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Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies.

Published on Jul 29, 2014in BMJ27.60
· DOI :10.1136/bmj.g4490
Xia Wang12
Estimated H-index: 12
(HUST: Huazhong University of Science and Technology),
Yingying Ouyang7
Estimated H-index: 7
(HUST: Huazhong University of Science and Technology)
+ 4 AuthorsFrank B. Hu202
Estimated H-index: 202
(Harvard University)
Cite
Abstract
Objective To examine and quantify the potential dose-response relation between fruit and vegetable consumption and risk of all cause, cardiovascular, and cancer mortality. Data sources Medline, Embase, and the Cochrane library searched up to 30 August 2013 without language restrictions. Reference lists of retrieved articles. Study selection Prospective cohort studies that reported risk estimates for all cause, cardiovascular, and cancer mortality by levels of fruit and vegetable consumption. Data synthesis Random effects models were used to calculate pooled hazard ratios and 95% confidence intervals and to incorporate variation between studies. The linear and non-linear dose-response relations were evaluated with data from categories of fruit and vegetable consumption in each study. Results Sixteen prospective cohort studies were eligible in this meta-analysis. During follow-up periods ranging from 4.6 to 26 years there were 56 423 deaths (11 512 from cardiovascular disease and 16 817 from cancer) among 833 234 participants. Higher consumption of fruit and vegetables was significantly associated with a lower risk of all cause mortality. Pooled hazard ratios of all cause mortality were 0.95 (95% confidence interval 0.92 to 0.98) for an increment of one serving a day of fruit and vegetables (P=0.001), 0.94 (0.90 to 0.98) for fruit (P=0.002), and 0.95 (0.92 to 0.99) for vegetables (P=0.006). There was a threshold around five servings of fruit and vegetables a day, after which the risk of all cause mortality did not reduce further. A significant inverse association was observed for cardiovascular mortality (hazard ratio for each additional serving a day of fruit and vegetables 0.96, 95% confidence interval 0.92 to 0.99), while higher consumption of fruit and vegetables was not appreciably associated with risk of cancer mortality. Conclusions This meta-analysis provides further evidence that a higher consumption of fruit and vegetables is associated with a lower risk of all cause mortality, particularly cardiovascular mortality.
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  • References (69)
  • Citations (557)
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References69
Newest
Published on Jan 1, 2014
George Wells11
Estimated H-index: 11
(U of O: University of Ottawa),
B. Shea19
Estimated H-index: 19
+ 8 AuthorsJ Petersen1
Estimated H-index: 1
Nonrandomised studies, including case-control and cohort studies, can be challenging to implement and conduct. Assessment of the quality of such studies is essential for a proper understanding of nonrandomised studies. The Newcastle-Ottawa Scale (NOS) is an ongoing collaboration between the Universities of Newcastle, Australia and Ottawa, Canada. It was developed to assess the quality of nonrandomised studies with its design, content and ease of use directed to the task of incorporating the qual...
Published on Aug 1, 2013in The American Journal of Clinical Nutrition6.57
Andrea Bellavia14
Estimated H-index: 14
(KI: Karolinska Institutet),
Susanna C. Larsson61
Estimated H-index: 61
(KI: Karolinska Institutet)
+ 2 AuthorsNicola Orsini43
Estimated H-index: 43
(KI: Karolinska Institutet)
Background: The association between fruit and vegetable (FV) consumption and overall mortality has seldom been investigated in large cohort studies. Findings from the few available studies are inconsistent. Objective: The objective was to examine the dose-response relation between FV consumption and mortality, in terms of both time and rate, in a large prospective cohort of Swedish men and women. Design: FV consumption was assessed through a self-administrated questionnaire in a population-based...
