Impact of fruits and vegetables consumption on cardio-metabolic health - a case control study

doi:10.21203/rs.3.rs-4966129/v1

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Research Article

Impact of fruits and vegetables consumption on cardio-metabolic health - a case control study

https://doi.org/10.21203/rs.3.rs-4966129/v1

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published 12 Nov, 2024

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Background

According to the World Health Organization (WHO), it is recommended to consume more than four hundred grams of (fruits + vegetables) per day to enhance healthful lifestyle and to lower the incidence of cardio-metabolic illnesses. Their low glycemic index helps prevent spikes in blood sugar, consequently controlling hunger. Our aim was to study the reflection of the intake of fruits and that of vegetables on cardio-metabolic risks in obese children.

Results

A case-control research enrolled 90 Egyptian children (44 obese, 46 normal weight control children) aged from 5–11 years. Thirty-three out of forty-six controls (71.7%) consumed vegetables on a daily basis compared to only twenty-seven (61.4%) among cases. As regards fruits, the daily consumption was frequented more among the obese group 25 (58.1%) and less frequented among the control group. Daily intake of vegetables was not associated with lower risks of increased levels of fasting blood glucose, total cholesterol, triglycerides, Low Density Lipoprotein-cholesterol (LDL-C), LDL/HDL ratio, Triglycerides/HDL ratio and Triglycerides/glucose ratio. P values were as follow 0.363, 0.774, 0.947,0.211, 0.714, 0.093 and 0.736. Not only vegetables but also daily intake of fruits was not associated with lower risks of high fasting blood sugar, cholesterol, triglycerides, LDL, LDL/HDL ratio, Triglycerides/HDL ratio and Triglycerides/glucose ratio. P value was as follows: 0.292, 0.663, 0.663, 0.32, 0.34, 0.062 and 0.219 respectively.

Conclusion

The role of fruits and vegetables is still debatable, our findings showed no significant associations between the frequency of their consumption and obesity, hyperglycemia or hyperlipidemia.

children

obese

vegetables

fruits

cardio-metabolic risk

Over the past decades, there has been a significant increase in obesity rates which caused marked increment of type 2 Diabetes Mellitus (DM) and cardiovascular conditions like heart attacks, and strokes. The high body mass index (BMI) initiates a bunch of metabolic derangements endangering the cardio metabolic status. These threatens include abnormal fasting glucose, dyslipidemia, abdominal adiposity and hypertension (Powell-Wiley et al, 2021). Nowadays, cardiovascular diseases are globally the top leaders of mortality. While typically the pathological changes manifest in adults, still the cardio metabolic risks can be depicted early in childhood (Siddiqui et al, 2022).

The lifestyle factors, including diet, exert a significant influence on cardio metabolic health. This is an evidence based fact in adults. Such a healthy diet mandates high consumption of both fruits and vegetables. This proved to lower the incidence of cardiac and metabolic drawbacks in adulthood. On the other hand, in pediatrics, inconsistence and controversial data were obtained by a multitude of studies. Therefore, dietary benefits remain debatable up till now in childhood (Hoppu et al, 2013). Many researches highlighted the preventive role of fruits and vegetables on the development of non-communicable diseases in children, while some studies have found nil association (Funtikova et al, 2015).

Vegetable consumption is commonly recommended as a key element in promoting cardiovascular well-being. Researchers have noticed that rich intake of vegetables was protective against hypercholesterolemia. Also, many meta-analyses and systematic reviews have also found consistent associations between high vegetable consumption and low cardiovascular and metabolic diseases in adults (Ma et al, 2023).

Consuming fruits has also beneficial effects on lowering the risk of many chronic diseases. However, its impact on metabolic syndrome remains questionable. The glycemic load of some fruits is elevated and consequently counted culprit rather than protective in development of obesity (Liu et al, 2021).

Given the inconsistent findings and the limited number of studies available, our aim was to investigate the association between frequency of fruit and vegetables consumption and cardio-metabolic risk factors, in children.

