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Observational epidemiological surveys (WG 3) page 47
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this tomato sauce-linked vitamin E intake might not be recorded in most studies, and lycopene
might be a marker of this intake. Another confounding factor might be fructose, concentrated
by cooking, and recently proposed as part of a protective mechanism for prostate cancer, via
vitamin D and phosphates (Giovanucci et al., 1999). Current results of epidemiological
studies cannot solve this problem.
Part 2: Tomatoes and tomato products, lycopene, other
carotenoids, vitamins C and E and CVD
2-1 Fruit and Vegetables, Tomatoes
The studies on fruit and vegetables intake and relative risk of cardiovascular disease have
been comprehensively reviewed by Ness and Powles (1997) and Law and Morris (1998). The
review by Ness and Powles summarized the data from 1966 until 1995. All studies (i.e.
ecological, case-control, cohort with either fruit and vegetables consumption or proxy
nutrients) were recorded and no attempt was made to evaluate the data critically. Ness and
Powles concluded that all the data are consistent with a strong protective effect against stroke
and a weaker protective effect against coronary heart disease. Concerning the studies of
dietary intake, only one included tomato (Gaziano et al, 1995). In this study, significant
correlations were obtained for carrots/squash and salads/green vegetables, but no correlation
was obtained for tomatoes. The subsequent review of Law and Morris (1998) made a more
critical analysis with the objective of quantifying the relationship between fruit and vegetable
consumption and the incidence of ischaemic heart disease (including coronary heart disease,
myocardial ischaemic and myocardial infarction). The main outcome measures were risk of
ischaemic heart disease at the 90 th centile of consumption and at the 10 th . Their conclusion
was that the risk of ischaemic heart disease is about 15% lower at the 90 th than the 10 th centile
of fruit and vegetables consumption, which is equivalent to about a four-fold difference in
fruit consumption and a doubling of vegetables consumption. However, there was no clear
correlation with the antioxidant components of fruit and vegetables. Our analysis took into
account both of these reviews and a summary of the most relevant studies is given in table 27.
Among the studies on fruit and vegetables, none mentioned tomatoes. There are no
randomized, intervention studies either for fruit and vegetables or for tomatoes. No case-
control studies were found with subjects free from disease. However, two small case studies
involve relatively small numbers (287 women in the Italian study by Gramenzi et al., 1990