ORIGINAL ARTICLE The association of fruits, vegetables, antioxidant vitamins and fibre intake with high-sensitivity C-reactive protein: sex and body mass index interactions A Oliveira 1,2,3 , F Rodrı ´guez-Artalejo 4 and C Lopes 1,2,3 1 Department of Hygiene and Epidemiology of the University of Porto Medical School, Porto, Portugal; 2 Cardiovascular Research and Development Unit of the University of Porto Medical School, Porto, Portugal; 3 Public Health Institute of the Porto University, Porto, Portugal and 4 Department of Preventive Medicine and Public Health, School of Medicine, CIBER of Epidemiology and Public Health (CIBERESP), Universidad Auto´noma de Madrid, Madrid, Spain. Objective: To study the associations of fruits, vegetables, antioxidant vitamins and fibre intake with high-sensitivity C-reactive protein (hs-CRP). Existing literature on these associations is scarce and has rendered conflicting results. Methods: Cross-sectional study of 1060 individuals (675 women, 385 men), representative of the non-institutionalized population, aged X18 years, in Porto, Portugal (70% participation rate). Diet over the previous year was assessed with a validated food frequency questionnaire. Associations between diet and hs-CRP (categorized into o1, 1–3, 43 to p10 mg/l) were obtained from ordinal logistic regression models (odds ratio, 95% confidence intervals-OR, 95% CI) adjusted for sociodemographic and behavioural variables. Results: In normal weight men (body mass index (BMI) o25.0 kg/m 2 ), for each 100 g increase in fruit and vegetable intake, there was 30% less probability of changing of hs-CRP category (no risk to moderate risk, or moderate to high risk). Protective associations were also observed between hs-CRP and fruits (OR ¼ 0.73, 95% CI 0.56–0.96 per 100 g/day), vegetables (OR ¼ 0.55, 95% CI 0.35–0.86 per 100 g/day), vitamin C (OR ¼ 0.34, 95% CI 0.14–0.80 per 10 mg/day) and vitamin E (OR ¼ 0.14, 95% CI 0.02–0.88 per 1000 retinol equivalents per day). Overall, associations tended to be weaker in overweight participants. In men (BMI X25.0 kg/m 2 ), fibre was also negatively associated with hs-CRP. In women, no significant associations were found between dietary variables and hs-CRP. A significant modification effect of the evaluated associations was found by sex for fruits and vegetables, vitamin C and fibre, but not by BMI. Conclusion: Intake of fruits and vegetables, vitamin C, E and fibre were negatively associated with hs-CRP in men. European Journal of Clinical Nutrition (2009) 63, 1345–1352; doi:10.1038/ejcn.2009.61; published online 22 July 2009 Keywords: fruits; vegetables; dietary fibre; antioxidants; C-reactive protein; effect modifier epidemiology Introduction Adequate intake of fruits and vegetables has been recom- mended for the prevention of chronic diseases, parti- cularly cardiovascular disease (Lock and Pomerleau 2005; Lichtenstein et al., 2006). Antioxidant vitamins and dietary fibre could independently or jointly be responsible for the reduced cardiovascular risk associated with fruits and vegetables (Van Duyn and Pivonka 2000; Maron, 2004), but knowledge on these specific mechanisms is still insuffi- cient. The ability of fruits and vegetables to reduce low- density lipoprotein-cholesterol oxidation is often claimed (Van Duyn and Pivonka 2000; Hu and Willett, 2002a), but research has also focused on some anti-inflammatory effects. High-sensitivity C-reactive protein (hs-CRP), a stable acute-phase inflammatory reactant, has been proposed as a powerful predictor of cardiovascular disease (Pearson et al., 2003), which highlights the importance of understanding its relation with fruit and vegetable consumption. Received 30 October 2008; revised 25 May 2009; accepted 29 May 2009; published online 22 July 2009 Correspondence: Dr A Oliveira, Department of Hygiene and Epidemiology, University of Porto Medical School, Porto Alameda Professor Herna ˆni Monteiro 4200-319, Portugal. E-mail: acmatos@med.up.pt European Journal of Clinical Nutrition (2009) 63, 1345–1352 & 2009 Macmillan Publishers Limited All rights reserved 0954-3007/09 $32.00 www.nature.com/ejcn