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Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies

Abstract

Increased consumption of fruit and vegetables has been shown to be associated with a reduced risk of coronary heart disease (CHD) in many epidemiological studies, however, the extent of the association is uncertain. We quantitatively assessed the relation between fruit and vegetable intake and incidence of CHD by carrying out a meta-analysis of cohort studies. Studies were included if they reported relative risks (RRs) and corresponding 95% confidence interval (CI) of CHD with respect to frequency of fruit and vegetable intake. Twelve studies, consisting of 13 independent cohorts, met the inclusion criteria. There were 278 459 individuals (9143 CHD events) with a median follow-up of 11 years. Compared with individuals who had less than 3 servings/day of fruit and vegetables, the pooled RR of CHD was 0.93 (95% CI: 0.86–1.00, P=0.06) for those with 3–5 servings/day and 0.83 (0.77–0.89, P<0.0001) for those with more than 5 servings/day. Subgroup analyses showed that both fruits and vegetables had a significant protective effect on CHD. Our meta-analysis of prospective cohort studies demonstrates that increased consumption of fruit and vegetables from less than 3 to more than 5 servings/day is related to a 17% reduction in CHD risk, whereas increased intake to 3–5 servings/day is associated with a smaller and borderline significant reduction in CHD risk. These results provide strong support for the recommendations to consume more than 5 servings/day of fruit and vegetables.

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References

  1. British Heart Foundation Statistics 2005. http://www.bhf.org.uk/professionals/uploaded/factsheet2005finalaw.pdf(accessed 13 January 2006).

  2. Report of the Cardiovascular Review Group Committee on Medical Aspects of Food Policy. Nutritional Aspects of Cardiovascular Disease. 1994. London: HMSO.

  3. Joint WHO/FAO expert consultation on diet, nutrition and the prevention of chronic diseases, 2003, Geneva. http://www.who.int/hpr/NPH/docs/who_fao_experts_report.pdf(accessed 22 March 2005).

  4. US Department of Agriculture. US Department of Health and Human Services. Dietary guidelines for Americans. http://www.health.gov/dietaryguidelines/dga2000/dietgd.pdf(accessed 22 July 2005).

  5. Ness AR, Powles JW . Fruit and vegetables, and cardiovascular disease: a review. Int J Epidemiol 1997; 26: 1–13.

    Article  CAS  Google Scholar 

  6. Law MR, Morris JK . By how much does fruit and vegetable consumption reduce the risk of ischaemic heart disease? Eur J Clin Nutr 1998; 52: 549–556.

    Article  CAS  Google Scholar 

  7. Van't Veer P, Jansen M, Klerk M, Kok FJ . Fruits and vegetables in the prevention of cancer and cardiovascular disease. Public Health Nutr 2000; 3: 103–107.

    Article  CAS  Google Scholar 

  8. Liu S, Manson JE, Lee IM, Cole SR, Hennekens CH, Willett WC et al. Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study. Am J Clin Nutr 2000; 72: 922–928.

    Article  CAS  Google Scholar 

  9. Hirvonen T, Pietinen P, Virtanen M, Ovaskainen ML, Hakkinen S, Albanes D et al. Intake of flavonols and flavones and risk of coronary heart disease in male smokers. Epidemiology 2001; 12: 62–67.

    Article  CAS  Google Scholar 

  10. Joshipura KJ, Hu FB, Manson JE, Stampfer MJ, Rimm EB, Speizer FE et al. The effect of fruit and vegetable intake on risk for coronary heart disease. Ann Intern Med 2001; 134: 1106–1114.

    Article  CAS  Google Scholar 

  11. Liu S, Lee IM, Ajani U, Cole SR, Buring JE, Manson JE . Intake of vegetables rich in carotenoids and risk of coronary heart disease in men: The Physicians' Health Study. Int J Epidemiol 2001; 30: 130–135.

    Article  CAS  Google Scholar 

  12. Bazzano LA, He J, Ogden LG, Loria CM, Vupputuri S, Myers L et al. Fruit and vegetable intake and risk of cardiovascular disease in US adults: the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Am J Clin Nutr 2002; 76: 93–99.

