Tea consumption and cardiovascular risk in the

SU.VI.MAX Study: Are life-style factors important?

Louise I. Mennen

a,b,

*, Denis Malvy

c

, Pilar Galan

a

, Paul Preziosi

a

,

Sandrine Bertrais

a

, Eric Bruckert

d

, Miche`le Maurel

a

, Claire Franchisseur

a

,

Serge Hercberg

a,b

a

UMR INSERM unit 557/INRA unit 1125, Scientific and Technical Institute for Nutrition and Food,

ISTNA/CNAM, 5, rue du Vertbois, 75003 Paris, France

b

Unite´ de Surveillance d’Epide´miologie Nutritionnelle, InVS-CNAM, 5 rue du Vertbois, 75003 Paris, France

c

INSERM unit 330, University Victor Segalen, Bordeaux II, 146 rue Leo Saignat, 33076 Bordeaux, France

d

Service d’Endocrinologie-Metabolisme, Unite de Prevention des Maladies Cardiovasculaires,

Hopital Pitie Salpetriere, Paris, France

Received 13 June 2002; received in revised form 12 March 2003; accepted 13 March 2003

Abstract

The relationship of tea consumption with classical cardiovascular risk factors was evaluated.

Cardiovascular risk factors were measured in 2926 participants of the SU.VI.MAX study (an ongoing
intervention trial on the effects of antioxidant supplementation on chronic diseases), who completed
six 24-hour dietary records in the year before. Analyses of variance were used in a cross-sectional
design. In women, waist-hip ratio, total cholesterol, serum-triglycerides and fasting glucose decreased
with increasing tea consumption, whereas, BMI, blood pressure and serum-triglycerides were related
with tea consumption in men (p for trend between 0.002 and 0.05). Fruit and vegetable consumption
increased, and consumption of meat, and coffee decreased with increasing tea consumption (p for
trend ranged from 0.0001 to 0.04). Total fat intake was positively related to tea consumption (p for
trend

⫽ 0.0005 in men and 0.0001 in women). Tea consumption may be important in evaluating

determinants of cardiovascular risk, but lifestyle factors should be taken into account. © 2003 Elsevier
Inc. All rights reserved.

Keywords: Tea; Cardiovascular risk; Lifestyle

* Corresponding author. Tel.:

⫹33-1-53018044; fax: ⫹33-1-53018070.

E-mail address: [e-mail] (L.I. Mennen).

www.elsevier.com/locate/nutres

Nutrition Research 23 (2003) 879 – 890

0271-5317/03/$ – see front matter © 2003 Elsevier Inc. All rights reserved.
doi:10.1016/S0271-5317(03)00073-3

1. Introduction

More then thirty years ago, Young et al [1] suggested that lower rates of cardiovascular

diseases among Chinese, when compared with rates among North Americans, may be due to
tea drinking. Their conclusions were based on evidence from ecological studies. This led
others to study the effects of tea consumption on cardiovascular diseases in an epidemio-
logical setting. Most prospective cohort studies indeed observed a protective effect of regular
tea consumption on coronary heart disease [2,3], stroke [4] and atherosclerosis [5,6], but this
relationship was not present in a Californian and a Welsh cohort study [7–9]. One case-
control study found a protective effect on coronary heart disease of drinking more than 1 cup
of tea per day, while in a cross-sectional study the relationship between tea consumption and
the prevalence of coronary heart disease disappeared after adjustment for classical cardio-
vascular risk factors [10].

There has been some debate on the relationship of tea consumption with these risk factors.

Some studies observed inverse associations between tea consumption and blood lipids, blood
pressure or body mass index, but others did not [3,11–18]. Often the ragen of tea drinking
was too small to draw firm conclusions. Several authors suggested that the relationship
between tea consumption and cardiovascular risk is confounded by lifestyle factors
[3,11,19 –21]. Regular tea consumers have been found to smoke less, drink less coffee, eat
more fruit and vegetables and have more physical exercise [3,11,19,20], although again the
Welsh population seems to be an exception to this [9].

