Abstract
Although fruits and vegetable consumption has been shown to be associated with lower risks of mortality, cancers, and cardiovascular disease (CVD), there are limited data from China on the shape of the association. This study aimed to quantify the relationship between levels of fruit, vegetable, and legume consumption with the risk of major CVD, CVD mortality, cancer incidence, cancer mortality, and all-cause mortality.
Generated Summary
This study, a large prospective cohort study, investigated the relationship between fruit, vegetable, and legume intake and the risk of major cardiovascular disease (CVD), CVD mortality, cancer incidence, cancer mortality, and all-cause mortality in China. The research was conducted as part of the Prospective Urban Rural Epidemiology (PURE) China study, enrolling 41,243 participants from 115 communities across 12 provinces. Dietary information was gathered through in-person interviews using validated food-frequency questionnaires. Clinical outcomes were centrally adjudicated by trained physicians using standardized definitions. Cox frailty models were employed to explore the associations between dietary intake and various mortality and disease outcomes. The study aimed to quantify the relationship between levels of fruit, vegetable, and legume consumption and the risk of major CVD, CVD mortality, cancer incidence, cancer mortality, and all-cause mortality. The study included a follow-up period of 8.9 years to assess these outcomes. The primary focus of the research was to provide insights into the potential impact of dietary modifications, specifically increased consumption of fruits, vegetables, and legumes, on public health outcomes within the Chinese population.
Key Findings & Statistics
- The average combined average daily intake of fruit, vegetable, and legume was 2.97 [standard deviation (SD) 1.22] servings per day.
- During a median follow-up of 8.9 years, the study recorded 1893 major CVDs, 794 cancer events, and 1324 deaths, with 411 CVD deaths and 429 cancer deaths.
- The risk of all-cause mortality was the lowest for four to five servings of total daily intake of fruit, vegetable, and legume (HR 0.73, 95% CI 0.55 -0.97).
- Compared with the reference group, the risk of all-cause mortality was the lowest for four to five servings per day (0.73, 95% CI 0.55-0.97).
- The average daily intake of fruit was 0.97 [standard deviation (SD) 0.96] servings.
- The average daily intake of vegetable was 1.78 (0.58) servings.
- The average daily intake of legume was 0.22 (0.22) servings.
- Compared with the reference group, higher consumption of fruits (>2 servings per day) was associated with a lower risk of all-cause mortality (HR 0.75, 95% CI 0.59-0.95) in the fully adjusted model.
- In the minimally adjusted model, the higher total intake of fruit, vegetable, and legume was inversely associated with CVD mortality, cancer incidence, cancer mortality, and all-cause mortality.
- After adjusting for additional covariates, the associations were evidently attenuated and only all-cause mortality (HR trend 0.92, 95% CI 0.86-0.98, p trend = 0.021) remained significant.
- The study found that Chinese people with daily consumption of four to five servings of fruit, vegetable, and legume demonstrated the lowest mortality.
- Higher total fruit and vegetable intake was associated with a lower risk of CVD mortality, cancer mortality, and all-cause mortality in the minimally adjusted model.
- The higher consumption of fruits (≥2 servings per day) was associated with a lower risk of all-cause mortality (HR 0.75, 95% CI 0.59-0.95) in the fully adjusted model.
- Higher consumption of legumes was associated with major CVD (HR trend 0.95, 95% CI 0.90-0.99, p trend = 0.028) and all-cause mortality (HR trend 0.94, 95% CI 0.89-0.99, p trend = 0.020) in the fully adjusted models.
Other Important Findings
- A higher total intake of fruit, vegetable, and legume was inversely associated with CVD mortality, cancer incidence, cancer mortality, and all-cause mortality in the models adjusted for age, sex, and center (random effect).
- Fruit intake was associated with a lower risk of all-cause mortality (HR trend 0.92, 95% CI 0.86-0.99, p trend = 0.020).
- Legume intake was associated with a lower risk of major CVD (HR trend 0.95, 95% CI 0.90-0.99, p trend = 0.028).
- The risk of all-cause mortality was lowest for those consuming four to five servings of total daily intake of fruit, vegetable, and legume.
- Higher consumption of fruits was inversely associated with the risk of CVD mortality, cancer incidence, cancer mortality, and all-cause mortality in the models adjusted for age, sex, and center.
- Higher consumption of vegetables was inversely associated with cancer mortality and all-cause mortality in the models adjusted for age, sex, and center.
- Legume intake was inversely associated with major CVD, CVD mortality, cancer incidence, cancer mortality, and all-cause mortality in the minimally adjusted models.
Limitations Noted in the Document
- The study’s reliance on observational data from a prospective study design limits the ability to draw strong conclusions about causality.
- Dietary intake was assessed only at baseline, potentially leading to random measurement errors due to variations in food consumption over time.
- The study lacked data on the specific types of fruits, vegetables, and legumes consumed, preventing detailed investigations into their individual impacts on health outcomes.
- The follow-up period of 8.9 years may not have been sufficient to fully capture the long-term effects of dietary intake on health outcomes.
- Although efforts were made to account for confounding factors, residual confounding from unmeasured or unknown factors could have influenced the results.
- The use of self-reported data for some covariates could have increased the risk of residual confounding.
Conclusion
In conclusion, this study provides valuable insights into the relationship between the consumption of fruits, vegetables, and legumes and various health outcomes in a large Chinese population. The findings suggest that increased intake of these food groups is associated with a reduced risk of mortality, particularly all-cause mortality. Specifically, the study indicates that consuming four to five servings per day of fruits, vegetables, and legumes is linked to the lowest risk of all-cause mortality. The study suggests that Chinese people with daily consumption of four to five servings of fruit, vegetable, and legume demonstrated the lowest mortality. The study’s results are consistent with the idea that dietary modifications, such as increasing the consumption of fruits, vegetables, and legumes, can have a positive impact on public health and may be an essential intervention target to prevent mortality in China. While the study acknowledges several limitations, including the observational nature of the data and potential for confounding factors, its findings support the existing recommendations for increased fruit and vegetable intake as part of a healthy diet. These findings provide a basis for improving Chinese nutritional dietary guidelines and also provide references for other developing countries.