    Article  CAS  Google Scholar 

  13. Steffen LM, Jacobs Jr DR, Stevens J, Shahar E, Carithers T, Folsom AR . Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 2003; 78: 383–390.

    Article  CAS  Google Scholar 

  14. Dauchet L, Ferrieres J, Arveiler D, Yarnell JW, Gey F, Ducimetiere P et al. Frequency of fruit and vegetable consumption and coronary heart disease in France and Northern Ireland: the PRIME study. Br J Nutr 2004; 92: 963–972.

    Article  CAS  Google Scholar 

  15. Tucker KL, Hallfrisch J, Qiao N, Muller D, Andres R, Fleg JL . The combination of high fruit and vegetable and low saturated fat intake is more protective against mortality in aging men than is either alone: the Baltimore Longitudinal Study of Aging. J Nutr 2005; 135: 556–561.

    Article  CAS  Google Scholar 

  16. USDA Nutrient Database for Standard Reference, Release 18. http://www.ars.usda.gov/Services/docs.htm?docid=10091&pf=1&cg_id=0(accessed 23 December 2005).

  17. Mann JI, Appleby PN, Key TJ, Thorogood M . Dietary determinants of ischaemic heart disease in health conscious individuals. Heart 1997; 78: 450–455.

    Article  CAS  Google Scholar 

  18. He K, Song Y, Daviglus ML, Liu K, Van Horn L, Dyer AR et al. Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies. Circulation 2004; 109: 2705–2711.

    Article  Google Scholar 

  19. Sahyoun NR, Jacques PF, Russell RM . Carotenoids, vitamins C and E, and mortality in an elderly population. Am J Epidemiol 1996; 144: 501–511.

    Article  CAS  Google Scholar 

  20. Fraser GE, Sabate J, Beeson WL, Strahan TM . A possible protective effect of nut consumption on risk of coronary heart disease. The Adventist Health Study. Arch Intern Med 1992; 152: 1416–1424.

    Article  CAS  Google Scholar 

  21. Higgins JP, Thompson SG, Deeks JJ, Altman DG . Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–560.

    Article  Google Scholar 

  22. Sterne JA, Egger M, Smith GD . Systematic reviews in health care: Investigating and dealing with publication and other biases in meta-analysis. BMJ 2001; 323: 101–105.

    Article  CAS  Google Scholar 

  23. Egger M, Davey Smith G, Schneider M, Minder C . Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–634.

    Article  CAS  Google Scholar 

  24. Knekt P, Jarvinen R, Reunanen A, Maatela J . Flavonoid intake and coronary mortality in Finland: a cohort study. BMJ 1996; 312: 478–481.

    Article  CAS  Google Scholar 

  25. Lock K, Pomerleau J, Causer L, Altmann DR, McKee M . The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet. Bull World Health Organ 2005; 83: 100–108.

    PubMed  PubMed Central  Google Scholar 

  26. Dauchet L, Amouyel P, Hercberg S, Dallongeville J . Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies. J Nutr 2006; 136: 2588–2593.

    Article  CAS  Google Scholar 

  27. Pereira MA, O'Reilly E, Augustsson K, Fraser GE, Goldbourt U, Heitmann BL et al. Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies. Arch Intern Med 2004; 164: 370–376.

    Article  Google Scholar 

  28. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937–952.

    Article  Google Scholar 

  29. Gramenzi A, Gentile A, Fasoli M, Negri E, Parazzini F, La Vecchia C . Association between certain foods and risk of acute myocardial infarction in women. BMJ 1990; 300: 771–773.

    Article  CAS  Google Scholar 

  30. Panagiotakos DB, Pitsavos C, Kokkinos P, Chrysohoou C, Vavuranakis M, Stefanadis C et al. Consumption of fruits and vegetables in relation to the risk of developing acute coronary syndromes; the CARDIO2000 case-control study. Nutr J 2003; 2: 2–6.

    Article  Google Scholar 

  31. Martinez-Gonzalez MA, Fernandez-Jarne E, Martinez-Losa E, Prado-Santamaria M, Brugarolas-Brufau C, Serrano-Martinez M . Role of fibre and fruit in the Mediterranean diet to protect against myocardial infarction: a case-control study in Spain. Eur J Clin Nutr 2002; 56: 715–722.