Tea is consumed by a large proportion of the population and its cardiovascular protective

effects, if proven, may have wide implications. In order to interpret data from studies on tea
consumption and cardiovascular morbidity and mortality, however, we have to know exactly
how tea consumption relates to classical cardiovascular risk factors and lifestyle behavior.
We have, therefore, explored these relationships in a large cohort of French adults who are
part of the “SUpple´mentation en VItamines et Mine´raux AntioXydants” (SU.VI.MAX)
Study.

2. Subjects and methods

2.1. Subjects

Subjects were participants of the SU.VI.MAX study, an ongoing randomized double-blind

placebo-controlled primary-prevention trial designed to evaluate the effect of daily antiox-
idant supplementation (vitamin C, vitamin E,

␤-carotene, selenium and zinc) at nutritional

doses on the incidence of cancer and ischemic heart disease. The cohort consists of women
in the age of 35 to 60 years (mean: 46.4, SD: 6.7) and men in the age of 45 to 60 years (mean:
51.1, SD: 4.7). Subjects were invited to participate by a multimedia campaign in France. In
total 12,735 subjects were included at baseline in 1994 and are being followed up for eight
years. Details on recruitment and study design have been described earlier [22]. In total, 2926

880

L.I. Mennen et al. / Nutrition Research 23 (2003) 879 – 890

subjects completed six dietary records in the year before the measurement of cardiovascular
risk factors and were included for the present analyses.

The SU.VI.MAX Study has been approved by the ethical committee for studies on human

subjects (CCPPRB no. 706) of Paris-Cochin Hospital, and the ‘Comite´ National Informa-
tique et Liberte´’ (CNIL no. 334641).

2.2. Dietary assessment

Subjects kept a 24-hour record every 2 months, for a total of six records per year. They

kept the record randomly for two weekend days and four weekdays per year, so that each day
of the week was covered in all seasons for the mean intake of all participants. Information
was collected using the Minitel Telematic Network. The Minitel is a small terminal widely
used in France as an adjunct to the telephone. At the beginning of the study, participants
received free of charge a tiny central processing unit specifically developed for the study and
loaded with specialized software that allows subjects to fill out the computerized dietary
record off-line and to transmit data during brief telephone connections. Conversational
facilities of the software and an instruction manual for codification of foods guided the
participants during the completion of the records. The manual contains photographs showing
portions in three sizes and along with the two intermediate and two extreme positions, seven
choices are available to indicate the consumed portion. Photos of portion sizes were
previously validated using 780 subjects in a pilot study [23]. Data on variables such as
cooking methods, seasoning, types of foods (fresh, frozen, canned etc.) and place and time
of consumption were also collected.

2.3. Measurements of risk markers

Weight and height were measured at the end of the second year of the study year with

subjects in underwear and body mass index was calculated by dividing weight by the square
of height (Kg/m

2

). Blood pressure was measured one time at each arm using a standard

mercury sphygmomanometer in subjects who had been lying down for 10 minutes. The mean
of these two measurements was taken for analyses. Information of smoking habits and
physical activity was obtained by means of a questionnaire. Blood samples were obtained in
vacutainer tubes (Becton Dickinson) from participants who had been fasting for 12 hours.
Fasting glucose, total cholesterol and serum-triglycerides were all measured by enzymatic
method (Technicon DAX). Laboratory quality assurance included analysis of serum from
standard pools with each run and, if available, international standards.