Published on Jan 1, 2013
K.T.B. Knoops7
Estimated H-index: 7
(WUR: Wageningen University and Research Centre),
Daan Kromhout9
Estimated H-index: 9
+ 3 AuthorsWija A. van Staveren64
Estimated H-index: 64
Context Dietary patterns and lifestyle factors are associated with mortality from all causes, coronary heart disease, cardiovascular diseases, and cancer, but few studies have investigated these factors in combination. Objective To investigate the single and combined effect of Mediterranean diet, being physically active, moderate alcohol use, and nonsmoking on all-cause and causespecific mortality in European elderly individuals. Design, Setting, and Participants The Healthy Ageing: a Longitudin...
Published on Jan 1, 2013in American Journal of Epidemiology4.47
Max Leenders21
Estimated H-index: 21
,
Ivonne Sluijs28
Estimated H-index: 28
+ 43 AuthorsMarie Christine Boutron-Ruault78
Estimated H-index: 78
In this study, the relation between fruit and vegetable consumption and mortality was investigated within the European Prospective Investigation Into Cancer and Nutrition. Survival analyses were performed, including 451,151 participants from 10 European countries, recruited between 1992 and 2000 and followed until 2010. Hazard ratios, rate advancement periods, and preventable proportions to respectively compare risk of death between quartiles of consumption, to estimate the period by which the r...
Published on May 1, 2012in Journal of the American Geriatrics Society4.11
Emily J. Nicklett13
Estimated H-index: 13
(UM: University of Michigan),
Richard David Semba1
Estimated H-index: 1
(UPenn: University of Pennsylvania)
+ 6 AuthorsLinda P. Fried117
Estimated H-index: 117
(Columbia University)
DESIGN: Six Cox proportional hazards models examined independent and additive relationships between physical activity, carotenoids, and all-cause mortality. Additional models tested whether physical activity and carotenoids were conjointly related to mortality. Models were adjusted for age, education, and race and ethnicity. SETTING: Baltimore, Maryland. PARTICIPANTS: Seven hundred thirteen women aged 70 to 79 participating in the Women’s Health and Aging Studies. MEASUREMENTS: Total serum carot...
Published on Apr 1, 2012in Atherosclerosis4.25
Wen Zhang4
Estimated H-index: 4
(Osaka University),
Hiroyasu Iso73
Estimated H-index: 73
(Osaka University)
+ 2 AuthorsAkiko Tamakoshi62
Estimated H-index: 62
(Aichi Medical University)
Abstract The authors sought to investigate the relationship between dietary magnesium intake and mortality from cardiovascular disease in a population-based sample of Asian adults. Reported findings are based on dietary magnesium intake in 58,615 healthy Japanese aged 40–79 years, in the Japan Collaborative Cohort (JACC) Study. Dietary magnesium intake was assessed by a validated food frequency questionnaire administered between 1988 and 1990. During the median 14.7-year follow-up, we documented...
Published on Jan 1, 2012in American Journal of Epidemiology4.47
Nicola Orsini43
Estimated H-index: 43
,
Ruifeng Li10
Estimated H-index: 10
+ 2 AuthorsDonna Spiegelman126
Estimated H-index: 126
Quantitative reviews of published epidemiologic studies of exposure-response relations typically include an assessment of the relation between exposure levels and risk of disease (1). The standard approach to trend estimation in meta-analysis of exposure-response relations when only published category-specific relative risks and their confidence intervals are available is to fit a weighted linear regression through the origin, in which the dependent variable is the estimated log relative risk, t...
Published on Jul 11, 2011in JAMA Internal Medicine20.77
Quanhe Yang35
Estimated H-index: 35
,
Tiebin Liu18
Estimated H-index: 18
+ 8 AuthorsMuin J. Khoury94
Estimated H-index: 94
confidenceinterval[CI],1.03-1.41per1000mg/d),whereas higher potassium intake was associated with lower mortality risk (HR, 0.80; 95% CI, 0.67-0.94 per 1000 mg/d). For sodium-potassium ratio, the adjusted HRs comparing thehighestquartilewiththelowestquartilewereHR,1.46 (95%CI,1.27-1.67)forall-causemortality;HR,1.46(95% CI, 1.11-1.92) for CVD mortality; and HR, 2.15 (95% CI, 1.48-3.12) for IHD mortality. These findings did not differsignificantlybysex,race/ethnicity,bodymassindex,hypertension stat...