The participants were recruited from the clinic of therapeutic nutrition of the Medical Research Centre of Excellence (MRCE). A total of ninety children were involved. Their age ranges from five to eleven years old. They were stratified according to their body mass index into forty-four obese cases and forty-six controls. The body mass index was calculated by dividing the weight in kilograms by the square of the height in meters. The cutoff for obesity was at or above ninety fifth percentiles as referred to Center of Disease Control and prevention (CDC) (Hampl et al, 2023). Full history was taken with special emphasis on dietary intake of fruits and vegetables. The frequency of consumption was quantified by daily, weekly, monthly, yearly or never consumed. The ingestion of fruits and that of vegetables was questioned and estimated separately.

Inclusion criteria

Egyptian children from 5 to 11 years old. Both males and females were included.

Exclusion criteria

Children below 5 or above 11 years old. Those who have a cardiac or metabolic disease.

Laboratory methodology

A blood sample was withdrawn after a ten hours overnight fast. The fasting blood glucose (FBG) was measured in plasma for both cases and controls. FBG was determined using enzymatic colorimetric method according to Trinder (Trinder, 1969). The normal FBG was referred to a range from 70–100 mg/dl (Patolia et al, 2023). The lipid profile was assessed only for obese children. Lipid profile included serum total cholesterol, High Density Lipoprotein-cholesterol (HDL-C), Low Density Lipoprotein-cholesterol (LDL-C) and triglycerides. They were estimated according to established Richmond for total cholesterol and Young for triglycerides. HDL-C was assessed by the enzymatic method according to Lopez–Virella. LDL-C was evaluated by the equation of Glatter (Richmond, 1973), (Young, 1997), (Lopes-Virella et al, 1977) and (Glatter, 1984).

The high levels of total cholesterol, LDL-C and Triglyceride were defined as > 200 mg/dL, > 130 mg/dL and > 114 mg/dL respectively. The least acceptable level for HDL-C was more than 40 mg/dL (Meral et al, 2015). We calculated the Triglyceride-Glucose (TyG) index as a reflection of Insulin Resistance (IR). This was done using the formula: Ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. The cutoff point of the TyG index to identify cardio-metabolic risk was 9.04. This cutoff value proved to be sensitive and specific in the study done by Araújo et al (Araújo et al, 2022).

Statistical analysis

A descriptive analysis of the data was done using SPSS version 16, in addition to comparison between cases and controls as regards the frequency of vegetables’ and fruits’ uptake. The fasting blood glucose values were compared between both groups and its relation to dietary fruits and vegetables was determined. The values were presented as mean, and standard deviation (SD). For the obese children the LDL/HDL ratio, Triglycerides/HDL ratio and Triglycerides/Glucose ratio were calculated. The correlations were investigated between the mentioned ratios and the frequency of vegetables/fruits intake. Independent Sample t-test was used to compare between groups for parametric data, and Mann-Whitney test for non-parametric data. Pearson’s correlation has been used to find the correlations. P value < 0.05 was considered significant.

The cases and the controls were of matching age. The minimum age was 5 and the maximum was 11 years with a comparable mean of 7.61 ± 1.79 and 8.16 ± 1.78 respectively as shown in table (1)

The fasting blood glucose showed an insignificant P-value of 0.535 between cases and controls as shown in table (1).

Table 1: Comparison of Age and FBG (mg/dl) between Controls and Cases

Table 1

Comparison of Age and FBG (mg/dl) between Controls and Cases
Parameters	Groups	N	Min.	Max.	Mean ± S.D.	Median	P value
Age	Controls	46	5.00	11.00	7.61 ± 1.79	8.00	0.148
	Cases	44	5.00	11.00	8.16 ± 1.78	8.00
FBG (mg/dl)	Controls	45	60.00	113.00	84.64 ± 11.62	84.00	0.535
	Cases	44	62.00	119.00	86.14 ± 10.98	84.50

The sex distribution was homogenous in both groups. There were almost equal numbers and percentages of both genders in the two groups with an insignificant P value of 0.404 as revealed in figure (1).