2.4. Data analyses

Intakes of energy, proteins, carbohydrates, total fat; saturated and mono- and polyunsat-

urated fatty acids, cholesterol, fiber, and alcohol were calculated from food consumption
using the French food composition table CIQUAL [24]. Tea consumption was estimated
from the mean intake of the six dietary records, expressed in ml/day. The dietary records did
not distinguish between black and green tea, but the consumption in general in France is

881

L.I. Mennen et al. / Nutrition Research 23 (2003) 879 – 890

mostly black tea. Taking the intra- and interindividual variations of tea consumption into
account at least 2 records are needed to estimate tea consumption with an accuracy of 0.9.
We selected 6 records to cover differences between seasons and days of the week. Tea
consumption was divided in four groups, 0 ml/day (non-drinkers), 0 –150 ml/day (corre-
sponding to 1 cup of tea or less), 150-300 ml/day (

⬎1–2 cups), ⬎300 ml/day (⬎2 cups a

day).

Differences in cardiovascular risk factors and energy and macronutrient intake were

compared between groups with analyses of variance adjusted for age and for energy intake
when appropriate. A test for trend was applied for the different categories of tea consump-
tion. The difference in percentages of non smokers, ex-smokers and current smokers and the
difference in percentages between the three groups of physical activity (no physical activity,
moderate physical activity (resembling less than 1 hour of walking per week), high physical
activity (resembling more than 1 hour of walking per week) were evaluated with a Chi-
square test. Data on serum-triglycerides and fasting glucose were log-transformed to obtain
normal distributions.

3. Results

Forty percent of females were non-drinkers of tea (Table 1). Female tea drinkers were

somewhat younger than non-drinkers, but the difference between the groups was smaller
than two years (Table 1). In men 64% were non-drinkers and no difference in age was
observed for men (Table 2).

Waist-to-hip ratio, total cholesterol, serum-triglycerides and fasting glucose showed a

decreasing trend with increasing tea consumption in women (Table 1). Often lower levels of
these variables were seen in women with an intake of more than 150 ml/day. In men, body
mass index, waist-to-hip ratio, systolic blood pressure and serum-triglycerides were inversely
associated with tea consumption. There was no clear trend in any of the other risk factors.

The percentage of current smokers was lowest among women with the highest tea

consumption, the difference with non-drinkers being 3.2% (p Chi

2

⫽ 0.001). The number of

Table 1
Cardiovascular risk factors (means adjusted for age (SE)) according to tea consumption in women

Tea consumption (ml/day)

0

⬎0–150

150–300

⬎300

p for trend

n (%)

640 (40)

403 (25)

196 (12)

366 (23)

Age (yrs)

48.1 (0.26)

47.7 (0.33)

46.8 (0.47)

47.5 (0.34)

0.07

Body mass index (Kg/m

2

)

23.1 (0.15)

23.1 (0.20)

23.3 (0.31)

22.5 (0.20)

0.10

Waist-hip ratio

0.77 (0.005)

0.77 (0.005)

0.77 (0.005)

0.76 (0.005)

0.003

Diastolic blood pressure (mmHg)

76.8 (0.31)

76.7 (0.46)

77.3 (0.71)

75.6 (0.51)

0.12

Systolic blood pressure (mmHg)

119.9 (0.51)

119.7 (0.71)

121.8 (1.02)

118.3 (0.77)

0.41

Total cholesterol (mmol/l)

5.78 (0.04)

5.76 (0.05)

5.62 (0.07)

5.69 (0.05)

0.04

Serum-triglycerides (mmol/l)

0.79 (0.01)

0.80 (0.02)

0.78 (0.03)

0.74 (0.02)

0.03

a

Fasting glucose (mmol/l)

5.37 (0.02)

5.37 (0.03)

5.28 (0.04)

5.28 (0.03)

0.002

a

a

Based on log transformed data.