Published on Jul 1, 2011in The American Journal of Clinical Nutrition6.57
Xianglan Zhang25
Estimated H-index: 25
(Vandy: Vanderbilt University),
Xiao-Ou Shu96
Estimated H-index: 96
(Vandy: Vanderbilt University)
+ 6 AuthorsWei Zheng110
Estimated H-index: 110
(Vandy: Vanderbilt University)
Background: Asian populations habitually consume a large amount of cruciferous vegetables and other plant-based foods. Few epidemiologic investigations have evaluated the potential health effects of these foods in Asian populations. Objective: We aimed to examine the associations of cruciferous vegetables, noncruciferous vegetables, total vegetables, and total fruit intake with risk of all-cause and cause-specific mortality. Design: The analysis included 134,796 Chinese adults who participated i...
Published on May 2, 2011in European Heart Journal23.24
Francesca L. Crowe50
Estimated H-index: 50
(University of Oxford),
Andrew W. Roddam47
Estimated H-index: 47
(University of Oxford)
+ 40 AuthorsCornelia Weikert37
Estimated H-index: 37
AIMS: A higher intake of fruits and vegetables has been associated with a lower risk of ischaemic heart disease (IHD), but there is some uncertainty about the interpretation of this association. Th ...
Cited By557
Newest
Published on Jan 1, 2020in Appetite3.50
Maxine Sharps (DMU: De Montfort University), Eleanor Thomas (Coventry University), Jacqueline Blissett27
Estimated H-index: 27
(Aston University)
Abstract Children's fruit and vegetable consumption is lower than recommended. Increasing consumption is important for children's health. Nudges influence children's eating behaviour, but less is known about the influence of a pictorial nudge on tableware on children's fruit and vegetable consumption. Two studies examined this. Study 1 examined whether a pictorial fruit nudge (a grape image) on a plate influenced children's fruit (grape) consumption relative to a control condition (no image). In...
Published on 2019in BMC Public Health2.57
Anne Lene Kristiansen5
Estimated H-index: 5
(University of Oslo),
Mona Bjelland19
Estimated H-index: 19
(University of Oslo)
+ 3 AuthorsLene Frost Andersen43
Estimated H-index: 43
(University of Oslo)
Early childhood represents a critical period for the establishment of long-lasting healthy dietary habits. Limited knowledge exists on how to successfully increase vegetable consumption among preschool children. The overall aim of the present study was to improve vegetable intake among preschool children in a kindergarten-based randomized controlled trial. The target group was preschool children born in 2010 and 2011, attending public or private kindergartens in two counties in Norway. Data abou...
Published on Dec 1, 2019in Global Food Security5.46
Carmelia Alae-Carew (Lond: University of London), Frances A. Bird2
Estimated H-index: 2
(Lond: University of London)
+ 7 AuthorsRosemary Green10
Estimated H-index: 10
(Lond: University of London)
Abstract Against a backdrop of a rapidly changing food system and a growing population, characterisation of likely future diets in India can help to inform agriculture and health policies. We systematically searched six published literature databases and grey literature repositories up to January 2018 for studies projecting the consumption of foods in India to time points beyond 2018. The 11 identified studies reported on nine foods up to 2050: the available evidence suggests projected increases...
Published on Feb 7, 2019in Archives of public health
Steven Ndugwa Kabwama4
Estimated H-index: 4
(MUK: Makerere University),
Silver Bahendeka9
Estimated H-index: 9
+ 2 AuthorsDavid Guwatudde18
Estimated H-index: 18
(MUK: Makerere University)
Introduction Adequate consumption of fruits and vegetables has protective benefits against development of coronary heart disease, hypertension and chronic obstructive pulmonary disease. However, approximately 2.7 million deaths annually can be attributed to inadequate fruit and vegetable consumption. We analyzed data from a countrywide survey in Uganda, to estimate the prevalence of adequate fruit and/ or vegetable consumption, and identify associated factors.