Figure (1): Comparison between gender distribution in both Groups (Controls and Cases)

A set of questionnaires was answered by all participants to specify the frequency of intake of vegetables and fruits separately (daily, weekly, monthly or not at all). Thirty-three out of forty-six controls (71.7%) consumed vegetables on a daily basis (43.5% once daily, 28.3% consumed 2–3 times per day) compared to only twenty-seven (61.4%) among cases (36.4% once daily and 25% more than once). On the other hand, the weekly consumption of vegetables was more prevalent in obese children than their normal peers with a percent of 31.8% and 21.8% respectively as shown in figure (2). As regards fruits, the daily consumption was frequented more among the obese group 25 (58.1%) (27.9% once daily, 30.2% consumed 2–3 times per day) and less frequented among the control group 20 (43.5%) (23.9% once daily and 19.6% 2–3 times per day). Twenty children from the control group were consuming fruits weekly while a lower number of thirteen obese children had a weekly intake of fruits as shown in figure (3).

Figure (2): Vegetables intake in cases compared to controls

Figure (3): fruits intake in cases compared to controls

According to the consumption frequency of fruits and vegetables, the cases and controls were divided furthermore into 2 main groups: a group who consumed daily fruits and vegetables, and the other group consumed fruits and vegetables occasionally as shown in table (2)

There was no significant difference between frequency of fruits and vegetables consumption in obese and control group.

Regarding the frequency of vegetable consumption, it was observed that among the control group, the percentage of daily vegetables consumption was higher (71.7%), (43.5% once daily, 28.3% consumed 2–3 times per day) than among the obese group (61.4%), (36.4% once daily and 25% consumed 2–3 times per day) with no significant difference P value 0.297.

Conversely, regarding the frequency of fruit consumption, our study found that the percentage of the obese group who had more daily fruits consumption 58.1% (27.9% once daily, 30.2% consumed 2–3 times per day) was higher than the control group 43.5% (23.9% once daily and 19.6% 2–3 times per day) also with no significant difference (P value 0.167)

Table 2: Comparison between cases and control regarding frequency of vegetables and fruits intake

Table 2

Comparison between cases and control regarding frequency of vegetables and fruits intake
	Control 46	Obese 44	P value
Daily vegetables intake	33 (71.7%)	27 (61.4%)	0.297
Occasional vegetables intake	13 (28.3%)	17 (38.6%)
Daily fruit intake	20 (43.5%)	25 (58.1%%)	0.167
Occasional fruit intake	26 (56.5%)	18 (41.9%)

As for the impact of frequency of vegetable consumption there were no significant differences observed between the two groups although those consuming vegetables daily had lower fasting blood sugar, total cholesterol, LDL, LDL/HDL ratio and triglycerides/HDL ratio than those with occasional consumption.

The mean fasting blood sugar level in the group consuming vegetables daily 85.59 ± 12.62, was lower than the group consuming vegetables occasionally 87.00 ± 8.00, The mean total cholesterol level was 161.74 ± 34.52 in the group consuming vegetables daily, while in the group consuming vegetables occasionally it was higher 168.59 ± 31.09, the mean triglycerides level was 81.56 ± 42.20, in the group consuming vegetables daily, while in the group consuming vegetables occasionally it was lower 74.00 ± 30.24, the mean HDL level was 38.59 ± 8.20 in the group consuming vegetables daily, while in the group consuming vegetables occasionally it was higher HDL 40.24 ± 10.08, the mean LDL level was 107.07 ± 32.1 in the group consuming vegetables daily, while in the group consuming vegetables occasionally it was higher 114.06 ± 30.2, the mean LDL/HDL ratio 2.92 ± 1.13 in the group consuming vegetables daily, while in the group consuming vegetables occasionally it was higher 3.11 ± 1.47, the mean triglycerides/HDL ratio 2.26 ± 1.34 in the group consuming vegetables daily, while in the group consuming vegetables occasionally it was lower 1.95 ± 0.90, the mean triglycerides/glucose ratio 8.06 ± 0.22. in the group consuming vegetables daily, while in the group consuming vegetables occasionally it was lower 8.03 ± 0.21. As shown in table (3)