882

L.I. Mennen et al. / Nutrition Research 23 (2003) 879 – 890

ex-smokers was, however, by far the highest in those with the highest tea consumption (Fig.
1). There were hardly differences in percentage of never, ex- and current smokers among the
different groups of tea consumption in men (p Chi

2

⫽ 0.21). The highest percentage of

current smokers was seen in non-drinkers and those drinking between 150 and 300 ml of tea

Table 2
Cardiovascular risk factors (means adjusted for age (SE)) according to tea consumption in men

Tea consumption (ml/day)

0

⬎0–150

150–300

⬎300

p for trend

n (%)

846 (64)

226 (17)

100 (8)

149 (11)

Age (yrs)

52.7 (0.16)

52.6 (0.32)

52.7 (0.48)

52.1 (0.39)

0.25

Body mass index (Kg/m

2

)

25.4 (0.10)

25.1 (0.20)

25.7 (0.31)

24.5 (0.31)

0.04

Waist-hip ratio

0.93 (0.005)

0.91 (0.005)

0.93 (0.005)

0.91 (0.005)

0.02

Diastolic blood pressure (mmHg)

83.0 (0.31)

84.1 (0.61)

82.6 (0.97)

82.2 (0.87)

0.18

Systolic blood pressure (mmHg)

129.6 (0.51)

131.1 (1.07)

127.1 (1.58)

127.7 (1.38)

0.05

Total cholesterol (mmol/l)

5.85 (0.04)

5.98 (0.06)

5.98 (0.10)

5.82 (0.08)

0.75

Serum-triglycerides (mmol/l)

1.15 (0.02)

1.11 (0.04)

1.10 (0.06)

1.03 (0.05)

0.03

a

Fasting glucose (mmol/l)

5.81 (0.03)

5.80 (0.05)

5.93 (0.16)

5.66 (0.06)

0.20

a

a

Based on log transformed data.

Fig. 1. Percentages of current, ex- and never smokers and of high, moderate and no physical activity according
to tea consumption in women and men of the SU.VI.MAX Study.

883

L.I. Mennen et al. / Nutrition Research 23 (2003) 879 – 890

(18% for both groups). There were no differences in percentages of tea drinkers in the groups
of physical activity in men (Fig. 1). Only in women, the highest group of tea drinking
contained more women having moderate physical activity and less women having no
physical activity than the other groups of tea drinking (p Chi

2

⫽ 0.03).

Energy intake did not differ between the four groups of tea consumption (Fig. 2). The

lowest intake was seen in men and women drinking between 150 and 300 ml of tea per day.
In both men and women the intake of total fat was lowest in non-drinkers and highest in those
drinking more than 300 ml/day (Fig. 3). This increase of fat intake with increasing tea
consumption was equally seen for the intake of saturated, mono- and polyunsaturated fat
(data not shown). No differences were found for protein, carbohydrate or alcohol intake (Fig.
3). No differences were seen for dietary fiber and cholesterol intake between the groups of
tea drinking women or men (data not shown).

Consumption of fruit and vegetables increased and consumption of coffee and meat

decreased with increasing tea consumption in women (Fig. 4). In men, only vegetables and
coffee consumption were related to tea consumption. There was a tendency towards a higher
consumption of cakes and cookies with a higher intake of tea in men, but this trend was not
statistically significant (p

⫽ 0.17). No association between these variables was seen in

women.

When the analyses on the relationship between tea consumption and cardiovascular risk

factors, were further adjusted for fruit and vegetable, coffee and meat intake and current
smoking, and physical activity, the results remained the same.

4. Discussion

In this paper we describe for the first time details on the relationship between tea

consumption and a variety of cardiovascular risk factors and lifestyle determinants in the
French population. The results have shown no extreme differences in major cardiovascular

Fig. 2. Total energy intake according to tea consumption in women and men of the SU.VI.MAX Study.

884

L.I. Mennen et al. / Nutrition Research 23 (2003) 879 – 890

risk factors between different groups of tea drinking in men. In women most cardiovascular
risk factors decreased with increasing tea consumption. Female tea drinkers consumed in
general more fruit, vegetables and total fat, and less meat and coffee. Such associations
existed in men only for total fat, vegetables and coffee consumption.

In men, we showed for some risk factors a weak decreasing trend with increasing tea

consumption. The absence of a statistically significant trend is not due to a lack of power: to
show a difference in for example total cholesterol of 0.10 mmol/l with a power of 95% and
a confidence of 0.05, 85 subjects would be needed in each group. The group with the lowest
number of subjects were men drinking between 150 and 300 ml of tea, which contained 100
participants. The numbers in our study were thus large enough to show a statistically
significant trend among the groups.

