Table 1.

Characteristics of the prospective cohort studies selected for meta-analysis

References	Cohort name, years of study (country)	Follow-up	Sample, sex, age	Outcomes, no. of cases	Diet assessment	Covariate adjustment
Hu [16]	HPFS, 1986 and NHS, 1980 (US)	8 years in men and 14 years in women	37,851 men (40–75 years) and 80,082 women (34–59 years)	866 CHD and 258 stroke events in men and 939 CHD and 563 stroke events in women	Repeated FFQ	Age, BMI, 2-year history of myocardial infarction, multivitamin supplement use, vitamin E, menopausal hormone use (women), history of hypertension, physical activity, and total energy intake
He [17]	HPFS, 1986 (US)	14 years	43,732 (40–75 years) men	725 stroke, 455 ischemic stroke, 125 hemorrhagic stroke events	Repeated FFQ	BMI, physical activity, history of hypertension, smoking status, aspirin use, multivitamin use, consumption of alcohol, potassium, fiber, vitamin E, total servings of fruit and vegetables, total energy intake, and hypercholesterolemia at baseline
Sauvaget [18]	LSS, 1979–1981 (Japan)	16 years	15,350 men (mean age 54 years) and 24 999 women (mean age 58 years)	1462 stroke events	FFQ	Stratified by sex and birth cohort, adjusted for city, radiation dose, self-reported BMI, smoking status, alcohol habits, education level, history of diabetes, or hypertension
Nakamura [19]	NIPPON DATA80, 1980 (Japan)	14 years	5186 women (≥ 30 years) and 4077 men (≥ 30 years)	112 stroke and 39 CHD events in men, 107 stroke and 41 IHD events in women	FFQ	Age, serum creatinine, total cholesterol, blood glucose, BMI, systolic and diastolic blood pressures, use of blood pressure–lowering drugs, cigarette smoking, and alcohol intake
Nakamura [20]	JPHC, 1990 (Japan)	10.2 years (mean)	19,856 men and 21,408 women, aged 40–59 years in cohort I; 23,463 men and 26,008 women, aged 40–69 years in cohort II	462 CHD events	FFQ	Age, sex, BMI, hypertension, diabetes, use of cholesterol-lowering drugs, smoking, alcohol drinking, whether or not intended to avoid cholesterol-rich diets, consumption frequencies of meat, fish, vegetables, fruits, and cohort effects
Trichopoulou [52]	EPIC-Greece, 1994–1999 (Greece)	4.5 years (mean)	1013 men and women (20–86 years)	46 CVD death events	FFQ	Gender, age, educational level, smoking, waist-to-height, hip circumference, MET score, treatment with insulin, treatment for hypertension at enrollment, treatment for hypercholesterolemia at enrollment, and other indicated food groups
Qureshi [21]	NHANES I, 1982–1992 (US)	20 years	13,586 men and women (25–74 years)	655 stroke, 1584 MI and 253 CVD death events	FFQ	Age, gender, race/ethnicity, systolic blood pressure, diabetes mellitus, serum cholesterol, cigarette smoking, BMI, and educational status
Djoussé [22]	PHS, 1981 (US)	20 years	21,327 men (40–85 years)	1550 MI, 1342 stroke events	FFQ	Age, BMI, smoking, history of hypertension, vitamin intake, alcohol consumption, vegetable consumption, breakfast cereal, physical activity, treatment arm, atrial fibrilation, diabetes mellitus, hypercholesterolemia, parental history of premature myocardial infarction
Djoussé [23]	PHS, 1981 (US)	20 years	21,327 men (40–85 years)	1084 heart failure events	FFQ	Age, BMI, smoking, alcohol consumption, physical activity, history of diabetes mellitus, atrial fibrillation, hypertension, valvular heart disease, and treatment for cholesterol
Nettleton [24]	ARIC, 1987–1989 (US)	13.3 years	14,153 men and women (45–64 years)	1140 heart failure events	Repeated FFQ	Energy intake, age, sex, race/center, education level, physical activity level, smoking, drinking status, and prevalent disease status: cardiovascular disease, diabetes, and hypertension