Table 3: Comparison between Frequency of Vegetables Consumption in obese groups as regards metabolic parameters

Table 3

Comparison between Frequency of Vegetables Consumption in obese groups as regards metabolic parameters
Parameters	Groups	N	Min.	Max.	Mean ± S.D.	P value
FBG	Daily intake of vegetables	27	62	119	85.59 ± 12.62	0.684
	Occasional intake of vegetables	17	79	109	87.00 ± 8.00
Chol	Daily intake of vegetables	27	100	227	161.74 ± 34.52	0.510
	Occasional intake of vegetables	17	112	225	168.59 ± 31.09
Trig	Daily intake of vegetables	27	40	242	81.56 ± 42.20	0.525
	Occasional intake of vegetables	17	25	148	74.00 ± 30.24
HDL	Daily intake of vegetables	27	25	53	38.59 ± 8.20	0.557
	Occasional intake of vegetables	17	23	55	40.24 ± 10.08
LDL	Daily intake of vegetables	27	46	166	107.07 ± 32.13	0.477
	Occasional intake of vegetables	17	57	149	114.06 ± 30.20
LDL/HDL	Daily intake of vegetables	27	1.02	5	2.92 ± 1.13	0.632
	Occasional intake of vegetables	17	1.14	6.48	3.11 ± 1.47
Trig/HDL	Daily intake of vegetables	27	0.75	7.33	2.26 ± 1.34	0.416
	Occasional intake of vegetables	17	0.50	4.24	1.95 ± 0.90
TyG	Daily intake of vegetables	27	7.69	8.71	8.06 ± 0.22	0.674
	Occasional intake of vegetables	17	7.51	8.41	8.03 ± 0.21
P value between the groups were calculated using Independent Samples T-Test.

Comparing the frequency of fruits consumption within the obese groups showing also no significant differences between the two groups, although those consuming fruits daily had higher fasting blood sugar and triglycerides, triglycerides/HDL ratio and triglycerides/glucose ratio, lower total cholesterol, HDL, LDL and LDL/HDL ratio.

The mean fasting blood sugar level in the group consuming fruits daily 86.52 ± 13.31, was higher than the group consuming fruits occasionally 85.44 ± 7.32, The mean total cholesterol level was 162.48 ± 35.23 in the group consuming fruits daily, while in the group consuming fruits occasionally it was higher 167.50 ± 31.46, the mean triglycerides level was 82.24 ± 46.40, in the group consuming fruits daily, while in the group consuming fruits occasionally it was lower 73.83 ± 23.12, the mean HDL level was 38.60 ± 9.79 in the group consuming fruits daily, while in the group consuming fruits occasionally it was higher HDL 40.06 ± 7.96, the mean LDL level in the group consuming fruits daily was 107.72 ± 29.43 while in the group consuming fruits occasionally it was higher 113.11 ± 34.96, the mean LDL/HDL ratio 2.94 ± 1.07, in the group consuming fruits daily, while in the group consuming fruits occasionally it was higher 3.09 ± 1.54, the mean triglycerides/HDL ratio 2.31 ± 1.46 in the group consuming fruits daily, while in the group consuming fruits occasionally it was lower 1.91 ± 0.68, the mean triglycerides/glucose ratio 8.06 ± 0.24. in the group consuming fruits daily, while in the group consuming fruits occasionally it was lower 8.03 ± 0.18. As shown in table (4)

Table 4: Comparison between Frequency of Fruit Consumption groups as regards metabolic parameters