Furthermore, the differences observed between men and women may have been due to the

difference in age group. The age range was chosen to ensure enough cases of cardiovascular
diseases and cancers to achieve adequate statistical power in the trial of which these subjects
were part, and the lower age level in women was justified by the incidence of breast and
uterine cancers. However, when we confined the female subjects to the same age range in
men, the results did not change (data not shown).

Our population is characterized by a high proportion of non-drinkers, which may have

diminished the association of tea with cardiovascular risk and lifestyle factors in trend

Fig. 3. Intake of macronutrients and alcohol according to tea consumption in women and men of the SU.VI.MAX
Study. *p for trend.

885

L.I. Mennen et al. / Nutrition Research 23 (2003) 879 – 890

analysis. Those subjects, who drink a lot of tea, may have a different lifestyle and a different
cardiovascular risk than non-drinkers. Since tea consumption differs between countries, with
respect to type of tea, brewing and time of consumption, no extrapolation from other
countries is possible. In this context, it is important to analyze factors associated with tea
consumption.

Several previous studies have evaluated the relationship between tea consumption and

serum-cholesterol and triglycerides. Three studies were conducted in Japan, where green tea
is the habitual type of tea consumed. Kono et al and Imai et al observed in men an inverse
relationship of tea consumption with total cholesterol [13,14], and also with serum-triglyc-
erides [13]. In both studies the relationships persisted after adjustment for lifestyle factors.
Tsubono et al [15], however, could not confirm these results in men nor in women, but the
highest tea consumption was

⬎5 cups a day, while in the other two Japanese studies the

highest group drank

⬎9 cups a day. Among populations drinking mostly black tea the results

were discrepant too. Four studies did not observe a relationship between tea consumption and
total cholesterol or serum-triglycerides [17,18,25,26]. Four other studies did find an inverse
association between total cholesterol or serum-triglycerides and tea consumption in men and
women, but the trends were not very strong or they were diminished after adjustment for
confounders [3,11,12,27]. The results of the present study seem to be similar to these latter

Fig. 4. Intake of fruit, vegetables, meat and coffee according to tea consumption in women and men of the
SU.VI.MAX Study. *p for trend.

886

L.I. Mennen et al. / Nutrition Research 23 (2003) 879 – 890

studies, as far as women are concerned. The fact that we did not observe an inverse
relationship in men for total cholesterol may be due to the high percentage of male
non-drinkers in our study.

The levels of other risk factors were compared between different groups of tea drinking

by Stensvold et al [3]; they observed an inverse relationship with systolic and diastolic blood
pressure, fasting glucose and body mass index. The relationship with body mass index was
not confirmed by other studies also evaluating black tea [11,28], nor by us for women. The
present study did, however, confirm the relationship with fasting glucose in women and with
blood pressure in men. Similarly, Lang et al [29] also observed an inverse relationship
between blood pressure and black tea consumption. The most important differences between
these studies can be found in the categorization of tea drinking. There is, however, no unique
method to split subjects according to the amount of tea consumed per day. For example,
Stensvold et al [3] combined non-drinkers with those drinking less than 1 cup a day, while
Tavani et al [28] used only two groups (non-drinkers vs. drinkers). Our large population
sample allowed us to split our population into four groups with increasing consumption,
which strengthened the statistical trend. Finally, one might consider that differences between
studies can be ascribed to the different types of tea consumed (black versus green tea), as the
type of polyphenols differ between green and black tea [30]. However, the discrepant results
on the relation with cardiovascular risk factors were observed between studies, which all
evaluated green tea consumption and also between studies, which all evaluated black tea
consumption.

