert community the model was over adjusted which made the interpretations complex. The study design was observational which are prone to bias reporting as well as the vegetable classification on the basis of source of category or group was absent in the study, for instance green leafy vegetable group, yellow green group, crucifer vegetable group all catagorise have different effect in lowering the risk of CVD.Thus ,study has not included the discrete group of vegetable .In addition to this the study lacked the mediation analysis of vegetable and lowering cvd risk during the follow up period . Another flaw observed by expert in the study the Researchers neglected the possibility of cofounding that may masks the real effect of vegetables.As..

Further scientific community also concluded that Researches of this study also concluded the protective effect of vegetable in lower incidence of CVD, however the headlines of the journal donot concludes the same.

Lastly, scientific community experts quotes finding of this study cannot subside the protective mechanism of bioactive,phytochemicals of the vegetable and cannot change the recommendations for 5 portion a day notion for fruit and vegetable consumption.

Discussion