Table 4

Comparison between Frequency of Fruit Consumption groups as regards metabolic parameters
Parameters	Groups	N	Min.	Max.	Mean ± S.D.	P value
FBG	Daily intake of fruits	25	62	119	86.52 ± 13.31	0.736
	Occasional intake of fruits	18	73	102	85.44 ± 7.32
Chol	Daily intake of fruits	25	100	227	162.48 ± 35.23	0.633
	Occasional intake of fruits	18	112	222	167.50 ± 31.46
Trig	Daily intake of fruits	25	40	242	82.24 ± 46.40	0.484
	Occasional intake of fruits	18	25	117	73.83 ± 23.12
HDL	Daily intake of fruits	25	25	55	38.60 ± 9.79	0.607
	Occasional intake of fruits	18	23	50	40.06 ± 7.96
LDL	Daily intake of fruits	25	46	158	107.72 ± 29.43	0.587
	Occasional intake of fruits	18	57	166	113.11 ± 34.96
LDL/HDL	Daily intake of fruits	25	1.02	5.68	2.94 ± 1.07	0.713
	Occasional intake of fruits	18	1.14	6.48	3.09 ± 1.54
Trig/HDL	Daily intake of fruits	25	0.75	7.33	2.31 ± 1.46	0.240
	Occasional intake of fruits	18	0.50	3.45	1.91 ± 0.68
TyG	Daily intake of fruits	25	7.69	8.71	8.06 ± 0.24	0.730
	Occasional intake of fruits	18	7.51	8.28	8.03 ± 0.18
P value between the groups were calculated using Independent Samples T-Test.

Daily intake of vegetables was not associated with lower risks of increased levels of fasting blood sugar, cholesterol, triglycerides, LDL, LDL/HDL ratio, Triglycerides/HDL ratio and Triglycerides/glucose ratio. P value was as follow 0.363, 0.774, 0.947,0.211, 0.714, 0.093 and 0.736. As shown in table (5)

Table 5: Effect of Frequency of Vegetable Consumption on metabolic parameters.

Table 5

Effect of Frequency of Vegetable Consumption on metabolic parameters.
Parameters		Vegetable Frequency Consumption		Chi-Square	P value	OR (95% CI)
Parameters		Occasional intake of vegetables (n (%))	Daily intake of vegetables (n (%))	Chi-Square	P value	OR (95% CI)
FBG	At risk	1 (5.90%)	4 (14.80%)	0.826	0.363	0.359
	Not at risk	16 (94.10%)	23 (85.20%)			(0.037–3.522)
Chol	At risk	2 (11.80%)	4 (14.80%)	0.082	0.774	0.767
	Not at risk	15 (88.20%)	23 (85.20%)			(0.124–4.721)
Trig	At risk	2 (11.80%)	3 (11.10%)	0.004	0.947	1.067
	Not at risk	15 (88.20%)	24 (88.90%)			(0.159–7.145)
HDL	At risk	7 (41.20%)	12 (44.40%)	0.045	0.831	0.875
	Not at risk	10 (58.80%)	15 (55.60%)			(0.256–2.989)
LDL	At risk	6 (35.30%)	5 (18.50%)	1.566	0.211	2.400
	Not at risk	11 (64.70%)	22 (81.50%)			(0.598–9.637)
LDL/HDL	At risk	3 (17.60%)	6 (22.20%)	0.134	0.714	0.750
	Not at risk	14 (82.40%)	21 (77.80%)			(0.160–3.506)
Trig/HDL	At risk	1 (5.90%)	7 (25.90%)	2.817	0.093	0.179
	Not at risk	16 (94.10%)	20 (74.10%)			(0.020–1.605)
TyG	At risk	1 (5.90%)	1 (3.70%)	0.114	0.736	1.625
	Not at risk	16 (94.10%)	26 (96.30%)			(0.095–27.838)
P value between the groups were calculated using Crosstab Chi-Square.

Not only vegetables but also daily intake of fruits was not associated with lower risks of high fasting blood sugar, cholesterol, triglycerides, LDL, LDL/HDL ratio, Triglycerides/HDL ratio and Triglycerides/glucose ratio. P value was as follows: 0.292, 0.663, 0.663, 0.32, 0.34, 0.062 and 0.219 respectively. As shown in table (6)

Table 6: Effect of Frequency of Fruit Consumption on metabolic parameters.