Bernstein [25]	NHS, 1980 (US)	26 years	84,136 women (30–55 years)	2210 CHD and 952 CHD death events	Repeated FFQ	Age, time period, total energy, cereal fiber, alcohol, trans fat, BMI, cigarette smoking, menopausal status, parental history of early myocardial infarction, multivitamin use, vitamin E supplement use, aspirin use at least once per week, physical exercise
Scrafford [26]	NHANES III, 1988–1994 (US)	12.2 years	6833 men and 8113 women (≥ 17 years)	168 CHD and 74 stroke events in women and 198 CHD and 63 stroke events in men	FFQ	Age, energy, marital status, educational status, race/ethnicity, smoking status, BMI, WHR, diabetes, hypertension and dietary variables
Bernstein [28]	HPFS, 1986 and NHS, 1980 (US)	26 years in women and 22 years in men	84,010 women (30–55 years) and 43,150 men (40–75 years)	2633 stroke events in women and 1397 stroke events in men	Repeated FFQ	Age, time period BMI, cigarette smoking, physical exercise, parental history of early myocardial infarction, menopausal status in women, multivitamin use, vitamin E supplement use, aspirin use, total energy, cereal fiber, alcohol, transfat, fruit and vegetables, and other protein sources
Houston [49]	Health ABC, 1997–1998 (US)	9 years	1941 men and women (70–79 years)	203 CVD events	FFQ	Age, gender, race, education, field center, smoking, alcohol use, physical activity, BMI, total energy intake, protein intake, fiber intake, multivitamin use, supplemental vitamin E use, statin use, aspirin use, oral estrogen use (women only), prevalent hypertension, and saturated fat
Zazpe [27]	SUN, 1999 (Spain)	6.1 years	14,185 men and women (20–90 years)	91 CVD events	FFQ	Age, sex, total energy intake, adherence to the Mediterranean food pattern, alcohol intake, baseline BMI, smoking status, physical activity during leisure time, family history of CVD, self-reported diabetes, self-reported hypertension, self-reported hypercholesterolemia
Dilis [29]	EPIC-Greece, 1994–1999 (Greece)	10 years	23,929 men and women (20–86 years)	636 CHD events	FFQ	Age, BMI, height, physical activity, years of schooling, energy intake, alcohol consumption, smoking status and arterial blood pressure, and nutritional variables
Misirli [30]	EPIC-Greece, 1994–1999 (Greece)	10.6 years	23,601 men and women (20–86 years)	395 stroke events	FFQ	Sex, age, education, smoking status, BMI, level of physical activity as measured in metabolic equivalents, hypertension, diabetes, and total energy intake
Yaemsiri [31]	WHI-OS, 1994–1998 (US)	7.6 years	87,025 women (50–79 years)	1049 ischemic stroke events	Repeated FFQ	Age, race, education, family income, years as a regular smoker, hormone replacement therapy use, total metabolic equivalent task hours per week, alcohol intake, history of coronary heart disease, history of atrial fibrillation, history of diabetes, aspirin use, use of antihypertensive medication, use of cholesterol-lowering medication, BMI, systolic blood pressure, and total energy intake, dietary vitamin E, fruits and vegetable intake, fiber
Goldberg [32]	NMS, NR (US)	11 years	1429 men and women (> 40 years)	719 CVD (266 stroke events, 226 MI, 452 CVD death events)	FFQ	Age, sex, race/ethnicity, BMI, diabetes, hypertension, LDL, HDL, TG, cholesterol-lowering medication, moderate alcohol use, moderate-heavy physical activity, smoking, high-school completion, daily kcal, Mediterranean diet score, history of stroke, myocardial infarction, daily consumption of saturated fat, unsaturated fat, carbohydrates, and protein