Chloe Clifford Astbury (University of Cambridge), Tarra L. Penney11
Estimated H-index: 11
(University of Cambridge),
Jean Adams29
Estimated H-index: 29
(University of Cambridge)
Background Despite inconclusive evidence, the idea that a lack of home food preparation and skills is a limiting factor in achieving a healthy diet is widespread. Cooking skills interventions proliferate, and several countries now mention cooking in their dietary guidelines. The aim of this study was to determine whether substantial consumption of home-prepared food is necessary for high dietary quality by exploring whether individuals can eat healthily while eating little home-prepared food. Th...
Ingrid Marie Hovdenak1
Estimated H-index: 1
(University of Agder),
Tonje Holte Stea10
Estimated H-index: 10
(University of Agder)
+ 3 AuthorsElling Bere29
Estimated H-index: 29
(University of Agder)
Background The rationale for promoting increased consumption of fruit and vegetables (FV) at an early age is based on results from previous tracking-studies, indicating that dietary habits learned in childhood sustain into adulthood. Previous tracking studies have several limitations (e.g. low study sample, few repeated measurements and/or short a follow-up period). In addition, to our knowledge, no study has shown that a dietary intervention initiated in childhood affects tracking of dietary be...
Peiyuan Huang1
Estimated H-index: 1
(Guangzhou Medical University),
Majella O’Keeffe1
Estimated H-index: 1
('KCL': King's College London)
+ 5 AuthorsSeeromanie Harding31
Estimated H-index: 31
('KCL': King's College London)
Background Evidence on the relationship between fruit and vegetable consumption (FV) and mental health in adolescence is sparse and inconsistent. Social determinants of FV include ethnicity, family environments and economic disadvantage. We investigated the relationship between FV and mental health in the British multi-ethnic Determinants of Adolescents (now young Adult) Social well-being and Health (DASH) longitudinal study.
Published on Dec 1, 2019in BMC Public Health2.57
Torbjörn Lind15
Estimated H-index: 15
(Umeå University),
Ulrica Johansson (Umeå University)+ 4 AuthorsOlle Hernell60
Estimated H-index: 60
(Umeå University)
What we eat as infants and children carries long-term consequences. Apart from breastfeeding, the composition of the complementary diet, i.e. the foods given to the infant during the transition from breast milk/infant formula to regular family foods affects the child’s future health. A high intake of protein, a low intake of fruits, vegetables and fish and an unfavorable distribution between polyunsaturated and saturated fats are considered to be associate with health risks, e.g. obesity, type 2...
Published on Dec 1, 2019in BMC Endocrine Disorders1.82
Colin J. Orr1
Estimated H-index: 1
(UNC: University of North Carolina at Chapel Hill),
Thomas C. Keyserling26
Estimated H-index: 26
(UNC: University of North Carolina at Chapel Hill)
+ 1 AuthorsSeth A. Berkowitz18
Estimated H-index: 18
(UNC: University of North Carolina at Chapel Hill)
Background The diet quality of adults living in the United States has improved overtime. We aim to determine whether diet quality among adults with diabetes mellitus has changed over time, and to examine trends in socioeconomic disparities in diet quality.
Published on Oct 1, 2019in Appetite3.50
Claire V. Farrow25
Estimated H-index: 25
(Aston University),
Esme Belcher (Aston University)+ 4 AuthorsEmma Haycraft22
Estimated H-index: 22
(Lboro: Loughborough University)
Abstract Children are not consuming the recommended amounts of fruit and vegetables. Repeated visual exposure, modelling, and rewards have been shown to be effective at increasing vegetable acceptance in young children. The aim of this study was to assess the effectiveness of an evidence-based mobile application (Vegetable Maths Masters) which builds on these principles to increase children's liking and acceptance of vegetables. Seventy-four children (37 male, 37 female) aged 3–6 years old were ...
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