Table 6

Effect of Frequency of Fruit Consumption on metabolic parameters.
Parameters		Fruit Frequency Consumption		Chi-Square	P value	OR (95% CI)
Parameters		Occasional intake of fruits (n (%))	Daily intake of fruits (n (%))	Chi-Square	P value	OR (95% CI)
FBG	At risk	1 (5.60%)	4 (16.00%)	1.111	0.292	0.309
	Not at risk	17 (94.40%)	21 (84.00%)			(0.032–3.027)
Chol	At risk	3 (16.70%)	3 (12.00%)	0.190	0.663	1.467
	Not at risk	15 (83.30%)	22 (88.00%)			(0.260–8.270)
Trig	At risk	1 (5.60%)	4 (16.00%)	1.111	0.292	0.309
	Not at risk	17 (94.40%)	21 (84.00%)			(0.032–3.027)
HDL	At risk	7 (38.90%)	12 (48.00%)	0.352	0.553	0.689
	Not at risk	11 (61.10%)	13 (52.00%)			(0.201–2.359)
LDL	At risk	6 (33.30%)	5 (20.00%)	0.977	0.323	2.000
	Not at risk	12 (66.70%)	20 (80.00%)			(0.500–7.997)
LDL/HDL	At risk	5 (27.80%)	4 (16.00%)	0.877	0.349	2.019
	Not at risk	13 (72.20%)	21 (84.00%)			(0.457–8.920)
Trig/HDL	At risk	1 (5.60%)	7 (28.00%)	3.481	0.062	0.151
	Not at risk	17 (94.40%)	18 (72.00%)			(0.017–1.362)
TyG	At risk	0 (0.00%)	2 (8.00%)	1.510	0.219	1.783
	Not at risk	18 (100.00%)	23 (92.00%)			(1.360–2.337)
P value between the groups were calculated using Crosstab Chi-Square.

The effect of vegetables and fruits intake on cardio metabolic health is still controversial, their high content of fiber, vitamins, phenols help in prevention of obesity and cardiovascular risk factors (Funtikova et al, 2015).

In our study there were no significant differences between both groups regarding the frequency of fruits and vegetables consumption. Nouri and his co-workers found that in their investigations, it is unclear whether the significant association between fruits and vegetables intake and body mass index is due to excess intake or due to other healthy behaviors such as physical activity and low kcal food choices (Nouri et al, 2023). In contrast, Toelsie and coworkers' study showed that overweight and obesity are positively associated with hyperglycemia (Toelsie et al, 2022). Similar to our study, in Spain Bawaked and colleagues did not find any associations between plant based food and obesity or any other risk factor (Bawaked et al, 2020). Funtikova and coworkers' review also concluded that fruits and vegetables are not related to pediatrics ‘obesity (Funtikova et al, 2015).

While Silveira and his colleagues have demonstrated a negative correlation between fruits’ and vegetables’ consumption and BMI (Silveira et al, 2011). Abril and coworkers also found that school snacks composed of fruits and or vegetables were related to low BMI (Abril et al, 2013). Another study done by Matthews and his colleagues on school aged children, deduced that diet rich in vegetables played a significant role in preventing overweight (Matthews et al, 2011). Downs and co-workers found that the intake of more than 3 servings of fruits and vegetables daily decreases the central obesity in both children and adolescents (Downs et al, 2008). Similarly, Wall et al. stated that the more the intake fruits and vegetables the lesser the BMI in adolescence (Wall et al, 2018).