Haring [33]	ARIC, 1987–1989 (US)	22 years	12,066 men and women (45–64 years)	1147 CHD events	Repeated FFQ	Age, sex, race, study center, total energy intake, smoking, cigarette years, education, systolic blood pressure, use of antihypertensive medication, high-density lipoprotein cholesterol, total cholesterol, use of lipid-lowering medication, BMI, waist-to-hip ratio, alcohol intake, sports-related physical activity, leisure-related physical activity, carbohydrate intake, fiber intake, fat intake, and magnesium intake
Haring [34]	ARIC, 1987–1989 (US)	22.7 years	11,601 men and women (45–64 years)	699 stroke events	Repeated FFQ	Age, sex, race, study center, total energy intake, smoking, cigarette years, education, systolic blood pressure, use of antihypertensive medication, high-density lipoprotein cholesterol, total cholesterol, use of lipid-lowering medication, BMI, waist-to-hip ratio, alcohol intake, sports-related physical activity, leisure-related physical activity, carbohydrate intake, fiber intake, fat intake, and magnesium intake
Larsson [35]	COSM, 1997 and SMC, 1987–1990 (Norway)	13 years	37,766 men (45–79 years) and 32,805 women (49–83 years)	1628 HF, 3262 MI, 2039 ischemic strokes, 405 hemorrhagic stroke events in men and 1207 HF, 1504 MI, 1561 ischemic stroke, and 294 hemorrhagic stroke events in women	FFQ	Age, education, family history of myocardial infarction, smoking status and pack-years of smoking, aspirin use, walking/bicycling, exercise, BMI, history of hypertension, hypercholesterolemia, and diabetes, intakes of total energy, alcohol, fruit and vegetables, and processed meat
Farvid [38]	GCS, 2004 (Iran)	11 years	42,403 men and women (36–85 years)	1467 CVD, 764 CHD, 507 stroke events	FFQ	Sex, age, ethnicity, education, marital status, residency, smoking, opium use, alcohol, BMI, systolic blood pressure, occupational physical activity, family history of cancer, wealth score, medication, and energy intake
Virtanen [36]	KIHD, 1984–1989 (Finland)	20.8 years	1032 men (42–60 years)	230 CHD events	4-d food records	Age, examination year, and energy intake, smoking, BMI, diabetes, hypertension, leisure-time physical activity, coronary artery disease history in close relatives, education, and intakes of alcohol, fruit, berries, vegetables, fiber, PUFAs, and SFAs
Díez-Espino [37]	PREDIMED, 2003–2009 (Spain)	5.8 years	7216 men and women (55–80 years)	342 CVD events	FFQ	Age, sex, BMI, intervention group, recruitment center, smoking status, physical activity during leisure time, and educational status, diabetes, hypertension, hypercholesterolemia, family history of CVD, Mediterranean food pattern, alcohol intake, and total energy intake
Guo [39]	CAPS, 1979–1983 and NDNS, 2008–2009 (UK)	22.8 years	2512 men (45–59 years)	715 CVD (248 stroke, 477 MI, 201 heart failure) events	7-d food records	Age, BMI, total energy intake, alcohol consumption, smoking status, energy expenditure, social class, family history of myocardial infarction, diabetes mellitus, sugar intake, fruit consumption, red meat consumption and fiber (cereal and vegetable sources)
Jang [40]	KGES, 2001–2002 (Korea)	7.3 years	9248 men and women (40–69 years)	570 CVD events	FFQ	Age, sex, educational level, residential area, monthly household income, alcohol drinking, smoking in pack-years, physical activity level, dietary supplement use, history of hypertension and dyslipidemia, and the intake levels of total energy, total vegetables, total fruits, red meat, fiber, vitamin E, BMI
Qin [41]	CKB, 2004–2008 (China)	8.9 years	461,213 men and women (30–79 years)	83,977 CVD (30,169 IHD, 7078 hemorrhagic stroke, and 27,745 ischemic stroke) and 9985 CVD death events (3374 IHD, 3435 hemorrhagic stroke, and 1 003 ischemic stroke deaths)	Repeated FFQ	Age at recruitment, sex, education level, household income, marital status, alcohol consumption, tobacco smoking, physical activity in MET-hours/day, BMI, waist-to-hip ratio, prevalent hypertension, use of aspirin, family history of CVD, intake of multivitamin supplementation and dietary pattern