    Article  CAS  Google Scholar 

  32. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N . Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999; 99: 779–785.

    Article  CAS  Google Scholar 

  33. Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 280: 2001–2007.

    Article  CAS  Google Scholar 

  34. Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997; 336: 1117–1124.

    Article  CAS  Google Scholar 

  35. Whelton PK, He J, Cutler JA, Brancati FL, Appel LJ, Follmann D et al. Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA 1997; 277: 1624–1632.

    Article  CAS  Google Scholar 

  36. MacGregor GA, Smith SJ, Markandu ND, Banks RA, Sagnella GA . Moderate potassium supplementation in essential hypertension. Lancet 1982; 2: 567–570.

    Article  CAS  Google Scholar 

  37. He FJ, Markandu ND, Coltart R, Barron J, MacGregor GA . Effect of short-term supplementation of potassium chloride and potassium citrate on blood pressure in hypertensives. Hypertension 2005; 45: 571–574.

    Article  CAS  Google Scholar 

  38. Wald DS, Law M, Morris JK . Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. BMJ 2002; 325: 1202–1206.

    Article  Google Scholar 

  39. Clarke R, Collins R, Lewington S . Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. JAMA 2002; 288: 2015–2022.

    Article  CAS  Google Scholar 

  40. He J, Whelton PK . Effect of dietary fiber and protein intake on blood pressure: a review of epidemiologic evidence. Clin Exp Hypertens 1999; 21: 785–796.

    Article  CAS  Google Scholar 

  41. Howard BV, Kritchevsky D . Phytochemicals and cardiovascular disease. A statement for healthcare professionals from the American Heart Association. Circulation 1997; 95: 2591–2593.

    Article  CAS  Google Scholar 

  42. John JH, Ziebland S, Yudkin P, Roe LS, Neil HAW . Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: a randomised controlled trial. Lancet 2002; 359: 1969–1974.

    Article  CAS  Google Scholar 

  43. Davey Smith G, Ebrahim S . Folate supplementation and cardiovascular disease. Lancet 2005; 366: 1679–1681.

    Article  Google Scholar 

  44. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002; 360: 23–33.

    Article  Google Scholar 

  45. He FJ, Nowson CA, MacGregor GA . Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet 2006; 367: 320–326.

    Article  Google Scholar 

  46. World Cancer Research Fund Panel. Food, Nutrition and the Prevention of Cancer: A Global Perspective. American Institute for Cancer Research: Washington, DC, 1997.

  47. Kelsay JL, Behall KM, Prather ES . Effect of fiber from fruits and vegetables on metabolic responses of human subjects. I. Bowel transit time, number of defecations, fecal weight, urinary excretions of energy and nitrogen and apparent digestibilities of energy, nitrogen, and fat. Am J Clin Nutr 1978; 31: 1149–1153.

    Article  CAS  Google Scholar 

  48. Rolls BJ, Ello-Martin JA, Tohill BC . What can intervention studies tell us about the relationship between fruit and vegetable consumption and weight management? Nutr Rev 2004; 62: 1–17.

    Article  Google Scholar 

  49. Rapola JM, Virtamo J, Korhonen P, Haapakoski J, Hartman AM, Edwards BK et al. Validity of diagnoses of major coronary events in national registers of hospital diagnoses and deaths in Finland. Eur J Epidemiol 1997; 13: 133–138.

    Article  CAS  Google Scholar 

  50. Ducimetiere P, Ruidavets JB, Montaye M, Haas B, Yarnell J . Five-year incidence of angina pectoris and other forms of coronary heart disease in healthy men aged 50-59 in France and Northern Ireland: the Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study. Int J Epidemiol 2001; 30: 1057–1062.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank the authors who kindly provided the data necessary for our meta-analysis.

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He, F., Nowson, C., Lucas, M. et al. Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies. J Hum Hypertens 21, 717–728 (2007). https://doi.org/10.1038/sj.jhh.1002212

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  • DOI: https://doi.org/10.1038/sj.jhh.1002212

Keywords

  • fruit and vegetables
  • coronary disease
  • prospective cohort studies
  • meta-analysis

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