Fruit and vegetable intake and cause-specific mortality in the EPIC study

Max Leenders, Hendriek C. Boshuizen, Pietro Ferrari, Peter D. Siersema, Kim Overvad, Anne Tjønneland, Anja Olsen, Marie-Christine Boutron-Ruault, Laure Dossus, Laureen Dartois, Rudolf Kaaks, Kuanrong Li, Heiner Boeing, Manuela M. Bergmann, Antonia Trichopoulou, Pagona Lagiou, Dimitrios Trichopoulos, Domenico Palli, Vittorio Krogh, Salvatore Panico, Rosario Tumino, Paolo Vineis, Petra H. M. Peeters, Elisabete Weiderpass, Dagrun Engeset, Tonje Braaten, Maria Luisa Redondo, Antonio Agudo, María-José Sánchez, Pilar Amiano, José-María Huerta, Eva Ardanaz, Isabel Drake, Emily Sonestedt, Ingegerd Johansson, Anna Winkvist, Kay-Tee Khaw, Nick J. Wareham, Timothy J. Key, Kathryn E. Bradbury, Mattias Johansson, Idlir Licaj, Marc J. Gunter, Neil Murphy, Elio Riboli, H. Bas Bueno-de-Mesquita

Consumption of fruits and vegetables is associated with a lower overall mortality. The aim of this study was to identify causes of death through which this association is established. More than 450,000 participants from the European Prospective Investigation into Cancer and Nutrition study were included, of which 25,682 were reported deceased after 13 years of follow-up. Information on lifestyle, diet and vital status was collected through questionnaires and population registries. Hazard ratios (HR) with 95 % confidence intervals (95 % CI) for death from specific causes were calculated from Cox regression models, adjusted for potential confounders. Participants reporting consumption of more than 569 g/day of fruits and vegetables had lower risks of death from diseases of the circulatory (HR for upper fourth 0.85, 95 % CI 0.77-0.93), respiratory (HR for upper fourth 0.73, 95 % CI 0.59-0.91) and digestive system (HR for upper fourth 0.60, 95 % CI 0.46-0.79) when compared with participants consuming less than 249 g/day. In contrast, a positive association with death from diseases of the nervous system was observed. Inverse associations were generally observed for vegetable, but not for fruit consumption. Associations were more pronounced for raw vegetable consumption, when compared with cooked vegetable consumption. Raw vegetable consumption was additionally inversely associated with death from neoplasms and mental and behavioral disorders. The lower risk of death associated with a higher consumption of fruits and vegetables may be derived from inverse associations with diseases of the circulatory, respiratory and digestive system, and may depend on the preparation of vegetables and lifestyle factors.