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

Xia Wang; Yingying Ouyang; Jun Liu; Minmin Zhu; Gang Zhao; Wei Bao; Frank B Hu

doi:10.1136/bmj.g4490

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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

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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

Xia Wang, Yingying Ouyang, Jun Liu, Minmin Zhu, Gang Zhao, Wei Bao and Frank B Hu

BMJ (Clinical research ed.), Vol.349(jul29 3), pp.g4490-g4490

07/29/2014

DOI: 10.1136/bmj.g4490

PMCID: PMC4115152

PMID: 25073782

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Abstract

To examine and quantify the potential dose-response relation between fruit and vegetable consumption and risk of all cause, cardiovascular, and cancer mortality. Medline, Embase, and the Cochrane library searched up to 30 August 2013 without language restrictions. Reference lists of retrieved articles. Prospective cohort studies that reported risk estimates for all cause, cardiovascular, and cancer mortality by levels of fruit and vegetable consumption. 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. 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. 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.

Prospective Studies

Vegetables

Fruit

Risk Reduction Behavior

Diet - statistics & numerical data

Humans

Risk Factors

Cardiovascular Diseases - mortality

Neoplasms - mortality

Female

Male

Cause of Death

Details

Title: Subtitle: Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies
Creators: Xia Wang - Department of Maternal and Child Health Care, School of Public Health, Shandong University, Jinan, China Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Yingying Ouyang - Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Jun Liu - Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Minmin Zhu - Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Gang Zhao - Department of Cardiovascular Sciences, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
Wei Bao - Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20852, USA nhbfh@channing.harvard.edu wei.bao@nih.gov
Frank B Hu - Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA nhbfh@channing.harvard.edu wei.bao@nih.gov
Resource Type: Journal article
Publication Details: BMJ (Clinical research ed.), Vol.349(jul29 3), pp.g4490-g4490
DOI: 10.1136/bmj.g4490
PMID: 25073782
PMCID: PMC4115152
NLM abbreviation: BMJ
ISSN: 1756-1833
eISSN: 1756-1833
Publisher: England
Grant note: Intramural NIH HHS
Language: English
Date published: 07/29/2014
Academic Unit: Epidemiology; Fraternal Order of Eagles Diabetes Research Center
Record Identifier: 9983995176002771

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