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Int J Epidemiol. 2017 Jun 1;46(3):1029-1056. doi: 10.1093/ije/dyw319.

Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies.

Author information

1
Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
2
Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
3
Bjørknes University College, Oslo, Norway.
4
Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
5
Department of Epidemiology.
6
Department of Nutrition, Harvard T. Chan School of Public Health, Boston, MA, USA.
7
Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
8
Department of Global Public Health and Primary Care & Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
9
Biostatistics Unit, University of Leeds, Leeds, UK.
10
Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.

Abstract

Background:

Questions remain about the strength and shape of the dose-response relationship between fruit and vegetable intake and risk of cardiovascular disease, cancer and mortality, and the effects of specific types of fruit and vegetables. We conducted a systematic review and meta-analysis to clarify these associations.

Methods:

PubMed and Embase were searched up to 29 September 2016. Prospective studies of fruit and vegetable intake and cardiovascular disease, total cancer and all-cause mortality were included. Summary relative risks (RRs) were calculated using a random effects model, and the mortality burden globally was estimated; 95 studies (142 publications) were included.

Results:

For fruits and vegetables combined, the summary RR per 200 g/day was 0.92 [95% confidence interval (CI): 0.90-0.94, I 2  = 0%, n  = 15] for coronary heart disease, 0.84 (95% CI: 0.76-0.92, I 2  = 73%, n  = 10) for stroke, 0.92 (95% CI: 0.90-0.95, I 2  = 31%, n  = 13) for cardiovascular disease, 0.97 (95% CI: 0.95-0.99, I 2  = 49%, n  = 12) for total cancer and 0.90 (95% CI: 0.87-0.93, I 2  = 83%, n  = 15) for all-cause mortality. Similar associations were observed for fruits and vegetables separately. Reductions in risk were observed up to 800 g/day for all outcomes except cancer (600 g/day). Inverse associations were observed between the intake of apples and pears, citrus fruits, green leafy vegetables, cruciferous vegetables, and salads and cardiovascular disease and all-cause mortality, and between the intake of green-yellow vegetables and cruciferous vegetables and total cancer risk. An estimated 5.6 and 7.8 million premature deaths worldwide in 2013 may be attributable to a fruit and vegetable intake below 500 and 800 g/day, respectively, if the observed associations are causal.

Conclusions:

Fruit and vegetable intakes were associated with reduced risk of cardiovascular disease, cancer and all-cause mortality. These results support public health recommendations to increase fruit and vegetable intake for the prevention of cardiovascular disease, cancer, and premature mortality.

KEYWORDS:

Fruit and vegetables; all-cause mortality; cancer; cardiovascular disease; cohort; diet; global assessment; nutrition

PMID:
28338764
PMCID:
PMC5837313
DOI:
10.1093/ije/dyw319
[Indexed for MEDLINE]
Free PMC Article

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