Fruit and Vegetable Intake and Mortality

Quick Takes

  • Higher intake of fruits and vegetables is associated with lower total mortality and cause-specific mortality including deaths due to CVD.
  • Approximately 5 servings per day of fruits and vegetables is associated with the lowest risk for mortality.
  • The thresholds of risk reduction associated with mortality were 2 servings per day of fruit and 3 servings per day of vegetables.

Study Questions:

Is there an optimal level for intake of fruits and vegetables associated with lower all-cause and disease-specific mortality?

Methods:

Data from the Nurses’ Health Study (NHS) (1984-2014) and the Health Professionals Follow-up Study (HPFS) (1986-2014) were used for the present analysis. All participants were free from cardiovascular disease (CVD), cancer, and diabetes at baseline. Diet was assessed using a validated semiquantitative food frequency questionnaire at baseline and updated every 2-4 years. A dose-response meta-analysis including NHS and HPFS, along with 24 other prospective cohort studies, was also completed. The primary outcomes of interest were all-cause mortality and disease-specific mortality (i.e., cancer, CVD, and respiratory related).

Results:

A total of 66,719 women from NHS and 42,016 from HPFS were included in the study population. During follow-up (30 years for NHS, 28 years for HPFS), 33,898 deaths were identified. Higher intake of fruits and vegetables was associated with older age, use of multivitamins, higher dietary quality, and higher physical activity level. After adjustment for known and suspected confounding variables and risk factors, a nonlinear inverse association of fruit and vegetable intake with total mortality and cause-specific mortality attributable to cancer, CVD, and respiratory disease was observed. Intake of approximately 5 servings per day of fruits and vegetables, or 2 servings of fruit and 3 servings of vegetables, was associated with the lowest mortality, and above that level, higher intake was not associated with additional risk reduction. In comparison with the reference level (2 servings/d), daily intake of 5 servings of fruits and vegetables was associated with a hazard ratio (HR) of 0.87 (95% confidence interval [CI], 0.85–0.90) for total mortality. Similar associations were observed for CVD mortality (HR, 0.88; 95% CI, 0.83–0.94), for cancer mortality (HR, 0.90; 95% CI, 0.86–0.95), and for respiratory disease mortality (HR, 0.65; 95% CI, 0.59–0.72). The dose-response meta-analysis that included 145,015 deaths accrued in 1,892,885 participants yielded similar results. Higher intakes of most subgroups of fruits and vegetables were associated with lower mortality, with the exception of starchy vegetables such as peas and corn. Intakes of fruit juices and potatoes were not associated with total and cause-specific mortality.

Conclusions:

The investigators concluded that higher intakes of fruits and vegetables were associated with lower mortality; the risk reduction plateaued at approximately 5 servings of fruits and vegetables per day. These findings support current dietary recommendations to increase intake of fruits and vegetables, but not fruit juices and potatoes.

Perspective:

These data support the current dietary recommendations for 5 servings per day of fruits and vegetables to lower risk for all-cause and CVD-related mortality. In addition, providers may also advise patients that fruit juices and starchy foods such as potatoes are not associated with lower mortality.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Diet, Exercise

Keywords: Cardiovascular Diseases, Diet, Exercise, Fruit, Metabolic Syndrome X, Neoplasms, Peas, Primary Prevention, Respiratory Insufficiency, Risk Factors, Risk Reduction Behavior, Vegetables, Vitamins


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