Fresh and Processed Fruit and Vegetable Intake and Risk of Cardiovascular and All-Cause Mortality in a Dutch Population-Based Follow-up Study

Introduction: Intake of fruit and vegetables has been shown to protect against CVD and all-cause mortality. Whether fresh and processed fruits have similar health effects remains unclear. Objective: We examined the association of total, fresh and processed fruit and vegetable intake with CVD and all-cause mortality in a population-based follow-up study in the Netherlands. Design and Methods: Between 1993-1997 a total of over 22,000 men and women aged 20-65 years were examined. Our analyses are based on 11,030 women and 9,118 men who were free of CVD at baseline. Fruit and vegetable intake was assessed by a validated 178 item food-frequency questionnaire. Seasonal differences were taken into account. Processed fruits are mainly fruit juices, whereas processed vegetables are cooked. Information on vital status and cause of death was obtained from national registries up to 2007. During follow-up, 678 participants died of whom 155 died of CVD. Hazard ratios (HRs) were calculated using the Cox proportional hazard model and adjustments were made for age, gender, energy intake, alcohol intake, smoking and socioeconomic status, supplement use, use of anti-hypertensive or cholesterol lowering drugs, family history of MI before 60 years, dietary fiber intake other than from fruit and vegetables, fish intake and saturated fatty acids. Results: A 100 gram increase of fruit intake was inversely associated with all-cause mortality, HR 0.94 (95%CI: 0.89-0.99). The HRs for fresh and processed fruit intake with all-cause mortality were 0.96 (0.93-0.99) and 0.98 (0.94-1.03), respectively. For a 50 gram increase of vegetable intake, we observed a reduction in all-cause mortality; 0.92 (0.85-0.99). The HRs for fresh and processed vegetable intake with all-cause mortality were 1.00 (0.97-1.04) and 0.89 (0.82-0.98), respectively. These trends in association were also observed for CVD mortality. However, these associations were less strong and borderline significant, which could be due to the low number of CVD deaths. Conclusion: Fruit and vegetable intake is inversely associated with all-cause mortality and possibly associated with CVD mortality in healthy, Dutch men and women. This relationship was mainly attributable to fresh fruit and processed vegetable intake