The lifestyle of regular tea drinkers has been evaluated in several previous studies

[3,11,19,26,29,31]. As in the present study, four studies observed a lower percentage of
smokers among those with a high black tea consumption, except for one study [3,11,26,29].
Regular black tea drinkers were also found to be more physically active [3,19]. Alcohol
consumption among tea drinkers seems more difficult to establish. Stensvold et al [3]
observed a higher intake of alcohol with increasing tea consumption in women, while Green
et al [11] observed a lower alcohol intake, except for those consuming more than 5 cups of
tea a day. In a recent study, the intake of catechins, a polyphenol mainly coming from black
tea consumption, was inversely related to alcohol intake [32]. A high intake of catechins was
further associated with a higher intake of dietary fiber, vitamin C and

␤-carotene, and a lower

prevalence of smokers. Furthermore, several dietary lifestyle variables are important to
consider, as they are risk or protective factors for cardiovascular disease. Coffee consump-
tion, for example, has been found to be associated with an increased risk for myocardial
infarction [7]. Both black and green tea consumption was inversely associated to coffee
consumption [3,19,31]. Also, a high consumption of fruit and vegetables is associated to a
lower risk of cardiovascular disease [33]. This dietary behavior has been found to be
positively associated to tea consumption in the same three studies [3,19,31]. Finally, meat
consumption, which is inversely associated to tea consumption [3,19,31], has also been
found to be positively associated to cardiovascular disease, probably in relation to its
saturated fat content [34,35]. The results of the present study are in accordance with these
former investigations, although the evidence was less strong for men. This means that tea
consumption is part of a more healthy lifestyle with a lower coffee and meat and a higher
fruit and vegetable consumption. These factors have thus to be taken into account when

887

L.I. Mennen et al. / Nutrition Research 23 (2003) 879 – 890

evaluating tea consumption in relation to cardiovascular risk. When we adjusted for these
dietary habits, our results remained similar, indicating that tea consumption may have a
beneficial effect independent of other dietary lifestyle factors.

The higher total fat intake in subjects with a high tea consumption seems to be contra-

dictory to the healthier lifestyle in those subjects [31]. This may originate from a higher
intake of cookies and cakes by regular tea drinkers, as was also observed by Stensvold et al
[3] and Schwarz et al [19]. However, when we checked this hypothesis in our population,
there was a tendency towards higher intake of cakes and cookies with increasing tea
consumption in men, but this was not statistically significant. As the difference in fat intake
between the four groups of tea consumption was not due to a specific higher intake of one
type of fatty acid, it does not seem surprising that this difference was not reflected in the lipid
profile.

Especially in women, tea consumption was related with a healthier lifestyle, which was

reflected in a more favorable cardiovascular risk profile. Lifestyle factors are thus important
and in future studies on the relationship between tea consumption and coronary heart disease,
possible confounding by lifestyle factors has to be taken into account.

Acknowledgments

The SU.VI.MAX Study has support from public and private sectors. Special acknowl-

edgements are addressed to Fruit d’Or Recherche, Candia, Centre d’Information Scientifique
The´ & Sante´ de Lipton, Kellogg’s, Ce´re´al, CERIN, Este´e Lauder, L’Ore´al, Peugeot, Jet
Service, RP Scherer, Sodexho, France Telecom, Santogen, Becton Dickinson, Fould
Springer, Boehringer Diagnostic, Seppic Givaudan Lavirotte, Le Grand Canal, Danone and
Knorr.

P. Galan, S. Hercberg and D Malvy initiated the SU.VI.MAX study and participated in the

writing of the manuscript. LI. Mennen designed the present study, performed statistical
analyses and wrote the manuscript. P. Preziosi and S.Bertrais participated in the organization
of the study, the preparation of the database and the writing of the manuscript. E. Bruckert
participated in the writing of the manuscript. M. Maurel and C. Franchisseur participated in
the organization of the study.