Xu [43]	GBCS, 2003–2008 (China)	9.8 years	28,024 men and women (> 50 years)	873 CVD, 388 IHD and 341 stroke death events	FFQ	Sex, age, education, occupation, family income, smoking status, physical activity, alcohol drinking, self-rated health and chronic disease history (diabetes, hypertension and dyslipidemia), dietary variables (daily dietary energy and vegetable, fruit, milk and nut intake were included in this model with additional adjustment for total energy, vegetable, fruit, milk and nut intake; only in 18,707 participants)
Zamora‐Ros [44]	EPIC-Spain, 1992–1996 (Spain)	18 years	40,621 men and women (29–69 years)	761 CVD death and 184 stroke events	FFQ	center, age at recruitment in 5 year categories, sex, smoking intensity, BMI, lifetime alcohol intake, education level, physical activity, energy intake, and adherence to Mediterranean diet
Abdollahi [42]	KIHD, 1984–1989 (Finland)	21.2 years	1950 men (42–60 years)	217 stroke (166 ischemic and 55 hemorrhagic) events	4-d food records	Age, year of examination, energy intake, BMI, pack-years of smoking, leisure-time physical activity, hypertension medication, intakes of alcohol, fruit, berries, and vegetables
Djoussé [47]	MVP, 2011 (US)	3.24 years (mean)	188,267 men and women (64.4 years mean)	10,160 MI events	FFQ	Age, sex race, education, BMI, exercise, smoking, alcohol intake, and dietary approach to stop hypertension score
Key [50]	EPIC, 1992–2000 (Europe)	12.6 years (mean)	409,885 men and women (~ 55 years)	7198 CHD events	FFQ	Age, smoking status and number of cigarettes per day, history of diabetes mellitus, previous hypertension, prior hyperlipidemia, Cambridge physical activity index, employment status, level of education completed, BMI, current alcohol consumption, and observed intakes of energy, fruit and vegetables combined, sugars, fiber from cereals, and stratified by sex and EPIC center
van den Brandt [53]	NLCS, 1986, (The Netherlands)	~ 9 years	3202 subcohort men and women (55–69 years)	2985 CVD death events	FFQ	Age at baseline, sex, cigarette smoking status, number of cigarettes smoked per day, and years of smoking, history of physician-diagnosed hypertension and diabetes, body height, BMI, non-occupational physical activity, highest level of education, intake of alcohol, vegetables and fruit, energy, use of nutritional supplements, and, in women, postmenopausal HRT
Zhong [45]	Pooled cohorts (from US)a	17.7 years	29,615 men and women (mean age 51.6 years at baseline)	5400 CVD events	Harmonized assessment	Age, sex, race/ ethnicity, education, total energy, smoking status, smoking pack- years, cohort-specific physical activity z score, alcohol intake, use of hormone therapy, BMI, diabetes status, systolic blood pressure, use of antihypertensive medications, high-density lipoprotein (HDL) cholesterol, non-HDL cholesterol, and use of lipid-lowering medications, dietary cholesterol consumption
Dehghan [46]	PURE, 2003, (multinational); ONTARGET/TRANSCEND, 2001–2004 (multinational)	9.5 years PURE; 56 months ONTARGET/TRANSCEND	PURE: 114,615 men and women (~ 50 years); ONTARGET/ TRANSCEND 31,410 men and women (≥ 55 years)	PURE: 3410 CVD death events, 8477 CVD events, 3664 MI, 3916 stroke, 939 heart failure; ONTARGET/ TRANSCEND: 2264 CVD death events, 5181 CVD events, 1554 MI, 1394 stroke, 1337 heart failure	FFQ	PURE: age, sex, smoking, location, education, physical activity, history of diabetes, daily intakes of fruits, vegetables, dairy, red meat, poultry, and fish; percentage energy from carbohydrate; total daily energy; and center as a random effect ONTARGET/TRANSCEND: age, sex, smoking, location, BMI, education, physical activity, history of diabetes, history of myocardial infarction; history of stroke; medication; trial allocation; daily intakes of fruit, vegetables, red meat, poultry, fish, and dairy; and regions as a random effect
