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

• Published in: International journal of epidemiology Vol. 46; no. 3; pp. 1029 - 1056
• Main Authors: Aune, Dagfinn, Giovannucci, Edward, Boffetta, Paolo, Fadnes, Lars T, Keum, NaNa, Norat, Teresa, Greenwood, Darren C, Riboli, Elio, Vatten, Lars J, Tonstad, Serena
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-06-2017
• Subjects: Cardiovascular Diseases - mortality; Diet; Fruit; Humans; Miscellaneous; Mortality; Neoplasms - mortality; Prospective Studies; Risk Reduction Behavior; Vegetables; cardiovascular disease; nutrition; global assessment; all-cause mortality; Fruit and vegetables; cohort; cancer; diet
• ISSN: 0300-5771; 1464-3685; 1464-3685
• DOI: 10.1093/ije/dyw319

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.
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.
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.
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.