References

[1] Young W, Hotovec RL, Romero AG. Tea and atherosclerosis. Nature 1967;216:1015– 6.
[2] Hertog MGL, Feskens EJM, Hollman PCH, Katan MB, Kromhout D. Dietary antioxidant flavonoids and

risk fo coronary heart disease: the Zutphen Elderly Study. Lancet 1993;342:1007–11.

[3] Stensvold I, Tverdal A, Solvoll K, Foss OP. Tea consumption, relationship to cholesterol, blood pressure,

and coronary and total mortality. Prev Med 1992;21:546 –53.

[4] Keli SO, Hertog MGL, Feskens EJM, Kromhout D. Dietary flavonoids, antioxidant vitamins, and incidence

of stroke: the Zutphen Study. Arch Intern Med 1996;156:637– 42.

[5] Geleijnse JM, Launer LJ, Hofman A, Pols HA, Witteman JCM. Tea flavonoids may protect against

atherosclerosis: the Rotterdam Study. Arch Intern Med 1999;159:2170 – 4.

888

L.I. Mennen et al. / Nutrition Research 23 (2003) 879 – 890

[6] Sasazuki S, Kodama H, Yoshimasu K, Liu Y, Washio M, Tanaka K, Tokunaga S, Kono S, Arai H, Doi Y,

Kawano T, Nakagaki O, Takada K, Koyanagi S, Hiyamuta K, Nii T, Shirai K, Ideishi M, Arakawa K, Mohri
M, Takeshita A. Relation between green tea consumption and the severity of coronary atherosclerosis
among Japanese men and women. Ann Epidemiol 2000;10:401– 8.

[7] Klatsky AL, Friedman GD, Armstrong MA. Coffee use prior to myocardial infarction restudied: heavier

intake may increase the risk. Am J Epidemiol 1990;132:479 – 88.

[8] Klatsky AL, Armstrong MA, Friedman GD. Coffee, tea, mortality. Ann Epidemiol 1993;3:375– 81.
[9] Hertog MGL, Sweetnam PM, Fehily AM, Elwood PC, Kromhout D. Antioxidant flavonols and ischemic

heart disease in a Welsh population of men: The Caerphilly Study. Am J Clin Nutr 1997;65:1489 –94.

[10] Brown CA, Bolton-Smith C, Woodward M, Tunstall-Pedoe H. Coffee and tea consumption and the

prevalence of coronary heart disease in men and women: results from the Scottish Heart Health Study. J
Epidemiol Comm Health 1993;47:171–5.

[11] Green MS, Harari G. Association of serum lipoproteins and health-related habits with coffee and tea

consumption in free-living subjects examined in the Israeli CORDIS Study. Prev Med 1992;21:532– 45.

[12] Green M, Jucha E. Association of serum lipids with coffee, tea and egg consumption in free-living subjects.

J Epidemiol Comm Health 1986;40:324 –9.

[13] Imai K, Nakchi K. Cross sectional study of effects of drinking green tea on cardiovascular and liver disease.

BMJ 1995;310:693– 6.

[14] Kono S, Shinchi K, Ikeda N, Yanai F, Imanishi K. Green tea consumption and serum lipid profiles: a

cross-sectional study in Northern Kysushi, Japan. Prev Med 1992;21:526 –31.

[15] Tsubono Y, Tsugane S. Green tea intake in relation to serum lipid levels in middle-aged Japanese men and

women. Ann Epidemiol 1997;7:280 – 4.

[16] Wei M, Macera CA, Hornung CA, Blair SN. The impact of changes in coffee consumption on serum

cholesterol. J Clin Epidemiol 1995;48:1189 –96.

[17] Carson CA, Cauley JA, Caggiula A. Relation of caffeine intake to blood lipids in elderly women. Am J

Epidemiol 1993;138:94 –100.

[18] Klatsky AL, Petitti DB, Armstrong MA, Friedman GD. Coffee, tea and cholesterol. Am J Cardiol

1985;55:577– 8.

