Consumption of fruit and vegetable and risk of coronary heart disease: A meta-analysis of prospective cohort studies
Introduction
Coronary heart disease (CHD) is a major cause of disease burden in both developed and developing nations. It is the leading cause of death and permanent disability, with heavy economic and social costs owing to functional impairments [1], [2]. Therefore the primary prevention of CHD is an important public health and clinical medicine priority.
Foods and nutrients are important, which are one of the main determinants of CHD. Of foods and nutrients, the role of fruit and vegetable has been of increasing interest since they are a good source of micronutrients, macronutrients and fiber requirements without adding substantially to total energy intake [3]. Fruits and vegetables are rich in antioxidant vitamins, minerals (e.g., potassium and magnesium), dietary fiber, and phytochemicals [4]. Controlled trials have shown that fruit and vegetable consumption has beneficial effects on several risk factors of CHD, including lipid levels [5], inflammation [6], and blood pressure [7].
A meta-analysis [8] in 2007 concluded that fruit and vegetable intake > 5 servings/day was associated with lower risk of CHD. However, there are some limitations in the review. Firstly, the meta-analysis only included twelve studies. Since then, a number of additional studies have been published. Secondly, it did not assess the potential dose–response relationship. Thirdly, several issues emerging from the inconsistent results of later studies still warranted to be demonstrated, including whether it was total fruit and vegetable consumption that prevent the risk of CHD, fruit or vegetable separately, and whether the associations were consistent in both sexes and different ethnic backgrounds, respectively [9], and what levels of consumption of fruit and vegetable that had the greatest protection remained unclear [10]. To investigate these key issues, we conducted a meta-analysis on all published prospective cohort studies to investigate the association between consumption of fruit and vegetable and risk of CHD and quantify the dose–response relationship of fruit and vegetable consumption with CHD risk.
Section snippets
Methods
We conducted this systematic review following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines [11].
Literature search
The results of literature research and selection were shown in Fig. 1. We identified 408 articles from the PubMed, 564 articles from the Embase and 332 articles from the Web of Science. After the initial screening, based on titles and abstracts, 452 articles remained for further full-text assessment. After retrieving the full-text review of the remaining 26 articles for detailed evaluation, three articles were excluded because they were duplicate publications. Finally, 23 prospective cohort
Discussion
This meta-analysis indicated that higher fruit and vegetable consumption is inversely associated with CHD. In the dose–response analysis, we found that the risk of CHD decreased by 12%, 16% and 18% for daily 477 g of total fruit and vegetable, daily 300 g of fruit and daily 400 g of vegetable, respectively. There was evidence of a nonlinear association for both fruit and vegetable consumption.
Results of this updated meta-analysis generally concur and further complement the findings of previous
Conclusion
In summary, this meta-analysis indicates significant inverse associations between higher consumption of fruit and vegetable and CHD. The risk of CHD was reduced by 12% for per 477 g/day in total fruit and vegetable, by 16% for per 300 g/day in fruit, and by 18% for per 400 g/day in vegetable. This nonlinear association of CHD risk with fruit or vegetable consumption separately was observed. Our results support current recommendations to increase fruit and vegetable consumption to promote health
Contributors
YG and ZXL conceived the study. YG and XYT searched and checked the databases according to the inclusion and exclusion criteria. ZJ and ZXL helped to develop search strategies. YG and XYT extracted the data and assessed their quality. YG, LQL, SYC, XXY and CG analyzed the data. SYC gave advice on meta-analysis methodology. YG wrote the draft of the paper. All authors contributed to reviewing or revising the paper and read and approved the final manuscript. ZXL is the guarantor of this work and
Funding source
No funding was received for this systematic review.
Conflict of interest
None.
References (61)
- et al.
Complaints of difficulty to fall asleep increase the risk of depression in later life: the health in men study
J. Affect. Disord.
(2011) - et al.
Fruit and vegetable consumption and risk of coronary heart disease: a meta-analysis of cohort studies
J. Nutr.
(2006) - et al.
Meta-analysis in clinical trials
Control. Clin. Trials
(1986) - et al.
Quantity and variety in fruit and vegetable intake and risk of coronary heart disease
Am. J. Clin. Nutr.
(2013) - et al.
Dairy products and colorectal cancer risk: a systematic review and meta-analysis of cohort studies
Ann. Oncol.
(2012) - et al.
A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010
Lancet
(2012) - et al.
Fruit, vegetables, and olive oil and risk of coronary heart disease in Italian women: the EPICOR Study
Am. J. Clin. Nutr.
(2011) - et al.
Flavonoid intake and cardiovascular disease mortality: a prospective study in postmenopausal women
Am. J. Clin. Nutr.
(2007) - et al.
The combination of high fruit and vegetable and low saturated fat intakes is more protective against mortality in aging men than is either alone: the Baltimore Longitudinal Study of Aging
J. Nutr.
(2005) - et al.
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)
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.
Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study
Am. J. Clin. Nutr.
Dietary sources of sodium in China, Japan, the United Kingdom, and the United States, women and men aged 40 to 59 years: the INTERMAP study
J. Am. Diet. Assoc.
Dietary patterns and blood pressure change over 5-y follow-up in the SU.VI.MAX cohort
Am. J. Clin. Nutr.
Effects of fruit and vegetable consumption on plasma antioxidant concentrations and blood pressure: a randomised controlled trial
Lancet
Cholesterol-lowering effects of dietary fiber: a meta-analysis
Am. J. Clin. Nutr.
Mono-O-methylated flavanols and other flavonoids as inhibitors of endothelial NADPH oxidase
Arch. Biochem. Biophys.
Metabolic transformation has a profound effect on anti-inflammatory activity of flavonoids such as quercetin: lack of association between antioxidant and lipoxygenase inhibitory activity
Biochem. Pharmacol.
Heart disease and stroke statistics—2014 update: a report from the American Heart Association
Circulation
Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee
Circulation
Components of a cardioprotective diet: new insights
Circulation
The effect of a plant-based low-carbohydrate (“Eco-Atkins”) diet on body weight and blood lipid concentrations in hyperlipidemic subjects
Arch. Intern. Med.
Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial
JAMA
Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial
Ann. Intern. Med.
Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies
J. Hum. Hypertens.
Fruit and vegetable intake and risk of cardiovascular disease
Proc. Nutr. Soc.
The global burden of disease attributable to low consumption of fruit and vegetables: implications for the global strategy on diet
Bull. World Health Organ.
Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group
JAMA
Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis
BMJ
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
Bull. World Health Organ.
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