Drouin-Chartier [48]	HPFS, 1986, NHS, 1980, NHS II, 1991 (US)	32 years (up to)	HPFS: 42,055 men (40–75 years); NHS: 83,349 women (30–55 years); NHS II: 90,214 (25–44 years)	HPFS: 6170 CVD, 4461 CHD, 1740 stroke events; NHS: 7411 CVD, 3896 CHD, 3587 stroke events; NHS II: 1225 CVD, 653 CHD, 576 stroke events	FFQ	Age, race, family history of myocardial infarction, baseline hypercholesterolemia, baseline hypertension, smoking status, BMI, physical activity, oral contraceptive use (in NHS II only), postmenopausal hormone use (in NHS and NHS II only), alcohol intake, and multivitamin use, hypercholesterolemia and hypertension, cumulative average of daily intake of total calories, full fat milk, bacon, unprocessed red meat, other processed meats, refined grains, fruits, vegetables, potatoes, coffee, fruit juices, and sugar-sweetened beverages
Tong [51]	EPIC, 1992–2000 (Europe)	12.7 years (mean)	418,329 men and women (~ 55 years)	7378 stroke events (4281 ischemic and 1430 hemorrhagic)	FFQ	Age, smoking status and number of cigarettes per day, history of diabetes, prior hypertension, prior hyperlipidemia, Cambridge physical activity index, employment status, level of education completed, current alcohol consumption, BMI, and observed intake of energy, and stratified by sex and EPIC center
Xia [54]	China-MUCA, 1998; InterAISA, 200–2001 (China); CIMIC, 2007–2008 (China)	15 years China-MUCA (median); 13 years InterAISA (median); 6 years CIMIC (median)	China-MUCA: 10,410 men and women (35–59 years); InterAISA: 12,660 men and women (35–74 years); CIMIC: 79,066 men and women (≥ 18 years)	Overall 4848 CVD, 1273 CHD, 2919 stroke (1832 ischemic, 862 hemorrhagic) events	FFQ	Age, gender, urban or rural resident, per-capita household income, education attainment, tobacco smoking, alcohol consumption, family history of CVD, physical activity, BMI and dietary factors (red meat intake, fresh fruit and vegetable intake)

ARIC Atherosclerosis Risk in Communities, CAPS Caerphilly Prospective Cohort Study, CKB China Kadoorie Biobank, COSM Cohort of Swedish Men, EPIC European Prospective into Cancer and Nutrition, GBCS Guangzhou Biobank Cohort Study, GCS Golestan Cohort Study, Health ABC Health, Aging and Body Composition, HPFS Health Professionals Follow-up Study, JPHC Japan Public Health Center-based prospective study, KGES Korean Genome and Epidemiology Study, KIHD Kuopio Ischaemic Heart Disease Risk Factor Study, LSS Life Span Study, MVP Million Veteran Program, NDNS National Diet and Nutritional Survey, NHANES National Health and Nutrition Examination Survey, NHS Nurses’ Health Study, NIPPON DATA80 Non-communicable Disease and Its Trends in the Aged, 1980, NMS Northern Manhattan Study, NR not reported, ONTARGET Ongoing Telmisartan Alone and in Combination with Ramipril Global End Point Trial, PHS Physicians’ Health Study, PREDIMED PREvencion con DIeta MEDiterranea, PURE Prospective Urban Rural Epidemiology, SMC Swedish Mammography Cohort, SUN Seguimiento Universidad de Navarra, TRANSCEND Telmisartan Randomized Assessment Study in ACEI Intolerant Subjects with Cardiovascular Disease, WHI-OS Women’s Health Initiative Observational Study

^aCohorts included were Atherosclerosis Risk in Communities (ARIC) Study, Coronary Artery Risk Development in Young Adults (CARDIA) Study, Framingham Heart Study (FHS), Framingham Offspring Study (FOS), Jackson Heart Study (JHS), and the Multi-Ethnic Study of Atherosclerosis (MESA)