[19] Schwarz B, Bischof HP, Kunze M. Coffee, tea, and lifestyle. Prev Med 1994;23:377– 84.
[20] Solvoll K, Serlmer R, Loken EB, Foss OP, Trygg K. Coffee, dietary habits, and serum cholesterol among

men and women 35-49 years of age. Am J Epidemiol 1989;129:1277– 88.

[21] Jacobsen BK, Thelle DS. The Tromso Heart Study: is coffee drinking an indicator of a life style with high

risk for ischemic heart disease? Acta Med Scan 1987;222:215–21.

[22] Hercberg S, Preziosi P, Briancon S, Galan P, Triol I, Malvy D, Roussel AM, Favier A. A primary prevention

trial of nutritional doses of antioxidant vitamins and minerals on cardiovascular diseases and cancers in
general population: The SU.VI.MAX Study. Design, methods and participants characteristics. Control Clin
Trials 1998;19:336 –51.

[23] Le Moullec N, Deheeger M, Preziosi P, Montero P, Valeix P, Rolland-Cachera M-F, Potier de Courcy G,

Christides J-P, Galan P, Hercberg S. Validation du manuel-photos utilise´ pour l’enqueˆte alimentaire de
l’e´tude SU.VI.MAX. Cah Nutr Diet 1996;31:158 – 64.

[24] Favier JC, Ireland-Ripert J, Toque C, Feinberg M. Re´pertoire ge´ne´ral des aliments. Table de composition.

Paris: INRA, CNEVA CIQUAL, Lavoisier Tec. et Doc., 1995.

[25] Kark JD, Friedlander Y, Kaufmann NA, Stein Y. Coffee, tea, and plasma cholesterol: the Jerusalem Lipid

Research Clinic prevalence study. BMJ 1985;291:699 –704.

[26] Aro A, Pietienen P, Uusitalo U, Tuomilehto J. Coffee and tea consumption, dietary fat intake and serum

cholesterol concentration of Finnish men and women. J Int Med 1989;226:127–32.

[27] Sheriff DS, Fakhri MEL. Tea consumption and serum lipids in a Libyan population in Benghazi. Ann Clin

Biochem 1988;25:670 –2.

[28] Tavani A, Negri E, La Vecchia C. Determinants of body mass index: a study from Northern Italy. Int J

Obesity 1994;18:497–502.

889

L.I. Mennen et al. / Nutrition Research 23 (2003) 879 – 890

[29] Lang T, Bureau JF, Degoulet P, Salah H, Benattar C. Blood pressure, coffee, tea and tobacco consumption:

an epidemiological study in Algiers. Eur Heart J 1983;4:602–7.

[30] Harbowy ME, Balentine DA. Tea chemistry. Crit Rev Plant Sci 1997;16:415– 480.
[31] Tsubono Y, Takahashi R, Iwase Y, Iitoi Y, Akabane M, Tsugane S. Dietary differences with green tea intake

among middle-aged Japanese men and women. Prev Med 1997;26:704 –10.

[32] Arts ICW, Hollman PCH, Feskens EJM, Bueno-de-Mesquita HB, Krombout D. Catechin intake and

associated dietary and lifestyle factors in a representative sample of Dutch men and women. Eur J Clin Nutr
2001;55:76 – 81.

[33] Ness AR, Powles JW. Fruit and vegetables, and cardiovascular disease: A review. Int J Epidemiol

1997;26:1–13.

[34] Menotti A, Kromhout D, Blackburn H, Fidanza F, Buzina R, Nissinen A. Food intake patterns and 25-year

mortality from coronary heart disease: cross-cultural correlations in the Seven Countries Study. Eur J Clin
Nutr 1999;15:507–15.

[35] Hu FB, Stampfer MJ, Manson JAE, Acherio A, Colditz GA, Speizer FE, Hennekens CH, Willett WC.

Dietary saturated fats and their food sources in relation to the risk of coronary heart disease in women. Am J
Clin Nutr 1999;70:1001– 8.

890

L.I. Mennen et al. / Nutrition Research 23 (2003) 879 – 890