While the anti-obesity effects of fruit are more noticeable than their pro-obesity effects, the mechanisms behind weight reduction due to fruit consumption, such as their low-energy density and ability to induce satiety, lack direct support. Several studies suggest the pro-obesity effects of fruit due to their high levels of simple sugars, including sucrose, fructose, and glucose, but their findings are often limited by factors like insufficient data about total daily energy intake or depending on self-reported fruit consumption also the lack of differentiation between studies that include fruit juices and processed fruits in energy-dense forms from those focusing on unprocessed fruit (Sharma et al, 2016).

Our study found no significant association between frequency of fruits and vegetables intake and blood glucose level. Similar to our study, Du, H et al in China and Yuan, Cin et al in Korea found no protective effect of vegetables against the rise of triglycerides (Du et al, 2016) and (Yuan et al, 2015). Our study found no significant association between frequency of fruits and vegetables consumption and hyperlipidemia. Our findings were in line with Siddiqui NZ et al, there were no associations between type of food diet and insulin, triglycerides, HDL cholesterol, or LDL cholesterol (Siddiqui et al, 2022). Different findings were found in Spain by Garcidueñas-Fimbres, T.E., et al, their study showed that higher adherence to the MedDiet which is characterized by a high intake of plant foods, mainly fruits and vegetables, showed significant decreased risk of overweight or obesity, hyperglycemia and was associated with decrease serum triglyceride levels (Garcidueñas-Fimbres et al, 2024).

Furthermore, Pinto A et al found that a dietary pattern that is low in vegetables, high in processed meat and energy-dense foods was significantly associated with triglycerides, HDL-cholesterol, LDL-cholesterol (Pinto et al, 2020). In China, Ma et al, noted that children with higher number of ingested vegetables’ servings per day had lower levels of both Cholesterol and triglycerides in comparison to those with lesser number of ingested vegetables’ servings per day. Moreover, higher daily vegetable consumption was significantly associated with lower cardio-metabolic risks (Ma et al, 2023).

Limitations

Small sample size, self-reported food frequency questions may lead to biases in the data obtained. Moreover, lifestyle factors like exercise have higher impact on cardio-metabolic risk factors.

Recommendations

We recommend to study the effect of different vegetable and fruit types on cardio-metabolic risk factors.

This study showed that there were no significant associations between the frequency of fruits and vegetables consumption and obesity, hyperglycemia, or hyperlipidemia. Thus an adjuvant impact of dietary vegetables and fruits is suggested in obesity rather than a fundamental one.

BMI body mass index

CDC center of disease control and prevention

DM diabetes mellitus

FBG fasting blood glucose

HDL-C high density lipoprotein cholesterol

IR insulin resistance

LDL-C low density lipoprotein cholesterol

MRCE Medical Research Centre of Excellence

SD standard deviation

TyG Triglyceride-Glucose

WHO World Health Organization

Ethics approval and consent to participate

A detailed explanation of the study was provided to parents. An informed consent was signed upon agreeing to have their sons and daughters participate in the research. The form of the consent was approved by the ethical committee of the National Research Centre (ethical approval number 130601102). This is matching with the code of ethics of the world medical association (Declaration of Helsinki) https://www.wma.net/wp-content/uploads/2018/07/DoH-Oct2008.pdf

Consent for publication

Neither identifying images nor other personal or clinical details of participants are presented that compromise anonymity; a statement of consent to publish from the patient is NOT Applicable

All authors were informed about publication and they agreed.

Availability of data and material

Data used during the current study are available from the corresponding author on reasonable request

Competing interests

The authors declare that they have no competing interests.

Funding

National Research Centre, Giza, Egypt provided the fund for this work.

Authors' contributions

NMand MA cooperated in the recruitment, history taking and clinical examination of participants under supervision of Professor AA. MA wrote the research that was revised by Professor AA. NM did the correspondence of the journal All authors have read and approved the final manuscript.

Acknowledgements

The authors are grateful to the nurses and the laboratory team of the MRCE who helped us to achieve this study. We reveal our appreciation to the NRC, Giza, Egypt for sponsoring this work. Also, we are thankful to the children and their parents for approval to participate in the research.

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Impact of fruits and vegetables consumption on cardio-metabolic health - a case control study

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